bk84nation

Good advice, thank you.

Just accepted a "formal offer letter" from an out-of-state employer contingent upon meeting and payor/credentials qualification. Had a great hour-long conference call after which they sent me an offer letter although we had not met in person. We have arranged to meet in 4 weeks as I will be visiting the area again at that time. The offer letter was fairly general and included pay rate, "full benefits" and some general responsibilities. Did not sign anything, just accepted the offer via email based on the stated contingencies. There has not been mention of a contract yet, although we did discuss details of benefits and employment in great detail on the phone. Is it appropriate to ask to review a contract before meeting in person? Or should I offer to fly out earlier to solidify the deal? I have another offer currently with a contract offer that expires in 30 days, so I don't want to mess around with uncertainty if possible. I have only worked as a PA using contracts, and I'm also wondering if anyone works using at-will offer agreements -- something I think would make me nervous.

Anyone working in ER have RVUs at part of their pay structure? I know its complicated and varies from practice to practice, but those of you who have RVUs could you tell me how much it typically adds to your paycheck?

Great, thank you for the insights. Much appreciated!

Would like to get any intel on working for this EM group, positive or negative. I have worked with a different group for several years and have seen some negative changes driven by the productivity/numbers game recently. Is this a general trend in larger ER groups that a merging together and becoming more focused on profitability?

Worked with a doc who handled a similar case. Elderly patient came in with similar presentation. Was poisoned with antifreeze. Wide osmolar gap. Serum osmolality was key lab. Great case but pt did not make it :(

Hey all, I have worked in 2 different ERs in the last 5 years and have noticed varying practices on what to do with opiate or ETOH patients that want to leave. We get (as I assume most ERs do) frequent arrival of patients either given narcan in the field or being just found drunk in the streets and brought in for evaluation. The majority of the drunks are frequent flyers and we see them ~ 3x week. Its just protocol for the police/EMS to scoop these guys from the park bench they passed out on and bring them in. My first job trained me assume the worst with these patient (subdural bleed, rebound opiate OD after narcan wears off, etc.. and to jump through the hoops and restrain these patients if need be to prove pt is safe, can make own decisions and can be discharged after labs, observation, repeat BAC, etc..). Im seeing some providers let a lot of patients walk out after they get narcan after an 1 hour observation, or not doing any work up on the drunks -- just feeding them, watching them until they are "walky/talky" and nurses agree patient "has steady gait, etc...). Seems risky to practice this way. Thoughts?

Hi everyone. I'm in the midst of job hunting out of state and my significant other and I are considering a couple different states to relocate to. Several attractive job listings state they require an active state license. Of course it would be ideal to be licensed in every state I'm looking into, but its not realistic. I'm looking to relocate in 4 months or so there is still ample time to obtain a state license and I am already in the process of filing for a Colorado license. Should I wait until I get the license to apply or simply apply and let them know I'm in the process?

Any insights into the average day working in Sleep Medicine? Do you guys just take naps all day or what?

General consensus seems to be poor. Will avoid, thanks for the input and insight :)

Anybody familiar with "Restorative Medicine" and bio-identical hormone replacement therapy? I keep seeing job postings for PAs with a certain group. My quackery meter is a buzzing a bit, but honestly I don't know much about it.

"Wigworm" is our population's colloquialism for ringworm. Try as you might, most do not accept ringworm as a correction. I have heard "metropolitan" used in several instances to refer to Metoprolol. "Vomicking" is often used in place of vomiting, and many times it just refers to coughing up sputum, not emesis, and so always requires a follow up question. I have not personally heard this, but I did have an attending tell me a patient reported a hx of "gas-stational diabetes". If at any time a patient tells me that their pain is "excrutiating", my next question is med allergies... Oh, and all of my previous pregnancies had negative urine tests until I had the blood test, so can I get that now? And now that you ask, yes, I am dizzy, nauseated and I think I did pass out just a little bit. :D

Thank you all for the advice and feedback. It's motivating and good to hear!

Hello fellow PA's! I'm been working 4+ years in EM, and currently find myself in a job that I cannot stand any longer. First of all, I work in Camden, NJ which is a god-forsaken, urban wasteland. The facility is a stand-alone ED, which basically serves as an all-in-one ER/family practice/STD clinic with no appointments and constant stream of patients. Patients either can't get in to see their PCP or simply do not want to wait, so they all funnel in here. Wait times in surrounding local ERs have steadily increased, so we are seeing more complex patients come in as people simply do not want to wait (knowing all-to-well that we will likely transfer them out). There is high autonomy which I am comfortable with. I would say only 1 out of 10 patients I see truly merit a trip to the ER, and that's being generous. There is constant eloping, AMAs, work-note seeking, walking out after preg test is negative, etc... The arrogance and rudeness of the average patient here is simply astounding. The drug seeking is actually not as bad as the suburban ER I worked at previously, presumably because street drugs are so easily to obtain. The volume is very high, as most patients are low acuity. And because of this, the entire staff is quite jaded and there is usually some push back on doing some testing unless it obviously needed. I've witnessed some pretty risky medical decisions being made in the spirit of "get 'em in, get 'em out". Now, I have to say I work with good people that seem miserable with work. Life circumstances have somehow trapped them into working here for years (debt, kids in school, inertia, etc...). Speaking for myself, I think I've tolerated this job for just over a year only because the hours are better than most ERs and I've got this notion that I must pay off all my student debt before I move on (which would be about another 18 months out at my going rate). Well, I've decided I simply can't do that anymore. Its affecting my relationships and personal life. I'm fighting off low-grade depression, and constantly exercising just to stay sane. I've lost a lot of enthusiasm for practicing medicine, although I still take pride in my work. I frequently feel like I'm wasting my time. I have other interests (much less lucrative) outside of the medical field. I not sure I can work emergency medicine anymore, but unsure what my next move is. So, my loose plan is resign around next July, and take a couple months off to recharge and regroup, travel and explore options. I have a significant other but no kids, and we both want to get the heck out of the Philadelphia area. Colorado, CA, Oregon? Considering part-time work for a bit, maybe locum tenens? Non-clinical work? How problematic is it to apply for jobs out-of-state without an active state license? Anyone with part-time urgent care jobs that can chime in on their experience? I have to get out this situation before it sucks my soul away! Any advice or sympathy is appreciated!

I distinctly remember reading some journal article written by PA participating in some pilot program or something similar over in Ireland, but can't remember any details.