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Everything posted by Devildog

  1. Greetings, newly formed group for those APP's who are either owners or contemplating becoming one. More and more of us PA's and NP's are taking the leap, so let's share experiences, best practices and "pro-tips". Here is the link: Advance Practice Providers Clinic Owners best, Miguel
  2. I truly hope that this message will not upset anyone as this is not the intention. Fair to say that those of us who have been in EM for a significant amount of time have learned the things that must be discussed with the attending as you manage a patient (insert here whatever train wreck of your choosing). As we all know, learning EM is a very steep learning curve at first you just dont know what you dont know - I know its a cliche but true nonetheless. In my experience, the new graduate - a term in EM unknown a few years ago-- realizes that the oral presentation is key to the learning process and in making them a productive member of the practice-->$$$. In contrast I have come across some seasoned PA's new to EM that times seem to be bothered and angered when asked to present a patient. Usually we hear, "well, in my last job as a hospitalist I did note have to present" or " I have been a PA for x amount or years and I shouldn't have to". Listen, I get it. As PA's we have carried a chip on our shoulders for decades. We have fought hard to gain the amount of autonomy we enjoy now. However, in EM one must accept and even welcome the opportunity to present your patient. One presents when sign out. One presents when talking to consultants. One presents when the attending asks. I have always tried to look at the oral presentation of my patients as an opportunity to polish my practice and learn. There have been a number of times that during sign out my colleagues have suggested tests, therapies that I either wasn't aware of or just forgot. Again, I hope that this did not offend many of you. Comments and your thoughts are always welcomed. In good health, Miguel (p.s., this does not apply to EMEDPA who mans an ED solo.....but I bet he even presents )
  3. My partner and i have been toying with the idea of charging $10 more on the weekend office visit charge. BCBS does pay the extra coin although you have to specifically code for it. So my question would pertain to the self pay patient. Thoughts? much obliged.. Dog
  4. 1. If required to submit a photograph of self, please make it professional in nature. No duck-facing, no spring break in Cancun with shades. Generally, a passport pix does the trick 2. Court-mandated volunteer hours DO NOT count for obvious reasons. 3. Stop texting, using your cell to surf the interwebs during the interview day. Nothing should be more interesting to you on interview day. 4. Research in-depth the program which extended the invitation to interview. We EXPECT you to have lots of questions when we meet you. Having no questions shows lack of interest and / or lack of drive to do prep-work. 5. Above all, be truthful and be nice to EVERYONE during your time there. Good Luck! Dog
  5. Thank you sir. BTW, I applied to Lynchburg College's DMS program. Wish me luck! Miguel
  6. Working on a presentation and I am failing miserably in finding any statistics regarding the number of APP-owned practices in the USA. Obtaining a trend over time would be icing on the cake. I have tried a general google search and an AAPA search. Any suggestions of where else to look would be welcome. Thanks!
  7. Greetings, Opened primary care clinic approx 10 months ago. Using Kareo. Not bad, simple, intuitive and relatively inexpensive ($150 per provider per month). All the bells and whistles-- electronic Rx, templates, patient ed, ect.. Customer service has alot to be desired of, therefore we are contemplating switching another EHR. I would really like to hear your recommendations, thoughts... many thanks! Miguel
  8. Greetings prospective PA students. As person who is full time faculty at a PA program and has the task of evaluating and reading PA school applicants allow me to offer an - as we say in medicine- application pearl. When you ask someone to write a letter of reference for you please educate him / her on the correct way to write the name of the profession: It should never be: Physician's Assistant Drop the 's. Have them write Physician Assistant. Physician Assistants practice medicine independently in collaboration with the physicians. Notice, I wrote, in collaboration with- the language of supervisory is no longer accurate in most states, therefore why the no "s". Needless to say if I see the dreaded "Physician's" in your essay then I will likely terminate the application process right there. Cheers Good Luck to all! Dog
  9. FYI as per NCAPA I urge all of you to visit the NCAPA website. The NC Medical Board currently has a "midlevel" seat on their board. It is currently filled by a Nurse Practitioner. If you go to the "advocacy" tab you can send a request that our legislators vote to expand the NCMB to 13 seats so that there can be a "PA only" seat. This would allow NPs to represent themselves and PAs to represent themselves. It is a very quick process and I think it is vital, if you do to please take the time to voice your opinion to the legislators. They already have a typed up letter that you can add to or send as is. Time is of the essence because this will be voted on very soon!! Denise Busbin Locklear PA-C Here it the link: http://cqrcengage.com/ncapa/app/write-a-letter?2&engagementId=91793http://cqrcengage.com/ncapa/app/write-a-letter?2&engagementId=91793 Peace Dog
  10. Man, is this ever becoming a "hot" issue....both sides definitely articulating their points rather convincingly. (Spoken like a true politician, lol..) No but really, I am certainly not smart enough to figure it all out but it is marvelous to be living in this phase of our profession!
  11. It is interesting that this article just came out in the AAPA journal. Putting aside my candidacy, whether elected or not, I think that the tide seems to be gaining mass in terms of independent practice. I am not at present time fully advocating independent practice but definitely welcome the language that describes our present relationship with the docs a collaborative rather than supervisory. In any case, if you have a minute this may be worth the read. Thanks Miguel http://journals.lww.com/jaapa/Fulltext/2015/01000/Is_physician_assistant_autonomy_inevitable_.2.aspx?WT.mc_id=HPxADx20100319xMP&_wcsid=B83A8FE9F0C2F4E1471579C4C94D757BACB9D0721F37AAEE8D0D6B1505253505#
  12. Totally! I lived in Seattle (Kirkland) for 3 years and I would love to hold meetings / conferences out west!
  13. No, I am not at this time. Thanks! Miguel
  14. Great Point! I do believe as well that independent practice is inevitable. Not sure on the timing,.. less than 10 years? I also think than when this happens it will be largely patient-driven, perhaps even, dare I say it.. insurance companies driven. Interestingly also is that the docs are getting tried of being "where the buc stops" when it comes to malpractice. One of my friends is a doc who does consulting for malpractice cases involving PA's and he says that it a recurring theme.
  15. I am currently a voting member of the AAPA, PAEA (Physician Assistant Education Association) and of course, SEMPA. Thanks for the question! Miguel
  16. Colleagues, No, Im not running for President in 2016...first Puerto Rican US president?...nawww. But I am running for one of the Director-at-Large positions at SEMPA. I have attached my platform statement below. Take a look at it and consider giving me your vote of confidence this January! In hopes of service, Miguel (p.s., feel free to share my platform statement and spread the word among other EMPA's that you may know!) Miguel A. Pineiro, MHS, PA-C Assistant Professor Campbell University Physician Assistant Program College of Pharmacy & Health Sciences P.O. Box 1090, 191 Main Street Buies Creek, NC 27506 (910) 814-4902 office (919) 244-3467 cell Platform Statement for Miguel A Pineiro, MHS, PA-C Dear Colleagues, My name is Miguel A Pineiro; I am currently a physician assistant working in emergency medicine for over 9 years in Raleigh, North Carolina. It is my intention to run for one of the two Directors-at- Large positions in the Society of Emergency Medicine Physician Assistants. As an experienced practicing EMPA I am keenly aware of the current issues that our profession encounters as it continues to grow in numbers and in scope of practice. Issues such as: • How do we meet our supervising physician expectations of practicing solid, evidence based emergency medicine? • How do we recruit and retain experienced providers in a field that needs and clamors for mentors? • In a rapidly expanding field for physician assistants, what tools can we use that we fulfill the promise to practice in underserved areas? Indeed, these and other important decisions will need to be addressed by the leadership of SEMPA and I hope to work closely with the Board of Directors in providing guidance to our profession. I believe that I am uniquely qualified to serve for the following reasons: In my role of Associate Professor at the Campbell University Physician Assistant Program I am a member of the didactic team and I take great pride in having the privilege of training the next generation of physician assistants. It is my hope to begin an emergency medicine fellowship to help satisfy the need for competent, compassionate and caring PAs in the emergency department. I am a proven leader evident by my service as the Chief Physician Assistant for our EM group during a period of rapid expansion; during my tenure of close to 5 years we almost more than doubled our numbers from just under 20 providers to surpassing 40 at the end of my tenure. In addition, our scope of practice was expanded to include essentially all areas of the emergency department. I have taken and passed the test for Certificate of Additional Qualifications in Emergency Medicine and I believe that it is important to expand test dates and continue to provide training that allows EMPA’s to become certified. Lastly, as a Hispanic PA I hope to attract potential Latino applicants into the PA profession and into emergency medicine. The Hispanic demographic is, after all, the fastest growing segment of the population of the United States. It is an exciting time to be and EMPA! We are increasingly entrusted with seeing the sickest patients and we continue to expand our horizons of practice while maintaining the Physician /PA team model. I hope and look forward to serving in the SEMPA Board of Directors and I humbly ask for your vote. Miguel A Pineiro, MHS, PA-C
  17. Colleagues, I have made the decision to make the jump into academia. (God Help Me!) Big school, tertiary care center. Surprised they have gone this long without a PA school. So.. we are starting from scratch. I am hoping to take a peak at someone's didactic year schedule map to get rough idea of how most set theirs up. PM me and I can give you details.. Thanks!
  18. So IMO this is the way it should be. If the docs are going to "enjoy" the benefits of having a provider work for a fraction of the physician salary then it is important for them to take a very active role in the training of the PA. Some points: Agree that the best place to get a new grad trained is from a pool of folks who rotated with you first. We employ a "tier system" where we have stratified our group and it provides a pathway for advancement. The new grad must, therefore, prove mastery of certain basic EM concepts before being asked to do more. We place no pressure on productivity on the new grad trainee for a least a good while (6 mo--1 yr).
  19. so I try to be as easy going as I can but recently I read a column from an admittedly new EM attending in one of the EM magz where this doc is imparting his "wisdom" on the yet to be annointed EM residents. here is the piece: http://www.epmonthly.com/features/current-features/rules-of-the-road-tips-for-the-new-class/ so what I am bothered is his couple of points about how to "handle" the ML's...I think this guy has a very myopic image of how to effectively work in the MD-PA model.. thoughts? Peace Dog
  20. anyone doing MOHS? my good friend who is already a derm pa would like to refer me to a solo doc. hear is what I know; doc is willing to train from scratch short work week good money? cons? repetitive? this would be a total change in specialties for me--doing EM now.. thoughts? Gracias! dog
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