EMEDPA

had a great case as a medic. suicide attempt. took a bottle of elavil, seized and coded. standard ACLS plus all the bicarb on the rig (8-12 amps if I recall correctly), intubated. initial abg in ED on arrival PH 6.8. More bicarb given by push and bicarb drip started. Multiple vfib arrests, successfully resuscitated. spent a week in the ICU and walked out without deficits. One of my best cases as a medic. he got almost every drug in the drug box, except ntg. Think his glucose was 40 so he got D50. He seized so he got valium. All the acls drugs.

agree. also, don't accept ridiculous offers. My most recent per diem job offered me(what I thought of as) an insulting rate of pay. I sent them a polite letter saying I really enjoyed my interview, pointed out again my relevant experience and mentioned that I am the only EM CAQ certified PA in the state and had over 30 years of EM experience, etc and they sent me a new offer $18/hr higher(still lower than other jobs, but close), which I accepted. I was polite. I actually said " is there any wiggle room on that hourly rate? At X facility I make this and at Y facility I make this. Thanks". a big part of this is how desperate they are. They had already interviewed several folks they didn't like. They liked me. It was April and covid was rearing its ugly head, and no one wanted to drive 2 hrs from the nearest major metro area to work there a few times/month. They emergency credentialed me and I was working shifts there the weekend after my interview.

pretty sure the drug epidemic is not a uniquely American issue. That raises an interesting question: If we (American medical providers) were better at limiting narcotics like say Australia, wouldn't we have fewer opiate addicts? A doc I knew did a sabbatical there and was pulled aside after his first month and told he had written more opiate scripts in a month than the rest of the hospital's medical staff did in a year. And he was not a candy man kinda guy, just a nl American ER doc. When we write percocet for ankle sprains( you know, because of press-ganey) and folks get hooked on them and then their pcp's don't refill them some turn to heroin. That is a structural systems problem...one of the big benefits of socialized medicine: It doesn't matter if the patients like you or not. You give good care and there is no did you like us, were we fast and polite survey. I love this study: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108766#23426274 especially this part: During 142 565 person-years of follow-up duration from 2000 to 2006, a total of 1396 patients died (3.8% of 36 428 patients). In adjusted survival analyses, relative to the least satisfied patients at baseline, the most satisfied patients had a 26% greater mortality risk (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.05-1.53; P = .02) (Table 4). The association between higher patient satisfaction and mortality remained significant in an analysis that excluded patients with poor self-rated health and 3 or more chronic diseases (aHR, 1.44; 95% CI, 1.10-1.88; P = .008).

pretty sure they are WHO stats.

MASS is a great model. OR had something similar for those on medicaid a few years when the Oregon health plan was more robust under Gov Kitzhaber(An ER doc). We need to cover everyone for legitimate medical issues, certainly communicable diseases, prevention (tobacco cessation, vaccinations, prenatal care, etc). I think if someone wants a cosmetic procedure not indicated due to a major trauma/burn/etc they should have to pay out of pocket for it. Hair transplants, breast augmentation(except s/p cancer, etc) should be the responsibility of the individual. It is ridiculous that places like Cuba have better infant mortality stats than we do.

I have no issue with lower pay if 100% of my health care for reasonable things is covered, like it would have been if I had taken the job in the UK. I also wouldn't have to have a $2400/yr disability policy, because guess what? They would cover that too. Also, no malpractice policy because it's not a thing there. You have probably heard of the "Happiness index". Know where people are consistently objectively happier? Socialized countries. It ranks the top 20 countries. we are #18 https://www.forbes.com/sites/laurabegleybloom/2020/03/20/ranked-20-happiest-countries-2020/#4f028b5a7850 World's 20 Happiest Countries Finland Denmark Switzerland Iceland Norway Netherlands Sweden New Zealand Austria Luxembourg Canada Australia United Kingdom Israel Costa Rica Ireland Germany United States Czech Republic Belgium

I was offered more like 90k to work there a few years ago. The list of things they were going to cover for me was impressive.

Like others above, I cover a critical access hospital and am responsible for floor emergencies at night. The hospitalist is 30+ min away, so the afterhours chf that needs bipap, etc is mine.

They continue to exist, but only for add on coverage for things not covered by the national plan. Things like cosmetic surgery. This is the option in Canada. You get a national health plan, but if you want something that looks more like concierge medicine you can cover it with additional insurance. Want your cholesterol checked every week or the newest and best nasal spray for your seasonal allergies or bi-weekly massages? pay for the extra coverage.

A friend of mine does that. has several docs, PAs, and NPs on his staff. Look at Lacamas family medical group in Camas , WA. Scott would probably be happy to discuss it with you.

I did this job for two years. I got 10% over base pay plus any hours worked at straight pay outside of normal shifts. I stopped doing it because it was too hard on the circadian rhythm. I worked a lot of swing shifts that were 3p-1a then and all the meetings were at 7-10 am, followed by, you guessed it another swing shift. . PS writing a schedule for 12 people sucks because you end up scheduling yourself last and get whatever is left after everyone else gets their cme, vacations, etc. I did this as a 110%+ FTE, not reasonably scheduled to include admin time. The guy who did the job after me lasted 3 months.

If you let your insurance lapse, it is harder to get insurance again later, especially for "pre-existing conditions".

if you need 90 days of insurance between jobs it is easier to continue with what you have than to get a new policy for 3 months. have done it twice. yes, it was expensive, but my time is worth something so not spending a long time filling out surveys or getting records sent for insurance I will have for 90 days is worth something.

https://mashable.com/2016/07/27/german-hyperinflation/

communicable disease is a must treat issue. Pay a little now or a lot later. Don't treat an immigrant with gonorrhea, and guess what, it spreads through the population. ditto TB, HIV, Covid, Influenza, etc. As above, non-communicable diseases are a gray area.