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Everything posted by ventana

  1. please search past posts
  2. I am seeing an ongoing trend with Cardio folks way overshoot the mark on what they are ordering to r/o AMI and pre-op clearance. Just the other day I sent a 51 yr old WITH ZERO RISK FACTORS to the ER as he had 2-3 days of CP, and I just was not 100% comfortable with saying it was not cardiac with out a troponin. Yup trop was NEG/to low to measure. Cardio consulted by ER doc, recommends a NUC stress - which they call the patient the very next day to do in less then a week. Meet with the patient urgently to discuss and he literally says HELL NO - he knows it is not his heart, he has no risk factors. I try out the HEART app and he has a score of like 2 (4 and above needs work up) And cardio has fast tracked him for a NUCLEAR study. This guy can walk, run, and literally has not a single risk factor (no DM, HTN, lipids are perfect, BMI normal, No FMH at all, normal EKG) Why order a nuc study when every guideline says at most he needs serial trops, leaning forward would be an exercise - never a nuc - - but of course the Nuc pays a lot more for the cardio doc.... Then I have lost count of the number of pre-op clearances which Cardio docs are ordering Cath's to clear people for low risk surgery in patient with NO symptoms - some are athletes who are certainly doing their "own stress tests" every time they ride their bicycles, or play basketball ball or go running - yet they are ordering caths on them for low risk procedures..... What is going on? is it being overly defensive, not knowing the guidelines or money making? Lots of articles coming out lay press about cardio to way to many interventions has me wondering....
  3. but if we "listen to that voice" with every single patient (they had note even seen the recent one - only a phone consult) are we just ignoring the guidelines?? I am pretty much done with this topic - I see rampant abuse of the system where specialists seem to have a carte Blanche to do what ever they want, and yet I am left filling out PA's for MRI's for everything..... or anything even slightly off formula .... the system stinks...
  4. Warning - the following is a vent I have had no less then 6 different interactions recently where people have been boasting, bragging that "their NP has gotten then Doctorate" some of these include 1) a local practice in which the Doc was bragging that their NP had their doctorate 2) local np's bragging that they now are doctors 3) local PA stating that his wife "has a doctorate" Then I look in the paper and see new practices (PT and Audiology) in which they talk about their DOCTORS - yup PT and Audiologist I am dismayed - some of these are newer grads, and are elevating themselves ABOVE a highly experienced PA's and NP's purely on the grounds of clinical degree (even if the PA degree is FAR harder then the online DNP degree a lot of them are touting...) 10 years ago I predicted this was going to happen, and now it is happening. The lay person has not a prayer of realizing the difference and the only thing PA's can do is get a doctorate to not get left behind..... Annoyed this is necessary, but how is the fastest cheapest way to get a DMS or other doctorate??
  5. No high horse here. Just a primary care PA that reads and believes that guidelines and EBM should be followed. I have no beef with the appropriate test getting ordered. But no risk factors by the heart data at 51 male says new trop x 3 and no additional work up needed. This is defensible EBM. It is not me making rash decisions, it is following best guidelines. Sometimes I think people forget interventions can be dangerous. Just had a great PT get second opinion in Cleavland. They got her so pre Renal dehydrated (kept postponing cath due to conflicts is scheduling but kept her npo and on her normail diurects that she got in trouble. Had zone 3 liver death likely from dehydration and now her abd is full of ascites. They likely took a few years off her life cause they kept ordering more studies and forgot the basics. Another cardio booboo. Point is we in primary care need not take a specialist word as gods as gods spoke word. We need to talk to and listen to our patients and synthesize the information presented to us. Don’t just go along, think. Read. Talk to patient. Team joint decisions. I hate to pick on cardio but it seems they are the biggest culprit right now. Just because we we can do something does not mean we should.
  6. I totally disagree with some of this Please show me even a SINGLE study or guideline that states in patient like I described, whom is perfectly able to walk and run that NUC should be ordered. In fact if you follow the HEART guidlelines on the iphone app for ER proviers a score of less then 4 doesn't need anything beyond serial trops. Sure work them up, IF EVIDENCE supports it, and with the right test. But I see just to many cardio folks going to the most expensive test with out any awareness of false positives and the injury possible by doing unneeded studies. One patient as a great example 73 yr old male, only risk factor was elevated lipids, not horrid just a little high. Plays very competitive tennis, 2-3 times per week, started to do cycling races this summer right before this evaluation (maximal effort for 45 min). Non smoker, healthy weight and diet. PCP in FL did clearance for elective hip replacement "say something" on EKG and got a cardio consult. They did a nuc stress (why not do a exercise was beyond me. In the nuc report it said there was basically an attenuation error due to breathing but could not 100% say. (Load of BS report) They were VERY hesitant to release a disc with images. After not discussion with the patient, and the risks of life long or 1 yr anticoag (they were advocating for a cath with STENT) in a healthy asymptomatic male he demanded a second opinion from a local university cardio. The short of it - he cleared him for surgery on the spot - then went on to state the the place that was recommending all these interventions had their own cath lab and just had purchased some new machine they were trying to pay for. WHY ON GODS EARTH WOULD A DOC SELL THEIR MORALS LIKE THIS? This was 4 years ago and the patient is fine s/p hip replacement and back to tennis and bikes..... was a total money unethical money grab. The PCP has since apologized to him for sending him there.... Their are some doc's that are just plain scumbags with medical degrees....
  7. I don't think it is bad to get a small amount of pay Medicine is simply a business now, and the idea that we should give away our time might (I stress might) be outdated... I don't think payment for rotations is what is driving the cost of schools If someone is getting $1000 for a month to 1.5 month rotation - that is MAX 12k additional on tuition As most times it seems tution and fees are in the 100k range for PA degree this is a 12% increase. Not pennies, but certainly not whey PA school went from a <50k degree to commonly a >100k degree.... It is not easy to have a student. At this point in my career I am highly efficient and am considering taking students if my place of employment will allow it. I had to assure them that I would not increase my hours (hourly employee) to teach, and this leaves me with giving an extra 40-60 hours a rotation "to the profession"??? That is something like $2000-4000 depending on your salary. With two young kids, a busy schedule, running a clinic, taking call every day, and trying to get time for myself I am not against a small payment for taking students. Not a lot, but enough to help offset the additional work. (I also believe PA students need to be challenged and this takes effort, they are not just shadow the PA)
  8. ventana

    Job issues- legality?

    If you are at will - yup they can just ask to you leave I would keep a METICULOUS journal of EVERYTHING that has gone on - you might end up before the board if you stay and you need back up paperwork. If you are experienced in the ALF and NH setting you should be able to get another job quickly
  9. ventana

    Crazy FB removals

    my way of thinking what attorney would sue if there was a signed form in the chart detailing that the patient should go somewhere else, and that this is against medical advice to have the provider here do it, and then a consent outlining possible complications. Just doesn't seem like a risky thing as long as the patient is informed and signs. This of course only works if the provider is comfortable with the procedure, and has made sure they will accomplish it the same way the specialist would (phone consult with the specialist). Simply ignoring the patients desires is not good medicine either... Maybe they were unable to even get to any other provider and this was the only choice they had??? so as long as a nice paper trail with signed consents seems like a reasonable way to do it. Back to the OP - anyone take anything out?? I swear I was the reattach finger tips on little boys whom got the tip of their finger caught in a door when I was in the ER - must hve done 4-5 of them over a year - first one plastics coached me on, then I did them in the ER my self...
  10. https://data.cms.gov/ many different ways to search, easy to find out ....
  11. What is a Physician Assistant? Physician assistants diagnose illnesses, develop and carry out treatment plans, assist in surgeries, perform procedures and guide patients. Their work is very similar to that of a general internist or doctor, but they are required by law to practice under the supervision of a licensed physician or surgeon. Jeffrey Katz, president of the American Academy of Physician Assistants (AAPA), says, "I diagnose and treat patients, illnesses and diseases and counsel them on their path to wellness." Often, the physician or surgeon supervision is more like collaboration, but there are certain archaic regulations that make life for physician assistants – and their patients – difficult. "To give a real-life example of these arbitrary regulations, in my practice, I can write a patient a prescription for morphine," Katz explains. "However by law, I cannot prescribe my diabetic patients diabetic shoes. Often, the stress comes in when PAs are not able to practice to the full extent of their training, education and ability." But the profession is filled with rewards that come from helping and treating patients. A 2015 AAPA study found that more than 96 percent would recommend their physician assistant career to others. Katz has worked in the same family practice in Taylorsville, North Carolina, for more than 20 years and has seen generations of families. "It is really cool to see the children of children. … I don't think there's any better gift," he says. Physician assistants are expected to continue to be an important part of providing health care services, as they can be trained more quickly than physicians but can provide some of the same services. The Bureau of Labor Statistics projects 37.3 percent employment growth for physician assistants between 2016 and 2026. In that period, an estimated 39,600 jobs should open up. Quick Stats $104,860MEDIAN SALARY 0.8%UNEMPLOYMENT RATE 39,600NUMBER OF JOBS Rankings Physician Assistants rank # 1 in Best Health Care Jobs. Jobs are ranked according to their ability to offer an elusive mix of factors. Read more about how we rank the best jobs. Physician Assistants are ranked: #1 in Best Health Care Jobs #3 in 100 Best Jobs #3 in Best STEM Jobs Salary 8.1 Job Market 10 Future Growth 6 Stress 4 Work Life Balance 8 Read about how we rank the best jobs. How Much Does a Physician Assistant Make? Physician Assistants made a median salary of $104,860 in 2017. The best-paid 25 percent made $124,200 that year, while the lowest-paid 25 percent made $87,980. 25th Percentile$87,980 Median$104,860 75th Percentile$124,200 What Type of Education Do Physician Assistants Need? Many professionals already have a bachelor's degree, or have some experience as a registered nurse, EMT or paramedic, when they start their physician assistant training. After this, hopeful physician assistants will need to apply to an accredited physician assistant program. These master's degree programs generally take 26 months to complete and include both coursework and supervised clinical work. Graduates then have to take a certification exam offered through the National Commission on Certification of Physician Assistants. Additionally, all 50 states and the District of Columbia require licensure, which is obtained by passing this exam and applying for a state-specific license. To maintain their certification, physician assistants must pass a recertifying exam every 10 years. Job Satisfaction Average Americans work well into their 60s, so workers might as well have a job that’s enjoyable and a career that's fulfilling. A job with a low stress level, good work-life balance and solid prospects to improve, get promoted and earn a higher salary would make many employees happy. Here's how Physician Assistants job satisfaction is rated in terms of upward mobility, stress level and flexibility. Upward Mobility Average Opportunities for advancements and salary Stress Level Above Average Work environment and complexities of the job's responsibilities Flexibility Above Average Alternative working schedule and work life balance Advice From Real Physician Assistants »
  12. it is little mentions of barriers to practice that end up getting attention from the politicians this is very strong work
  13. I can not say that I have ever felt "ranked" or paid based on what school I attended. Having an MBA might have helped, top 5% with honors in PA school might have helped. But not the school Think about it - what matters is your license, not the diploma/degree (beyond being able to sit for boards) So as long as one of them is not a HORRIBLE educational program (highly doubtful) go for the cheapest alternative
  14. while in IR I kept logs, and still have them somewhere... it might not be a insurance company requesting this, hospitals are now requesting this to prove proficiency. JACHO is pushing hospitals to keep/prove proficiency of their providers.... You should be able to contact insurance companies (pick the biggest 3 plus medicare and Medicaid) and request your past 3 years billings for certain codes or something like that - it is you UPIN after all...
  15. wonder if AAPA needs to look into this ??
  16. avoid the PSLF just live tight, get a second job, bank money - think about it - you can earn 50k extra in a year and pay off 100k in two years....
  17. Zero from home. Just dont do it.
  18. ventana

    Salary Report Optoins

    Have to look at years of experience and such. AAPA is tilted toward less experience pa last tI’ve i looked close at numbers. Also sample size is dwindling to almost irrelevant. MGMA yeah they are always low. Explain in your value and generated revenue and go from there. Yes you need to know what you generate.
  19. ventana

    CRNA's salary vs. PA's

    I make north of $100/hour as a PA.... I am happy where I am at even though I looked at AA and could have worked in VT
  20. ventana

    IR PA job with minimal radiation exposure?

    did rad for a few years some years ago left due to time in the lab, to much radation, even with doubled up lead, preg weight, leaded glasses, thyroid belt and the like Fact of the matter is when a patient crumps you stick you hand in the beam, or other direct exposures I loved it, and maybe will go back to it when I am old and now I have kids....
  21. ventana

    Interpretation of Labs

    the doc is pushing the non-reimbursable work to you you are not a scut worker carefully bring it up again, if that does not work try the passive aggressive approach of asking him on everyone, in email, that he has to reply to before you can answer patient. He will eventually get tired of this and do it himself (which is what it should be)
  22. I think there was an optional donation that popped up last time?? Maybe you donated?
  23. med school if you can if not PA then bridge program
  24. ventana

    New Year and New Job

    might not jump from current job with out voicing your concerns to management/bean counters if nothing else it shows them you care, and maybe it will change for the next person I have seen the tides change locally to where they are now trying to let the PCP actually do their jobs and going to 15, 30 60 min appointments Consider a good correctional medicine (not a bad one) maybe a acute rehab facility for some medicine and dependency issues- straight BUP clinics sounds horrid but an acute detox facility can e fun - challenging medicine, not their PCP for years, challenging cases.....

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