jmj11

Yesterday I completed my 8th and last PANRE pilot exam, the last PANRE of my life. I took my PANCE in the fall of 1981. It has been long ride. Never had exam anxiety. Never studied for any of them. Did well (not 100%) on this one and I've worked most of 38 years in headache medicine and have not worked at all in 13 months (busy doing things like chemotherapy and bone marrow transplant). But, it is glad to have this behind me for good.

I've known several PAs in my career who worked two jobs. I spent most my career in headache medicine, but twice moonlighted in the ER or Urgent Care to keep my general skills up. It wasn't two part time jobs but one full time and one additional part time.

I spent three years doing mostly nonclinical (more public health) work overseas. Moved back to the US and had to go straight (2 days later) to take my NCCPA exam (which I was sure I would flunk) but did fine on it. Took a 3 week ER medicine course and was right back in the saddle in FM/ED without a problem.

I'm feeling my way through this. I profoundly love writing (am deeply into a thriller novel with a PA protagonist) because I get to create a parallel universe of my liking and live within that world for a few months. But, it is not conducive to building friendships as it is a solo venture. If it had not been for COVID and me getting a bone marrow transplant just before, I would have been part of many groups (love sailing and hiking). I'm back to hiking, kayaking, sailing and biking, but all solo save my Saint Bernard Greta. I do miss immensity the people I worked with and some of my patients. Now I am no longer in the provider role, I'm becoming more friends with some of those patients (as long as we don't talk shop too much). I'm having coffee (social distancing) with a patient and her husband next week, with whom I've become close.

Your "kid" is college age already? I'm shocked with the passage of time.

Now this is a twist on the question. One of the things I'm realizing is how much of my socialization took place around work (both interacting with patients and staff). I know we are living in odd times with COVID, and if it were not for COVID, I think I would have moved right into other groups, sailing, hiking, writing, but the isolation intensified how much I missed those work relationships. I know that some people, and I've had jobs like that, where you never counted patients or colleagues as friends. So, how much would you miss your work environment socially?

About 5 years ago I was at a physician friend's house. She made the comment that her entire identity and self esteem was tied up in her being a doctor, that if she lost that title, she, herself, would be lost. At the time, I could not relate. I have so many varied interests that loosing my career as a PA, I thought would have little impact as I would pursue something else. Now that it has happened, it is much harder than I expected. I was thinking as food for thought, what impact would it have on you if your PA career ended today? Financially? Emotionally? What would be your fall back career?

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.