jmj11

My information is dated. When I finished school, I was hell-bent to find a position overseas. I had my eye on Saudi Arabia, which had hired some PAs in the 1970s. However, by the time I finished school, they switched to MDs from the UK or the developing world and were not hiring PAs (1980s). I finally got a position with a group in Cyprus (run by an American with a PhD in public health). I was not allowed to practice in Cyprus even after finding a Cypriot doctor sponsor. I ended up moving down to Egypt and had a student visa but worked (under the radar) in a slum area. I met a PA there working for General Dynamics. They eventually sold their contract to SEAVIN. Since my situation was untenable I tried to get a job over at SEAVIN but they weren't hiring (I don't think they exist anymore). Since I could not find a job overseas anywhere, I came home after three years. After I got home, I continued looking for an overseas position. SEAVIN did call and offer me a job two years later but I had just (same day) found out my dad has terminal cancer and decided not to take the job because of my dad. I interviewed with the CIA and as a staff person with the Peace Corp. I had four small children at the time and both of those job situations were too challenging for having children abroad (for example the CIA required two years in Washington DC before assignment, and then the assignment is without children. The Peace Corp would assign you to the least desirable country and you have to work you way up. I ended up joining the Air Force just to go overseas (I realize that you said non US government) but could never get an overseas assignment and got out. I then applied for a civilian post in Germany, supporting the US Army. Can't remember why I did pursue that. Applied to the UAE PA program as a professor. I think me not having a PhD held that up. I applied several times to work for the Cleveland Clinic's hospital in Dubai as a headache specialist. Never returned my calls or respond to my CV and query letter. Applied to work for the Scottish NHS as a headache specialist. They had advertised for a MD headache specialist. They rejected my application when they figured out I was a PA, even though I was a headache specialist at the Mayo Clinic at the time. I did work in Pakistan twice for three weeks each time and in Nepal once for about two weeks. That's my sad story. Loved living abroad! As you know there are PA programs and jobs in the UK and the Netherlands. Mike

I have renal failure from light chain deposition from cancer, multiple myeloma. Please, know your patient before you make a diagnosis on line. Knowing what I've been through this past year, in the throes of death for much of the year, I find comments from people like you who have no clue what you are talking about when you address my case as highly offensive. I was making a point in my original posting about how we need to take patients seriously. I regret using one personal example from my own experience to illustrate the point about listening, not knowing that someone would not "listen" to my personal story and then exploit it so they could market their own alternative agenda. There is nothing more offensive to a cancer patient than having someone try to profoundly oversimplify their nightmare to suit their own worldview.

I think if you are suggesting that I personally looking into these alternative explanations for my (one illustration and only a minor point in the article) symptoms, that I don't think you understood my story. We know what has caused my symptoms. It is well known and established that living in a state of uremia can cause neurological damage. The mechanism of that damage is poorly understood and attributed to some unknown neuro-toxin produced in the state of uremia. There is also no reliable treatment for what I have except renal transplantation or if the native kidneys return to near normal functioning. My point was the gross lack of curiosity among my healthcare providers, save the one PA.. It would be absurd for me to think that a dental amalgam was causing my neuromotor disorder when I was unknowingly walking around with a BUN of 165 and a creatinine of 14, not to mention a potassium of 7 for weeks. For some of my patients, which I've alluded to, they have truly had not answers and I do think something going on within that Dark Matter of medicine, of which we don't fully understand. I do understand why these patients start grasping for unproven theories for their answers, which is equally a travesty for many and would be best left said as "we don't know" but with a mind of curiosity and compassion.

One of a hundred things wrong with healthcare, knowing the unknown and listening to what the patient is saying: Blog Post: The Black Matter of Medicine.

I agree. Since they have chosen to go ahead of us in promoting their profession, they have nothing to gain, only to loose by merging with us.

This may have been covered, and this is not meant to be political. I just listened to the COVID-19 update. Now, that "Dr. Trump" (or you could say "Donald Trump, PA-C") has prescribed hydroxychloroquine and azithromycin for the entire country to prevent COVID-19 ("those people taking hydroxychloroquine for Lupus or malaria aren't getting this horrible virus", my paraphrase of what "Dr. Trump said.") How do you handle this on the front lines? I can't imagine the flood of healthy patients coming in and demanding these drugs that "Dr. Trump" has prescribed for them.

This is a complicated answer. I got laid off and my clinic closed because I was gone, playing around with cancer and getting a bone marrow transplant. I, however, was starting to create a new clinic with a neurologist and then this shit happened. Because of my risk factors, I could not start seeing patients in person, so, by mutual agreement, we pulled the plug on the clinic, for now.

Part of my answer has to do with the season of the profession in general. When I graduated in the state of Kentucky, in 1982, we were treated like pieces of crap. It was a struggle getting established. Then I ran into anti-PA pockets, such as around Houghton, Michigan in the mid 1990s where life was made hell by some doctors and nurses (who hated our profession). In the past 15 years, it has been a piece of cake, mostly related to location and changing times rather than me changing into a better PA.

Two points (having spent my career in migraine treatment) I have not used Xeomin although a ton of Botox, which is the only neurotoxin approved for migraine prevention. Of course, you may have had better luck or some reason you are using Xeomin (I have used Dysport off label do to a cost issue). But my main point is that migraine is a neurological disorder like epilepsy, MS, etc. Is treating status epilepticus in the ED "elective?" Is treating relapsing MS "elective?" Migraine has had a great injustice of stereotype forever, often even by neurologists. I've heard neurologists say, "No one dies from migraine." Well, I beg to differ. I've seen countless lives ruined by migraine. I've had (as I sit here and think) at least 4 patients commit suicide due to endless migraines ruining their lives. So, my conclusion is, if Xeomin is working to prevent migraine days, it is not elective and certainly should not be lumped into the category of cosmetic treatments. I would advise patients not to seek elective treatments right now, such as cosmetic. But not giving a migraine the treatment they deserve, is different.

I have searched here but have not found such a thread, but are any of you "in the COVID-19" trenches PAs doing a blog? I'm talking about ED, hospitalists, Intensiveness, etc.Maybe if you are really in the trenches you are too pooped to write about it. But I would be interested in following your blog.

There will be lasting ramifications from this national crisis just like 9/11 led to the TSA (and unfortunately the Iraqi war). I hope we capitalize on this for lasting changes to improve health care and the PA role.

Our governor said today, (my paraphrase), "We are grateful for those on the front lines during this pandemic, Doctors, nurses, and Physician Assistants." I agree, we loose these battles far too often, but it was nice to hear Inslee include us.

2020 will be the year that telemedicine came of age due to its role in the pandemic.

This is not about the medical aspects of screening and treating the infection. COVID-19 pandemic will, in some ways, be like healthcare's 9-11. For us who remember well the pre-9-11 world, there were many societal changes that became permanent. In what ways, if any, do you think healthcare will change going forward? For me personally, I'm not practicing right now, but will hopefully return soon. However, my wife is a hospital administrator and we have been up throughout the night several nights this week as she is on the phone, conference calls and etc. Each day her hospital, like all hospitals, face new crises. Yesterday, it was mis-information from the government that anyone could be tested at will and the ED was completely overwhelmed by patients (most asymptomatic) wanting testing. What do you think?

I agree with the above however, for your protection, I would sign it ASAP or if there are other red flags and if the issue that you wanted to change is a deal breaker, then look for greener pastures. The smartest thing I ever did, and I've made some mistakes, was when I went for a site visit for what sounded like a wonderful new job with a very generous productivity-based salary and didn't sign the contract right away. I had the contract in hand and when for my last visit, the hospital had done some shuffling, moving my position from one clinic (very pro-PA) to a new clinic were my SP (so warned by the CEO) didn't care for PAs but he was hoping that I could "win him over." Now, in my career, I have "won over" many physicians who were not PA friendly (like the whole department of neurology at Mayo Clinic). But I have also run into asshole physicians who hate PAs due to their own insecurity. Anyway, after that last visit I felt unease. I took the unsigned contract home and I altered it to add a provision that said something like, "There will be no artificial hindrances by the supervising physician or anyone to the PA's ability to schedule or see patients." Well, this SP was my worst nightmare. Before I came he met with scheduling and told them that I was only hired as a token provider so that his clinic could get RHC status and I was to never, ever actually see a patient in his clinic. . . not over his dead body. We fought for weeks over this and when he caught me seeing patients while he was on vacation in Mexico (and our phones were ringing off the hook, I had asked the CEO to open the schedule as me sitting idle was nuts), this SP came back and was pissed. He had the hospital immediately move me to a tiny office off the beaten path 10 miles away to prevent me from seeing any patients. I then met with the CEO and pointed out the line I had added to the contract. They reviewed it and signed it after me (I don't think they read my new version due to their fault). He gave me a 10K bonus since I was not seeing patients and making no bonus income. But it was still insulting. So I sued them, and I won based on that one line I added to the contract. The scheduler said in the deposition that the SP had told her to never allow a patient to see me not matter how much they wanted to. That was the slam dunk. But still a bad experience. I will also comment that this was the only job I ever took based on a lead from an ad (in the Physician Assistant Journal). All other positions I created from scratch and those worked out well.