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Everything posted by medic25

  1. Recently had an elderly patient with "abdominal bloating" after eating a burger, triaged as an ESI Level 4. Markedly hypertensive at triage, past surgical hx of a AAA repair. I'll let you guess what his diagnosis was....
  2. Nah, it always matters what you think I definitely don't want to downplay the importance of serial exams, especially in abdominal complaints; just saying that they may not always change much of the care plan. In the patient with appendicitis on CT, they'll be getting antibiotics and a surgical consult regardless of what my repeat exam shows, then the surgeon will again push on their abdomen when they see them. If I don't have a specific clinical question to address, it's not unreasonable to defer the repeat exam at times and spare the patient some additional discomfort.
  3. Pretty common in our department as well. We all carry hospital-issued iPhone's, so if the consultant is quick with their callback you are often in the room with the patient giving them an update. I don't think it's always a guaranteed that at patient will need another abdominal exam 90 minutes after the initial exam. If the patient the patient had RLQ tenderness and has CT-documented appendicitis, they will still need to see the surgeon regardless of the repeat exam; in some situations it's just more likely to inflict more discomfort without adding much to the clinical management.
  4. Is it a possibility to stay on as a casual employee while in PA school? We've have several ER techs go back to school and come back to be hired as PAs; by staying with the hospital while in school they maintained their seniority within the health system.
  5. Paramedic practitioners have already been a part of the health system of other countries for several years, including the UK and Australia. They are to the best of my knowledge prepared at the Masters level, and primarily work in ED's, EMS and some primary care settings. Here in the US we have no structure set up yet for educational requirements, and importantly billing reimbursement (not really an issue in the NHS). It is an uphill battle nationally getting American EMS agencies to pay traditional paramedics a living wage; without a mechanism to improve reimbursement for paramedic practitioners I wouldn't anticipate a huge rush to adopt this level of training if the medic will get a Masters degree and still be lucky to make $20/hour. I don't know if community paramedicine is driving the Missouri efforts or if there is someone else leading it; just sharing some info about how other countries are structured. Here's a video highlighting a paramedic practitioner in the UK: https://www.emsworld.com/video/12106357/u-k-reporter-spends-24-hours-with-nhs-paramedic-practitioner
  6. FYI, they just did the first field ECMO cannulation in North America earlier this month in Albuquerque; I've got a couple of buddies in EMS leadership down there and they have a very progressive system from the sounds of things. https://www.abqjournal.com/1375453/unm-debuts-new-response-to-cardiac-arrest.html
  7. I didn't actually see a rotation breakdown on the APP fellowship website. They list rotations for a 1 year physician EM fellowship designed to prepare IM/FP physicians to work in an ED (I won't even open that can of worms). Odd that in 12 months they don't list any actual rotations in the ED as part of the fellowship; I'm not sure if a month in OB or a month in ophtho are a substitute for actual time in the ED.
  8. My daughter has had her median sternotomy scar since her first birthday. I’m pretty sure her big brother would disagree that the knee he injured when deployed in Iraq is more “worthy” than her heart condition. Sent from my iPhone using Tapatalk
  9. Check with the program you are looking to teach at. As already stated, many states have their own state certification, and in many cases it is only required if you are the program head or core faculty. If you are just coming in from time to time giving PRN lectures you may not require any specific EMS instruction certification.
  10. The beauty of living in a beach town; no need for a vacation to enjoy views like this every day...
  11. Sounds like a winner! Unless you are going to a top-tier MBA there isn’t much point in spending a ton. With my hospital tuition reimbursement I was able to have the cost of my whole program covered; can’t beat that for ROI! Sent from my iPhone using Tapatalk
  12. I just completed my MBA in Healthcare Management last week, so it's too early to say what impact it might have on my future career. It definitely has been noticed by some of our senior hospital leadership who reached out to congratulate me; I don't think it's a free pass into an administrative role, but it should help to set you apart from other candidates for a position that don't have an MBA or MHA.
  13. For some perspective, you're getting paid as a PA what our ED techs get paid. Are you having these conversations with the surgeon or with an office manager? might be worth going directly to the surgeon, and include in the discussion the estimated $100-200k it costs to lose, recruit and train a new APP.
  14. Agreed, I think Heady gets more press than it deserves. Hill Farmstead however brews the best beers on the planet; never had such consistently amazing brews. Sent from my iPhone using Tapatalk
  15. We developed our clinical ladder, but still haven't implemented it (waiting for final finance approval, since it could affect salary for over 1300 PAs, NPs, CRNAs and CNMs in our system). Look at the AAPA Distinguished Fellow application for inspiration; we award points for various achievements such as precepting students, committee leadership, publications, etc. We also built in a big emphasis on mentorship, with those higher up on the ladder being expected to provide guidance to junior APPs.
  16. If you’re still looking for reasonable proximity to NYC, look at Connecticut. We aren’t Midwest cheap, but once you get past Fairfield county the cost of living is much more affordable. My town calculates out to being 72% cheaper than Queens (never mind Manhattan). I live on the shoreline, 5 minutes from the beach in one direction and a state park in the other, but I can still hop in the train and head into NYC for a Yankee game or a broadway show (going with my wife to see Harry Potter next month...). Our state practice act hits all six elements of the AAPA, and in general PAs are treated relatively well. If you aren’t quite ready for the cosmic jump to Alaska or Nebraska, we are a nice alternative to NYC (I left an ED job in Queens 16 years ago and would never go back). Sent from my iPhone using Tapatalk
  17. Excellent; you'll have a blast having the chance to advocate for your fellow PAs.
  18. This is probably the most important point in this whole thread. Far too many PAs are content to gripe continuously about nothing getting done and complain about the leadership, but they make no effort to actually work with their professional organizations (either AAPA, your state CO or your specialty organization). The PAs running these organizations aren't appointed from Mount Olympus; they are other PAs who cared enough to volunteer their time and effort to try and make a difference, typically at personal expense. We would have a lot more lobbying power if more of us got involved in advocating for our profession. OK, getting off my soapbox now....
  19. We do use portable radios for certain nursing staff to communicate (e.g. triage talking to charge). We also have all hospital staff using a HIPAA compliant smartphone app called Mobile Heartbeat that allows us to text each other and receive group notifications for things like trauma alerts. Sent from my iPhone using Tapatalk
  20. It's hard to explain how great a help this is to your mental health until you work in a system where you decide who gets admitted and who doesn't. You've got a little old lady feeling weak who looks good on paper but something just feels a little off to you? Then you keep her in the hospital for observation, and don't lose sleep over sending someone home who might have a bad outcome. We even stopped having discussions with the admitting teams years ago; the only time I make a phone call is for an ICU/stepdown unit admission. Otherwise we just enter the admission order and make sure that our note is written, and the admitting team gets the story from the chart. I've had this conversation more than once with students and new grads; don't just look at the salary, look at the ED resources and how the system works. Sometimes it's worth giving up a little salary to work in a shop with systems in place that help to keep you sane.
  21. CAH, or just consider looking at a different hospital in general. I've been in my ED for 16 years (big academic hospital); love 99% of the nurses, generally good interactions with specialists, and no problems with our hospitalists because the ED determines who gets admitted without their input. Bureaucracy is everywhere, but there are definitely always better places out there.
  22. The trouble with that E is that with the changing demographics of our profession it leaves an awfully small candidate pool to choose from. For example, my ED group has over 50 PAs and NPs; only 3 of us are paramedics, but we have some other super strong PAs who'd be great in this type of role. I see a comparison for us with the EMS physicians out there; many of them don't have past EMS experiences, but with the right training and mentoring we can teach them how to take care of patients in the field. With EMS now being a recognized sub-specialty of emergency medicine we don't want to exclude PAs from the specialty just because they don't have prior certification; we just need to make sure that we train them the right way. We don't require pulmonary PAs to have past RT training or ortho PAs to be past ATC's; they definitely have an advantage coming into those specialties with past experience, but we shoot ourselves in the foot if we restrict access to the specialty to only those who've worked in the field before becoming PAs.
  23. This model is already being utilized in a variety of cities, using both PAs and NPs. LAFD recently expanded the number of APRU (Advanced Provider Response Unit) trucks in their system. It's also being done in Anaheim, Littleton, CO, and until recently Mesa, AZ. Depending on how the system utilizes the unit there are a few different objectives: 1) Treating low-acuity 911 calls without an ED trip; a lot of the units carrying testing equipment (e.g. rapid strep, i-stat), and will suture, prescribe, etc. 2) They are targeting 911 "super-users" to try and proactively prevent repeat use of the 911 system. They are checking in on the patients, adjusting medications, involving social work, etc. to try and keep them out of the ED. 3) Hospitals flag high-risk discharges, and the APP unit sees the patient at home the day they are discharged to ensure they've got all of the necessary meds, DME, etc. and if needed can prescribe anything else (like the COPD'er the discharging resident forgot to give steroids to). This can be a huge money-saver for the hospital if they don't get a bounceback admission. 4) The unit sees psych/substance abuse patients in the field and medically clears them for transport to an alternative destination to the ED such as a sobering center or psych facility. One of the main issues with this model in the past is that CMS won't reimburse for ambulance patients who aren't transported to an ED. Earlier this month they announced funding for a pilot project next year in which EMS will be reimbursed for transporting to alternative destinations like urgent cares, or treating on scene by a provider. Using us correctly this actually has the potential to be a great opportunity for PAs; I already had a meeting this week looking at my own hospital/EMS system developing a project to submit to CMS for funding. For those who are worried about putting a PA or NP into the prehospital environment, it might offer some reassurance that every unit I've seen is partnering them with an experienced paramedic; this way even if the PA or NP doesn't have prior EMS experience they have someone with them who knows how to manage a scene.
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