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surgblumm

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surgblumm last won the day on October 15 2018

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About surgblumm

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  1. For those that have their C&P completed by a PA or DNP, in which states did this occur? For the PA-S from the Army who had a five minute exam, you were cheated. If we do this type of sloppy work we will never be appreciated as HCP. We have an obligation to do the same type of exam that you performed in school only now with experience and more knowledge.
  2. Thanks Army PA. We know in part and understand in part. the purpose of this forum is to fill in the gaps of that which is unknown. your comments were and education to me and I don't know how many states have this program. Fortunately on my review from a VA provider , I went from 60% to 90% but this is not like winning a lottery as this means you have a serious disability which will shorten your life expectancy. Thanks for the information. Bob
  3. Loved the comments about the "Entitled Patient." I just retired from a Plastic Surgery Practice that focused mainly on Cosmetic reconstructions. I know all about entitled patients as they were the cause of many of my interventions with both physicians and nurses at my hospital. Good riddance to them.
  4. The AOS recommends a book on Muscular Skeletal Exams and Office Orthopedics.
  5. I am on 90% Combat Related Disability and had to have a re-examination at five years by a VA Physician who was familiar with all of the necessary paperwork as well as exams. People on the receiving end of this process are very engaged as they are rightfully due compensation and yet any poor exam or paperwork can start another three year wait. To my knowledge, only VA Docs are doing this. I have examined troops returning from the Middle East Combat Theater, as this is a mandatory requirement by order of Congress, within three month of return to CONUS. I engaged in this every other weekend for three years as they needed advocates.
  6. The Next Step in your Career Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus A multitude of PAs and NPs are on professional social media sites requesting information on how they can apprehend that first job. In contrast, I see very few requests relating to how to disengage from a current job, with the exception of those who thought that they were being victimized or underpaid. As a senior resource for PAs and NPs, I am often contacted with privileged information that many cannot openly discuss on the public forums. I thought that, as a service to you, I would undertake discussion of this type of problem with some reasonable suggestions. Working as a PA or an NP can be akin to being a co-pilot: when you lack confidence in the pilot, their decision-making process, their inconsistent results or their visual limitations. When you begin to doubt the integrity of those that stand across the table in the OR, when the pilot has problems with truth and reality. When, as my plastic surgeon associate of 46 years asserted, “When it stops being fun, Bobby… it’s time to quit.” Perhaps it is useful to remember that a fighter jet has an ejection system that is fast to react at the touch of a finger. What can happen if you fail to recognize that the future is looking bleak and that the aircraft will not land safely? What will happen to the two hundred souls on the aircraft or the one patient who has placed their confidence and truth in you and your profession? What if you fail to recognize the signs and then fail to hit the ejection switch or hit it too late? The answer is imminent disaster for you personally and for the patient with whom you share a sacred trust. Their assurance is your integrity. The choice we must make to eject into the unknown skies with strong winds is small when compared to being involved in a tragic medical error. If the aforementioned conditions exist, you are on an unsure journey that could possibly end in disaster. Our very foundation is built on the iconic pledge “Do no harm.” The risks in patient care are great. The risks of practicing medicine and nursing and caring for patients is greater if you do not have a personal liability insurance policy. Why even mention this in an article that calls for a decision to eject? Because many clinicians are unaware of their liability. They are unaware of the fact that the aircraft or the practice has ceased to be safe. They have failed to do a “walk around” and to do an intensive search of their practice situation. They have slowly been desensitized to the inadequacies of their contractual relationships with supervising or collaborative physicians. There are also those who feel a sense of obligation because they have been in a practice for a lengthy time and leaving would feel like a betrayal. These emotions spell an imminent disaster. Having thirty thousand miles in your aircraft or thirty years in practice can make you a conformist. Now is the time to be adequately insured and represented and your lifeline can be a call to CM&F and the purchase of A++Best Superior rated policy. This decision is as important as your decision to eject from your practice as it gives you the freedom to think clearly.
  7. The Next Step in your Career Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus A multitude of PAs and NPs are on professional social media sites requesting information on how they can apprehend that first job. In contrast, I see very few requests relating to how to disengage from a current job, with the exception of those who thought that they were being victimized or underpaid. As a senior resource for PAs and NPs, I am often contacted with privileged information that many cannot openly discuss on the public forums. I thought that, as a service to you, I would undertake discussion of this type of problem with some reasonable suggestions. Working as a PA or an NP can be akin to being a co-pilot: when you lack confidence in the pilot, their decision-making process, their inconsistent results or their visual limitations. When you begin to doubt the integrity of those that stand across the table in the OR, when the pilot has problems with truth and reality. When, as my plastic surgeon associate of 46 years asserted, “When it stops being fun, Bobby… it’s time to quit.” Perhaps it is useful to remember that a fighter jet has an ejection system that is fast to react at the touch of a finger. What can happen if you fail to recognize that the future is looking bleak and that the aircraft will not land safely? What will happen to the two hundred souls on the aircraft or the one patient who has placed their confidence and truth in you and your profession? What if you fail to recognize the signs and then fail to hit the ejection switch or hit it too late? The answer is imminent disaster for you personally and for the patient with whom you share a sacred trust. Their assurance is your integrity. The choice we must make to eject into the unknown skies with strong winds is small when compared to being involved in a tragic medical error. If the aforementioned conditions exist, you are on an unsure journey that could possibly end in disaster. Our very foundation is built on the iconic pledge “Do no harm.” The risks in patient care are great. The risks of practicing medicine and nursing and caring for patients is greater if you do not have a personal liability insurance policy. Why even mention this in an article that calls for a decision to eject? Because many clinicians are unaware of their liability. They are unaware of the fact that the aircraft or the practice has ceased to be safe. They have failed to do a “walk around” and to do an intensive search of their practice situation. They have slowly been desensitized to the inadequacies of their contractual relationships with supervising or collaborative physicians. There are also those who feel a sense of obligation because they have been in a practice for a lengthy time and leaving would feel like a betrayal. These emotions spell an imminent disaster. Having thirty thousand miles in your aircraft or thirty years in practice can make you a conformist. Now is the time to be adequately insured and represented and your lifeline can be a call to CM&F and the purchase of A++Best Superior rated policy. This decision is as important as your decision to eject from your practice as it gives you the freedom to think clearly.
  8. " Tis far better to SHOW what you know than to SAY what you know, and equally important to say, rather than show, what you don't know"
  9. I have come upon less than a handful of Opthamological PAs in my entire career. I believe that Paul Lombardo worked for a year in Opthamology before going into academia. As has been brought up, only so many people can crowd around and eyeball. As a first assistant all you can really do is retract and cut suture. There may be courses but I do not know if there is certification in refraction. You could do eye emergencies but you would always be working closely with a Doc if the injury was sufficient to require surgery. Maybe someone wants to be a trailblazer.
  10. The Next Step in your Career Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus A multitude of PAs and NPs are on professional social media sites requesting information on how they can apprehend that first job. In contrast, I see very few requests relating to how to disengage from a current job, with the exception of those who thought that they were being victimized or underpaid. As a senior resource for PAs and NPs, I am often contacted with privileged information that many cannot openly discuss on the public forums. I thought that, as a service to you, I would undertake discussion of this type of problem with some reasonable suggestions. Working as a PA or an NP can be akin to being a co-pilot: when you lack confidence in the pilot, their decision-making process, their inconsistent results or their visual limitations. When you begin to doubt the integrity of those that stand across the table in the OR, when the pilot has problems with truth and reality. When, as my plastic surgeon associate of 46 years asserted, “When it stops being fun, Bobby… it’s time to quit.” Perhaps it is useful to remember that a fighter jet has an ejection system that is fast to react at the touch of a finger. What can happen if you fail to recognize that the future is looking bleak and that the aircraft will not land safely? What will happen to the two hundred souls on the aircraft or the one patient who has placed their confidence and truth in you and your profession? What if you fail to recognize the signs and then fail to hit the ejection switch or hit it too late? The answer is imminent disaster for you personally and for the patient with whom you share a sacred trust. Their assurance is your integrity. The choice we must make to eject into the unknown skies with strong winds is small when compared to being involved in a tragic medical error. If the aforementioned conditions exist, you are on an unsure journey that could possibly end in disaster. Our very foundation is built on the iconic pledge “Do no harm.” The risks in patient care are great. The risks of practicing medicine and nursing and caring for patients is greater if you do not have a personal liability insurance policy. Why even mention this in an article that calls for a decision to eject? Because many clinicians are unaware of their liability. They are unaware of the fact that the aircraft or the practice has ceased to be safe. They have failed to do a “walk around” and to do an intensive search of their practice situation. They have slowly been desensitized to the inadequacies of their contractual relationships with supervising or collaborative physicians. There are also those who feel a sense of obligation because they have been in a practice for a lengthy time and leaving would feel like a betrayal. These emotions spell an imminent disaster. Having thirty thousand miles in your aircraft or thirty years in practice can make you a conformist. Now is the time to be adequately insured and represented and your lifeline can be a call to CM&F and the purchase of A++Best Superior rated policy. This decision is as important as your decision to eject from your practice as it gives you the freedom to think clearly.
  11. The obnoxious patient that is offering you the opportunity to diagnose a disease although you are not a doctor. Their feelings of superiority are sometimes overwhelming and their smirk and response to your questions and then your diagnosis demonstrates that they were smart enough to rulke out the other causes that you have mentioned and then ask to speak to the real doctor. Its been a long time since I have personally experienced this but yet it is memorable.
  12. One of the greatest incentives for being a PA is that you have the opportunity to make many of these choices and without experience. If the employer desires to teach as you go the opportunities will be immense because of your formal PA training. Derm is a great specialty for three reasons; 1-Little call 2- You have the option to choose a medical derm practice and learn a tremendous amount of new medicine 3- You can choose cosmetic Derm and gibe Botox and fillers but you need to ask yourself this important question; "why did I both to learn all of these specialties only to use my knowledge for cosmetics?" A combination of both is ideal and in a rural practice you will get far less cosmetic work but will learn every rash in the book. Like ron, I feel there is plenty of time to move to the city and if you start rural you will have the necessary experience to work in a metropolitan area with some of its increased demand.
  13. Your critical access ER sounds more like a level 11 trauma center. That is not Urgent Care which in NY is minor medical problems, rashes, fractures and sprains, laceration, cardiac problems which are bused out to the ED.
  14. I agree in terms of volume but it is an unusual day to get a very esoteric case and there is no major trauma. When I formally work in the ER in the late evening I hated a trauma case at 10 PM because it took me two hours after getting home to think about the outcome for the patient.
  15. If your main area of concentration is a family life and you desire to use your EM experience, you can try Urgent Care. You have enougfh experience at eighteen months in an ER to do Urgent Care and you will get more experience in medicine. Urgent care is for those that NEED TO HAVE A SLOWER PACE, FOR PAs who are at your level of experience and for those who are preparing for retirement. Rural EF experience is definitley out of the question without five years of solid ER and Cardiac and Trauma experience.
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