Reality Check 2

Local NP schools banned PAs from being preceptors because we didn’t have doctorates.... Now they have changed their minds and that WHOPPING 80 HOURS of Primary Care can be with a PA. 80 HOURS OF PRIMARY CARE. Try six MONTHS at one bloody site PLUS other nationally mandated PA rotations..... I declined. If I wasn’t good enough six months ago - never mind.

Shut down the OP please. Troll and pot stirrer.....

Don’t forget my neighbor’s sister’s boyfriend who is a chiropractor........

I have no idea what the OP is talking about. I haven't taken an ORDER from a physician as a PA - ummm, EVER. I am a licensed practitioner who makes my own assessments and plans. My SP wanders by every few weeks and is available by phone or instant message. I brainstorm with my colleagues in my dept - MD, DO, PA, NP but I don't take orders from anyone. It baffles me that someone thinks this is normal, acceptable or proper practice. My history is ER, family practice, ortho and internal medicine with some occ med thrown in over all these years. OP - please identify yourself - PA, pre-PA - what you are describing pretty much doesn't exist.

The ART of medicine shall not die. Telemedicine can't do a UA with culture and treat the right bug. Can't tell mono from strep or pneumonia from CHF from asthma sometimes. Telemedicine can't do a monofilament exam or palpate a joint for warmth or ligamentous stability. MAYBE a stable diabetic or even some psych stuff but - really - Hands on can't be replaced. I think it is fraught with danger and the licensure issues have NOT been ironed about between states. I will stick with my patients in the room - body odor, foot odor and halitosis and all that - can't freeze a wart over the telly either.

If the SP mandates a tax plan that doesn’t follow guidelines or seems inadequate — document that Dr Bozo DETERMINED plan to be ******* whatever after discussion and those orders were placed on his/her DETERMINATION. If an SP is going to dictate treatment - give them credit..... If you are treating something and want to say where you got it - say it. Cat bite treated per current recommendations in Sanford’s. UTI tx’ed based on regional health dept resistance listings. If you really don’t like their plan - enter it for THEM TO SIGN. MD does not mean Medical Deity.

This is not a recruiting site. Bye

Deep sigh - STILL - don’t call me honey....... and my eyes are up HERE.

In all complete honesty - wait until after baby if possible. Your first job will be hard enough without fatigue, preggo fog brain, back pain and swollen feet. And constant doctors appts and hopefully no bed rest or complications. You also need to stay healthy and not ill - think cold, flu, snot season. It takes months in a new job to adjust to the germ genre of any particular place. Thinking from the hiring aspect - interview, hire, train, mentor, and then lose it to maternity leave - not many places are willing to do that. Just my own Mom type of thoughts - I would wait if possible.

Commercial driving is laden with anxiety producing situations, hours, and timing. If this person encounters road rage, a wreck, a person cutting them off, bad weather - what is to say he/she won’t pass out? The meds mentioned - lexapro is fda approved for generalized anxiety. Trazodone can cause a stuporous hangover. Neither actually controls syncope. Perhaps a non-driving, non machinery related job is in this person’s future.... I would not certify and I am a DOT certified examiner.

Stay your path. Don't give in. Medicine is not McDonalds and Press Ganey and Yelp be damned. Don't mix stupid drugs, wean off whenever possible. The VA has a national policy of LESS than 50 MEDD and ZERO benzo mixes. At least I have a national support behind me. I no longer Rx ambien and have no problem telling folks I will not contribute to bad habits, bad ideas and outdated ideas. Document the crap out of it. "offered patient a weaning program to stop benzos and then would work on narcotics to a lesser level. Patient declines all plans and attempts and wants to continue on a combination of medications that have medically been found to be dangerous." We have to stay the high road or it will get worse for providers = all of us. And YES the state and the DEA are going after folks. Good Luck!

Have to play devil's advocate. Is the drug screen clear of stimulants/amphetamines? What psych diagnoses does this person carry? Bipolar not well managed? Is the patient on Wellbutrin? First side effect is insomnia. Does the patient have any schedule during the day and any physical activity? I really don't like adding more drugs to drugs if at all possible. Could this person be switched to buprenorphine from methadone? Safer profile overall. I would strongly suggest a sleep study and then behavioral cognitive therapy or even hypnosis to work on a sleep pattern. Drugs would be my last choice. Polypharmacy is not always better living through chemistry. My crusty old 2 cents. And, I am a buprenorphine waivered provider, for what it's worth.

Worker's Comp can be like Urgent Care in some settings - foreign body in the eye, laceration, sprained ankle, burns, etc. I could treat and street about 70% in one clinic. Tdap, suture, wound instructions, limited work if applicable for 7-10 days depending on laceration and case closed in 21 days max. Those cases come to fruition usually without much issue and someone gets better and goes back to work. Back pain is the most difficult to work with - real, malingering, surgical, do they ever get better? I dealt with some weird stuff too - chemical exposures, TBIs from unsafe work sites, faked injuries where an investigator brings me video of actual "injury" that is sooooo fake. Human bites from folks who work with troubled youth and our local state mental hospital where the criminally mentally ill are housed - one guy with permanent brain damage from being picked up and slammed into metal doors - he was only 32. Nails through digits was a also a favorite. I am in Washington like Rev. In our state, patients have a right to pick their provider. In Texas - it was employer driven. They could legally contract with a specific site where workers HAD to go to get care. In WA- patients can pick their provider but there are benefits to using a real Occ Med provider - something called COHE in WA where a provider is trained a bit and gets better reimbursement. As Rev says - there is a billing code for everything - phone calls, forms, paperwork - you really do bill for everything you do. So, not too bad on that note. Learn your forms, learn your state rules. Remember common sense - someone with a 2.5 cm laceration on their forearm does not need 6 weeks off and a bunch of hydrocodone..... Good Luck

Your VA location sounds woefully underinformed - there are HUGE national VA policies on narcotics. Your Medical Director sounds complicit with bad behavior. Were you able to locate the actual CHIEF OF STAFF? You can print out the VA directives and conveniently and anonymously leave them on desks. I feel certain the director of the VISN would be fascinated to hear all this. Sad to hear that not all VAs are created equal. Hope your time is short and you can get out unscathed.

If seriously unhappy consider depression as an issue or start looking at other careers. No benefit to you or patients if you stay in a PA job/career you loathe. Not trying to be all out mean but don’t do it if you hate it. It will affect your work. I would much rather see a burned out cop, doctor, PA, lawyer being a chef or running a fishing guide service than hating their first profession so much. Consider professional counseling to evaluate the situation. Been there, survived...