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LoRezSkyline last won the day on March 26 2015

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  1. Textbook Morgellon's/delusional parasitosis as others have suggested - have had similar patients in the ED convinced there was something sub-q that needed to be dug out or (even better still!) bring in ziploc bags/envelopes of said mysterious substance to be "analyzed" - makes for an interesting conversation when you tell them that isn't exactly possible...
  2. Considering the tuition repayment bonus of $5K and the fact that your dental, medical and vision are paid at 100% by the hospital, I'd say that makes up for being short a grand or so in CME funds as compared to average? Overall, sounds like a solid offer for a new grad in EM - especially if it is a good learning environment and you're given a fairly broad scope.
  3. ...except there's not an Ortho Exam for PANRE. Your choices are Adult Medicine, Surgery or Primary Care - see NCCPA's own site THE PRACTICE-FOCUSED COMPONENTYou have choices if you plan to take the PANRE. While 60% of the generalist exam will cover the same content as always, the remaining 40% can be directed towards more general questions in one of three areas: Adult medicine Surgery Primary care This option gives PAs the opportunity to focus more of the exam on their general area of practice--or continue with "business as usual" by choosing the "primary care" option. The PANRE will still be an exam based on general knowledge, you will just have the option of having more generalist questions in one of the areas listed above.
  4. I've transitioned to UC now after 5 years in the ED in search of more time to spend with family, so there's already a good deal of overlap and I've been to my share of EM CME conferences thus far. Curious as to what is out there that's UC-centric, however, and interested in opinions of others who have worked in UC longer than I have? I've looked some things up online, but primarily interested in opinions from fellow PAs. Open to any suggestions, but a couple I had seen and was interested in feedback on: Urgent Care Assoc. of America (is this organization worthwhile to join, are their conferences any good? I paid $50 for just a JUCM subscription alone they offer this year, wondering what the $195 dues offer on top of that?) http://www.ucaoa.org Hippo ED Urgent Care Rap (ditto - any good?) https://www.hippoed.com/urgentcare/rap Ortho ED (not specifically UC, but was looking at boning up on rads/MSK - worth the membership?) http://orthoedu.com ...and anything else you might suggest? Thx in advance!
  5. An aside, but for anyone looking for a fascinating read/listen laying out all the factors that brought us to this place - check out "Dreamland" by Sam Quinones. https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521/ref=sr_1_1?s=books&ie=UTF8&qid=1475887947&sr=1-1&keywords=dreamland It ties together the hollowing out of America's heartland, the rise of disability & Medicaid, the initial shift towards opiates being seen as "safe" and "non-addictive," Oxycontin's debut as a blockbuster drug and all the lies that accompanied it - and last but not least, the wave of cheap black tar Mexican heroin that followed. It gets a little redundant by the end (I listened to it via Audible) but it's well worth your time regardless as some of his points deserve to be driven home. So many lives destroyed, lost, down the tubes - it's just too much to comprehend by the end. I'm off to check "Hillbilly Elegy" by J.D. Vance next, which I've heard is equally good... https://www.amazon.com/Hillbilly-Elegy-Memoir-Family-Culture/dp/0062300547/ref=sr_1_1?s=books&ie=UTF8&qid=1475888519&sr=1-1&keywords=hillbilly+elegy
  6. Curious - why is PAEasy so bad/to be avoided? Questions too simplistic, not representative of true PANRE content? Or something else? I'm considering buying a month or two to ROSH Review, although Kaplan Q-Bank is still in the running as well. Any thoughts/feedback on those? How about this PA Life guy's PA Academy PANCE/PANRE prep course? I take the test in two months so I don't have the time for something involved or the need for 12 month access. Having been in ED/UC since graduation, I feel like my knowledge base is still solid though. I also sat through one review course already, but not sure how much I absorbed as a 4-day review conference just gets mind-numbing after a while! Still have the manual and plan to review that when I'm able, though.
  7. Wake Forest is an ideal mix of PBL a few days a week - it's integral to the program, but not the only way you learn. You'll also get classroom-based lectures on core topics, gross anatomy, lab medicine, small group sessions to learn physical exam/interviewing skills and more. I couldn't have asked for a better experience.
  8. Heya Febrifuge So you're leaving UC?!? I was surprised to hear that along w/ your questions about AFPPA. I attended AFPPA's conference as a student in 2010 or 2011 (can't recall exactly) in Charleston, SC and it was really well-attended and well put together. Sounds as if their website may be the main issue, as they're definitely having conferences - here's the link to last year's? I recall them having both Spring and Fall conferences at different locales in the past. https://www.regonline.com/builder/site/default.aspx?EventID=1634050 I thought the AFPPA conference I went to was on par with SEMPA's yearly conference, and as a soon-to-be-new-grad-sitting-for-PANCE student it was a solid overview of HTN, DM, women's health, basic ortho and the likes. I'm fairly certain I ended up getting a print journal or two out of the membership as well, and they had an email list of some sort I'm no longer on. I basically signed up for a year's student membership to be able to attend the conference at a discounted rate, let that lapse when I graduated and went into EM instead. I think since I attended, they may have brought in Jay Chamberlain, PA-C and his company CMR4CME to help organize and oversee their conferences - but he does his own conferences and helps out MAPA and possibly some other regional PA groups with theirs as well, so again, a well-run-outfit putting together the conferences? Things could have changed in the last few years, but that's my experience? Also, to the other poster mentioning the lack of a psych PA organization - head over to AAPA's Huddle website/forum, there have been several psych PAs networking over there lately and talking about representative groups. Hope that helps!
  9. Curious as well to hear how this goes - please report back? Would like to know how many of the initial online/distance lectures they have you view also and what topics they cover?
  10. What you're experiencing sounds dysfunctional - and I'm not sure which personalities sound more pathological to me, your homeless heroin-addicted patients or your attendings?!? While your patients sound potentially more problematic and risky than your average Fast Track patient population, as EMEDPA said you should not have to present every single patient to an attending if they are truly ESI Level 4-5 and fast-track-appropriate. If they truly want to get the times down, they should allow you to TX/dispo the ones that you feel comfortable handling and aren't mistriaged/potentially sicker. That at a minimum (and much more with time and experience...) is well within your scope of practice as an EM PA-C. Your lack of bluster and false bravado shouldn't cause them to think you're incapable, either - a healthy measure of caution as a new grad starting in the ED is exactly what you should have right now. Attendings should welcome/expect that in a new grad. Those other PAs are faking it 'til they make it - right into their first court deposition/lawsuit because they didn't know what the hell they were doing and were too afraid to tell anyone! With that said, you still need to present yourself in a composed fashion and with confidence (have your presentations down cold and at least propose a differential/treatment plan, even if you're uncertain of it) but they should not treat you the way you're describing above. Sink or swim is one thing, try to swim while I'm tying weights around your ankles and pushing down on your head is another thing entirely! My guess is you have limited options if you're in an urban area where competition for jobs is tough and people put up with this kind of crap to get their foot in the door for an ED job - but I would look elsewhere if at all possible as this environment sounds toxic. Work on shoring up your core knowledge as fast as possible so your own confidence/competence will improve as well. EM Basic podcasts/show notes are a good starting point, as are a CME course like the EM Boot Camp below? Minor Emergencies is probably the one Fast Track text I'd recommend. A new setting plus a good foundation will likely change your opinion on what it's truly like to work in EM. http://embasic.org/podcast-direct-download/ http://traffic.libsyn.com/embasic/EM_Basic_Show_Notes_Master_File_PDF_8-27-12.zip https://www.ccme.org/embootcamp/ http://www.us.elsevierhealth.com/family-medicine/minor-emergencies-expert-consult/9780323079099/ (Minor Emergencies is cheaper elsewhere, for some reason this site is not letting me post an A**zon link though!??) Best of luck, let us know if we can help in any other way...
  11. This is the kind of stuff that keeps me awake at night after busy ED shifts - have had a couple good saves myself, but on the other hand I always wonder what I've missed!!! I do appreciate threads like these and learning from the experience of others, though. Curious on the vertebral dissections you mentioned below - traumatic/atraumatic, with what symptoms/how did they present, what caused your radar to ping and order the CTA versus all the other neck pain/HA that you don't scan?
  12. ...believe it or not, there's actually a podcast devoted to this - i'd be wiling to wager that's where your pharm friend got the idea as i think it was created by a pharmd or pharmd student? i listened to a couple episodes out of curiosity in PA school - i would highly recommend it as a sleep aid, but not for much else! as others have said - there's so much out there you COULD memorize before PA school - this wouldn't even make my own personal top 200, though. whatever anatomy resource you prefer plus a copy of clinical pathophys MRS plus a $1 used copy of the merck manual of medical info is all i'd recommend flipping through. memorize nothing - take the opposite approach. forget the lyrics to every pop song you know. start with "achy breaky heart," that one is particularly useless - even if you go into cardiology! you will need every neuron, nook and cranny of storage space you can muster for PA school!!! http://www.amazon.com/Clinical-Pathophysiology-Made-Ridiculously-Simple/dp/0940780801/ref=sr_1_1?s=books&ie=UTF8&qid=1428892204&sr=1-1&keywords=clinical+pathophysiology+made+ridiculously+simple http://www.amazon.com/The-Merck-Manual-Medical-Information/dp/0743477340/ref=pd_sim_b_3?ie=UTF8&refRID=0YBGPQYBS7BN8TXWRFT0 honestly, though - read whatever you'd like for pleasure and you'll probably still be better off. i remember somewhere midway through first year where i would have killed to have had an hour just to kick back with a favorite novel for a change!!! you do so much reading, and it's all so clinical it really starts to wear on you :(
  13. Move. This is more important. You have an acceptance in hand at a good school. You're not going to be able to continue working while you're in school anyway. Your friends will understand and your boyfriend will as well if the relationship truly has the weight you assume it does. If you haven't yet achieved your goals, those need to come before the relationship anyway. You'll be finished in two years. Another year waiting means passing on that lost acceptance and missing out on a year or so's new grad PA salary at $80K or so a year as you'll be delaying your bump up in salary. Don't even think twice about it.
  14. This is what ticked me off the most. It's not an actual editorial from their staff, but it is a letter from a reader that the editors chose to publish. Unless their goal was simply to generate clickbait, that seemed a pretty disingenuous dodge to me as it's still coming out under the banner of ACEP Now. I am starting to wonder if collaborative, dependent practice is truly the compass we need to be following the more and more stuff like this I see or run into in my own experience :(
  15. Gregory Raines' response merits re-posting here, for anyone who hasn't had a chance to check it at the original link. When I first saw the article, there were zero comments - glad to see folks stepping up to take this guy's rant to task, as ineffectual as it was! "Dr. Menowsky, Your “letter to the editor”/opinion piece is no more than a call to arms to attempt to disarm a group of health care professionals who too have spent many years training and working in medicine, usually in partnership with physicians, providing access to people where physicians won’t go. Your solution is to attempt to roll back the clock and make access for them more difficult? How exactly does that benefit patients? It doesn’t. Do you have any data showing advanced practice providers (mid-level providers is a DEA designation for non-physican providers, not an official designation assigned to PAs or NPs) are inappropriately misprescribing medications? Do you have any data at all showing worsening abuse potential by PAs and NPs when prescribing medications? We can look at the disciplinary complaints of various medical boards and compare apples to apples – when you do, you’ll find its physicians who abuse their prescription rights moreso than PAS and NPs. Do you have any data showing that PAs and NPs have higher complication rates associated with placements of central lines, intubating patients, placing arterial lines, or doing other advanced procedures? You don’t. The only literature that is available looks at ICU use of PAs and comparative outcomes of PA-run ICUs (under physician supervision of course) vs. traditional ICUs. You won’t like the data – the PA ICUs have better outcome rates. So at a time when there aren’t enough health care providers, PAs already prescribing in all 50 states (some have schedule limitations – again, no data to support this nonsensical handcuffing of providers), and NPs are trying to attain prescribing rights so they too can care for patients to their fullest capability, what is it exactly that you are protesting? And why? You want to stay at the top of the medical food chain – that’s the only thing I glean from your article. This retrograde approach to the practice of medicine had no basis in fact, is nothing more than a call to arms to “protect turf” against other providers, and smacks of elitism. Even as an opinion piece, I am surprised this was allowed to be published in ACEP Now as EM PAs have been nothing but supportive of our physician colleagues and supportive of ACEP itself. Be careful in how you choose to lump PAs and NPs together – PAs have always supported the team approach to care, with physicians as the lead provider, but if you are going to pick a fight with other providers, perhaps PAs themselves would be better off aligning with NPs or declaring themselves independent providers and push for changes in legislation to that end. As this is in response to an “opinion” piece, I will state that this is just my “opinion” as well. But be careful in how you catalog PAs – we support the Physician-led team approach. We do not support inhibition to access to care. Sincerely, Gregory Raines, PA-C Immediate Past President Society of Emergency Medicine Physician Assistants"
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