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About LonguylandPA

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    Physician Assistant

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  1. I have 1.5 years of orthopedic and spine surgery/outpatient experience making 135k in private practice in Long Island a nyc Hospital posted an ad for “great pay” ortho position so I interviewed it turns out the base salary is 109.5k including the 5% evening shift differential. There is opportunity for overtime at $84/hr which is 1k/13hr weekend shift. she said I get this ~lavish~ amount after saying how my salary would be higher Bc I’m in a surgical role and because I have experience...they also said there is no wiggle room for negotiation. This is also NYC where cost of living is high the benefits of this job: great hospital floor/ surgery total knee replacement and other ortho surgery experience and a “chill work environment according to the head pa” 29 days PTO instead of 20 days currently 403b with 8% match instead of none currently $1400 cme instead of nothing currently What do you guys think?
  2. Hello, I am from long island and I have rotated in hospitals offering this program and I knew the "residents" in them. they were typically in fast track, and once in a while in main from what I saw this company typically staffs Catholic health services hospitals and from what ive been told, the pay is 40 an hour, and 18 months long. there are apparently formal lecture components that are mandatory and paid for I believe once a week. otherwise I dont believe it was a good offer compared to other ER positions in the NYC area
  3. 25 year old male PA, Long Island NY working for a private ortho/spine surgeon doing 3-4days a week outpatient and 1-2 days a week OR doing spine, shoulder scopes, knee scopes. I get paid $65/hr making that $135k a year plus a bonus which I should be getting this week.. no idea how much (I understand This is good for a new grad) I get 20 days PTO a year. I only used 15 this year since I started 2 months into the year and didnt want to look bad CME he said is covered originally but he may have forgotten... I feel awkward bringing it up.. CMEs are due next year for me Malpractice and Health insurance covered no 401k reasons I think a raise is appropriate: - Doesnt everyone get a raise every year? most obviously in hospitals - I really work like 3 hours a week overtime each week without compensation (since my paycheck is the same for 40 hours/wk every time) - job offers no 401k or match and as someone whose saving for retirement, I feel like thats a huge financial asset im missing out on - I RUN his office, out of a 50 patient day. I see typically 15-20 patients in 8 hours which I know valuable to him. (but then again maybe thats why im getting paid what I am). the set up is me, the surgeon who may see 10 patients , and a physiatrist who typically does EMGs half the day and sees like 10-12 patients. - I know for a fact that I am upselling EMGS/imaging/physical therapy (all part of the practice) reasons im hesitant to ask for a raise: - I appreciate his patience with me in the OR.. I dont feel confident with surgery yet. even simple things like closing im poor at because I dont get enough exposure or volume since il only get an opportunity to assist once a week. and he always reminds me sternly how I have long ways to go. I would feel awkward asking for a raise in these circumstances - he's already paying me what I consider a lot. - business is slow and its a known fact around the office.. unless this is just a tactic he uses to make everyone feel guilty about asking for a raise.. haha - ive heard that a previous pa before me asked for a raise and his response was that "the experience to first assist him is more valuable than a raise" thank you!
  4. Been Working in ortho spine surgery for the past 4 months. we also do knees and shoulders.. the issue is.. volume of surgeries is low. we do about 2 knees a month, 2 shoulders a month, and 2-4 spines a month (including lumbar , cervical anterior/posteriors so theres really no muscle/mind memory from acute repetition happening I was thrown into the OR with no experience and believed I would just naturally pick things up.. with volume so low, i've only done about 8 knees, 8 shoulders, and 8 spines. My surgeon definitely verbalizes the set up to me each time, but in a very big hurry. and theres always equipment missing/malfunctions so it doesnt help the fact that im trying to learn a step by step set up. Hes told me the past two-three cases that I really need to get the set up/draping down.. and its starting to make me feel inadequate Im frustrated because in the moment of setting up/draping, im so focused on not messing up, that I dont really get to internalize what im doing. and by the time ive set things up after being mildly humiliated, im then focused on the surgery so the set up/draping memory goes out the window.. and Its not like I can write down what I just did because by that time im already scrubbed in. I did a knee today.. the next time I do a knee probably wont be for another 2 weeks.. I checked on youtube, I cant find good videos that break down the set up and draping in terms of the way that we specifically do it... I cant tell if I'm all the sudden super slow minded, or its just almost impossible to grasp under these circumstances... any advice appreciated, Thank you
  5. This pretty much explains my situation I also have patients on ambien from an ORTHO office... Whats your go to method of weaning off ambient assuming starting from 10mg ohs with monthly visits
  6. Follow up Q: if I am actively weaning down opioids, even if its just 2 out of 90 pills less per month at a time, thats still considered progress right? I know that the Gradual dose reduction guidelines sort of say for a 10-20% reduction PER WEEK which I find very unrealistic for a patient thats been on opioids for years and doesnt want to give them up note: this is for a patient who I believe is on a high proportion of meds compared to their pathological findings/physical/personality/history
  7. Sort of a follow up post.. I just wanted some assurance or any criticism to my current job role. I am swimming so far and so far so good.. but who knows I was hired out of school (3 months now) at a spine & ortho practice under the guise that "theres a small amount of post surgery patients on chronic pain management" however its more like 90% of the patients. Most patients are on around 90-120mg Morphine equivalent dosing a day. and they are all previous surgery cases. These are patients that have been on opioid therapy under the orthopedic surgeon for 2-10 years Before I started working: antineuropathics like lyrics and cymbalta have not been utilized. there has been no urine testing in 2-3 years. some patients charts are pretty much the same from month after month (besides getting updated imaging/EMGS) I am now implementing Gradual dose reduction with attempts to switch patients from oxycodone/vicadin instant releases over to Tramadol, or MS Contin, Nucynta, Adding lyrics/uptitrating gabapentin from previous doses of 800mg/day towards 1600mg/day. adding pain creams, switching to NSAIDS with famatodine for GI protection, discontinuing benzodiazepines and adding nonbenzo anxiety meds if the situation calls for it. Hell, I'm even recommending turmeric/curcumin to some of my arthritis patients because of good study results ive read a good amount of the patients that are on high doses (120mg/day) resist my reduction attempts to 90mg a day, and with them, I only lower them by 2 pills/month so I can at least show something. I am now also getting urine tests on a good amount of patients with 50% pain med reduction if positive results (with solid documentation of a marked and final warning before discharge) I see about 10-20 patients in an 8 hour period. Its not stressful. What is stressful is the lack of guidance from my surgeon. He really focuses on the surgery and doesnt really educate me or have any advice on the pain management... There is another PMR MD alongside me however he isnt too knowledgable, and basically mirrors whatever the surgeon does. A question of mine is also: I am working under a ortho surgeon but I am fulfilling more of a pain management role as a PA. is this allowed? I know pain management is considered its own field
  8. Sorry if this post does not fit the this forum, feel free to remove if so. I am working in an orthopedic office and we have a large amount of patients on opioids that ive been successfully and actively weening down. Ive also included starts/increases in gabapentin/lyrica and which has allowed me to ween some patients off the opioids further. My question is: I understand that cymbalta is approved for neuropathic pain and I know that amitryptaline also shows good results.. My only concern is having a patient (which most likely has addictive perosnality) start one of these antidepressants while on oxycodone with risks of further synergistic CNS effects. Would I be opening up a further can of worms by trying to incorporate these medications into my practice? Thank you
  9. arent all practices interested in money though? I will be having a discussion with the surgeon this week very bluntly with the ultimatum
  10. New grad-ish in NY Working for an ortho spine practice.. was hired under the original pretense that it would be 20% patients on opioids, however its really like 80%... a fair amount of self pays which make me feel uneasy. the rest are workers comp, no fault and private insured. Most patients get a little less than 100 morphine Meq/day however there are patients on about 120 meq/day and a few over such amount... I am trying to switch most patients from oxycodone/percs to things like nucynta and tramadol. we also dont do prior authorizations in the office so I cant prescribe abuse deterrent opioids like xtampsia. Ive brought it up to the surgeon before that I would like to drug test and he politely sort of brushed it off.. like, "oh yea, ok most of these guys are fine and have been coming for years. I know them well.. let me know before you do any of that type of stuff ok?" Its a tough situation because obviously he doesnt want to lose the business of these self pay patients, especially. so I see his motive to keep them/ and lack of strictness with testing them.. but its my license involved and I want to practice defensively I am actively trying to reduce meds.. even if I can reduce a patient from 90 pills to 85 In a visit I feel good. I am always checking the state ISTOP PMP. and am always dictating that "patient takes medication to maintain functionality". we always get updated MRIS/EMGs to "justify" the pain management however I dont know if I should be scared or not. there are a few patients that look like ticking liability time bombs and I just pass those patients over to the surgeon and remain nothing to do with them.. I do like my job otherwise Any advice?
  11. relative New grad on Long Island New York Looking to supplement my 40hr wk full time ortho job with a once a week/per diem thing. a fam med/urgent care gave me an offer for Saturday hours. They seemed super impressed/desperate to get me working. Saturdays are hard for them to get someone for, and it makes sense.. its Saturday.. weathers getting warmer and spring is in the air.. Should I ask for more? Saturday PA 9am-2pm. they said to expect 16-20pts from 9-1 and then one hour to catch up on documentation they asked me how much Id like and since I make 65/hr at my current job, I went with that. they accepted. But after taxes and the 20 min drive each way, and the fact that its on a Saturday.. doesnt seem like its really lucrative. They would have to pay for my malpractice which is ~$4,300/yr so I understand they're not exactly getting the most bang for their buck if I only work 5 hours a week. Just trying to figure out how the whole per diem thing works. Thanks in advance!
  12. So Im a new grad and left a ridiculous urgent care job because of crazy high patient load and not really learning anything... listened to all your advice and went on a few interviews.. I was enticed at this orthopedic + spine interview that entailed 2 days OR+ 3 days office/wk ~20 pts a day/8hr shift (an hour lunch break factored in) and thought it over for a week and decided to take it;. I liked the offer 125k 40hr/wk 20 day pto, full benefits and occurance/tail end malpractice coverage, 10 min drive from home. I also verbalized my concerns of not wanting to work in a high liability arena as a new grad and he said he understood. During the interview, . The surgeon (employer) told me that only 20% of the patients are on opioids and that they have been cutting down on this number over the years, they dont take new pain management cases, and they actively try to ween them off meds. He also assured me that this would be a more "sophisticated" experience that would give me a backbone into a specialty Today on my first day of work, Ive noticed that maybe 50-60% of the patients were on some sort of opioid, granted it seemed like a low dose PRN, and its been the same drug for years, and the patients so far have seemed like educated middle class backgrounds but obviously I know this profiling can only go so far. The PMR doc who works in the practice is super laid back and honest told me that this practice used to have a HUGE problem with opioids 5-6 years ago but since he was added to the practice, and with the help of the last PA, they now have it under control confidently. he also says that 50% of pts on opioids is a more realistic # than 20%. He also chuckled that the doctor sort of just threw me into see a few patients to see how I swam today and hasn't really taught me the first thing of opioids yet. The PMR doc said that I would not be at a liability risk and he wouldn't have stayed himself for 6 years if he felt there was one. the previous PA was also there for 4 years which I know for a fact (my friend knows this pa currently) At the end of my shift I told the surgeon again that I would need to be trained on opioids as I know nothing and he said it would happen The surgeon today was incredibly busy going from one patient to another then dictating charts. we saw one-two interesting pre op cases, a few postop checks, but the rest were basically all refills. he seemed to be more focused on getting me introduced to the groove of the patient schedule rather than the medical care portion of the job. I Know its only the first day.. but I dont want to end up working in a PMR practice as a new grad when I had these ideas in my head that it would be a purely orthopedic surgery practice.... unless this is just how the game works Any thoughts would be appreciated... I like the idea of specializing in ortho. I dont want people to read this and think im just job chasing for salary.. although it a nice benefit
  13. Right. I realized this after I did some research.. I plan to max out my Roth IRA.. and set up my own 401k. any thing else you would recommend I look into?
  14. I said 130k for 4 12s. wasn't tryna deceive anyone ahhh
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