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  1. Hi all I am facing a tough spot and looking specifically for the names of some good self help books I am a 20 yr PA Typically changed jobs every 2-5 years Two jobs ago I had to quit as it was a totally toxic setting where administrators ran the jail this job started great but a huge amount of decrease in the provider staff (2 medical retirements, one leave) has taken a 5 provider practice to 2. As well the Doc/Owner/Manager appreciated my help with running the clinic but then would not back me up on staffing issues and policy. Needless to say I have resigned my job, and found another. Last Day is coming up, and I have about 2 months before starting my new position. The problems are numerous I am facing and having a tough time working my way through them 1) I am totally burned out. I no longer have any patience with COVID topics - rather is the the staff member rooming a patient with a 101.8 temp and not telling me (we do not see febrile patients in clinic) or that she looked at me with a strange face when I asked her to go recheck a temp and if febrile (she clearly had no recollection of the past 1.5 years of me telling her this and this being the office policy. Or patients that want to use me as their verbal unload point on why they are not getting their vaccine (I was unaware it has killed 3000 and the medical profession is in cahoots with the gov't to hide these facts. 2) I am feeling regret and disappointment as leaving my current job - it is a great panel, and the doc (medicine wise) treats me fairly, like a partner, and we support each other. But we have 5 staff members, 4 who are LONG term employees, 3 of which were laid off with COVID and were not going to be rehired (long story short is they are great people but awful employees. (i.e. refuse to learn computer, refuse to take BP's, refuse to log vaccines, yell at patients) But when push came to shove he rehired all 3. So we are not back to full staff (for when we had 5 providers) and we really only need 2.5 good staff.... 3) The practice is not sustainable with out me there. I have full access to the financials and this is simply a fact. Overhead heavy (5000 sq feet) with 5 employees on 1 provider is a no go. And he has not made efforts to hire anyone. I think he is either going to close or sell out. 4) in spite of the employees being fairly poor at their jobs, not being team players and actively undermining me (they run to him and he sides with them) they are all nice people and on a case-by-case basis they needed the job and all are my friends. Problems I am truly struggling with 1) doc ran a great practice into the ground by caring about his employees to much and avoiding tough decisions. His total lack of big picture vision will be the end of the practice. I understand it is his practice and he gets to decide but I have some survivor guilt already starting. (as mentioned I already have another job lined up). Had I stayed on there is about a 60% chance the practice would have continued - hence I feel guilty (but I am being forced to lower my standard of care due to the employees so I am okay/at peace with leaving) 2) these are my friends and I am leaving them. 3) I truly thought this was the place I would retire out of. As stated I have changed jobs every 3-5 years and I am 10-15 yrs out of retirement. I no longer have the energy for job changes, just want to be in a supported environment and valued. I know leaving is the right thing to do but emotionally I am not ready to change jobs again. 4) I am a mother of a 4-7 yr old, through covid times, and it have been rough. rough, rough on the kids/family. I want to be there for them but the angst, lack of patience self is making it tough (and at the same time they are desperate for the structure and interactions of schooling which start in a few weeks) So long winded explanation to get to this final question I am close to quitting medicine, but the pay it essential as a young family. So I have another job lined up (pay raise) and know that I am in a pretty negative emotional state. Yes I am aware family comes first but I need to still work. I am looking for suggestions on a self help book that I might be able to read/consider/ponder that might allow me to work through a lot of these negative feelings in the last two jobs. Most the issues and reasons I have left have been outside my control (and almost all my peers agree that the last two jobs were really tough settings) were not with in my control and I am very thankful to have stayed employed through out covid. So anyone have any suggestion on some books to read?? The self help type.....
  2. I work in a CHP in the western US Last year I had the craziest Foreign Body removal I have ever done older, gentleman comes in saying he wants "it removed" Has refused to see anyone else (love the value of PCP relationships) He had self implanted a piece of plastic a few years back in the dorsum of his penis under the skin........ He did not want anyone else to remove it - even after i explained I am not a surgeon or urologist. had him sign basically an AMA saying that I was recommending against me doing the removal procedure and that he should see Uro. He signed it, then signed a consent form for me to do. Quick phone consult to Uro to make sure I did things correctly. 15 min later it was out, dressing applied and he was on his way. Never in a million years would I has suspected I would do this in my career - removing self placed body art in the penis/foreskin..... Gotta love primary care and my visit probably saved the system some 5-10k (heaven forbid that he have and EKG and Cardio recommends useless interventions) in that he would have likely needed a preop, and then surgical clearance, then inpatient post op..... all for a quick numb, slit and remove.... no matter your beliefs, letting a PCP function as such is certainly important to the efficiency of the system. Question to everyone in the primary care fields.......... What things have you done at the edge of your skill set (I have a lot of suturing and minimally invasive experience from years in IR and ER so I was comfortable with the process so it was not reckless) where it felt good to help someone and fueled your mental fire for a little bit? Great Dx, great finds, management strategies that helped? Lets hear them, ring your own bell, shows us that PA's rule!!
  3. Job #1 $115/hour for 20 hours per week and on call 24x7 for correctional facility (built into hourly) Job #2 Per diem $90/hr no bennies Thought I was doing great, but by other peoples post I might have to rethink.....
  4. https://gis.cdc.gov/grasp/fluview/main.html https://www.cdc.gov/flu/weekly/#S5
  5. looks good, but it is not.... (maybe) pay could be great - but they have to give you FULL access to books, AND bill everything under you - this appears to be a small doc practice and they love to take advantage of you No medical - no way - every job I have had pays most of family, or 100% of individual Non-compete - will not go into details (all over this site) but the non-compete can not overly restrict your ability to make a living. all neighboring counties... yeah no way - something like 5 miles for one year would be reasonable So counter with same offer PLUS Full Medical for family Non-compete of 5 miles for one year Mandatory access to all billings, and that anything you do it billed and tracked under you
  6. Grad about 2002 first job 5 years - left after no raise over 75k Various jobs - highest of which wa 125k (er working my butt off) Returned to primary care in 2012 as that was my love 2014 Hired for a local correctional facility, state employee, help run the department with the DON and manager 20 clinical hours a week, hourly, full bennies, and a PENSION 120k/year feels like I am finally paid fairly, and respected for what I bring to the table....
  7. $120k 20 hours a week ~$115/hour corrections 120k last year for 1/2 time
  8. Answer: to perihilar fluffyness on CXR - prominent vasculature due to fluid overload? Questions: pseudomembranous coating on tonsils with a sore throat that doesn't get better with ABX treatment for strep? Bullys eye rash on skin red sand paper feeling rash on an youngster Aprical lesion on CXR that is not solid
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