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primadonna22274 last won the day on August 15 2017

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  1. Hi, 

    I was just accepted into the upcoming APAP class. Can I send you a message somehow? 




  2. I rarely check the boards anymore. But, since you asked.... None of the APAP folks have had any difficulty matching to residency of their choice. What you want to do can be accomplished by FM or IM with sports med fellowship, but might be best achieved with PMR with or without sports med fellowship. I’m thankful every day that I went back when I did. I am happier and more fulfilled as a physician where the buck really does stop with me. Good luck! Lisa Sent from my iPhone using Tapatalk
  3. hi. my name is Jill. i just did interview at lecom today. ive been a pa for 7 years, am 32, married w 3 children. i read that u worked some through school. would u mind sharing how much u worked? im currently used to working a full time job and 2 part times... do u think working a shift per week would be doable? Thanks! Jill 

  4. Last I checked there were 19 PA programs in that small state...it's probably more like 20-22 now. Sent from my iPhone using Tapatalk
  5. I think it folded quite some time ago, but I've lost track. It's sad though because they had a good model and people came out well-prepared and respected. As all things in PA residency go, the funding dried up. Sent from my iPhone using Tapatalk
  6. Not likely eligible for deferral unless significant extenuating circumstances. You would reapply. Sent from my iPhone using Tapatalk
  7. The way I read the proposal, it's specifically designed to be exclusive. Likely whoever wrote it has a vested interest in this--it makes some shred of sense to me that the proposal is intended to extend independence to PAs who have completed advanced clinical training, unlike a DHSc. The sticky wicket here is what about all those highly trained residency grads who have loads of experience but only a certificate to show for it? Sent from my iPhone using Tapatalk
  8. LECOM does have a reputation of being rigid. Can't argue with their results though. Go anywhere you want, but don't expect an established program that's worked the way it's worked for 25 years to accommodate you. Sent from my iPhone using Tapatalk
  9. There is an art to telling patients frankly that their lifestyle is directly harming their health. It can and should be done without shame--but this requires a respectful discussion. I like to ask directly: how do you think your weight impacts your knee pain? I have had blank stares from a few folks who honestly never put 2+2 together, but most people tell me they know it's not good. What you don't do is what I used to say in my younger and less tactful days (INTJ me, sorry lol): "The human body was not designed to carry the weight of three people on one set of knees". I used that line a few times...ouch. True but yikes. Sent from my iPhone using Tapatalk
  10. This is interesting. Semantics, though: Doctorate of Medical Science (DMS), not Doctorate of Medicine. The distinction is important because the training is different. I will watch this with interest. Sent from my iPhone using Tapatalk
  11. Mandatory attendance for lecture pathway (I found I learned best this way). PBL and IDP require less time in seat but much more reading and if you fall behind, you are toast. Must not miss mandatory meetings and there is always OMM which is non-negotiable. Anybody who expects to work even half-time in any clinical capacity and is found to miss class obligations will be canned. Would you take that risk at 50+k/yr? I wouldn't. Sent from my iPhone using Tapatalk
  12. Marriage did not last but for many other reasons. Me pursuing APAP was only a small part of many other difficulties. One could argue that I sacrificed home life for career. For me, that was the right choice, but I don't have kids. Sent from my iPhone using Tapatalk
  13. Yes, but difficult. I had a hard time finding work the first year at all--Hamot ED never got back to me and St Vincent's ED wanted full time only. Urgent care was scant at the time (I think there was only a MedXpress and I didn't like their concept at all). PA pay was far lower than I was accustomed to as the area is saturated with 22yo who will work for 30/hr. I did teach a physical diagnosis class for the PA program and that provided a small amount of income and I enjoys it. Really I had no business working M1 anyway as that was the most challenging time academically. I ended up making my first FM rotation into a Saturday job and it was a godsend as I was running out of money by then. Honestly having some regular income allowed me to stay in school at a time when financial hardship was the most difficult. (I was sending half my loan check every semester back home to support my husband and dogs...don't do that...it only leads to resentment and erosion of respect). I worked all through M2 quite regularly and sporadically during M3 when I could, although very difficult on rotations and there is no vacation in the accelerated program. Sent from my iPhone using Tapatalk
  14. I support collaborative practice over the supervision model. I would like to see this evolution in the next decade. I truly believe it's possible. Sent from my iPhone using Tapatalk
  15. Hockey player: Proud of you for getting through so far. Remind me, are you M2 or M3? Don't remember...life has moved so fast since I started this journey in 2008-2009. I haven't had much time the past three years of residency to peruse the PA forums. When I do look, I am chagrined to see that there seems to be a rather vocal representation of the "primary care doesn't need a doctor" mentality. Let me tell you about my typical day as a primary care physician. Take just a half day of clinic. I have 10-12 patients, average age 68, with no less than three and generally 5 or more overlapping and intersecting chronic conditions. Let's just say representatively (off the cuff here): 68 yo F widowed, lives alone DM2, Hypothyroid on TRT (the only medicine she takes faithfully), BMI 39, dyslipidemia, depression with somatization, caregiver stress, housing and food insecurity, chaotic family members, widowed, isolated, lacks a reliable car, lives in a rural area without public transportation, still periodically supporting her almost 50 yo kids who are sicker than she is due to a combination of lifestyle disease and really crappy luck. Will only see me because she doesn't trust just anybody. Very sweet but can't get through a visit in less than 25 minutes for simple refills. 84 yo F, retired diploma RN, was as high up in the local order of Masons as a woman could get. Had to give up her post after progressive struggles with memory and cognition. Beat breast cancer 5 yr ago and now facing Alzheimer's dementia that she is aware enough to know she has lost anything higher than first grade math or sixth grade reading. Terrified to drive and has given up her license under family pressure after getting lost a few too many times. Knows what she has lost and grieves it. Still lives alone but wonders when she will have to move into a supervised setting. 47 yo M with infantile spastic CP who works as a mental health counselor. Biggest problem is spasticity of lower limbs and progressive difficulty walking. Super nice guy who struggles with mental alertness vs symptom relief. 26 yo F mother with three worthless baby daddies whose picker is broken. Lovely woman. Works damn hard, just enough to not qualify for Medicaid and not enough to afford private health insurance for 3 kids under 8. No family support. Moderate persistent asthma that was well controlled during pregnancy but as no longer pregnant no longer qualifies for state Medicaid and can't afford steroid inhalers. 3 ED visits this month. And oh yeah the 3 yo has had a few visits too for breathing problems. No social support and worse in my residency clinic with no social worker so two babies 2 and 3 yo are severely behind in preventive maintenance and immunizations. 62 yo F with autoimmune hepatitis of uncertain explanation. Doing much better on prednisone and will be starting biologics soon. Thank goodness for the GI specialist who can review all the labs we've done short of liver biopsy and confirm suspected dx of AIH and order Imuran for the patient but doesn't have/take time to explain diagnosis and prognosis of AIH. Patient wants to know if this will kill her. 31 yo M hospital f\u decompensated SHF EF 15%, idiopathic. Also uninsured. Needs incredibly expensive medicine and close followup to have a chance at recovery. Can't afford any of the above. Family is suddenly without income as he is a long-distance trucker. Patient is scared and wife is more scared. This is my first hour of the day. Do any of these need a doctor? Perhaps not. But I can breeze through them far more easily after several years of progressive responsibility as a physician resident and now an attending who has seen every permutation of these four scenarios in residency training over the past three years. It doesn't take me much time to exercise these hurdles with facility because I've been immersed in the system for the past few years. I know how their disease pathology interacts with certain medications and can anticipate drug-disease interactions without batting an eye. I don't tease myself that any experienced PA couldn't do this either-I know they could, and I did. It may be an unpopular view on this board but I don't support independent practice rights for PAs right out of the gate. I do support a tiered system that allows for experienced PAs to advance their role and limit dependence on a supervising physician over time. I don't know what this looks like in real time. I can tell you that I functioned fairly autonomously in outpatient primary care from postgraduate year 3 and beyond as a PA, but when I went to the ED in year 6 I again faced a very steep learning curve and it took about three years before I didn't feel risky starting some critical patients before staffing with an attending physician. I still would not staff an ED solo as an FM physician (and don't believe I haven't been asked, for far too little money and far too much responsibility) even as a BC FM physician because I hate trauma and I feel inadequate there. I can run a hospitalist service and stabilize and transfer critical care quite well. Perhaps you can as well. But that isn't the question. The question is does the patient need a physician to treat their multisystem disease with no less than 9 drugs (the magic number at which drug-drug interactions are notable) or if this patient would be adequately served by having a PA or NP as their PCP? I don't think we know the answer to that question. I do believe (biased though it may be) that patients want to have the most highly prepared and qualified HCP attend them and there is no substitute for three plus years of 80+ hr weeks and the immersive training that is physician education in the US. On that note, I'm going to bed. Night all. Sent from my iPhone using Tapatalk
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