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donwinder last won the day on September 22 2009

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About donwinder

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    Physician Assistant

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  1. I appreciate the responses but I was not asking about a visit with Dave Ramsey. I understand budgeting needs and actions. I am not going to go into greater details but several life events have diverted a large amount of funds, including several major surgeries and lengthy hospitalizations for my son. I am grateful for my higher than average salary that has allowed us to get through all of that. So, my real question was to see about creative options to continue to chip away at loans in addition to what I already pay. I feel it would be a creative way to negotiate my upcoming contract renewal. Has anyone been able to set something up similar to what my post suggested?
  2. I do many peripheral nerve blocks (lateral femoral cutaneous, occipital, auricotemporal, supraorbital, iliioinguinal, iliohypogastric, peroneal, etc), sphenopalatine ganglion blocks, De Quervain's, trigger finger injection, TPI's all over, mainly with ultrasound guidance, Botox for HA and dystonia, all the joints, PRP at any joints outside of facet joints. I can technically do SI joint injections BUT there is a much better auth rate and reimbursement if MD does it. Check on that where you are. Technically not a procedure but we also do SCS/DRG/PNS lead removals at the end of the trial. We are looking into starting stem cell injections and ozone injections. So I continuously review pain medicine to see about other interventions and medications to keep patients improving which ultimately means great things for the clinic if the public and medical community knows you get results and not just hand out pills.
  3. I ran into this article about ozone injections for OA. Looks to have promising results. http://www.clinicalpainadvisor.com/arthritis/intra-articular-ozone-injections-shown-to-be-beneficial-for-knee-oa-pain/article/684149/?DCMP=EMC-CPA_Update_DMD_20170825&cpn=cambia95638&hmSubId=Erc4RB5Wl0E1&hmEmail=3EwM6qFINfqvevRqbSxSiviAWyDGhZct0&NID=1336411636&dl=0&spMailingID=17958328&spUserID=MjA1NzMxMjY2MDAS1&spJobID=1081696380&spReportId=MTA4MTY5NjM4MAS2 -Any experience with this? Does it really help at all? -How does insurance feel about it? We do PRP injections and insurance is useless for that injection. -Is the required equipment expensive? Thanks for any input.
  4. i am coming up on contract negotiations. Most likely I plan on staying. I have been here for 5 years and really like it, mainly because of who I work for/with. Something that would help me progress financially would be paying down student loans. I am already at a high salary and get some bonuses. The only thing I could think of that would improve the money situation would be some sort of loan repayment. Ideally, tax free for me and clinic, money goes directly to loan, lowers principle and overall cost of loan, and I still write off loan interest. I do understand there are some tax codes against this but it is changing. (https://www.congress.gov/bill/115th-congress/house-bill/108/text) I have run into another option through https://studentloangenius.com/. Does anyone have experience with them? Any other creative options to minimize tax implications but still drive money to loans? I would even accept slight decrease in salary for larger amount to loans IF there were also tax benefits.
  5. Everything is negotiable. I worked really hard and long days at the beginning, understanding I was new. But once I was comfortable and producing I renegotiated a 4-day work week. As NJPL1213 mentioned if you paint it in a way that shows productivity won't change shouldn't matter as much in a private practice. Offering seeing 2-3 more patients a day helps. I would also try to negotiate some admin hours if your charting, etc is getting overwhelming. I have a buffer of 20 min before lunch and 20 min end of day to help.
  6. I found this book and all the books in this series to be helpful. http://www.amazon.com/gp/product/0323040195/ref=oh_details_o00_s00_i00?ie=UTF8&psc=1 Also helpful: http://thepainsource.com/ And finally, go to any accredited pain assosciation website to find resources, maybe attend a conference: https://www.asipp.org/ http://www.americanpainsociety.org/
  7. I have done countless extracranial nerve blocks with moderate success. I have some patients come in every 4 or 6 or 12 weeks for repeat blocks and love it. TPI's work great as well. I recommend them all the time to my ED friends. The nerve blocks numb it all away instantly if done right. Patient is happy enough to move along. Jmj11 knows all about the greater occipital nerve stimulator we placed for a patient. Dramatic results.
  8. I am about 6 months into this year's contract. Contract stipulates 5 days CME and I have 7 days PTO left. I am resigning this week. Can I use those twelve days to shorten my 60 days notice to 48?
  9. My contract stipulates a 60 day notice. I have 8 days of PTO and 4 days CME left on current year which had renewed this past February. Would it be reasonable to use those twelve days against the 60 days, i.e. leaving in 48 days? And assume those are calendar days, not work days correct? Not that I hate where I am. I just want to move to the new job ASAP. Sent from my SGH-T769 using Tapatalk 2
  10. I have a great position that is available in salem right now. New grad, experienced, either way. It is a terrific place to work. It is actually a really fun day at work. Let me know if anyone is interested. We need someone now because we have grown so fast.
  11. I went into PM right after graduation. It is interventional PM. Procedure heavy, opioid light. We successfully move patients away from opioid, at least those who want to. What has been said about PM is true about the patient population. BUT if you have clearly defined parameters that all providers follow, it works and drug seekers will self discharge once they realize pills don't come easy. If they truly want help they will get it. If they truly want opioids they won't unless there is a valid reason and proper use. Drug seekers and abusers will declare themselves fairly quickly if you do proper management. As far as a new grad job, I was extremely fortunate to find this job. Terrific SP and team. Best place I have worked since working Burger King at 16 yeas old. I am 37 and have worked alot of places. You still get exposure to a lot of neuro and other areas. Working with a heavy work comp well drain you. We do not do any of that except providing procedures. Stats show 6+ months on disability equals 70% or so will never return to work. We try to avoid crippling people mentally with the disabled tag. Incidentally for many family and personal reasons I am resigning and moving back to home state. It has nothing to do with the clinic, patients, and definitely not with staff. Message me if anyone is interested in it. It is in Salem, OR. Amazingly fun job and great small but not too small city. Or let me know if you have any questions generally about PM.
  12. Thanks for everyone's input. I am always worried about the greener grass perspective. But I do feel like this grass is greener for many reasons, not just the job itself. I want to stay married, I want my son to be healthy and happy, I want a better financial situation for our family, and I want greater professional growth. I can achieve that at the new place better than where I am at now. I have combed over contract and 60 days is all I need to safely and professionally end contract. I have to tell my SP within this week. That moment is looming over me heavily. It is weird walking around knowing how my decision could effect all those there. BUT I also realize he may find someone even better suited. That is my hope. I also need to end it well because my next license requires a letter of recommendation from previous SP. I have already posted job on different sites. He had wanted me to do that anyways since we needed another PA, which btw message me if anyone is interested. It really is a terrific job and terrific people to work with. I will update on how this goes. I am positive it will work out for the best for all.
  13. So no one has an opinion or advice? The offer is outstanding and I will be taking it. But still concerned about the other side of it.
  14. Yes. At the place I want to leave we need another PA because my schedule is full fire a few weeks. He us even looking for another physician. At the place I want to go their PA left for another opportunity. So needs someone now. Sent from my SGH-T769 using Tapatalk 2
  15. So I have a great job. I randomly connected with an even better job near family. I really respect my SP and see that we are growing rapidly. A large part of that is with my addition. I want to change and move to this other position which is a much better situation for me professionally and our family. What I am concerned about is breaking the news that I want to leave. Again I really like him and the work and the staff. That is what makes it harder. But this other position needs to happen ASAP if I want it. How would you break it to my SP? How long advance is fair before I leave especially with his momentum and that I respect him. One thing to keep in mind: in February I started my second year on a three year agreement. Each year is negotiable. But I am still in the middle of this year. I am also afraid of creating an uncomfortable environment if I cannot leave for contract reasons etc. He is not the type that would become mean or malicious to my progress but it still would effect our relationship. So let me know what you think. I am very curious for your thoughts. Also he has been looking for an additional PA anyways. Sent from my SGH-T769 using Tapatalk 2
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