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Everything posted by surgblumm

  1. 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. I don't think that any novice PA can do ER seamlessly. There is so much to learn and so many experiences to participate in. It looks like there are many of your colleagues rooting for you. Do an EM residency. Think about that suggestion relating to your PTSD and move forwasd. You can do it!
  2. Often Imitated…Never Duplicated Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus & PA Ambassador for CM&F Group, Inc. Almost twenty years ago, a small group of PA leaders addressed the issue that many clinical positions claimed to fulfill the same professional role as a PA. Determined to bring attention to PAs’ uniqueness, we designed a slogan that we wore on our lab coats: Often Imitated…Never Duplicated. That expression sums up who we are – with pride. We are so much more than an organization or a profession - we are an ever-evolving mission - in constant metamorphosis, delivering cutting-edge medical care. John F Kennedy said, “Change is the law of life. And those who look only to the past or present are certain to miss the future.” Because things are the way they are, things will not stay the way they are. This is why we are a profession of leaders. Not all of us hold a national or state position, but we can and must continue to affect positive change. We are faced with many choices that influence how we are perceived and how we can distinguish ourselves from other providers. At this point in our evolution, our focus remains an absolute Commitment To Excellence. The only limits are, as always, those of vision. I remember sitting down with Jeremy, a PA Program Director at Lynchburg University. We were waiting for a PAFT Board Meeting to begin. As fellow board members, we spoke casually and he mentioned a vision he had of starting a Doctoral Program at Lynchburg. Jeremy took that vision and dream, and made it into a reality. Sometimes I am asked - Why do you support that company or course or program? Support is much more than an endorsement. It is an affirmation of quality whether for a specific program, course or degree. Simply, support is a component of excellence. Fifty years ago, we would have never thought that a PA might need a doctorate degree, as one is not needed to practice. But advanced degrees denote a striving for excellence, as well as parity with other professions. We are no longer an emerging profession, we are an evolving profession. And central to that evolution is the recognition of professional excellence in its many guises. There are certain programs which I recommend to all those in specialty areas or in primary care. Among those is a pharmaceutical course which is two days in length every two years. No, it is not mandatory - but Yes, it will help us to better understand the newest medications and rationale for prescribing them. It will alert us to interactions and cross sensitivities as well as black box warnings. Many of our specialties involve the art of suturing. I support advanced suture workshops which teach twelve or more techniques and address the “when and why” we use a technique or a certain type of suture. I’ve hosted many such workshops for industry, PAs, and NPs for more than twenty years, and I have many talented peers who do the same. Suturing is an art - like preparing a good steak: there are many ways of doing it. Last month, I advocated for an ultrasound course. I had no personal ties to it, but after reading the content, I felt that it was necessary in our practices. Mastery of reading an ultrasound can mean the difference between life and death in trauma situations as well as in diagnosing a plethora of medical and surgical emergencies. Learning echocardiograms and EKGs is essential for both primary care and cardiology PAs. Look for a nationally certified course and become an expert. Splinting and casting are essential skills. Every PA should go beyond PA school training and learn the pitfalls and techniques to prevent catastrophes such as compartment syndrome. A surgical PA or a critical care PA must be prepared to read CT scans and MRIs. We should not need a physician to interpret these studies. We have the same capacity and obligation for excellence. And we are now in the age of the critical care specialist. PAs shine in this arena and are sought after in hospitals and have proven to be a valuable asset to all physicians but most importantly, to patients. Another important area of concern, which has been a personal passion of mine for many decades, is the vital issue of malpractice protection which enables PAs to practice with assurance and peace of mind. I recommend CM&F who has supported the PA profession for decades and is endorsed by AAPA. Their product has the features and benefits which PAs need most, at very competitive rates and is underwritten by a top (A++ ) rated carrier. So, what are your feelings on this topic? Our lives, both personal and professional often leave us with little time to reflect, evaluate and engage in honest self-criticism; but we must - in order to maintain our focus on Excellence! You are a PA-C: Often Imitated… Never Duplicated.
  3. I sit in the same boat as Lightspeed and Cideous on this issue. Nursing is savvy enough to spend time on having abstract classes where these issues are discussed and their culture is one of change. It's not just NPs but BSN's like my son, who know their value and will not settle for less. sure, there are those that work like animals and are abused by administration and physicians but today, with unions and education and an empowerment that only comes from self-woerth, they are changing and they are demanding more. And they are getting more. PAs need to stop looking and complaining and become action oriented. Wherever PAs are involved, in numbers, they need to both gather for discussions and go out on a limb and make the same educated demands of other professions. People allow themselves to be abused and settle for it , just ask unhappy married couples. We need an awakening as our talents and knowledge and our care of patients is generally excellent and our expectations should reflect these things.
  4. This too, is part but not all of the problem. The urgency to maintain bottom line salaries has produced lousy physicians, NPs and PAs. Administration is to blame and is responsible for our falling numbers in health care as a nation.
  5. Let's hope that the OTP can achieve this as I think your projection is within a reality figure and I too have seen BSN Nurses on critical care areas getting 85.00 an hour in NYC.
  6. Place some aluminum foil on your sidewalk or brick and spray some Pam and you can have an entire breakfast.
  7. I did it the O'Neill way" If you want to be the best kind of PA, I do highly recommend my path of military practice and then doing a residency in a field of your choice. But I'm biased " and I feel exactly the same as he is describing. Military service is one of the greatest direct care entrances into advanced practice medical care and the resources and experiences are priceless. Longevity in the military only makes your practice experiences multiply and there are always additional schools to train you new skills. It is one hell of an eadventure and simultaneously you are serving your country, preserving the fighting strength and usually have a disability check as well as some outstanding VA care in certain states and facilities.
  8. Not unlike Scott, I echo his praises of the article in general and its lack of bias. This is a true snapshot and should be read by every potential healthcare provider. Yes, it is a keeper!
  9. I encouraged my brother-in-law to join the Air Force as a pilot after his college graduation. He had already been a pilot of small aircraft. He made it through flying school and had a choice of what type of aircraft he would fly and for what division, SAC, MAC or TAC. I told him to choose MAC although it would not be as exciting as the other two. He put in thousands of hours, flew troops and supplies into the Mideast and even co-piloted Air Force 2. Upon leaving the military after seven short years be became a Delta co-pilot. After ten years in the right seat he moved to the left seat as a Delta Pilot and flew internationally.He made great money and had a great pension as a pilot and started buying real estate in Charleston, SC. After owning thirty houses that became huge rental properties and gentrifying Charleston neighborhoods he started a small firm. We were talking last night as he visited me for five days and plans on being one of those 2022 passengers on a flight to the moon or wherever. Yes, it will cost him a quarter of a million but investing in real estate easily made his dreams reality.d
  10. We've heard all of the positive and that great photo by Scott now for a little negativity. What does a Tsunami do to that photo of paradise and it's Melanoma crop?
  11. That was the first issue that came to my mind, Tom. I guess we pay the price to win the prize. Being retired, the only avenues for me to utilize my skills are in education, public speaking, workshops and medical writing. I l know it's hard for you to put down the stethescope but a tombstone that says you were a great PA is not equal to enjoying five-ten years of relaxing and enjoying the family.
  12. I think that its time to say goodbye. Not just to the leadership role but to the facility as it sounds like it stinks. The reason I stayed a PA so long was because I enjoyed it, felt fulfilled and was appreciated most of the time. Don't burnout----get out!
  13. Perfect Response, Reality Check. There is and never will be a magic bullet but will require intrepid effort and commitment.
  14. The CEO is a managerial/leadership/corporate role. The CEO is a steward of the business side of the organization and the permanent paid staff. It is management. While they would certainly have a voice in policy at the end of the day they carry the board's water. These words were penned by Scott and make absolute sense. There is an enormous amount of money that flows through the AAPA and there are at least a hundred paid employees of this organization. Scott has called it a non profit whereas looking at the programs, the CME, the videos and little trinkets for sale, I wonder. But any large association needs a person with history that is documented and successful management experience and the ability to acquiesce to the BOD and to be a listener to the membership and to draw attention to the complaints with the BOD. I remember that before Dorn there was backroom talk of a PA, someone like Cawley or others of that framework but at the end of the day, none had the experience of management of a large employee base or this type of enterprise. Yes, familiarity helps but the BOD must make the decisions and has been pointed out, everyone of them is a PA and has at least practiced one time in their lives.
  15. Have you considered speaking to a Diabetes Educator as well as the nutritionist? Diabetics are notoriously obese and need behavioral changes and a daily food book or diary. The acceptable weight loss for any really successful program over a three month period is .5 pds to 2 pds weekly. Patients who manage this are on the road to a normal BMI. I just do not think that any diet medication is able to correct their indulgences , particularly when eating out. It takes determination, is as difficult as adjusting to marriage and has a plethora of benefits, just like marriage.
  16. Nice to hear a happy ending to your story and now you can share your advice with others or write an article on this site or elsewhere.
  17. I strongly agree with Lt O Neal as this represents the relationship between the PA profession and just a advocacy group. I would suggest in a kind way that your focus be directed to who we are, what we have done and where we are going. The strides of tis profession have become long, because of the dedication of its many leaders and its many clinicians. We did not start this profession because of finances or security but rather because we had served in the similar capacity and desired to continue this role because the people of our country need more health care providers who could treat its population and particularly the poor and those in remote area. Some held to that philosophy and others branched out starting specialties, such as the one I spent most of my career on, surgery. If you want to focus on the profession and have the proper motivation for becoming one of us think on this quote."If you practice an art, be proud of it and make it proud of you....It may break your heart, but it will fill your heart, before it breaks it---it will make you a person in your own right."Maxwell Anderson (1888-1959) Dramatist
  18. excellent Response, Ventana and I agree 100 5. I am of the opinion that PAs are far more ethical than their physician counterparts and we find fewer excuses to destroy
  19. Members 423 713 posts Report post Posted 1 hour ago Homan is a tool, just as every other tool in the bag...it should still be taught in my opinion, but in addition, should be taught that it does NOT rule out a DVT (i.e. sensitivity vs. specificity). I agree wholeheartedly with your assessment and would place emphasis on the fact that it does NOT Rule Out a DVT. DVT is ominous, it is like a Ninja warrior, stealth and unseen until it strikes, and we have the embolism. I cannot speak to all of the comments separately but can say that a good history that includes cramping and pain, as well as congestion, cough and difficulty in breathing, will lead you to follow the algorithm that Rai sent as we have the D-Dimmer as well as radiographs and even an EKG. We become detectives in medicine and we cannot afford to have "cold cases'" I like what Lt. Ryan stated as he is a PA and a Resident with experience and his comment diffuses the difficulty. I argue that this course can teach you on a three day weekend and offers much more assistance later. check out the link as it is one of the best I have seen and if Rev Ronnin is going that puts more gas into its efficacy. Maybe he can report on this after August.
  20. This topic kind of brings you back to a historic question asked by a Roman Governor; "What is truth?" Like Scott, I do not feel that we need to give everyone a dire diagnosis or an absolute prognosis because there is no absolute prognosis. I have seen pancreatic cancer patients expire in a month and I have seen them comfortable and able to have a normal life for three to four years. We are not the Judge and Jury but we are the witness. We share what we know to be clinically correct and offer hope. Rather than play the Grim Reaper, we have the ability to "be a rainbow in someone's cloud." Maya Angelou Just a thought not a hardline expectation.
  21. Ral- this happened thirty years ago prior to the advent of POCUS. There was an intelligent response on Huddle to this post from a PA who was expertly aware of POCUS and our need to have this course in PA programs, nationwide. &5% of the profession has been taught what is now archaic medicine in terms of the diagnostic approach to this problem as well as others. Thanks for your question.
  22. I just looked at it and it seemed to post OK. did you get this? A number of years ago I lost a close friend who died of a pulmonary embolism secondary to a DVT that he was seen for by a PA and two physicians. It is so important to look beyond erythema, tenderness and a negative Homan's sign when trying to rule out a DVT. Homan's sign is as antique as your grandfathers model T Ford. Today as clinicians we have a responsibility to either order better and gold standard tests or know how to perform them ourselves. Here is a very important summer course for Rural Health Personnel to learn to perform Ultrasound Diagnostic Exams. If you are a cutting edge PA or NP than this is for you. PracticalPOCUS.com/CriticalAcess2019
  23. A number of years ago I lost a close friend who died of a pulmonary embolism secondary to a DVT that he was seen for by a PA and two physicians. It is so important to look beyond erythema, tenderness and a negative Homan's sign when trying to rule out a DVT. Homan's sign is as antique as your grandfathers model T Ford. Today as clinicians we have a responsibility to either order better and gold standard tests or know how to perform them ourselves. Here is a very important summer course for Rural Health Personnel to learn to perform Ultrasound Diagnostic Exams. If you are a cutting edge PA or NP than this is for you. PracticalPOCUS.com/CriticalAccess2019
  24. Good reply and I personally would not tell a patient all of the differential diagnosis of presenting symptoms lest they decide on using a razor to their wrist. We can talk about questionable diagnosis with the need for more clinical correlation. As far as the patient with a possible testicular cancer; I remember when my SP told a patient that they had melanoma when he had not performed a biopsy. This became a malpractice case for creating severe psychological damage. I forget the outcome but an insurance company does look at the number of cases presented against you.
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