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  1. I have read, and read, and read every single post on PAF on telehealth, telemedicine, and I still cannot get a straight answer. I find it mindboggling that there just is no consensus on this. I just need a direct, clear answer: Is telemedicine a viable, safe career option, or is it the direct path to mal practice and loss of license? For reference, I am talking mainly about de-novo, "new patient" telemedicine (like urgent care), not after-hours virtual care for your own established patients who you know personally, although I am curious about how it applies to both. Sorry for the curt-ness of this post. Frustrated by the lack of clear guidance.
  2. Something to think about! Let me see how it all plays out once the current craziness is over...
  3. To add to the advice above...keep in mind that PA school is overwhelming by design. Every student feels totally overwhelmed and like they are definitely failing at least some of the time. It's by design... inundate you with too much information in the hope you remember a small percentage of it. It will be totally different during clinical year, and astronomically different when you're working. Unless you're one of those geniuses with photographic memory, once you are out working for a few years, you will have forgotten 85% of what you learned, except for the particular field you are in, which you will know better than you can imagine. That's why PANRE exists (for now)...trust me, you'll be shocked at how little you remember in 10 years. It's just the nature of medicine. Whittle down the essential information you need to know for tests, focus on that, take the test, and then move on. Didactic year is designed to give you the basic tidbits you need to know as a provider, and in order to pass PANCE. After your brain has been put through the washing machine of PA School, if you retain just the most crucial tidbits and concept associations, then thumbs up. You will be learning and relearning and relearning and relearning and relearning and relearning every day of your career. As long as you are passing tests, don't sweat it.
  4. Interesting, I'll have to take a look at that. I was looking more for something oriented towards office-based internal medicine...you know, the nuts and bolts of hypertension management, diabetes management, GI complaint workup, sort of typical "internist" daily patient stuff. But perhaps there is some crossover with the hospitalist stuff.
  5. Hey all, sorry to distract from the current raging topics of Covid and NP/FPAR, but wondering: Think of transitioning from UC/EM soon (after this mess cools off) to something a little calmer and more relationship-oriented. Considering IM/FP (as well as psych, occ med, pain med or hospitalist, or practically anything less stressful and factorylike). Wondering if anyone can recommend multimedia or written resources that might be good for a quick brush-up, something akin to a boot camp, for outpatient internal medicine/family practice. Reading Harrison's or CMDT cover to cover seems like an inefficient approach. (While we're at it, any resources for Psych and Hospitalist?) Thanks all.
  6. I get that Telemed is a crappy option...but as everyone points out, it's here, big time. That being said, an exhaustive search on this forum did not find a definitive discussion thread for the following questions, wondering what y'all think. (1) Being that telemed is a reality, especially now during this mess, what are the legal pitfalls? Are providers, at some point, going to sued en masse due to lack of physical exams? Like, do we (or the AAPA) have an official stance as to whether PAs should truly be engaging in telemed? All I could find on this forum are a wide range of opinions, but no hard guidance or personal employment experiences... (2) I notice a lot of "cold" telemed jobs online that are willing to take PAs...these seem to be mostly "prescribing" jobs (evaluate patient for men's health supplements, OCPs, ED meds , etc etc)...are these all too risky to work at? (3) Does anyone here actually work telmed primarily, and what are the medico-legal guidelines your employer gives you? Are you pressured to do things like rx ABX without physical exam, or are you given the latitude to say "I'm not comfortable prescribing this over the phone without listening to your lungs" etc?
  7. Thanks for the replies. My thoughts: I can't imagine this is always the case. For one, if you are literally typing into the doctor's note (via screen sharing), not logged in on your own account, it's just as if the doctor typed and erased something. I wouldn't think EMRs save every iteration and version of a particular note...Every deleted letter, word, rearranging, spelling correction, etc...that would be dozens or even hundreds of pages for a single encounter. I hear that (especially the overthinking part!) but I don't know that that's the case. Let's say the medic is obviously inebriated, or is completely getting something so wrong that any BLS provider would notice...I would think not stepping in would be failure to act or even negligence of some variety. Seriously doubt it, as it is likely an independent contractor position, and it would have to be PA-level coverage to be effective in the sort of situation we are talking about anyway, no? Scribes, to my knowledge, don't get anything beyond what any clerical worker would get...but not what clinical staff get. I believe the nurse AND the institution are both sued in those cases. This seems to be supported by a quick search online. As well, I recall hearing that in many suits, especially private practice, practically everyone gets named, from RN to MA to receptionist to janitor. I'd fear that in a scribe situation, especially if it's independent contractor, the entire malpractice burden is passed right along to the individuals involved, as there is no hospital.
  8. For various reasons, looking for medical work from home. Only job I've found available is remote medical scribing. Wondering about medical malpractice risks. On the one hand, many sources (including insurance companies) say non-physician providers CAN scribe, as long as they include a disclaimer such as "Mr/Ms ____, acting as scribe for Dr _______". Of course, though, the doctor/provider can erase that line in three seconds if they wish, once they finalize their chart, leaving no record of this required disclaimer. Furthermore, even though nurses are just following doctor's orders, it seems they could be subject to malpractice if they did not oppose an order they thought might be harmful and challenge the provider. I can only wonder if this same caveat would apply to a PA acting as a scribe who scribes something they believe might be incorrect/harmful...does having professional licensure prevent one from "downgrading" their cognitive involvement beyond simply typing someone else's words, because they should "know better" from a practice standpoint?
  9. Hey all. I'm professionally lost, and trying to find an experienced career counselor to help guide me towards something new in Medicine or a related field. I have tried two so far, one of whom could only offer a few vague ideas and some resume building (but no direction), and the other who wanted me to make lists of my fantasy jobs (but offer no direction). Trying to find someone competent who knows the medical field and knows PAs, and who can take a good inventory of skills and offer some unique direction. If anyone has experience with one, please let me know! Thanks
  10. My experience in an inner-city hospital was absolutely horrendous. Toxic people, toxic managers, toxic work environment. I believe that is the rule, not the exception, in NYC. If you mean a city owned hospital, in my experience, they are bastions of terrible providers and massive incompetence, and more toxicity.
  11. Again, Thanks all for the responses. Read all of them, I appreciate the encouragement and validation. Residency is pretty much out of the question... Too few and far between (I'm geographically fixed), and I've been rejected in the past for EM... They very admittedly wanted fresh meat, super young and bounding with energy, and right out of school..and I'm none of the above. In any case, not interested anymore in the residency specialties...EM, surgery, etc. It's nice to hear volume of these places are demanding are ridiculous... It's crazy because in the New York City area, 50-60 patients a 12-hour shift is becoming standard. Standard. Interventional sounds interesting but honestly I'm not so comfortable with all the radiation exposure. In the meantime trying to find something in a concierge primary care or perhaps something unusual, like working in a rehab facility or such... Honesty really lost and directionless, but looking. But certainly keep the comments coming, I am reading all of them even if I can't respond to each individually. Thank you all.
  12. Thanks all for the responses. Read all of them, I appreciate the encouragement and validation. Got to figure out what's next for me...
  13. Sorry all for what might be a rant. Just trying to figure out if my career in medicine is just a failed fantasy. Unfortunately, my school clinicals were pretty crappy and disorganized, from the top down, due to a combination of factors...didn't learn a whole lot about the business of medicine. After graduating and spending a long while in an inane diagnostics specialty (an MA could do my job), I made the jump to emergency medicine. Worked in a busy, transitioning inner-city ER, and It was a complete, utter shit-show. Horrible leadership, no mentoring, no help for the other PAs, overall toxic ER. After a while, I was asked to leave because I just wasn't "catching on"...like, yeah, of course I wasn't, as somehow 4 weeks during school wasn't enough to fully engrave the entirety of emergency care to into my brain. But I digress. But the abuse was...exceptional, and the trauma remains. I had a brief good run early in Urgent Care, with a very supportive doc, and a moderately paced practice that had, max, 3 patients per hour on a busy day...4 per hour only on an insane full-moon, exceptionally rare occasion. Unfortunately, the place downsized one location, and I was the last in, so first out. Since then, I have been struggling. The PTSD from my time in the ER has never faded, and has bled through into my work. My last job was a monster of a corporate behemoth, with about 30-40 demanding, wealthy, multiply-comorbid, talkative, "oh yeah I forgot to mention this chronic problem" patients per 12 hour shift, with a consistent 3-4 patient per hour load for those 12 hours, with back-to-back 12 hour breakless, lunch-less, bathroomless shifts....and a whole cast of backstabbing, lie-to-your-face, cold-hearted ER docs staffing the place. It did not go well, and I was unceremoniously thrown out the door after a few months for failure to adapt to the kiss-ass environment, while solving all of the patient's problems and managing all their comorbidities and referring them out to all our associated providers, every shift, all by myself, within a sufficient time...and failure to avoid asking the supervising docs an occasional question on a complex patient. They made clear I was there to sink or swim, not learn, and that I was excess weight they were glad to be rid of. Now...I feel like a failure. I failed to hack the ER. So many PAs can manage it seamlessly..yet I was an utter failure at emergency medicine. And Urgent care? my peers are like "sure, 6 patients an hour for 12 hours is a breeze, why can't you get your shit together and handle 4? As I've long passed my high-speed teens, and after the abuse in the ER, I've slowed. I want to help the patients, form a bond, address their needs, and not have to shove them out the door because they are slowing me down. I have decision anxiety, comorbidity anxiety, time anxiety...all borne of an unguided, mentorless career. I hate the rush of 10 minutes to see a patient, discuss their (usually) complex situation with my sup, make a plan, answer their myriad questions and "oh also"s, push them out the door, and fully document and lock that chart...and do so, hour after hour after hour. This is not why I got into medicine. Yet I am aware that ALL my peers in Urgent Care and the ER are seeing 4 patients per hour with ease, juggling 8 rooms or beds at a time, and have the equivalent of pure cocaine running though their veins and adderall coursing through their brain...perfect recall, no questions, all knowledge, pure confidence, and endless energy. I feel like an utter failure for feeling like, "heck, why can't I just see 2-3 patients per hour and actually practice humanistic medicine." I feel like a failure at Urgent Care, at Emergency medicine, and a failure as PA...as this is the business we are in, and I just can't hack it at the speeds necessary to stay hired. I'm not a dumb guy, and when I am given plenty of time, I am an excellent diagnostician and planner, technically adept, and am great with the patients on a personal level...but this is not medicine anymore. No one wants to hire someone to see patients at 2-3 an hour. I feel like....maybe it's time to apply to Home Depot, or get my CDL truck driving license...somewhere with few decisions, somewhere I can excel, and not have to live with the way medicine is today. Sorry for the rant. Thanks for listening.
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