DigitalFusion04

Thanks for the input everyone. Serenity now - yes this is a Neurosurgery consult service for a trauma center. There is new data coming out to allow intervention up to 24 hours but there must be a special CT done which shows core infarct volume and pneumbra volume. This is not available yet in most places, and was not done on this patient. You have all brought up good points. We are a very agressive service and often change and write orders because my attendings want me to because it seems no one ever reads or implements plans well enough.

Medical device sales medical writing?

I lived at home for 2 years. Kept a beater and put 85% of paycheck into paying loans off, and got a per diem.

Today I went into a trauma center that I occasionally go to for the practice to see one of our patients on the weekend, a post bleed day 8 ruptured aneurysm patient. If anyone has experienced these cases they are very complicated patients that have multiple electrolyte, renal, cardiac disturbances. Anyway, i see the patient and note that he is on inappropriate medications for his condition including long acting narcotic meds. I inform the family of the changes, put in the orders, and walk out to find a PGY 3 resident in the ICU. I review the case briefly and explain to him which medications I've changed when he simply turns to me and says "no your not" and makes up some reasoning about how he is "like one of those pain management patients". Later, I check my orders and he has canceled them and resumed his own medications. I let my attending know who says she got into a fight last week with the trauma ICU attending and called him out for being unprofessional, rude and condescending. Several months ago I had another situation at this hospital where I was on call at night and had an inpatient s/p cabg develop stroke symptoms. The problem was he was last seen normal almost 9 hours earlier because the cardiothoracic team did not wake the patient up post op to do a neurological exam (which we are pushing more for recently to avoid these type of things) I informed the resident that a mechanical thrombectomy at this time, in the literature, can only be treated up to 6 hours after last seen normal due to poor recovery for patients beyond that time as well as risk of hemorrhaging. Later, the attending of the resident called my attending directly and convinced her to come in and do the case (as he was some chair of the hospital or some nonsense), of course the patient didn't improve. The next morning I came in and this attending rounding in the hallways in front of the patient's room, in front of his 4 residents and medical students, asked who had made the initial decision. I admitted to it, he asked why I would do such a thing as a PA. I informed him of the literature and he told me I had no idea what i was talking about and that the concept of last seen normal was clearly bullshit and I should never be able to make any decisions as a PA. I calmly just walked away before I said things I would have later regretted. In any case on the way home I realized that I have 6 years experience in this position, while this resident barely has 3, and is only doing an ICU rotation. I am very non-confrontational myself which makes it difficult to handle these situations, so i'm looking to see how you would all handle this. In the end I just put in a note that this resident had refused to implement the attending neurosurgeons orders. Any advice?

I think If they did it well I would do that. Being in a specialty we don’t get a lot of general medicine refreshing or even updates with new things. If they put it together as a great refresher and with new up to date guidelines and meds for managment of common diseases I think it would be a good alternative to do once in a 10 year cycle

For more on this google Mr. Money Mustache

Very true. The headline is a little misleading. But it's a good advancement for the profession there!

https://www.theguardian.com/healthcare-network/2017/aug/30/nurse-perform-surgery-patients-alone-surgical-care-practitioner?CMP=share_btn_link

I have heard of several PAs who have done angiography but implantation of stents no.

I contacted them for further info... here was their reply: CAMTS does not certify or accredit individuals - only medical transport services. CAMTS receives numerous questions about PAs as part of a transport medical team. In the 10th Edition Accreditation Standards - we do not specifically include PAs. However, in the next edition, we will include Emergency and Critical Care PAs. In the meantime, PAs are not excluded from being on the team. The CAMTS Board considers Emergency or Critical Care PAs to be qualified as along as they meet the same pre-hire and education requirements as the RNs or paramedics. You can find the pre-hire experience for standard 03.01.03 on page 3.4. The orientation and continuing education requirements begin on page 3.15. Accreditation standards are a free download on the camts.org website. When we start to make changes the drafts will be open on the website for comments. Employers may reject PAs because they are not specifically listed but you can use this email as verification that CAMTS does accept Emergency or Critical Care PAs as long as they meet the same pre-hire requirements as the RNs and paramedics. Or I am happy to confirm by phone. My number in WA is listed below. Eileen Frazer - eileen.frazer@camts.org CAMTS Executive Director Commission on Accreditation of Medical Transport Systems Eileen's office: 360-370-5990 To clarify further here here are the requirements from the manual: One member of the clinical crew is a licensed nurse with CEN, CCRN, CFRN or CTRN (or equivalent national certi cation) within 2 years of hire (required). Primary care provider may also be a resident or staff physician or a paramedic. Nurses and paramedics who are the primary care providers must have 3 years of critical care experience. (Critical care experience is de ned as no less than 4000 hours’ expe- rience in an ICU or an emergency department. In addition, nurses and paramedics in the primary-care-provider role must have pre-hire experience in the medications and interventions listed below as well as IABP management (if part of scope of care), central line monitoring, left arterial wedge pressure monitoring and ventilator management.

You should add these to my thread! Clearly we're thinking along the same lines

I actually found the AAPA salary report useless because it was already below what we were making and it was difficult to give as a clear instructional guide to the physicians. What I did was identify 2-3 major groups in the area, ones I knew my docs would respect as either "competition" or a different specialty and were either the leaders (like they wanted to become) or had a great PA system (that they knew about and wanted a similar structure). I then reached out to these people and opened up to them about my woes and just politely asked if they would share what they were doing. I've found most people are willing to give details on their salary to help another group out as long as its not for gossip. So, I reached out to some in person, and some on places like Linkedin. Discussed with them, and then preped a sheet with 3 practices and their breakdown and showed it to my boss. He was not happy at all and had objections because some were in other specialties where "PAs do more" etc etc. It did work however by breaking their resistance to discuss things. IF I had to do it again I would look for practices in the same specialty, or very closely related specialty as direct comparisons.

AnneFL, Thats exactly what I'm talking about. Makes no sense. For 3k more in salary they would have gained 48 weeks of half a day billing, which should far outweigh 3k. This is where dealing with HR in big systems don't make much sense, and dealing with individual practices understand these things. I think there will be an epidemic of this within 5-10 years with hospitals buying up these practices. Unfortunately I think a lot of PAs will end up running these services lines doing scut work for the hospitals to keep attracting the physicians with this round the clock coverage in house.

This will be a tough thing for the future. Around here PMDs and even surgical practices are getting absorbed into hospital employees or the practice is leased. I'm sure the docs make out well but not the mid levels. Also noticed increases in hospitals hiring PAs to cover service lines running scut for all docs in that field. Hopefully something changes. I have heard of a few cardiac surgery PAs negotiating better but I suppose that's when the hospital is desperate for that particular experience. I interviewed at a hospital the other day for a Perdiem position and had to sit down with HR and answer the typical HR questions. Painful.

If it's really only a month and you just finished school. Do something fun if possible because a year of residency will require a lot of time and study. A month is perfect for a backpacking trip. Just saying...