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familygal

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  1. I have been a PA for over 10 years now and worked at my current practice for over 5 1/2 years. I've worked with the same two very supportive supervising physicians this whole time and believe I have more than proved myself competent. It's family practice, so I see my own schedule of patients and don't hesitate to ask my SPs for advice or present a case for their opinions. Last week I was presenting a rather complicated case to one of my SPs and he started pimping me. Now, I will be the first to admit that I don't know everything and always have room for learning and improvement, but I was very annoyed about it. It was condescending and made me feel like I was back to being a PA student! In general this guys is pretty supportive but he does apparently have a side to him that needed to feel superior. Annoyed, I shrugged it off ....but I'm wondering peoples thoughts on this--do you get pimped by your SPs after years of practice?!
  2. I had a similar case in FP clinic recently with a 48 y/o female c/o pleuritic CP.....Had a recent hx of breast cancer and had just finished several airplane flights before coming in. But, PE, pulse ox, ECG in office were normal so I did the exact same thing you did....CBC, stat D-DIMER, Chest X-ray and sent her off with instructions that if pain gets worse, go to ER, etc etc. Well guess what? At 11 pm (which is STAT in our outpatient world), her D-Dimer came back positive. So to the ER she went for a CTA. Which was negative..... I had typically practiced under the theory that someone mentioned above-if you think it's important enough to order the bloodwork (D-dimer, trops), then they should be in the ER where the testing and follow up can be done immediately (BTW I would never order trops in outpatient setting). Then, a few months ago I ordered a stat outpatient CTA on a patient to r/o a PE and got major pushback from insurance (after it was done) since I didn't have a positive D-dimer. They didn't want to pay for it. I had to argue with them as to why it was needed without the D-dimer. So there is that unfortunate but real aspect of practicing medicine. These are good opportunities to look back on what you might have done differently. In my case with the 48 y/o woman, I should have just ordered the CT scan and saved the patient the time waiting and the cost of the ER visit. Yes, hindsight is 20/20! We all have difficult calls like yours. This will be one you won't forget and will probably save someone else's life in the future because you learned from this case.
  3. Give him/her a list of "orders" to start on the patient before they are seen by you, depending on their chief complaint. i.e. Anyone coming in with: Shortness of breath: get a pulse ox Female with abdominal pain: get urine preg Cough: Spirometry "Lightheadedness": orthostatics etc, etc. Let them know exactly what you want set up in the room for procedures, pelvic exams, rectal exams, preventative care visits As far as placing orders for xrays, labs, meds, etc...that can be up to you, but don't expect them to know what you are going to want to order. I will have my MA load in the rx-refills the pt needs when they come in which makes it easier for me. I think your basic SOAP needs to be done by you. In our practice the MAs do almost all of the callbacks, we have a referral coordinator for referrals. they do not scribe the notes. Some of these things take some time for you to learn about yourself, your habits and preferences, so it might take a while for you to be able to identify everything at once. I am always evolving.
  4. And I'll add the encouragement to DO IT as well. Obviously, you aren't going back for financial reasons. Your reasoning to go back goes far beyond financial and "practical"..it's much deeper than that. Congratulations on making the jump!
  5. I have had recurring thoughts about going back to med school since year one out of PA school. I'm now 6 1/2 years out, in my early 30's, and both my husband and I are paying down our grad school debts. If money and time are on your side, I would recommend you pursue this option now. Yes, you still should be the best PA you can be for now, but you might find that the desire to go back doesn't go away with more training or different jobs. After working for a year or so, take a look at your priorities, question how much better your life would be with another degree/job title, and if these are worth the (not unsubstantial) sacrifices. Sometimes it is easy to look at the other side of the fence, however don't take for granted the great things about being a PA that we have going for us that aren't afforded to docs!
  6. Would the potential employer be open to you asking them this? If they have had a PA before, they should be able to show you what the last one brought in. The practice I work for gives me a monthly billing and collections summary which I think is the right thing to do. I think it is only fair for them to provide this information if they are offering a bonus structure.
  7. I gross around $30,000/month in FP, seeing 14-16 Pt per day on average. Our payors are 40% medicare, mostly the rest is private insurance, some cash pay and we don't take Medicaid. I have been doing FP for the past year. Also use eCW and I believe it slows me down.
  8. DON'T SIGN A 3-YEAR CONTRACT!!! All of the above advice is good, I agree. You will never be able to gross $70,000 in a month in at least your first year or 3 years. And having a mentor is a must.
  9. 15 patients a day as a goal is reasonable. See if they'll pay you bonus for what you see above 15 pts a day, because by 6 months you should be able to see more than that (and BTW, don't start out seeing a full 15 pts if you're a new grad. Give yourself 1 pt an hour at first to learn the system, get to know the medicine, take time to run your patients by your supervising physicians).
  10. Hmmm, thanks for the insight. What do you think the overhead is for a PA in FP? 50% or so?! They give me a monthly salary, pay my malpractice, licensing, fees, etc. I get no bennies-no health insurance or retirement package. I have 1 MA. Practice is 4 docs and me, total staff is less than 20. I really like my job; I'm not looking to leave at this time. Been there about a year and now I'm exploring ways I could get more money. I may even consider offering to take no base but ask for 45% of my collections on a 3 month cycle (so I'm not penalized one month if I take a week of vacation). I was roughly assumming that my overhead is 50%, I get 30%, so each of my 2 bosses takes home about 10% of what I bring in. Anyone else have any insights on this? To the OP-sorry to take over this thread!
  11. I would be interested to see your replies. I am in FP and get a base monthly salary or 30% of my collections each month, whichever is higher. It's pretty straight forward and my bosses are good about showing me my numbers month by month. I think it's fair but am interested in what others think.
  12. Thank you to everyone for the advice on charting; I will certainly take this advice and work with it. The docs did mention something to me about getting a Dragon, so that is still an option. To tell the truth though, what takes my time is not necessarily the typing-I'm a decently fast typist and I usually type the HPI in the room while the pt is talking to me. I am starting to get faster with patient encounters and with experience I have been able to make my medical decision-making faster as well. I'm finding what is slowing me down is typing my phsical exam and inputting the orders into the "plan" section- finding the correct RX and e-prescribing it, loading up diagnostic imaging and lab orders. I have made some favorites but it is definitely time to update my favorites list now that I know what I like and use often. My MA also needs some more guidance, part more EMR teaching from the practice, and part delegation from me. This I am working on as well. Sometimes I will just do something myself that I know could be delegated because I can get it down faster or it's just easier. I really need stay in the mind frame that I am the boss of my MA and she's there to help me get through the day. It is good to read what others do to get through their clinic. I'm always up for more recommendations. Thanks again.
  13. Anyone else have a system that basically requires them to chart at home in the evenings? I really don't know how I can continue to sustain this! I generally take about 2 extra hours in addition to my clinic hours each evening to finish up my progress notes on our EMR system (this doesn't include going through labs and stuff). I'm about 5 1/2 months into my first family practice job (however I've been out of school for nearly 6 years) and the evening charting every night is killing me. Granted, I'm still a bit slow and I know I'll be faster each month. I see 14-16 patients per day at this point, working my way up, and we are using eClinical Works. Its a challenge for me to finish the note on each patient visit during the patients' visits; I will try to get in most of the HPI while I'm there in the room, the physical exam, and bits and pieces of the A/P and billing. There's tricks with the system to make it go faster that I'm still getting the hang of. I've tried to limit the amount I type, i e avoid typing long paragraphs, but the charts just don't seem to get finished and I'm ALWAYS working on them in the evenings. I would think it is just me, but my two SPs aren't able to finish their charts during the day as well and do a significant portion of their charting outside of clinic hours. I have never had this much extra "homework" in other jobs (yes, yes, the nature of FP) When I talked to a few of my friends who work in primary care, they think it might actually be an inherent fault in the EMR system. Nonetheless, if anyone has any tips/tricks for quicker charting it would be much appreciated!
  14. There are a lot of factors that go into PAs in the ICU being satisfied. I worked in 1 unit where, for the most part, we all were pretty happy. There are many other places, however that PAs aren't. Type of ICU, supervising physicians (are you working with CV surgeons/trauma/pulmonary/internists?), autonomy, work hours, +/- academic hospital where you have residents working along side of you...In my experience, the midlevels had the most positive experience when we did not share patients with residents, had set hours, no call, rotated weekend coverage, and had positive, trusting relationships with our supervising docs (it was MICU). Also, the concept of an open or closed unit makes a difference as well.
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