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kargiver last won the day on February 2 2018

kargiver had the most liked content!

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About kargiver

  • Rank
    Just an old school EM guy...


  • Profession
    Physician Associate

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  1. If you have the choice, do the PhD. In Academia, it is THE degree - All of the professional doctoral degrees carry some degree of degree creep whereas the PhD in any field is just that - a research based doctorate showing you possess the skills and attributes necessary to achieve the highest academic degree. G
  2. Agree with others working in rural EDs... this is common until they learn to trust you. I'd even go so far as to say they are testing you, as they know what normally comes through their doors routinely and knows what works for them. Deviation from this makes them pucker a little... until they get to know YOU. Then what you know becomes what they know, they'll grow with it, and in time, it works. All politics is local... and this is what it sounds like. Sounds like the "lead" PA spoke up when needed. They'll either agree with you in time or you'll leave, validating any of their complaints (just how they will perceive your leaving, not that there is any validity to them). If you like the environment, ride it out. If not, move on. But, be like a reed in the wind... resist when you have to, bend, don't break. It generally works out. G
  3. Any degree, Biology, Philosophy, or otherwise, is worth what you put into it. I went the biology route and it more than worked out for me. Of course, understanding sciences (all of them, for they are all related... can't do biology without chemistry, can't do chemistry with physics, etc) has been more than beneficial to me (I have an advanced degree in biomedical sciences as well, along with my degree as a PA) so if someone told me my biology degree was worthless, I'd kinda just chuckle and ignore them. Gotta decide what you want and then pick the road to get there. Many roads lead to the same place. Just matters what stops you want to enjoy along the way. Want to learn virology and organic chemistry to strengthen your sciences background for PA school? Consider biology. Want to approach medicine with an artistic background? Get a degree in Art Interpretation. In the end, the degree is just a ticket to the next level without which, you don't get to play. whatever you decide, just do what you think makes you the most competitive because in an applicant pool of thousands, you want to be at your best. Whether its basket weaving, biology, or otherwise... G
  4. Small, critical access hospital in southern Vermont looking for an experienced, full time (will consider part time as well depending on person) EM-PA comfortable functioning solo in a low volume, moderate to high acuity ED. Average number of visits 3500-4000/year, solo coverage, with most care provided by yourself and if needed, patients transferred elsewhere for specialty care (trauma, cardiac care, etc). Excellent working relationships with area specialty groups for referrals, etc. You have to be comfortable working by yourself in this position as hospitalist back-up available, but you are the primary EM provider. Residency experience is highly recommended. If interested, please PM me or email me at gregory.raines@ymail.com for more specifics.
  5. I live and work in rural VT. The area in which I work is economically depressed, but that is just where I work. I am in the middle of ski country, hiking, camping (pick the outdoor event), live on 30+ acres, have a river running though my property, can hunt if I want (the wildlife is ridiculous where I live), play drums at 3 in the morning, and do whatever I want at my job. I work for a small hospital as a solo ED provider, am treated very well and make more than enough to live what I think is my best version of life. Most important, VT is home to some of the finest beer brews in the world, and they are all within an easy drive to get. I know you want to get away from the cold, but there is a huge difference between coastal cold weather and mountainous cold weather. Not sure it matters for you but its one of the reasons I haven't gone south... Boston is 2 hours away, NYC is 4, Montreal is 3, and the ocean is 90 minutes. Growing up a city kid and working EMS for 2 decades in the Boston area made me think I would never like rural living. Now - I would never go back. G
  6. Best book about how to deal with life... sits on my nightstand and gets read often. Highly recommended. You have a lot of options. You are just too beat down to see it. Lots of great advice here though. - VA (or a job that is not insurance for profit i.e. urgent care) - Teaching - Family Medicine (you'll see a panel and throughput will be expected, but its a different kind of environment. At least everywhere I have worked and overlapped with the FP folks - they all love it, even during the height of cold and flu season - Hospitalist positions You got options... let the book be your guide If you are willing to move you have a lot more options than you think. G
  7. If you don't mind my asking - why the tPA in a massive embolic stroke? These are known to cause significant vasogenic edema, are prime setups for hemorrhagic conversion, and lytics are generally not recommended in these patients... was it a stroke that evolved? Just curious, G
  8. Why doesn't TAPA retain legal representation and send a "Cease and Desist" order for Restraint of Trade to the TMA? They are clearly not friends of the profession and what they are trying to do is tantamount to a restraint of trade. G
  9. Borderline Patients. All else pales compared to them. G
  10. Working solo in a rural ER isn't the relevant issue - we practice medicine. All of us. Doesn't matter who supervises you, collaborates with you, or anything else - your decisions are your own. If you think you cannot be named in a lawsuit because you ran something "past your SP," think again. The OP is making a case for "Medical Practitioner." I don't think initials that are reminiscent of "Mid-Level Provider" - M.P. are the answer...along with the other reasons mentioned. APP was chosen for a very specific reason when it came up within our specialty organization. MP is not the way to go. But, like all things... just an opinion. G
  11. You are right where you should be. Some days you know stuff, some days you don't - you are still learning what is sick, not sick, how to differentiate the subtleties of what is what, and when you need physician involvement and/or consultant involvement. Expect this until about year 5 - when you have seen enough to know what is normal vs. not normal, and how to differentiate it. It's not by accident EM residencies are 3-4 years in length and most EM residents are doing fellowships as well. There are things you should be comfortable seeing at this point - but the most important thing to know is what you don't know. That pool shrinks over time - but it never goes away completely. G
  12. I remember the last time this came around, about 5-7 years ago, when I was in the HOD, NPs were the threat then too, just as they are now - except they are not - and this got nowhere. It was pawned off for study in committee for a year to placate those who wanted the name change but in the end - nada. I expect the same will occur - regardless of what is spent. If folks wish to spend their time and energy on something like a “name change” that somehow will grant us greater autonomy, open up greener pastures, and make the world a happier place - have at it. But that’s not reality... we are governed not only by AAPA, NCCPA and ARC-PA, but by federal and state statute. Want to make change - you have to change it there first. The name isn’t the issue... being a generalist is. Money moves the world - not titles. For a rose by any other name is still a rose. And my license to practice medicine says that - I practice medicine. I’m held to the same standards as MDs, DOs, other PAs, NPs, name it... whether I am an “assistant” or not - I have to practice to the gold standard that is the standard of care. Politicians know this, lawyers know this... and amazingly, patients know this. My patients don’t care that “assistant” is in my title - they can’t see a doc if they wanted to - unless they want to travel quite a distance further. As for the NPs - good luck with that... CMS and other federal entities see them as gateway keepers in primary care medicine. The logical approach is to join them - they are an overwhelming force to be reckoned with - ask members of the BODs of the AMA behind closed doors. No wall you build will hold back that current - use it to our advantage. Or not. They won’t care either way. G
  13. Well, opinions vary... but your assertion is factually incorrect. Their training, by definition, is specialty based. If they are family practice NPs, they are, by definition, limited to that field. If they are acute care NPs, they are limited by training in the patient population they see. What they have done with it politically in their respective states of practice after the fact is another matter for debate (and the point of yours). But the fact remains - they can claim they are specialty trained in a specific area of medicine - we cannot. I'd like to think I have some insight into what NPs are doing at the national level and what their political activity is... G
  14. I hope you didn't cut the benzos in half... this will precipitate a benzo withdrawal. If you are intent on weaning patients of this nature, you need to understand, cold, the pathways involved, what interacts with what, the timeframes for proper weans, what is "en vogue" in the FP/IM community to "replace" narcotics, and the best way to get from point A to point B. If the PATIENT is the focus - treat them as such... or you do a disservice to both of you. There is a stigmata emerging (already has emerged) about "controlled substances" and the people who take them. I see this in new grads as they come into our group and with students who rotate through with us. Everything we prescribe is "controlled." The only difference is where it works and its potential to cause harm. The reality is the most dangerous drugs do not fall on the DEAs controlled substances list at all - the idea of pulling people off of regimens they have been on for years, their body is now physiologically dependent upon, causes a lot of strife unless done carefully, methodically, and with buy-in from a patient. You wouldn't abruptly stop someone on high dose beta-blockers... why would you abruptly stop their clonazepam? Food for thought... G
  15. I don't think any of this really matters... there is a reason why it hasn't changed in the last 20 years and isn't likely to anytime in the near future. The nature of NPs and MDs do is vastly different than what we do, with the exception of family practice and IM docs, who by design see a wide spectrum of illness and farm out a lot to specialists. NPs specialize from the get-go in whatever field they wish to pursue. Docs do fellowships in certain fields and maintain boards in those specific fields. We don't. The closest we come is specialization via the CAQ, which just shows a "mastery" of a specific area of medicine - but the core does not change - we are still generalists. The only way this changes is when Congress mandates it based on Medicare and Medicaid re-imbursement issues or we collectively sue, the AMA, using the FTC route. Until the field accepts specialization outside of the NCCPA mandated generalist curriculum and/or we extend our education (which is self defeating), I see no reason to change the name except to either APP or Physician Associate. Medical Practitioner is even further confusing I suspect to the general population and requires a rebuild from ground zero - a battle not worth fighting. G
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