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About PAnewgrad50

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  1. Wow ctalbot, no offense but you seem like a defeatist, perhaps a career in theater would suit you well. I agree this is likely a troll. Ways to work as a physician assistant without "giving medical advice" - Do PHA's for the military (periodic health assessments) go through screening questions and flag those charts who need further evaluation/treatment. - Do physical examinations for insurance companies. Are you comfortable interpreting basic labs, and listening to someone's heart and lungs? - Go work in one of these new fad weight loss clinics. Sell nutrition bars, shakes, supplements and encourage people to exercise. Seriously, did you get yelled at by another clinician or something? I have never met a second year out of school PA-C who "knows everything..." sounds like you went into the completely wrong field... Amazing you didn't realize it sooner.
  2. 1 week of vacation the first year? 2 weeks of vacation the second year? That seems like a really small amount of vacation time...
  3. Has anyone started dealing with getting their 20 credits of PI or SE CME's? It really is quite a pain, as they are fairly expensive and many of the topics/subjects do not pertain to the current field I am working in. There are very limited approved options at this point, as they are both fairly new requirements. Does anyone know of any websites that offer free CME's that fit these criteria? I just ordered a "self evaluation" CME which is essentially a "test" of "acute care" knowledge. $107 for 10 credits. Just wondering if anyone has experience with these, or ideas on ways to earn these without blowing entire CME allotments.
  4. Just wondering for those of you who do DOT Physicals... For people with cardiac issues such as atrial fibrillation etc, do you require a letter from the Cardiologist stating that in their expert opinion the patient is able to safely operate a commercial vehicle? My attending physician makes us send these letters out to other physicians, and the majority of time they either do not want to write the letter because it is "our responsibility to make this determination" or they are just nasty/unhappy about having to do the extra work. On some of the more straight forward cases I have accepted office notes from visits to the specialists, and made the determination on my own based on notes/testing/etc. My attending physician said this is not allowed and it is MANDATORY to have these letters in such instances. I was just wondering how other people handle this? Do you give out similar letters? If so do you get a lot of push back?
  5. When dealing with a large second degree burn, should the burn be covered at all times 24/7? I had a patient with fairly large 2nd degree burns to the abdomen and left groin. I had her use bacitracin and cover the wounds during the day, but said it was acceptable to leave them open to the air at night. My rationale for this is that warm/moist environment is perfect breeding ground for infection. The attending physician I worked with said that second degree burns must be covered "at all times until full resolution of the burn." I tried to find literature which strongly supports either rationale, but there does not seem to be a lot out there. Thanks for the input.
  6. We do them. We charge $90, which seems to be the lowest around. I find these exams to be a real headache, as many primary care physicians used to issue cards left and right despite major contraindications and medical problems. I have people constantly coming in with HTN, Diabetes (out of control), Sleep Apnea with minimal to no CPAP compliance... and all expect to be issued a card promptly. When I tell them further documentation is required, or I can not issue a card, it usually ends uncomfortably and with argument from the patient. I honestly prefer not to do DOT physicals unless I have to.
  7. As a recent graduate, rotations are truly what you make of them. There is also some luck involved as to who you get as a preceptor, but just because a preceptor does not constantly teach (although it is nice if they do), does not mean you can't make it a great learning experience. Go home every night and read about the things you see, especially those you are not sure about. When you have downtime on a rotation, go on UpToDate that most hospitals/clinics have free access to. My Internal Medicine rotation was between 6 and 7 12 hour shifts a week depending on which week it was. They seem like long daunting hours, but the experience was so valuable. Work hard and help the residents, as you will spend the majority of your time with them. If they see you are hard working and interested, they will teach you a lot, and perhaps you will teach them some as well. This ended up being my best rotation, and I still keep in touch with a lot of the residents I worked with. A lot of my classmates complained about this rotation... Either they did not take initiative and were limited to being a "medical assistant" or the hours were 'long and miserable" Good Luck
  8. Thanks Paula. I just wanted to make sure they were not questioning my patient care. I have gotten a lot of crazy paper work in my first few months of practice, but had not seen this one yet. Thanks for the info/advice.
  9. I got a letter from firstscript pharmacy regarding a patient I had prescribed Tramadol for. Essentially the letter states that Tramadol should only be used for "severe pain" and that they strongly encourage review of this patient's pain management treatment. My patient fell and had a scaphoid fracture, and multiple contusions of the knees and back. I think a week of Tramadol is well warranted? What gives them the right to send this letter? How would they even have information on the patients case?
  10. I graduated with a bachelor's in psychology. I spent almost 2 full years after graduating from college working in a Cancer Center as a medical assistant, while taking the remaining pre-reqs at a state school. I ended up having to take 4 or 5 difficult classes per semester including organic chem 1/2, calculus, bio 1/2, a&p, etc. Like a previous poster mentioned, it would be best to take these pre-req's during your undergrad degree instead of after, as it will save you a boat load of money. My GPA also was not the best, however it improved drastically my last 2 years in college, and my GPA in the pre-req's were close to a 3.75 (obviously I was pretty motivated at this point). Good Luck
  11. I was recently certified to perform DOT physical examinations. While seeing my colleagues perform these DOT examinations, 99.9% of them are straight forward with no real issues. Of course my first patient for a DOT certification shows up, checks no to all past medical history, and I think great a perfect start. Turns out that the second he took off his shirt he had surgical incisions all over... "I tore my labrum" "I had a biceps tendon tear repaired" These are no big deal... I can easily assess functionality and strength of these body parts... The real concern came when I look in his mouth and noticed he did not have a uvula. I inquired with the patient, who told me he had "loud snoring" (which he omitted in his health history) and according to him as a result "had his uvula and probably his tonsils removed". Since sleep apnea is a big deal to the DOT, I became concerned and told him I could not certify him until he got a letter from his treating physician stating that his sleep apnea had been treated and resolved, along with the appropriate studies. Patient returned to the office 3 hours later, swearing up a storm, stating "I never had sleep apnea, I had a deviated septum" Turns out he had a uvulopalatopharyngoplasty and septoplasty performed almost 10 years ago, which resolved this issue. He did have a report documenting all of this. At this point I issued him certification, as there is no guideline by the DOT stating a deviated septum is grounds for disqualification. I used my medical judgement to deem the patient safe to drive. Did I make the correct decision?
  12. A 152 on the packrat administered by your program is a rock solid score. I scored a 146 and had no difficulty passing the PANCE. The NCCPA exam is a good simulation of the PANCE, as they are actual retired questions. It also gives you a gauge of "if you are ready" based on incompetent, borderline competent, and competent. If you are anywhere from the upper end of borderline to the competent range, you should have little difficulty passing. Anything you don't score at or above the average on, you should study more for. With 2 days left, it doesn't give you much time to use this test to your advantage. I guess you could use it as one more, very realistic, practice test. Good Luck.
  13. They claimed to me that all hospital providers including MD's PA's and APRN's pay their own licensing fees. Maybe they lied?
  14. I am new to this, but the hospital I am working for does not pay for board exam fees or licensing fees (including state license, controlled substance license, and DEA license). Between all of these fees I spent well over $1,000 out of pocket. (They will not allow me to use my CME allotment to cover these fees either.) I was just wondering which, if any of these were tax deductible. Thanks
  15. I agree with what you have written here. While on rotations you should really soak it in. Go home each night and read about what you saw, and learn about things that are not necessarily taught in school. This will help prepare you for the PANCE better than anything else in my opinion. Nothing replaces real world experience. Studying 4-6 weeks after rotations is more then enough time to prepare for the exam, on top of what you learned over the past 2.5 years+
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