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kadiah

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About kadiah

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  1. So I know this offer is pretty shit and it hurts to even consider, but I'm pretty annoyed at my current job where the ONLY nice thing is the salary. I have 5 years experience, mostly in Urgent Care and Family Medicine, currently work for a hospital system. I currently get 2 weeks PTO, 10 days CME, $3500 CME, and automatically 5% to 401k. I currently make about $107k annually. I was offered a Dermatology position - The starting base salary they offered is $80k. I understand I don't have any dermatology experience and pay for PAs in my area is shit to begin with, but based on AAPA salary report a Dermatology PA with 0-1 years experience is making $84k at the 25th percentile. They said they justify this because after 1 year they give you quarterly bonuses based on RVUs, which they said gives their PAs about another $15-20k annually. The only other good benefit is they pay for healthcare for me and family 100% - no premiums and they pay deductible, which is worth about $5k based on my calculations. Otherwise, it's 10 PTO days, 3-5% to 401k and there is a 2 year non-compete contact, only for Dermatology in a 60 mile radius, I could leave and practice in other specialties without penalty. I'm planning on countering at $85k, because with the health care bonus that brings me about to $90k-ish, but it still feels kind of awful. I've never worked on RVU bonuses so I don't know how not stuck I would be. I'm considering it because I want to avoid the burnout of my current job - very long hours, seeing almost 40 patients a day, working every other weekend. This current position is 7:30-4, no weekends. There is call, but it's pretty manageable, only happening every 6 months. If they won't budge I'm pretty sure I won't take it. I told my work I had an offer and they're scrambling to try to get me help. I'm mostly countering the offer to buy myself time so the opportunity doesn't fly from the table. But I'm not crazy right? it's a terrible offer. They tried to pressure me, saying that's the most they've offered PAs with Derm experience.
  2. So the "Urgent Care" (we're honestly just walk in clinics because most of us don't even have x-ray available 24/7) I work for is run by a huge non-profit group. They've told us that we will NOT be participating with any auto or worker's comp insurance, BUT if someone comes to us and demands to be seen for a problem relating to these two things, to let them know we don't participate and bill their health insurance instead. I just don't understand how this isn't insurance fraud but every time we say it is, they tell us it's not. I don't even know who in my organization I would ask about this, because every time I ask administration they say "do what is right for the patient"... and I think sticking a patient with a $500+ bill is not right, when I can direct them to an Urgent care that DOES participate.
  3. Well since I saw one in a 16 year old female with completely normal vital signs and no trauma history who's complaint was chest pain - yeah. I think about it. I had convinced myself it was costochondritis, as she had referred breath sounds, but did the x-ray anyway to CYA, and I'm glad I did. And if the chest pain ISN'T concerning for ACS, and I truly think it's GERD and they have no risk factors, then I don't refer to the ED, I get them a close f/u with their PCP. Any yes, I order DVT r/o all the time, and my UC clinic actually has a protocol for acute abdominal pain where our hospital is required to get them in and whatever imaging we order read in under 2 hours. Actually, sometimes we find the appys sooner than the ED would. I truly DO try to keep as much out of the ER as possible - I just think that just because the ECG doesn't show a stemi, that should mean we can be all happy. Yeah, that's why I pray our cardiology group will kick this in the bucket. It doesn't even make sense to me.
  4. Oh yeah I'm 100% aware of the work up for cardiac chest pain. This post is 99% venting that my medical director even finds it mildly appropriate to suggest we attempt a work up. I mostly made this to reorient myself to reality, that indeed, cardiac chest pain belongs in the ED.
  5. Our system is big on "taking burden from the ER." We can open up all the Urgent cares in the world, and some patient is still going to go to the ER because they stubbed their toe. I already have high acuity in my UC. just last week I sent out a lady having a stroke and a patient with a heart rate in the 180s (apparently she was hyperthyroid for years and it finally became a problem). I don't need to trend troponins for 6 hours. The PAs in our ER only see level 3s and below.
  6. So I'm looking for advice here. I work for a health system in their "Urgent Cares" . Honestly, we're glorified walk ins, we don't even have x-ray on staff 24/7, we're usually solo providers unless it's a busy clinic then there's 2 providers, always a PA/NP, never a physician. Most of our clinics have 2-3 rooms max, the biggest has 5 rooms. Support staff is generally LPNs and MAs, and sometimes it's just you and 1 support, who rooms and checks in. Well, we have monthly provider calls and on today's call, our medical director said he visited another urgent care (that is staffed by physicians and RNs) that has a protocol for chest pain, where if it's not a STEMI and they're stable, they send them acutely to cardiology same day, not the ER. He didn't really give us specifics, but we have zero ability to get STAT troponins unless we call a STAT courier. And obviously not all chest pain is an ACS - but how do I rule out a spontaneous pneumo if I don't have x-ray. And d-dimers for PEs has the same problem with STAT labs, and I don't want to think about the prior auth I might need to get a STAT chest CT for pe. I'm just floored that they want to do this. Honestly, when it comes down to it, I will 100% send them to the ER if I have concerns. I sent an email with my concerns and what I think it would take to make this work and be safe, just in hope that he sees how ridiculous and how much work it would be to implement.
  7. I have this thought daily at work. I work at an UC that's attached with a FP clinic and I'm actively trying to get out because I just think Urgent Cares pander to a needy population. Todays been a light day - only 12 so far and only 3 of them actually needed to been seen - a laceration, a woman with a UTI, and a 6 year old who I caught a pneumonia (flu was also positive, so that was the cause). Everyone else was sniffles or 6 years of back pain ridiculousness. I give the sniffles their atrovent nose spray, tessalon, and "oh I know its rough when you sick" compassion. But when I was young my Mom NEVER took me for a cold - heck I had a broken arm for 4 days before she took me. No one knows any kind of first aid care anymore - and the PCP office doesnt help because when patients call with 2 days of a runny nose they tell them to come to the walk in. Like Rev said, I'm here for catching DVTs/PEs/SAH... scary acronyms patients didnt even consider for their symptoms.. to make sure nothing falls through the cracks. But I find myself just getting more and more bitter when patients try to treat me like a Fast Food workers - they just are here to place their order and move along... and thinkertdm is right - it's due to everyone NEEDING instant gratification
  8. Came up today... I won't clear someone for a work physical if I don't see you accomplish everything on the physical. Physical asks for immunization status and you don't provide vaccinations? Show me the vaccs or you're getting titers drawn. Physical asks you to lift 50 lbs? You're lifting 50 lbs. So many people try to talk us into things at my UC and say "oh just cross that out" but our legal dept actually said absolutely dont cross something out and sign it because it won't hold up in court.
  9. I was reading through this thread and saw this: and automatically knew we work for the same company, even though I'm in Eastern PA and it's 2 years later. Still the same CME. Was hired about a year before CVTSPA's post and got the same response when I asked for more time off. But this system has a monopoly on Western/Central/Eastern PA, so they keep pay low and benefits minimal for APs.
  10. In my mind it's similar to the reason pharma reps no longer are able to provide us with pens and mugs - if you're given even a little bit of "profit" (in the pharma case, free stuff, in your poll's case, actual monetary gain) it influences in a negative way. In my experience with MLM schemes, and I know you said it may not be but it so frequently is, the harm doesn't come to the well off people - it preys on the population that has little to spare: the poor who don't have steady income, stay at home moms who "just want to contribute"... At the very least in this case, this provider is using his authority to influence people to buy something he's directly profiting from. This just gives us a bad name, which is bad enough because everyone already thinks we're profiting from "big pharma".
  11. I've been getting a string of patients who are IN SO MUCH PAIN that they refuse to let me examine them. It's funny how quick they change when I tell them I'm just going to document refusal of examination and I therefore can only really "guess" as to what's really wrong with them.
  12. Whew. Yeah, I'd get insta-rage at that. I always say the hardest part of the job is the acting and poker face that goes along with patient satisfaction, but this one probably would have made me crack.
  13. Honestly I have close - about 5 months in savings. I'm just a very risk adverse person and throwing caution to the wind and completely quitting or daring them to fire me just gives me too much anxiety to think about. Would my husband and I be fine? Yeah, probably. But our goal is to aggressively pay down the rest of our debt, and we'll do that at the current rate in about 2 years. That's mostly what I'm worried about. Not much in my current area (Pennsylvania, for those asking) interests me. I've wanted to do ENT since school and there is a position in upstate NY in the area where most of my friends live, so I applied and am talking with their recruiter tomorrow. It's nice having almost 5 years experience behind you - the job hits happen a lot easier now.
  14. I wish I had the balls to just wait. I couldn't take a hit like being fired, my student loan payment is like a second mortgage (but its 2 years from being paid off, so yay?) My coworker on the opposite shift of me beat my record and saw 32 patients by himself today. We both need these jobs until we find something else. The most protesting he and I do is refusing to do the bs busy work of double documentation they make the LPNs and MAs do with results and we've been refusing to do stat blood draws. My best friend talked me into applying to jobs by her, and an inpatient psych position was posted yesterday at a hospital near us. It's a huge change, but after ER my psych rotation was my second favorite. I figure anything is worth a try!
  15. Thank you. I know the answer is to leave. I think I'm just gun shy because I'll either have to make a huge change (move out of the area), have an 1+ hours commute to work, or just work in a different specialty in the system, which I don't see being a great change.
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