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About polarbebe

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  1. Has anybody found any literature on this topic? The only article we found so far: "Professional Advancement for Advanced Practice Clinicians" found in JNP, Journal for Nurse Practitioners, Volume 14, Issue 1, January 2018 Authored by: Carmel McComiskey, CPNP-AC/PC, Shari Simone, DNP, CPNP-AC, Deborah Schofield, DNP, ANP-BC, Karen McQuillan, MS, CNS-BC, RN, Brooke Andersen, M Thanks in advance.
  2. Congratulations on accepting the offer. Working with the sickest and most complex patients will make you a better clinician and help you get noticed if/when you move on (generally easier to move down in patient acuity then up). I agree hospitals can pay whatever they want but I disagree that working in a higher level acuity (critical care) does not demand higher compensation than a hospitalist AP. Intensivists are paid higher than hospitalists for a reason (more training required and sicker patients with far less room for error). Hospital will find retaining highly trained and experienced PAs to run an ICU very challenging without appropriate high level compensation as approximately 1% of PAs are in critical care... and the difference in care between a PA with 2-3 years of experience is very different from > 8-10+ years in a emergent life threatening scenario. PAs are trained in primary care. A new grad PA has to learn internal medicine then build upon that foundation to practice critical care. In general critical care is one of the top 5 paying specialities.
  3. So after half a year, several committees have been formed with the mission to “standardize, engage, professionally develops PAs into leadership, education, research or clinical expert role to promote job satisfaction, retention which will turn into best practice and improved patient outcomes” If you know of any systems or institutions that have implemented any type of structure (successful or unsuccessful) I would really like to learn from it and how you thought it may or may not have benefitted any APPs Thank you in advance.
  4. HR 70s on presentation argues against acute pericardial tamponade or other causes of acute obstructive shock; however could have a chronic compensated obstructive process (quick POCUS to help evaluate undifferentiated shock may be helpful to r/o tamponade but studies shown that it doesn’t improve mortality...though there are many potential holes in this study) https://journalfeed.org/article-a-day/2018/pocus-for-shock-dont-be-shoc-ed Definitely agree given hypothermia (without environmental exposure factors) is most likely septic shock until proven otherwise. TSH is extremely reasonable given hypothermia, hypotension, AMS... Procalcitonin has not been validated for screening for sepsis as it has a low sensitivity (~80%) in a pathology with a high mortality (~18-29% from the PROMISE , ARISE and PROCESS trials). It it has been validated for the de-escalation of antibiotics in patients that have a clinical picture not suggestive of a bacterial infection. It also can be used to trend and can shorten the duration of inpatient antibiotics without mortality difference. In the inexperienced provider due to the low sensitivity it may sway clinical decision making against antibiotics which would be VERY worrisome. ICU/ER PA
  5. https://www.beckershospitalreview.com/quality/care-concerns-emerge-from-missouri-s-assistant-physician-licensure-program.html
  6. Interesting case. Bili 12: Elevated bilirubin (or rhabdo) can also darken urine besides hypovolemia Hepatorenal, agree that it is a diagnosis of exclusion, usually see portal hypertension and a FENa < 1% (unless they are on diuretics for their cirrhosis)
  7. Looking for help from other PAs at hospital/systems that have established a “PA clinical ladder” to get some ideas. I’m at a large metropolitan hospital system that is looking to initiate a PA clinical ladder system wide. What does that mean? So far I take it to mean: veteran PAs not interested in management seeking further challenges and recognition for advanced clinical knowledge with the goal to act as “experts”, help standardize PA knowledge (give lectures etc), help new grads, etc. If you have a system at your hospital or health care system, how is it employed? What are the requirements (obviously tied to some metric, years, certifications)? What are their responsibilities? Any extra compensation? Any noticeable improvement in PA staff morale, retention, etc? Any proof of improved patient care through any data? At this point there is a lot of talk at the committee level and throwing around ideas . Any ideas/thoughts appreciated.
  8. A NP in the fellowship had an off-site service rotation in the ICU where I work (smaller community hospital). The PAs in the fellowship complete their MICU rotation at Cornell (perhaps better structured educational opportunities at a teaching hospital but less hands on/autonomy). From my discussions with her, she thought highly of the program.
  9. Just a thought... There are 234k NP per AANP. Roughly twice the number of NPs than PAs https://www.aanp.org/all-about-nps/np-fact-sheet NPs graduate about twice as many PAs per year. There has been a “boom” of new NP and PA programs leading to saturation in certain markets. Several people have posted that decreasing the number of PA programs will help decrease the “flooding” of new PA graduates driving down salaries. In my opinion if that happens it is doubtful the NP profession will also concurrently decrease their new graduate numbers but instead place their new graduates in positions that might instead go to a new PA (due to decreasing new PA graduates). This will lead to a decrease in the number PA positions over time in respect to the number of NP positions. Don’t know what the correct course would be ... but unless NPs decrease their number of graduates limiting PA graduates does not seem to be an ideal situation for the future of our profession.
  10. Per diem experienced ER PAs should get around $71-75/hr. Urgent care should be a little higher with bonuses.
  11. Good rule of thumb. When considering clearance also bear in mind to take in a patient's renal and/or hepatic function, volume of distribution and whether the drug has active metabolites (some of my ICU patients will stay sedated for weeks after a versed gtt or a patient who is ESRD will remain therapeutic on vanc until their next HD session vs a normal steady state after 4-5 doses in a patient with normal renal function).
  12. Early in my PA career, the above pretty much summed how I felt regarding my own private malpractice coverage. Fresh out of school with a financial negative net worth... certainly not a target for an ambulance chaser. Entering the middle part of my career and having accrued assets through hard work and sacrifice makes me rethink this strategy. Certainly all malpractice lawyers look at the providers and will think "provider practicing for X years (the higher number of years the higher likelihood of more assets) certainly has assets who we can sue for" vs a fresh grad. Having a family, you want to protect them financially of course. So I am reconsidering this approach ... any other thoughts?
  13. I wonder what percentage of PAs carry their own private malpractice insurance? Also wondering about the premiums (which I imagine vary by state, specialty, etc). I have heard from some people that carrying your own coverage makes you a bigger target for lawyers. I have also heard that hospital coverage/lawyers may throw you under the bus and it better protect your assets. Any thoughts?
  14. I doubt if you had done anything differently the that outcome would be any different. That said, it's great to talk about cases and see if anything can be learned from them (as mentioned previously) Some thoughts: Afrin in addition to a person with aortic stenosis (should be severe) could lead to high afterload leading to flash pulmonary edema,.. but this presentation would be more gradual and pt would have noticeable complaints and hypoxia. Or stroked from the afrin. It is possible he was supratherapeutic with the Coumadin (nosebleed only from nose picking? or from high INR?) . Although you stated one month ago it was within "normal range". We know it can vary widely with multiple interactions. A posterior circulation head bleed could cause sudden death.
  15. NYC as you may have heard is over saturated with PAs (greatest number of PA programs per state), in addition many hospitals are teaching hospitals make it difficult to obtain an ICU PA position for someone with no critical care experience. In addition to the very competitive market, compensation is depressed compared to the rest of the non-metro markets. I agree with the above, the large health systems have a set rate based on years of experience and have a small range in which they are flexible (critical care is paid at the maximum and medicine at a lower range). I would say pay is about 10-20% less than nationwide average if you look at salary reports.
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