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jmj11 last won the day on June 10

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About jmj11

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    Physician Assistant

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  1. I think technical writing would be of benefit. Medical terminology would be much better as a subgroup. However, having written about 30 papers for journals (and participated in the writing of several others) the general technical writing would have some merit.
  2. In a perfect world, yes it would be best to do a general medicine job first. However, with that said, it is not a perfect world. I've mentioned before that I went from Headache Medicine (out of school) to public health in the developing world, to ER, to Internal Medicine and back to Headache Medicine. It is a learning curve with each change, but if life says you need to specialize before generalizing, then don't panic. It is NOT a career ender or even hurter (is that a word?).
  3. I just wish that before they tell my patient that they "have never heard of this treatment and it sounds crazy" that they would simply google it. Everything I do is google-able. For example, daily methergine for the initial control of intractable migraine (https://www.ncbi.nlm.nih.gov/pubmed/8376101 ).
  4. I know this is a struggle. I've lost my temper before with them, and I regret it. I have to do unusual things in treatment (but on the same page of every headache clinic in the country) and the pharmacist will sew disrespect or doubt with my patients by telling them that this is was an outrageous treatment for headache. It is hard for me to win them back after that. That's what pisses me off. We had this discussion at an International Headache Society meeting in Spain. The non-Americans were appalled that a pharmacist would tell a patient that the prescriptions given by the provider were not safe. They suggest that the pharmacist be immediately reported and their license revoked. The American contingency, well, we just laughed and shook our heads, explaining it is a different world here.
  5. Looking forward to seeing you.
  6. I have a patient who told me he is making about 80k/yr doing that in Seattle.
  7. Way back in the prehistoric days (did you see Alpha the movie? It was about that era) I graduated from the PA program at the U of Kentucky. It was a nightmare for all 14 graduates. Six months after our exams, still only two had PA jobs (one committed suicide because he could not find employment). I was hungry, literally. I didn't have $5 to my name. I used to go through the dorms looking for loose change in the lobby couches to buy one box of Mac and Cheese to last two days. I had made contact with 123 doctors and all told me to go to hell. I was depressed. I took a seasonal job at Sears (during the holidays) as well as worked with manpower doing clean up work (where I met another unemployed PA). I saw a couple of patients who had seen me at the Internal Medicine Clinic at the UK. They asked, "Weren't you my doctor?" two which I replied, "You must be mistaking me for someone else." I never mentioned this job on my CV. So, I can understand how situations may work out.
  8. jmj11

    Down-Code Billing issue

    The only time I've ever seen down-coding is where the chart notes don't support the code. Here, if that issue ever comes up (and rarely does) I have the opportunity to amend the chart notes to create an agreement with the code. I've never seen a case where we had to down code. If an insurance company is down-coding based on diagnoses, unless that is clarified in their contract, giving them the right to do that, then they need to be sued. But suing insurance companies is very hard. I started a case, but then my own lawyers suggested it would cost me 300K to complete the case and I may or may not win anything, I let it go. But there need to be some class-action suits to hold these bastards (insurance companies) accountable.
  9. My only experience is that I've never used my first name in my life (even in preschool) however because it is my legal name, everything professionally, DEA, Prescription Pads, listing with Insurance company contracts, all have my first and last name. I have always gone by my middle name. At one large institution, where I contracted part-time, they forced me to wear a name badge with my first name and last name despite my protest. So, do be surprised if your professional life has to use the name that's in your passport and driver's license.
  10. jmj11

    Concierge Medicine

    A couple of our physicians opened this clinic last year and employ PAs. I think it is cash only and is a little like you are talking about.
  11. I cannot remember getting an order from a physician in over 20 years. I see my SP three times a month and he would never give me an order. It is mutual respect. He probably asks me as many questions or more than I ask him. Maybe you need to find a new job situation rather than starting over in med school. PA can be a great profession.
  12. I love Morocco and was planning on retiring there (at least at one time). What kind of work would you be doing? Each country is different in their regulations. I also thought about retiring to Malta and working there with refugees (from North Africa), however, Malta has strict laws about non-licensed medical providers actually giving care to patients. When I was there, there were stories in the paper about an American Vet, who had retired there, giving care to stray cats and was arrested. Also, an American physician was expelled for giving medical care to refugees. So, each country is different. PAs don't exist in Morocco as far as I know but like EMEDPA (who has plenty of experience in this), the organization should cover you, but again, there are no PAs in France. Years ago, I use to travel beneath the radar overseas and no one cared. It isn't so easy anymore. For one, national doctors' groups have fought against outsiders delivering medical care without a license. That's what happened in Egypt and UAE (places I had worked).
  13. There are a few things that render themselves rather nicely to telemedicine, but plenty of others that do not. For the sake of easy money, misdiagnoses will occur. Here are some sensible uses: Follow up appointments for chronic problems that are under reasonable control. The Acne guy (about 10 + years ago). a dermatologist who would have you take a photo of your face on your phone and he would prescribe acne treatment based on what he saw. Triage, "1. Okay, that can wait, 2. Okay, that needs to go to urgent care or see your PCP, or 3. OMG, get the hell to the ED before you bleed to death! Maybe a handful of other simple issues. But here is what's going to happen. Someone gets an uncomplicated URI. They call pocket-doc. He/she feels obligated to do something to make it worth the patient's 50 bucks. So, he/she sends in a Z pack, This already happens in Urgent Care. I had a cough two weeks ago and the two nurses and two MAs in my clinic kept telling me to go upstairs to the urgent care clinic to get a z pack before it gets away from me. I took it as a moment of education.
  14. jmj11

    An avoidable error

    Maybe the moral of the story is to always send them to the zoo if you are looking for zebras.

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