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RealityCheck

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RealityCheck last won the day on September 2 2015

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  1. My take is a tad different: I cannot remember who introduced this idea to me but it has stuck with me all these years. I understand the basic pathophys of disease processes. I am not a research scientist nor an epidemiologist - the PA strongpoint is helping the PATIENT understand their condition in terms that they understand and makes sense to them. My patients could care less about Krebs Cycle or nephrons for the most part but want to know why their kidneys don't work right. They don't get endotoxins and gram negative - they understand sick and feel like crap. If I can explain it to the patient and family and they gain understanding, comfort and can participate - all the while the patient has received the right meds, IVs, labs etc from me -- we have a winning situation. The best compliment I can get from a patient is that they understand their disease, illness, injury and know how to help themselves. Not to say physicians do not know how to do this - I am not sure it is stressed in their education or demonstrated. My program all those years ago touched on a key to healthCARE - education and participation. In moments of bitterness or feeling unvalued - I have wanted to prove my worth and take the FLEX and become a doctor - but wouldn't want it to change the provider I have become over the years. I know what I know and don't know and know where to look for answers. I have to be proud of what I do and stop comparing myself to other professionals - no purpose in it. Yep, old and waxing philosophic.....
  2. Oh My! 1. If it is not in the contract it doesn't exist - period 2. Benefits start the day I do - I support my family. I will make a practice revenue. Insurance starts DAY ONE 3. Never work for half pay or less pay. ANY business should know they have to support you to get you into their system 4. NEVER BE A SCRIBE 5. NEVER EVER EVER EVER EVER EVER work in an office or setting where a physician's spouse is involved with the practice 6. They pay your malpractice and it has to match but never exceed that of the physician 7. Complete transparency of your charges and receipts - do not let them bill under the doctor to get higher rates without the doctor having seen the patient - FRAUD, my friend 8. Control of your schedule - NONexistent in corporate medicine where they will fill every slot to make you "productive" and you get no say whether you are an hour behind because indigestion turned into an MI…... 9. You must have support staff - you are not an MA or nurse and should not act as one 10. It if seems funky or weird - IT IS - trust your gut and protect yourself 11. ALWAYS have an attorney review the contract BEFORE YOU SIGN IT. COST ME $250 and worth every dime 12. Be proud of who you are and what you do - not arrogant - proud and smart
  3. I want to flush the parents' phones down the toilet!!!! If you can't do 24 hour dietary recall on a toddler but can tell me your high score or your Facebook status - we have a parenting problem. When I am seeing a teenager - I put my palm out and take the phone and place it face down on the cabinet in plain view. Most parents congratulate me. The others don't notice because they are playing Candy Crush................... I wish I had some device - jammer - in the room that would shut their phones down. I don't bring mine in the rooms at all unless I am semi-patiently awaiting a specialist to call me back about a same day emergency. Sheesh!
  4. P.S. I don't endorse or like telemedicine. Just me. Too fraught with mistakes and disasters in the making. I do not endorse the TMA doing what they do, though.
  5. Welcome to Texas! The Bible Belt full of good ole' boys who make unilateral decisions just based on whatever.................. Born and raised there. PA educated there. Left nearly 20 years ago. A nice place to grow up but getting more funky everyday. I am embarrassed by Rick Perry and Ted Cruz and all the others. Sorry to hear how bad it still is.............................
  6. One time look between patients at work - did not cheat or look at other posts................................. diabetic 50 yo m with "shoulder pain" -- MI 85 year old htn male with atraumatic "neck pain" - hmmmm - vertebral fracture or impending vascular event 30 yr old fe on o.c.'s with "blurry vision" - VTE, stroke 75 year old male with worsening "leg pain" x weeks - spinal stenosis 35 yr old fe with btl with "bad gas pains and dizzyness" - ectopic pregnancy 17 year old fem with "yeast infection and fever" - PID 18 yr old male iddm pt with" new onset asthma" - pneumonia 50 yr old morbidly obese poorly controlled htn m with "heartburn" - MI again 45 yr old fe "bleeding gums" - NSAIDs - not sure on this one 22 yr old fe "taking LOTS of otc pain meds for menstrual cramps, now n/v" - pregnant
  7. I am having painful flashbacks to a breast surgeon from 25 years ago who could put 600 titanium heme clips in one mastectomy. Her initials were AML and we all giggled because the M could stand for malignancy. She was MEAN in the OR and had no mercy. An anesthesia resident would hold up anatomy books over my corner of the curtain to try to help me and others from her wrath. I hate Cooper's ligament............................. The residents were evil and threw the new student in on a case with her first thing in the morning with no prep as to who the patient was and no access to the chart. You walked into a draped OR patient and got the joy of retracting a 10-15 pound breast while she painstakingly removed it with every piece of titanium in the state. This thread is so much more fun and meaningful than the berating I received for 6 solid weeks. I will check back in and play along!
  8. Never mind - we aren't on the same page. I am saying the test has NO really good questions if you look at clinical reality..................... Agree to disagree Done
  9. cinntsp - Unless you have the statistics on which questions a majority of folks missed - I think you are missing the entire point. The test is flawed and doesn't represent what - across the board - PAs are facing clinically. I suggest a reform to the test and completely support going back to a 3 day PANCE with mock patients and clinical skills testing. I am 25 years in and have tested multiple times - I LOVED Pathway II and felt it was actually educational. I do not think the PANRE is reflective of what PAs know, should know or need to know. "A few bad questions won't really hurt" is NOT the point.
  10. One of my main problems with the recert tests over the years has been the ambiguous questions and the ones where "book answers" don't meet real answers. My lowest score on one test was psych - why? - more than half the drugs are used off label or in weird combos. The test also assumes that one has access to resources that actually do not exist. So, my answers were based on what I DO not what some book says. The psychiatrists I work with support my medication decisions 100% and they are who I learned it from. So, am I bad at psych - NO. The other questions that drive me insane are the "what is the FIRST thing you would do?" - ok, chest pain - MONA. Well, I am not alone and I am not out in the woods - so the patient is already on oxygen as I enter the room and has probably already chewed the ASA and the monitor is on and the IV is being put in. Sooooo, how do you want me to answer this? The FIRST thing I would do is introduce myself to the patient and ask what they are feeling and determine that they are conscious and have a pulse. There is no right answer to these questions. Also, any questions that ask "what one thing can you do for this patient?" - the answer is ALWAYS - stop smoking. Seriously - duh. I found drugs on the test that seemed to have a regional flavor and were not in Sanford's guide or on any list as most commonly used. I have questioned NCCPA for years on where they get this information and who makes the test questions. It has never reflected what I do or what I learned or what I see in my community. And that survey that NCCPA sent out that I got 1.5 Cat I CMEs for - useless, absolutely useless if they think it will help with PANRE test questions. So, my two cents is that the test needs to be reviewed by a LARGE panel of long time practicing PAs from all over the country who are allowed to tear questions apart and give feedback and data and real information so NCCPA can see reality, not some book, whatever book that may be. Time for a reform in my opinion.
  11. To the original post - you are not alone! I come from the days of #2 pencil and bubble sheets. One of my classmates failed the cert exam 3 times and vomits before ANY test. She got help from NCCPA and had an oral proctor and extra time and a private room and probably some Xanax the night before and some Zofran during the test. I haven't talked to her in years but imagine she needed help with recerts - insert my love for Pathway II here - she is super smart and worked in neurology and neurosurgery for years. Use your EAP at work or find a PhD or Psychiatrist quickly who can work with you. Hypnosis might help too. Have them put on writing to NCCPA your needs and have them request accomodations. Take care of yourself! Ask a colleague to READ a practice test question to you and see how you do. I hate going to Pearson for the whole jail lockdown testing procedure on the computer. It makes me nuts! You might be an auditory learner or need an alternate environment. Best of luck! AND remember these issues as your newborn grows and enters school - we all learn differently!
  12. I am curious as to how this will affect liability insurance and benefits offered to PAs within offices and hospitals. We have always been given benefits by our employing physicians for licensure, memberships, insurance etc. If the reimbursement doesn't change with this, though, we will still be paid less with way more expenses. It doesn't sound like it means a PA can hang his/her own shingle, though. Are we still employees, contract employees or practice partners now? Lots to iron out. Hope it doesn't get bogged down in litigation or bureaucracy....
  13. I had a PA student once from Alaska whose entire town funded her education as long as she promised to come back to the hinterlands and stay for X number of years. They paid everything - room, board, books, travel, etc. I too would say to work with a contract attorney and look at all kinds of issues - the dreaded what-ifs -- What if you become ill or medically disabled and unable to complete your education? What about potential maternity and its affects on school or employment? You have to protect the business relationship from the medical relationship and ensure that you are properly supervised and insured, protected, etc. What if this physician passes away or becomes unable to continue practicing before the contract is complete? Is it transferable or escapable? It sounds like a good idea in that the doc gets what he/she needs in a PA that is already a known entity with a knowledge of the practice. Just protect yourself and make sure it is what YOU want for your future and you can realistically fulfill all the tenants of the contract. Good Luck
  14. When I was a student, we did cadaver lab in the summer --- in Texas. A bunch of us would go to a Chinese buffet that we could afford. Boy, could we clear a room. We had no clue - no idea what we smelled like. We just thought the lines got smaller at the buffet................
  15. mjl194 - as I said when I started my post - no personal attacks or individual connotations. I do not like the PA profession being seen by some - not all and not you - as a fallback to inability to pursue other avenues. I would like the profession to stand on its own as a #1 choice. Many physicians I have spoken with over the years have told me that they wished they could have gone to PA school instead. When I went to school there were 54 programs in the whole country. Now well over 130. So, no offense implied to you or your significant other. In 25 years I have had to explain what I do and what I am too many times and still work with physicians who have no clue. It gets frustrating. A frequent comment often by physicians is "what, you couldn't cut it in med school". Comments like that imply that this is a lesser profession with diminished knowledge requirements or responsibilities. So, again - just something that has happened to the profession that still strikes a nerve.
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