jmj11

You may want to check out what our state, Washington, is doing: https://time.com/6105532/foreign-trained-doctors/#:~:text=In May%2C Washington governor Jay,with the possibility of renewal.

The simple answer is that the fight with insurance companies to get paid took the fun out of medicine. Our number one insurer in our area, after telling me they would contract with me, then refused all claims. It was a five year battle with them, even meeting with the VP of the company. However, my competitors, neurologists, voiced to the insurance companies not to do business with a PA-owned practice. I started a law suit against them, however my lawyers said it would cost me at least 200 K to fight them in court, and in the end, the most I would get out would be a contract. Medicine stopped being fun, so I got out as owner, selling out to a local hospital.

I started my own practice (headache) here in WA state around 2013-17. If you have any specific questions please feel free to PM me. I had a PA-owner, mentor, which was a help. I had a LLC.

I had my share of conflict with nurses in my early days ... not in the past decade or so. I covered much of that in my first (not so well written) book, A Kernel in the Pod. However, two stories that I like are very similar. My first job at a major headache clinic (the largest in the world devoted to inpatient treatment) the director of nursing vowed to resign if I was hired. I was hired and she resigned. Got to know her personally and later we became good friends. She even financially donated to a work I was doing overseas. Twenty years later, when I went to Mayo Clinic, the head of nursing in neurology (65 neurologists) threatened to resign if I was hire. I was hired and she resigned. I took her office.

Can't believe that Milligan has a PA program now. I did my BS at nearby East Tennessee State and had a lot of friends at Milligan.

This is truly odd, a teenager with TN. I worked 38 years in a headache clinic, seeing probably TN patients in the hundreds if not thousands and never remember seeing a teenager. Usually over age 60. If <60 raises concerns about the diagnosis. Yes, TN can occur at almost any age, but it is very rare in these young ages. There are many other facial pain syndromes that mimic TN. So the pain was isolated in the trigeminal nerve and lasting 1-3 seconds, provoked by touching the face, etc? Glad your nerve block worked.

Another interesting take on this, I'm writing a novel (thriller) with a PA protagonist. I just finished a phase where I had beta readers (like a focus group for writers) read it and give me feed-back. All three non-PA readers, one with a PhD in creative writing, one with a PhD in sociology and teaches at a small college and the third, all non medical, made the same tone of comments. The PA's role seems unrealistic, steps outside his boundaries, doesn't get permission from the doctor for some of the things he's done. I've painted the role of the PA in very realistic terms, with him either doing things I've done (in the developing world) or have seen other PAs do. But this is how much of the general public still sees the PA role. I wouldn't call any of the states about PAs as disparaging, but just misinformed. If I had a dollar for every person I had to inform correctly what a PA really is over the past four decades . . . well, I would be sitting beside Jeff and Mark Bezos on their ride into space. That is also what I hope to accomplish (second to entertaining) with my book.

I'm going to make a statement at the bottom of this and I'm interested in your take on it. I will say that I'm not dogmatic on it. But in 1981, when I began my career as a PA we were told, "Soon the world will know who we are and respect our profession." After completing a 38 year career, recently I had two conversations with laypeople that stood out to me. These were both college educated, but older 60s and 70s. Both are recent (1-2 year) friends. The first one made the comment, "PAs can't have independent judgement, but only carry out the specific orders of a doctor whereas the NP (whom he sees) can think for herself." The second, who knows I've had a long career as a PA, said, when I told him I couldn't have coffee because I was volunteering to do COVID vaccinations he acted very surprised, "I thought only nurses and doctors were trained in giving shots. Have you ever done this before?" "Of course," I said. "I gave dozens of shots every day, mostly in the head and neck." He was very surprised that my training qualified me to do something this simple. I know we have a lot of people coming here who are trying to decide if they want to go the PA route. I also realize that much has indeed improved since 1981. However, if I were in high school or early days of college (didn't get interested in medicine until after undergrad) I would have chosen the MD route. Here is the reason and prospective PAs need to understand this. If you are a PA, society will always assume that you are dumber than you really are. If you are a physician, society will always assume you are smarter than you really are. So, do you think that above statement is true?

After a long career, and the first part during the difficult years of being a PA (1980s) and several job changes, I started to leave off one 6-month job and a moonlighting job for the sake of brevity. The only time it became an issue was when I was suing a hospital for breach of contract years later they tried to pin in on me during a deposition as if I were hiding something they had found during their "discover" phase. I gave them the phone number and told them to call the employers that were not mentioned on my CV (left both with good standings). It became a mute point and I prevailed in the case.

I am waiting for someone with more current information to chime in, but historically the American-trained Physician Assistant was not recognized in China. I would do a lot of research into it first. We had a house guest for 3 years from China, doing her nursing studies in the US. She had planned on staying here but then love pulled her back to China. I know that her transition to Chinese nursing after training here was easy. But the PA role is another matter. I lived overseas in the 80s-90s and the PA profession was not recognized in most places I live.

I don't know if others were in this boat. I started the pilot two years ago. At that time (2018) I paid my dues and submitted my full CME. But it takes 2 years to complete the exam, which I did in December. When I got a notice I had passed, in the back of my mind, I was thinking I was set until 2022. But understand I was quite distracted by the fact I'm not working right now and was focused on staying alive. However, I went to the NCCPA web site in Feb, and realized that I owed fees for 2020 AND needed 100 hrs of CME. I rushed and finished the CME in about three weeks and hastily paid the fees. So, if this is true about the 4,000, I think others "had the feeling" they were okay because they got a notice in December they had passed the test AND remembered submitting their fees and CME when they started the exam. But that was two years ago!

Related question, if I decide to keep my cert, having just finished the re-cert and paid the fees, the only thing lack is Cat I CME. I know this question has been asked before, but for an update, where is the best place to get free Cat I CME online? I always had mine via conferences.

I have to decide if I keep my cert by the end of March. The only thing I lack is Cat I CME. With my COVID vaccinations done (had work restriction due to bone marrow transplant) I could go back to work if I wanted. I miss it, but other times I don't. Am staying busy writing, hiking daily, building a stone cottage, but there are times I miss medicine. I have two more years on my disability, which ends if I draw a salary, so it makes no fannical difference to me. But it raised he intriguing question if people loved medicine enough to do it for nothing.

I'm curious as I'm at this juncture. If working made no difference to your income, would you continue working as a PA, or pursue your other interests?

I have not seen the 2021 E&M guidelines, but if that is the way they are written, then it will be the death of the full exam. Money and time-saving, always trumps. I'm not saying that is a bad thing (although it doesn't feel good to me) but the question stands if this is good for medicine? Is the hands-on exam superfluous? What about, as mentioned, the human aspect of face to face time and touch? Are we heading to a Dr. Jones on Star Trek medicine, a hand-held device that does a full body scan and finds any abnormal state and not touching required? I'm a great believer in the convenience of telemedicine and relied on it heavily when I had my headache clinic. But never in lieu of a needed hands on exam. I am sure we can all tell stories where our hands-on exam was telling us that our patient was fine, but then some test showed that they had a serious problem, and the reverse. I can think of dozens of my own stories. But here's one that stuck with me. I was working the ED. A mother brought a child in (I think he was about eight). The front desk checked him in and the MA did the vitals. His vitals were normal, temp of 98.6. His mother said up front (diagnosis by proxy) that he had a terrible headache, one of his typical migraines. She has them too. Since migraine was the crux of my day job, I always took acute headaches seriously and did a full hands on exam. Mother just wanted a "pain shot" which I would not have done anyway. But doing my exam, I found a child that was in no distress but uncomfortable. But when I placed my hand on his forehead to do my ophthalmologic exam, his head felt hot. I looked as his recorded temperature and it was 98.6 F, I went up to the check in area and got a glass thermometer. I checked his oral temperature again, and it was 103F. I was first worried about meningitis. To make a long story short, this took me down a far more serious path. With a closer exam, his lids were slightly redden and swollen AND painful with movement of his right eye. SO (fill in the blank) was confirmed with a CBC and CT. My point being, with the mother's leading comments, I could have dismissed this child as migraine if I had not touched him. I also had a chat with the MA who didn't seem to take his job that seriously.