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PACdan

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PACdan last won the day on February 9 2016

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  1. Unless you are doing only sports physicals or immunization visits all day long (and even then) this is wholly unsafe and unsustainable. Why would you subject yourself to this breed of medicine? 45-55 a day? 10 minute appointments? What is being accomplished besides more billing and revenue for some business owners... The sad part is some admin or clinic director will come upon this and think "wow, what a great idea to make more money, I'll have our PAs do this" and they'll use it as proof positive "see, others are doing it". Anything over 3 an hour avg in primary care is pushing the revelance of the primary care in the first place. No wonder there is such widespread burn out. We should oppose any group or business that tries to push this insane scheduling. It only enriches them and does both the provider and patient a disservice.
  2. Watch "How to Die in Oregon" It's a 2011 documentary on the subject of physician assisted death that explores the subject through the lens of patients going through the medical aid in dying process.
  3. Finally earned the PA-C

  4. Ah. I hear that Florida is quite saturated due to the number of PA programs in the state. This drives down salary averages as well.
  5. Definitely turning some places off with this question. But I assume those are places I don't want to begin my career at...
  6. 10 days PTO seems criminal. Are you in an area with a low cost of living? What area of the country? I hate the idea of bonuses. And your base salary is ~5k below the national average. I'm currently applying in Family Med. Lowest offer for a new grad so far has been $85k + incentive pay. Several offers at 95-100k. Lowest vacation/PTO has been 14 days. Averaging 21 days, plus major holidays. Some have call or rotating Saturdays, most do not though.
  7. 50 people need you in a given day. 100 people. Probably more. Realistically there is an upper limit to the number of people you can see and treat in a given day while still providing safe and appropriate care. A few walk-ins on top of an already full schedule, split among available providers? Sure that sounds reasonable. But you seem to be dealing with new/younger providers. How new are they? Are they reluctant to take on the increased patient load for other reasons that may not being addressed? Do they feel unsafe at that volume? Are they stressed beyond what they feel is achievable for them? Certainly a veteran provider will feel more comfortable at a faster pace. For those of us that haven't honed our clinical acumen that sharp, I can see a concern. I am much like Rev, in that I know I cannot see 25-30 patients a day in family medicine and provide the quality of care I believe they deserve. It would stress me too far and be doing my patients, and myself, a disservice. I'm being upfront with that during job interviews, and I'm sure it has/will cost me offers. That is fine. I will take less pay to see patients at a pace which provides them my best service and skill. Especially in the first few years out of school. I'm sure as I gain experience I'll grow more comfortable and be able to see more patients per day. But this will be a gradual process, not something achieved in 4 weeks. There is certainly a sense of duty. Primary care providers should be the first stop for most patients. We need more PCPs, but it remains a less attractive field for many. Yet no two providers are the same. And I believe that providers need to be honest with themselves and employers and establish expectations BEFORE starting a job. For new grads, this is even more important.
  8. Also, if you're documenting in the EMR (which you should be) and a preceptor is just taking over or copying your entire note; that is fraud under CMS: B. E/M Service Documentation Provided By Students Any contribution and participation of a student to the performance of a billable service (other than the review of systems and/or past family/social history which are not separately billable, but are taken as part of an E/M service) must be performed in the physical presence of a teaching physician or physical presence of a resident in a service meeting the requirements set forth in this section for teaching physician billing. Students may document services in the medical record. However, the documentation of an E/M service by a student that may be referred to by the teaching physician is limited to documentation related to the review of systems and/or past family/social history. The teaching physician may not refer to a student’s documentation of physical exam findings or medical decision making in his or her personal note. If the medical student documents E/M services, the teaching physician must verify and redocument the history of present illness as well as perform and redocument the physical exam and medical decision making activities of the service.
  9. We could (hopefully) use it to our advantage, much like NPs, and carve out a better standing for our profession. A new certifying body could bring about a name change, set precedence for improved practice for PAs, etc. And then one day we wake up and they've decided to implement their plan despite all the blowback. The downside to only having a singular certifying body in my mind, is that you have no alternatives. They really can do what they want.
  10. Hello all, It's hard to believe I'm only months from graduating now. My strong interest in Family Med has not wavered, and in fact I had an excellent rotation in a small clinic who's environment is one I aspire to work in. That said, I got to see a little more of the inner workings of coding & billing and I know this will be part of my future practice. Most patients we saw were established (85%), and got coded as either level 3 or level 4 visits. I've looked at the documentation and time requirements between the two and it seems that the divide really comes between levels 2&3 and 4&5. The lower levels being single problem focused (narrow or expanded) and the upper levels being a comprehensive exam (i.e., for multiple issues). When looking at the Medicare reimbursement schedules, I hear that most private payers/insurers follow those schedules. Have those of you in outpatient FM found this to be true? As a student I've gotten quite expedient at initial H&Ps (and usually sent to do these for the residents), so I'm used to writing more comprehensive notes. But I assume that the way the patient presents and their PMH/co-morbidities dictate what type of level/note you write for that visit? Thanks for the input, just trying to map the jungle before I get air-dropped in.
  11. The mandatory attendance policy is sound: 1. It covers the lowest common denominator. It's not subjective, everyone has to be there. If we leave up it to student discretion, there will be problematic arguments over what's important to attend and what is not. You'll have students who think they can handle not being there fall behind and then have higher attrition rates or stressful periods of playing catch-up. The policy is a safety net. The sharpest and the dullest crayons have to be there, they are going to get the same didactic experience. 2. We don't have as big a safety net as medical students. We average 15 months in didactic, 12 in clinical, pass the PANCE and then we're out practicing. Treating patients day one. When my class saw the lax attendance of our medical school colleagues in didactic portion, their "video lectures", we were a bit envious. But they have MULTIPLE accrediting tests at various stages, and the guarantee of at least 3 years of mandatory attendance during residency. We have 1 accrediting test and no required residency. PA schools have to make sure we're graduating with a minimum fund of knowledge and skills, and making attendance mandatory has been a pretty successful way of doing such. 3. Mandatory attendance doesn't mean you can't ever miss. You will have sick days, emergencies pop up; we're only human. It's there so we don't take a mile from an inch. Yes, I felt like a grade schooler when I had to turn in an absence form for one missed day in an entire semester. But again, they're removing the subjectivity and making it uniform for everyone. Our education is so jam-packed, so fast paced, that while we lamented some of those days where lectures were entering their 9th hour, is solidified us in a way that I don't think anything us could. This is why I don't like the idea of online PA programs, our model is pretty unique. It's the price we pay to be out and practicing medicine in ~2 years.
  12. If you start at program A in January and then leave several weeks into it for program B (if accepted), two things: 1. You'll be effectively denying a seat at program A to another applicant. Some programs will admit replacements last minute, but after orientation and usually the first exam period, they often cannot, as the new student will be too far behind. 2. You may not get your first semester's tuition back. The honest thing to do would be to inform program B that you are accepted at another program, although I don't know if that will expedite your admissions process in any way. They may simply choose to select another candidate. I don't see a problem in holding more than one spot if you pay your deposit; however there is quite a problem with STARTING a program with the intention of leaving after a month. At this point you have a sure thing, that is an admission in hand. You can certainly roll the dice on the other program, but you might not end up at either school.
  13. There will always be people in your class that seem to spend every waking moment cramming the smallest minutia into their heads. Whether it all sticks and is retrievable later is another story. While it's important to know when an antibiotic would be appropriate, and what an appropriate choice may include, I think that memorizing doses and scheduling is largely worthless. That can be looked up in a few seconds, is more up to date, and doesn't run the risk of misremembering. We'll look up the same medication dosing hundreds of times when starting out, and then by shear repetition it will be committed to memory. But by far, the recognition is the more important aspect. You don't have to be passionate about every single area of medicine to be a good provider. Empathy is probably the single most important thing, and that can't be taught. I like reading about esoteric diseases and obscure infections. That's not high-yield PANCE material, but that interests bleeds into the bread and butter stuff. If charts aren't your thing, find a good podcast, or maybe even a book. There are so many avenues to amassing clinical knowledge. Of course you need to know the testing material, but if you can get excited about a little niche somewhere in medicine, I think that will help motivate you in the other areas too. Everyone in my class has two or three rotations we aren't looking forward too. Either because it's some area of medicine we're not interested in or because it's something we just dread. The best advice I've gotten about this is too look at it as a once-in-a-lifetime experience. While you may not ever work in surgery or EM, you'll pick-up many useful tidbits and skills that crossover into something else. Just some thoughts. Good luck.
  14. Having taken classes with the med students in my system, I can say the difference is enough. But not if PA school gets any longer... especially if it stays at the Master's degree level. :/
  15. http://www.ada.gov/service_animals_2010.htm I think it would be an amazing opportunity to connect with patients on a level that many will not. You would probably be the most popular person ever on your pediatrics rotation. Maybe try to get multiple rotations with the VA as well? I could see service animals being welcomed there. Of course you will encounter people and situations where a dog may incite fear or unease. But it should be doable overall. I am assuming you have a professionally trained service animal that is well controlled in all scenarios. Go for it. I like how the ADA flyer specifically mentions dogs and the OR. :)
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