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jmj11 last won the day on October 25 2019

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About jmj11


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    Physician Assistant

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  1. 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.
  2. 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.
  3. 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.
  4. 2020 will be the year that telemedicine came of age due to its role in the pandemic.
  5. 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?
  6. 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.
  7. Panic attacks cause panic attacks. The fear becomes the fear of the fear, if that makes sense. The first time I was in surgery, as a student, I went from talking to a patient to holding his heart in my hand in what seemed like minutes. Besides that, I was wearing strange surgical garb (for the first time) and a room full of people watching every move I made and I started to have a panic attack. I would have hyperventilated if it were not for my mask. I became terrified that I would have another one, which caused me to start having them for minor reasons (I had been an MA in the ER and saw MVAs, stabbings and etc. with just great curiosity and no fear). It took a mental process to break the pattern but I was able to. The work book Mind over Mood has some good exercises. But don't let this event give you doubts about who you are or what you can do.
  8. Each state has it own rules about the supervisory role. For example in my state, Washington, we have a remote practice and regular supervisory roles and they require different levels of supervision. Then it comes down to finding the physician who is willing, usually in exchange for $. When I owned a practice ( I don't think it has changed) Medicare and Medicaid required that the PA could not own 100% of the business so I gave 1% ownership to my SP, however with a good lawyer you could also created a business that has a family member (who is not a PA) to be the other 1% owner.
  9. Yeah, errythemia okay, vesicles bad. Different from this, but I saw a guy with a recurrent unilateral periorbital headache that came about once a month to every few months, lasting 5-10 days. He mentioned his eye turned red and was diagnosed by a neurologist as "cluster headache." The character of pain made no sense for cluster headache. I asked if he had any lesions around his eye and his eyes lit up, "Yeah, I get a couple of blisters on my lower lid." I had him come in with the next outbreak and he did. I unroofed a cluster of small vesicles on his lower lid and did a viral culture which came back as herpes type II.
  10. It was tough getting a position as I created one from scratch (first PA in neurology), so it took a whole year for that process. There was also resistance from some of the neurologists and the head nurse fought hard to keep me out and she resigned when I was hired. But once there, it was tremendous. My boss was as good as it gets and treated me like a physician. I left only because I could not stand the long, cold winters and the long hot and humid summers with nothing to do outside.
  11. I did not read all the responses so this may be redundant. I will say, there may be seasons in your career when things look like crap, then that passes and things go much better. I became disillusioned during one stretch when I took a job, and it was a disaster (slotted for 8 providers, I was # 5, but then quickly became the only one when the others quit), moved on to the Air Force (loved it) but then the base closed and they wanted me to go remote and I left. Next job my SP attempted suicide within 3 months of me joining them (problems in her love life) and her attempt left her disabled. Next job was a huge mess where they lied to me and I had moved my family to that city and started building a house. I sued them for breech of contract and won. I was damned depressed and thought about leaving the PA profession (wrote a book about that period called A Kernel in the Pod). But then I got a wonderful position at Mayo Clinic and the last half of my career was very positive. So hang in there.
  12. I can't imagine getting credit for being a PA in a RN-based midwifery school, because of philosophical problems that nursing schools have with the PA profession. However, a PA who works with a GYN/OB could ending up doing virtually everything the physician does including deliveries. I've done deliveries during my OB/Gyn rotation. Maybe I'm missing something here, unless it is simply added the label "Midwife."
  13. I'm a patient there (SCT June 2019) and was very impressed how they utilized PAs.
  14. After hearing a lot of good things about the TV show Virgin River, my wife and I just binged-watched the entire season in about three days. If you are not familiar with it, it is about a "Nurse, Midwife, and Nurse Practitioner" (all one person) who moves from LA to work in a very rural mountain town in N. California (BTW it is filmed near where I live, but across the boarder in British Columbia). While the front story is her love life, the back story is about her trying to work in a clinic where an older (72 yo) family physician doesn't like non-physicians treating patients. Of course, like most TV shows, there are lots of unrealistic things, including that the clinic is "very busy" but they average seeing about one patient per hour between the two, and the waiting room is always empty. But in her struggle to be accepted by the physician, there are a lot of social commentary about non-physician providers. For one, the MD always wants her to do things like make coffee, clean the waiting room, etc. But one interesting thing that she keeps saying is (my paraphrase) "I'm not an assistant, I am a nurse and nurse practitioner and your equal." What do you think of the depiction of NP and the struggle for acceptance by some physicians?
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