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sas5814

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sas5814 last won the day on August 20

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About sas5814

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    President Elect, PAs For Tomorrow

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  1. My RHC covered the local campus for about 18 months after their provider retired. It was not difficult work but I found them to be the most whiney neurotic delicate little flowers on the planet. Every emotion needed a pill.
  2. My PA program was the Army. We were woke at 5:30 for PT. That was about as woke as we got.
  3. This has been an interesting, if wandering, thread. Just my .5 cents worth. Health care isn't a right. If it was the governement could force me and every other health care provider to give it away to anyone who needs it. We haven't made food and a roof over your head a right. How can something like health care be a right? Most people need health care. That doesn't automatically entitle them to it. It would be nice if everyone who needed care got it. Right now the perfect system, including the oft lauded universal health care system, doesn't exist. The words "fair" and "entitled" and "free" have become trigger words for me. Fair is you eat what you kill. Fair is taking care of people who can't take care of themselves. Fair is letting people who could take care of themselves but won't devolve naturally. Free doesn't exist. You can't give something to someone without taking something from someone else. Free things provided by the government are only free to the recipient. The rest of us pay for it in taxes. You aren't entitled to anything in this life except a fair shot at succeeding under your own power.
  4. My understanding is your malpractice won't cover you if there is a complaint you committed a crime (manslaughter). I'm sure legal experts will have opinions but as Cid said there is a difference between error and acting in such a way your actions could would be believed to cause harm by a reasonable person. It is the many shades of grey in between that become the battle ground. I think any time we do anything "off label" we put ourselves at risk. Anytime we do something we aren't credentialed to do, any time we do something we are qualified to do but don't have adequate documentation of training and skill maintenance. It seems some days are an exercise in self protection.
  5. The title is a bit of a generality and I understand that but I recently had an experience that brought this up. I have "enjoyed" this attitude at the state and national levels in matters of regulation and policy but this was the first time I ever got it locally from a leader in my own organization. For the first time in almost 3 years I had direct access to a physician at the highest level of our organization. We are a huge organization and do not have a senior PA or NP or APP at the top of the organization. We have 3 mid level APPs who are really in charge of nothing except being one more level of management to carry policy to the hoi palloi. So, after a department meeting he came to me and thanked me for my comments (which was BS because I called him out for not having a "maximum number of patients" policy in the UC) so Itold him this organization employes 300 PAs and NPs in this region and needs a senior APP to help make sure the organization is using us to maximum benefit. Without any dicussion he said "no we don't." The shallow follow on discussion basically said we don't need an APP at his level of management because the physicians will make sure we are taken care of. I asked him who at his level was responsible for the APPs. The answer? The CNO. I told him flat out that was wholley inappropriate and his reply was "I hear you." End of discussion. I went home and drank a lot. As giant corporate medical machines go this one is better than many. They value work/life balance and people being treated with respect. I am well paid with better than average benifits. I am about 5 years from semi-retirement (unless my new business takes off then I am gone) and I'm wondering if this is a windmill worth tilting at.
  6. If you limit your options you limit your options. This little bon mot I have used for years and what I mean is the more limited your desires are for a job in terms of specialty and location the more limited your choices are. You seem to be casting a pretty wide net and that is good though your geographic restrictions may limit your choices. A residency is a great thing but I think sometimes people give it too much power. If you are in a highly competative market it can certainly make a big difference. But there are other options. Just as an example I live in Texas and we probably have more under-served counties than any other state in the country. If you are willing to go where other people arent you can start work tomorrow. Just food for thought. Best of luck.
  7. Back when I was young enough and my back was good enough I used to ride horses a lot. I wasn't great at it and took a lot of advice from people more experienced than me. I remember being told a horse knows when you have no confidence in what you are doing...its a sense they have. Patients can be the same way. I don't know how to help you exude confidence. That really comes from inside. I have had the other problem more....over confidence. That combined with being a pretty big guy with the basso profundo voice I tend to intimidate even when I don't mean to. 30 years in I think I have hit a better middle ground. So from what you are describing I suspect the patients are sensing your trepidation. In this day and age of patient satisfaction surveys and Yelp reviews it is more likely you will have confrontational or even angry patients. They will sense weakness and pounce like a hawk on a field mouse. This sounds basic but how often do you practice being confident in the face of questions? Practice builds muscle memory so when the fear creeps in (or whatever word you use to describe it) things happen automatically. This was a critical skill in the military and during my time in law enforcement. I remember events unfolding and suddenly I am at an end point not having consciously taken any action but having done the right thing. Muscle memory. I would recommend seeing a therapist to see where this is coming from. It is unlikely it is a sudden unexplainable feeling with no clear origin. I am sure it is something that can be improved. You just need the right guidance. Best of luck
  8. I work in UC and I make 154 base with OT after 40 hours
  9. I share this not to make any point about evil-doers among physicians but to illustrate a point that applies particularly here in Texas. These 2 prescribed Vicodin illegally for about 12 years. One wrote his colleague Vicodin for years without documentation. Same-said colleage wrote Vocodin for his wife, 90 every 2 weeks, took the prescription to the pharmacy himself, and paid cash so there was no insurance involved for more than 10 years. After he was arrested he turned himself in to his employer as having an addiction and started a treatment program no doubt at his attorney's insistance. So my point is, particularly here in Texas, the medical board has fewer requirements and standards for physicians than any non-physician. Why? If they are so special and imbued with such broad power why don't they hold themselves to higher standards than everyone else instead of lower? I couldn't fill a prescription I wrote for my wife for an antibiotic much less Vicodin for years. This is what happens when you hold your particular group above others without having commesurate standards of screening and management. This on the heels of all Texas PAs having to be re-fingerprinted and have criminal background checks (I have had an unblemished license for 20 years after a background check with my initial application) but the physicians .....not so much. https://tylerpaper.com/news/local/tyler-area-doctors-accused-of-illegally-diverting-opioid-prescriptions/article_0c820ff2-c5e1-11e9-a354-4ff5db0e6422.html
  10. It is almost always baby steps. I bet in Cali they can hear my eyes roll in Texas every time someone says "you just need to pass a law" like its writing a postcard. people who complain about "someone should do something" or "change the law" are often the ones who have no idea the work it takes.
  11. or another of my favorites.... there is only one generic manufacturer so they keep the price artificially elevated because...why not?
  12. sooooooo....why aren't they fingerprinting the physicians? It seems stupid, wasteful, expensive and pointless. But if you are going to do it why not do it across the board?
  13. insurance companies are about money not healthcare. They aren't your neighbors, your helping hands or anything other than a business that wants to make the most money. Their decisions will be driven by that. I think any major change invokes the law of unintended consequences. I think they will be trivial compared to the improvement in our professional lives after OTP and direct payment from CMS finally happens.
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