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Reality Check 2

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Everything posted by Reality Check 2

  1. Going to throw this out there and probably gets all kinds of hell. Once an RN becomes an NP - the nursing world should be left behind. Either join the medical world as the Practitioner title implies or stay in the nursing world. You shouldn't jump in and out of the boat depending on the weather. NPs should not have RN lobby backing - they are different and don't do the same things. Just my crazy brain
  2. There is an International Forum area with references to Mexico. Some are quite old.
  3. Good medicine cannot be measured in minutes or CPT codes. Real peer review and quality assurance show the benefits of an interaction or intervention with a medical professional. This type of job is obviously not for me. If it works for others - great. We should put quality practice ahead of the number per hour and time of visits. I expect some snippy reply from CEO guy - whatever. Be good practitioners - do good things - do things right.
  4. I do telehealth and no call/video is EVER 5 minutes. Chronic disease management takes time and effort. Billing is not all there is to it. Notes, rx's, referrals, etc. Our calls take the first 5 minutes to just get the tech going - older crowd - and do all the disclaimers and such for telehealth - e911, address of patient location, disclaimers. etc. So, I would be billing 99214 without doubt. I could maybe do 3, maybe 4 in an hour. But, again, not interested in this employer - telehealth in general is evolving and needs to be held to standards. Medicine should never be all about money. It is an ART.
  5. No purpose in continuing this conversation. Not interested in this company or its communications. Done
  6. Simple math and your website told me all I needed to know. No thank you.
  7. I got that vomity taste in the back of my throat with this. NOT at all an apology. She is just an awful person who wants to sell her stupid books. =============================================================== COMMENTARY PA Name Change Bad for Patients and the Profession Rebekah Bernard, MD DISCLOSURES January 07, 2022 291Read Comments Add to Email Alerts Physician assistants (PAs) are angry with me, and with good reason. I had the audacity to lump them together with nurse practitioners (NPs) in my book Patients at Risk, an act which one highly placed PA leader called "distasteful" in a private conversation with me. Rebekah Bernard, MD I will admit that PAs have reason to be upset. With competitive acceptance rates including a requirement for extensive healthcare experience before PA school, standardized training, and at least 2000 hours of clinical experience before graduation, the profession is a stark contrast to the haphazard training and 500 clinical hours required of NPs today. Further, unlike NPs, who have sought independent practice since the 1980s, PAs have traditionally been close allies with physicians, generally working in a 1:1 supervision model. The truth is that it hurt to include PAs with NPs in my book. I've had my own close relationships with PAs over the years and found the PAs I worked with to be outstanding clinicians. Unfortunately, the profession has given me no choice. Following a model set by the NP profession, PA leaders have elected to forgo the traditional physician relationship model, instead seeking the right to practice independently without physician involvement. Their efforts began with a change in terminology. "Optimal team practice" (OTP) was supposed to give PAs more flexibility, allowing them to work for hospitals or physician groups rather than under the responsibility of one physician. Not surprisingly, corporations and even academic centers have been quick to take advantage, hiring PAs and placing them in positions without adequate physician support. OTP paved the way for independent practice, as PAs sought and gained independence from any physician supervision in North Dakota, the first state to grant them that right. Most recently, PAs have determined to change their name entirely, calling themselves physician associates. This move by the American Academy of Physician Assistants (AAPA) is the culmination of a years-long marketing study on how to increase the relevance and improve patient perception of the PA profession. The AAPA decision is expected to galvanize state and local PA organizations to lobby legislators for legal and regulatory changes that allow the use of the "physician associate" title, which is not currently a legal representation of PA licensure. PAs' latest attempt at title and branding reform follows years of advocacy to not be referred to as physician extenders or mid-level providers. For example, to gain more public acceptance of the PA model, the profession launched the public relations campaign "Your PA Can," closely mirroring the "We Choose NPs" media blitz. PAs have also followed other dangerous precedents set by NPs, including 100% online training and a new "Doctor of Medical Science" degree, allowing PAs, as well as NPs, to now be called "doctors." I can understand PA reasoning even if I don't agree with it. PAs are frustrated to be treated as second-class citizens compared with NPs, who have been granted independent practice in half the states in the union despite having a fraction of PA training. Frankly, it's unfair that NPs are being hired preferentially over PAs simply because of looser legal requirements for physician oversight. The bottom line is that NPs have been more successful at persuading legislators to allow them independence — but that doesn't make it right for either group.
  8. 1. I am a dinosaur - ask my kids and some snotty new grads 2. in my 30th year - start 31st year August 2022. Likely 10 more years to work. 3. Starting my DMSc next week. Have to have something to advance out of pure clinical. 4. Historically have worked for crappy bosses and corporations. Corporate medicine is awful but the way it is in life. Independent docs have their own baggage and thus, do not work for corporate machines because they cannot fit in. 5. Working for federal govt suits me - not for everyone, but it is working out for me. Structure, potential for advancement - sort of - not without its headaches and politics. The FIRST time in my career I feel like I can move forward and potentially with educational support. 6. I have always struggled with politics - we need AAPA, I don't like them and don't pay them currently. Hard to pay them when they suck at representing what the profession HAS TO HAVE to survive. The old guard irritates me. Not sure how to change that. I also struggle with working, family, obligations, etc AND finding a way to support change other than money. No great solutions. AAPA does need a visionary leader unafraid to challenge things. How can we make that change - money alone is not an option? 7. The progress of NPs is terrifying on many fronts. They are killing us professionally and I do not believe they are uniformly capable of good medicine with their education and boarding structure. A doctorate does NOT make one a better clinician - period. Online schools for clinical instruction are NOT ok for hands on profession. PAs have a much better educational structure and guidance. NPs should leave their nursing PACs and lobbyists once they become an NP - either practice medicine or stay a nurse. 8. NCCPA is a profitable organization that is NOT advocating for PAs. Just collects money and sets up tests. We deserve a better accreditation organization with oversight and a nonprofit concept - their CEO should NOT make half a million dollars. We need a better structure to reflect what we actually do. 9. I do believe PAs need autonomy and independence - graduated over time. Minimum number of years of experience, mentoring, something to show abilities. Docs can fight all they want - the US needs medical providers - period - if docs are not in sufficient number - that is their problem - meanwhile highly qualified advanced practice providers are out there and ready to rock. 10. I love what I do and I am very very good at it. Taking care of folks and providing them with sound medical advice is very rewarding. Some days suck and politicizing a pandemic has made the world kind of suck in general. I strive for the high road of science and doing what is right. 11. If you are unhappy with your job - YOU HAVE TO DO SOMETHING. It will affect your patient care and patients deserve better. Nothing like a half ass approach to potentially life threatening issues. 12. Take each day as it comes. Do my best. Do no harm. Try to be the person my dogs think I am.
  9. Hey SK732 - How is Canada, eh? Miss seeing you on the forum!!!
  10. For those still asking questions - I think the message is ringing loud and clear - this place is a money mill and a nightmare. Stay away Find something else to do Don't get taken They aren't nice people RUN
  11. I gave up the white coat a very long time ago. I am warm - personal summertime of life - the coats are polyester and uncomfortable. The sleeves get filthy and I would rather wear cotton. So, business casual or full PPE - pick of the day. No white coat. Name tag - always. To each his own........
  12. Like Scott, my team has BOTH RN and LPN in primary care at the VA. We don’t have many MAs, if any. Some departments have something called a Health Tech - no clue. I am horribly spoiled now with two nurse teammates. We all work to the top of our licenses. LPN schools are fading away and that sucks. We need all levels of nurses. MAs can be rockstars but - by and large - they aren’t licensed (“registered”) and 9 mos of education would never cut it in my world. I hope people want to work again soon and COVID quits torching health care workers…… a girl can dream
  13. I don't see how someone who became a PA was scared and went on to medical school and that made anything better... You are either cut out for the field of medicine or you are not - it is not the title that makes you. The argument that "only physicians" can do things is stale and we have proven ourselves clinically for decades now. Roll with what the public needs - medical care - make it happen - that involves PAs working to the highest levels and - oh, wait - teamwork. A doc I worked with had some of the best mantras ever - his thoughts on this situation would have been - Don't walk in the swamp alone. Time to evolve
  14. Murphy’s Law of COVID medicine and rationed procedures…. We are sending home FIT kits instead of low risk screening colonoscopies since early 2020. An inordinate number (in my mind) are coming back positive and GI is overwhelmed with need for colonoscopy now when they are trying to limit procedures due to staffing, hospital overload and COVID exposures. Thankfully a minimum of bad findings but just bizarre….. My insurance won’t cover Cologuard…. Got the standard little tube take home kit.
  15. I still hate the questions about what to do FIRST, as though you are alone in a room out in the woods with no help and a table containing a fish hook, a ball of yarn and a bottle of aspirin and someone has chest pain. Those are loaded questions - assuming no prehospital care, no triage and no nurses, techs, etc simultaneously working the patient. My first response was always - check your own pulse then check the patients and say HI and ask what is going on…. I guess I am dumb though to think of common sense.
  16. Just yesterday, pt chronically anemic with known bone marrow dysplasia. A tad more anemic but not bad, Hgb 10. Hx of GIB and PUD. RECENT hx of heme positive stool - visible. He tells me onc is planning bone marrow bx, but no one has checked his stool again or asked about the NSAIDs he has been taking….. So, how about we look for obvious cause of blood LOSS before we do a bone marrow bx?…. Just a thought
  17. I think I am in the window to start this for my 10 yr recert. This Pathway II type thing is very appealing. Might even learn something. Regardless of the functionality, I have my "C" and plan to keep it - as trying to get it back would be painful and costly. So, I keep it. Hate paying an organization that doesn't really support us - but - it is a choice to keep my "C". If I am counting correctly and hell doesn't freeze over, I should only have to recert one more time before potential retirement................ Deep sigh
  18. Breaking news from NCCPA. I did Pathway II eons ago and liked it. What are the thoughts now? Discuss...... From NCCPA: NCCPA is pleased to announce that beginning in 2023, PAs will have two options for their recertification assessment. The traditional PANRE that is administered at Pearson VUE test centers will remain as one option, and NCCPA will also launch an official alternative longitudinal, take-at-home process.... The application period will open later this year for PAs who are due to recertify in 2024, 2025, and 2026 and want to participate in this new process. The registration period will close December 15, 2022, and the first block of exam questions will be available in January 2023. So, what does the new PANRE-LA look like? Here’s an overview: Each quarter, 25 questions will be administered in an online format that PAs can take anywhere, anytime, and on any compatible device. Each question will have a five-minute time limit, and PAs may use online or printed references to help inform their answer selection. Before opening an exam question, PAs will be provided information on the content category that will be assessed and can decide to move forward with opening the question or defer it until later in the quarter. This way PAs know in advance what content area will be coming up in case they want to review the exam blueprint topics or reference materials before opening the question. Immediate feedback will be provided to PAs to let them know if the answer they submitted was correct, and they will be provided a rationale and references that can be accessed for additional information. The content of questions that have been completed and the rationales will be available throughout the process so PAs can review it anytime, at their convenience. PAs will have three years to complete the new process. During the 12 available quarters, PAs will be required to complete eight quarters and may skip up to four quarters. This allows PAs more flexibility to participate in quarters that fit best with their schedules. There are benefits for getting started right away and working straight through. PAs who complete the first eight quarters may be able to finish the process in two years, if they reach the passing standard. PAs who have not met the passing standard may continue in the program, and scores will be recalculated at the end of each subsequent quarter, using the best eight quarters. This provides PAs an opportunity to improve their performance before the end of the 12-quarter process. PAs will apply for the PANRE-LA process in the year six of their certification maintenance cycle and the exam questions are administered in years 7-9. As previously noted, one of the foundational principles of the PANRE-LA process is to help PAs identify and close core medical knowledge gaps, and NCCPA anticipates that only a very small percent of PAs will not reach the passing standard after completing the PANRE-LA. However, another benefit of this process is that PAs will still have up to three opportunities to take and pass PANRE in the tenth year of their recertification cycle before their certification expires.
  19. I did have an employer take money out for 401K but never send it to the investment company. Used it to pay overdue bills and personal expenses. But, it is correct that one must enroll in 401K to participate. This whole job sounds like a nightmare.
  20. Follow your dreams, be professional about leaving other job. MAKE SURE this job is the dream it appears to be. Ask hard questions. Regrets suck.
  21. I saw the bull riders in Texas all the time. Lose a testicle - no big deal…. Gored in the chest and inches from the heart - meh, ready to ride again Stomped and compartment syndrome in the leg or foot - just a normal day I had to resign myself to the idea that they were out of the gene pool - usually. Because the next incident would likely be fatal and the tight jeans and bucking were not sperm friendly. Similar issues with my motocross folks. One BENT the IM rod in his tibia when he hit a tree - AGAIN. And wanted a boot instead of surgery or cast - he could still ride….. I have to use the mantra - give good advice, document the hell out of it, hope they make good decisions Deep sigh
  22. The articles I searched indicated that, at any one given time, about 10% of the military is not deployment ready. Mostly for medical reasons. They did not count pregnancy and post partum in that batch. Any type of cancer was a NO-GO for deployment. Thus, HPV cancers would meet that index. What if a soldier is deployed and cannot have routine medical screenings and develops HPV, thus becoming a potential burden on his/her unit when disease develops and has to be medivac'ed or taken out of duty to deal with this diagnosis? Why couldn't we prevent that issue by vaccinating? Reduction in costs and manpower, training, transport, etc. Anal warts can be huge and painful. Abnormal menstrual bleeding and pelvic pain can be debilitating. Throat cancer can cause dysphagia and weight loss or coughing up blood. That doesn't help your military unit. What about the soldier who develops HPV and doesn't know until LONG after deployment and suffers unneeded consequences or loss of fertility, etc due to having to have more aggressive HPV treatment? Why couldn't we just prevent something before it happens? It is completely naïve to think that troops aren't having sex when deployed. And more naïve to think they are always using condoms or that sex is always consensual. Why NOT vaccinate to reduce one type of issue that can and likely will arise in a set of soldiers. Men under age 30 were more likely to seroconvert to HPV during their military tenure than any others. Men can spread HPV to partners - men and women - and those in other countries with whom they associate which widens the web of spread. So, again why NOT prevent a potentially harmful disease with somewhat unpredictable outcomes? If you just want to argue to argue - go ahead. I am done arguing. I see logic and forward thinking and - again and again - A CHANCE TO PREVENT A CANCER - SERIOUSLY, WE CAN DO THAT NOW. Why would you NOT get an HPV vaccine???
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