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Everything posted by ventana

  1. Yes own policy needs to be paid with after tax dollars then if you use it income is tax free yes to own policy at some point I will drop mine but now it is about 450 month and good for about 80k per year and is my profession and speciality, meaning if I can not work as a pcp pa I can collect. No saying I could go work in a different field and therefor denying me. Expensive but worth it. I mtb and race a bit and have young kids and sig debt but also approaching 50.
  2. What about this scenario. Sheriff (she does not hold any type of license to practice medicine) states “no suboxone or methadone in a jail because I don’t believe in them, I believe in abstinence” so people coming in (even those stable for years) are forced detox. Is this his person practicing medicine with out a license? Is this admin making medical decisions?
  3. easy to tell rather you will sink or swim in PC length of visits is everything (just about) new patients - one hour in the book (45min for young simple) follow up - mostly 30min only the most basic simple nothing type complaint gets a 20min visit NEVER NEVER NEVER over booked or double booked or dove tailed or any other polite way to tell you they are going have you see more patients in a day Total daily patients 12-16 MAX that is is and less if highly comorbid or new provider As well YOU control your schedule, no some remote bean counter as well YOU have an MA dedicated to you at all times You get a lunch that NEVER gets taken - or you are paid right on through you lunch (most will work right through lunch so this idea of getting 30min unpaid for lunch is just a way to take money away from you) CME $2500 min Time off CME one week Salary - at least 90k - if you look at the amount you make *not billed but collected* most new grads will be in the 180-200k range so you are covering you own overhead Oh yeah and mostly a 4 day work week is considered full time - it is just the way it is..... I love PCP but I hate insurance companies - I now work for the state in a highly respected small jail and love the medicine - and I get to pretty much always mostly control my practice.....
  4. I like it - but I think it is too late.... What good reasons do you have for making our degree a doctorate? I find that more of a barrier than anything. Oh boy - PLEASE go read previous threads on this - it is perception and politics - and yes they do make a difference.... Thread views is just that - I have probably "viewed" this thread 100 times, but only voted once and only one person... BINGO We got passed over for Hi-Tech funds due to our Name - Assistants fall under the Doc - so Washington (and the old guard at AAPA who were asleep at the wheel!) cost the PA profession ($24,000 x 100,000 pa's) $24,000,000,000 That is REAL NUMBERS and that PERCEPTION is everything in DC Would you rather get seen by a practitioner or assistant
  5. This is not meant to be self edifying... Have a new patient - 45yr old male, hx of Hodkins lymphoma many years ago - something like 15 I am not overly familiar with this, and read uptodate on it - (I know what I don't know) Says that they are at increased risk for colon CA and should have colonoscopy early I talked to him, explained - NO ONE not his PCP or Onc doc had ever mentioned this to him, so off to colonoscopy he goes - turns out precancerous polyps seen and removed... PCP is not about knowing it all, PCP is about reading, educating, and communicating to the patient what you have learned - it is not degree specific (to Boarded Doc's had NEVER mentioned this to him.....)
  6. the point is a doc would be 200k+ and they are treating us better then the 100k 3-4 weeks PTO (which everyone seems okay offering)
  7. One year. Start looking elsewhere at about 10 months. Hve seen jobs in Ca for 160k so 50 per hour might be low. Based on col.
  8. oh yeah, and if you ever come up the the New Lebanon NY area and want to open a clinic let me know - getting tired of the corp area and I could be your local guy....
  9. how did you work around the law that states in no way may a PA employ a doc? How can you own the practice and have a CP?
  10. have run into a few of these CV booster NP's - they have never worked as NP and have no clue about it I have also seen some RN's get their NP - try to work as a NP, fail and go back to floor nursing..... being the decision maker is not as easy as second guessing the decision maker.....
  11. full disclosure. I deleted all the off topic banter. Let’s keep it on track and not attacking each other.
  12. DO NOT rely on the VA coming through with an offer.... they are historically slow I have tried for almost 17 years (Yup YEARS) to get hired they offer a 50% pay cut stay where you are at.... so much of the time I think new grads are overwhelmed and unable to see the positives of a position. Branch out a little bit - see some other patients, do it on your own, wander around, ask questions. NEVER change you notes based on someone telling you something NEVER NEVER NEVER put legal words in you notes that you do not understand - EVER - you will be burned, hung out to dry, and eaten alive for this. This is a tough lesson, but it is YOUR note and no one elses - be kind to your attending - he or she can sink you and the way of the world they are higher on the food chain... accept it, defer to them on medical decisions you disagree with (this can come in handy sometimes when you play it right) Document that you consulted with your doc and they wanted to do XYZ. If anyone besides your doc tells you alter, edit or change you note - politely answer "no thank you" I really mean it simply say that even it does not make sense in the conversation. You are not to be bullied or influenced. Period. So hang out, collect a pay check, get to a year of work, still do the VA application process, hope you get that and you can simply move on painlessly - BUT DO NOT quit with out something lined up. Meaning sign contract that outlines start date and pay irrelevant to credentialing process. Do you have your X number? Ask to get sent to a CME to get it - it directly applies to your field, and gets you 3 days out, and a valuable knowledge base and an X number. go to CME, call in sick, take your vacation, show up and leave on time, read a lot on shift.... you get the idea. create your own realm of happiness while you look for something else.
  13. This is what reasonable job posting is..... (I am not a recruiter or in any way connected to this job - just a good example) Nurse Practitioner or Physician Assistant National Medical Services - Oakfield, ME $110,000 - $160,000 a year Apply Now We are seeking a Nurse Practitioner or Physician Assistant for an Internal Medicine practice in Maine. Practice Features and Requirements: Will consider experienced providers only. No new graduates. Other providers on site. Anticipated patient load will be 16 ppd. Schedule will be M - Th, 8a - 6p (4 - 10's). No call and no weekends. Salary will be $110 - 160k(including incentives). A comprehensive benefit package includes 8 wks vacation, malpractice, health insurance, dental/vision/disability, retirement, and 1 wk paid CME expenses. Financial relocation assistance. Generous sign-on bonus. This employer has own internal Loan Repayment Program worth $45k ($15k for 3 years).
  14. Totally fine with this, as should the AMA and NCCPA Age is no joke and out profession has a huge amount of pressure and power - with horrid effects if we get it wrong. I think safety to society trumps an individuals right to keep working when they are unsafe.... have seen Doc's fall asleep in the exam room and certainly not stay up to date....
  15. I know you have a bug about nucs, having interacted with you on the thread you mention. My point here on this particular thread wasn't to rush to order one but to recognize that people who need total hips (the case presented here) or total knees are generally NOT currently active marathoners or competitive racquetball players. And it often hurts like crap for them to even try to exercise. Add in some risk factors and the patient ends up needing an evaluation. If the patient can't exercise (as in many THR cases), the fallback evaluation would be a chemical stress test -- like with dobutamine -- which certainly should be considered. From a practical standpoint, these can take a lot of clinician time (I've done many of them) in that the patients often need a kicker of atropine and then sometimes yet another injection of metoprolol after the test is over. Compared with that, the 4 minute Lexiscan nuclear stress test is often less stressful for the patient and it takes way less clinician time (I've done a fair number of these, too). Going with a nuc for a relatively sedentary patient (due to hip pain) is not an instant indication of fraud or contraindicated by data. And it bothers me greatly to see my specialty painted with that particular brush as I know it would pain you to have yours similarly labelled. Now I'll hop off of my soap box, too. The patient I was referencing was for a total hip! just because a joint needs replacing does not mean the person can not move. In this case he was highly mobile and giving himself a great stress test 2-4 times per week with maximal effort on the court and bike. My point is apply the guidelines, don't just default to the nuc because you can and it provides pretty pictures. I have also seen more then one person (many) get cath'ed of a ? nuc - to have a normal cath oh those "attenuation errors or possibly ischemi$" lines kill me......
  16. the BS wasted time of notifiy and reviewing shi%% with my doc for the mere purpose of record keeping. what a waste of both out times....
  17. what was the outcome??? I think there is liability to be spread around i think providers should be documenting in some way when admin tells them to do things that negatively effects their patient care. I would be very interesting to draw admin in on these suits and see them sweat getting sued..... love the idea
  18. Gotta add one thing. For those that do preop evals. Please read review and learn UpToDate sections on how to do them. Commonly people do way to much. Simply talking, figuring out surgery reviewing data. Is all that is needed. There is no evidence that ore operative cath and stent placement on asymptomatic active folks does anything but make money and sentence the patients to a lifetime of accessing care. First the stent. Then plavix then the Er. Then the follow up. Then the recath. Blah blah blah.
  19. Here we go again. Why always go to a nuc stress. First get to know the patient. Are they capable of an ETT. If so do that. Stepping to a nuc stress on everyone is fraud in my mind. In needed. Not supported by data, exposure to radiation and in general just cards folks overthinking (and over ordering testing). Now if the patient can’t do an ETT I will be first to order nuc I have literally had a cards doc order crazy stresses on a guy doing mtb races and 2+ hours of competitive A level racquet ball Patient finally fired the cards doc, got another one Did fine with surgery and still doing fine years later Turns out the overzealous doc owned a catch lab and was known to do thus with all patients Sorry my band wagon I will be quiet now See my my other thread about 6 months ago on this exact topic.
  20. Well after spending the day in the ER and having a family member admitted I noticed one thing.... The first 5 seconds of your visit are the most important for raport building.... and to put someone at ease. Lots of people coming in and out of the room, only one actually stopped, fully introduced themselves and explained their roll in the delivery of care. That one was received the best by the patient and myself (I was there as family, no name tag, keeping quiet in the corner so no one knew my position/education/title) Those first 5 seconds are critical and so many people waste them by just jumping into history, or even worse exam (way to fast!) So stop outside the door take a deep breath knock, ask if okay to come in walk in slowly, close the door behind you - hospitals are noisy places introduce yourself, your title, and your role ie I am the hospitalist provider Shake a hand or make and effort to touch the patient is a gentle introductory way - if received well indeed shake the hand, if not received well just stop looking for contact Pause briefly and let the patient and family absorb who you are, what you are, and what you are likely doing there.... Max 5-10 seconds and yet it sets the stage for a successful interaction...
  21. bad idea to ask specific medical questions on this forum.... But EKG Echo done Consider perioperative betablockers and stress test based on activity level of the patient - if they are a runner doing 10k's with this EKG unsure of the value of a stress, if they are a 100pk year smoker, every relative has died of AMI < 50 yrs old, and cholesterol is cruddy, well then you know what to do (right, you do know what to do right???) Some of this will also depend on what you have to access to specialty care
  22. But what is the fun in that? But seriously - sometimes giving credence to a stupid question is not the way to handle it. they will just keep calling and calling (is what I have found) Another pharmacy, another pharmacist, another pharma tech, then the front office person, then corporate..... blah blah blah. Just let them fill the legal script you provided - if they have questions THEY can look up the state law on interchange. Just make sure you know the state law on interchange 100% so that you are positive in the script you write.
  23. good luck if a place of employment is not interested in defining or advancing your roll you will run into roadblocks every step of the way. I have seen this over and over again in practice when PA and NP are just hired as and after thought then dumped on. it sucks and trying to change it is well worth it. I would start with about a week of a time study - literally write down everything you do and how much you do it - min by min tracking of what you do Then compile this and develop a list of the things you do Then use this to write a job description. in selling it to the admin folks explain how you came up with it - stressing all the positives and even things you are willing to do, and just politely leave out the things you don't want, and hope they don't realize it.
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