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physasst last won the day on September 28 2013

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  1. At this point in my career, I function exactly like my physician colleagues. I practice in a non operative Spine Center under the division of PM&R. I see referrals from all over the world. I frequently get referrals from all over the country to see me. I cannot remember the last time I had to run a patient by one of the physicians. I work them up and manage them completely on my own. There is a physician...usually a different one every day, that is "assigned" to be my resource, but after years of experience.....it is rare that I talk to them. They don't even know about 95% of the patie
  2. Great discussion John. I agree with you. Hope you are well. Give your wife a hug from me. Kindest, Mike
  3. We get our DEA reimbursed by renewing it with our corporate credit cards. Then we submit for re-imbursement, which means it is not taxed. It's interesting, they will pay for DEA, but NOT for state license renewal or NCCPA renewal. Those are on the individual PA to take care of. Mike
  4. This is not as uncommon as you might think. My first job was this way (one of the reasons I left)...but I also know of many, many PAs with similar workplace environments, where the PA captures the H&P, presents to the physician, and then the physician goes in, verifies the H&P, formulates a treatment plan, and then asks the PA to do the orders and scheduling.... Basically a glorified secretary. It sucks, but I would caution people against thinking that this is rare...it is more common than many believe. FWIW, many PAs are okay with this. Many PAs look at being a PA as a job....
  5. http://networker.paeaonline.org/wp-content/uploads/2014/08/RGC-Impact-Debt-Load-on-PA-Exec-Summary.pdf Heavy Education Debt May Discourage Physician Assistants From Practicing in Primary Care or Underserved Settings Washington, DC, August 18, 2014 — Given the recent concerns about the ability of the future primary care workforce to address the health care needs of the nation, factors influencing career decisions are vitally important. Nearly nine out of 10 physician assistant (PA) students owe education debt that could influence the primary care PA workforce of the future. That’s a concl
  6. Sure, of course, that study cost the RWJF and the nursing associations over 3 million dollars. Just for clarification. IOM isn't cheap.
  7. A Kernel in the Pod......Mike Jones. BTW, a PA forum member. Good Read. Mike
  8. Yep....I got heavy over the past ten years....too much work, research, school, etc. I got up to 248 this winter. I've lost 28# since April 1st, and looking to lose another 30... Mike
  9. Yep, LP with elevated OP, and elevated protein at 58 with 11 oligoclonal bands. ANA, CMV, RPR, EBV, and NMO all negative. TSH normal. Sed rate WNL. Both outside MR and internal MR with Gad showed lesions. Our Neurologists decided against steroid burst as primary complaint was neuropathic pain. Very cool case. Mike
  10. The hallmark in this history was the left sided numbness and weakness that occured back in January with the cord signal changes noted on the MRI. No spasticity on exam, and CN exam was normal. We typically do not use gadolinium for spine MRI's if the suspicion is nerve root impingement/radiculopathy etc. However, we also have a neuro radiologist review every brain/spine MRI before the patient is allowed out of the room. If there is an indication for gadolinium we do it. This was an outside MR, and not sure what the procedure was where this patient had it done. My working differenti
  11. Here's a good case for those of you out there to think about.... HPI: 72 y/o right hand dominant male farmer presents to the Center with a 4 week history of severe unbearable right arm pain. He is unable to localize this pain, and states that it involves the entire arm. It seems to extend from the right side of his neck into his arm. He also complains of pain into the right jaw and face, and even extension into the anterior neck. Complains of significant balance issues, but feels that these have been present for several years, and cannot determine if they have worsened. Denies any history
  12. Agreed with this, but the underlying notion that the diagnosis in a difficult patient cannot be made by anyone other than a physician is inaccurate. I practice in a complex spine clinic. I've made many diagnoses that others have missed, or more often, have to correct inaccurate an inaccurate diagnosis made by primary care. I've even came up with my own axiom....(stolen from the House of God)...."If the primary care provider thinks there is 'spinal stenosis' present, there can be no stenosis there". Mainly because I seem to see many patients with axial back pain with no pseudoclaudi
  13. I was a corpsman in the Navy. That's when I met my first PA, but to be honest, I was going to school for economics. Worked as a framing and finish carpenter, painter, was a splicer's apprentice with the phone company for a while. All while I was finishing school. Back up career now would be working as an economist for consulting firm, academia-teaching, specifically, research methods to graduate students in any number of disciplines, or, possibly work in political circles, etc. I actually have a local candidate who asked me if I would run his campaign......LOL....so, there's always tha
  14. Yep, Jack Welch so infamously used it at GE. I agree that team building is more important, as the other problem with vitality curves is that they promote perverse incentives in the top performers, altering the curve. That's sort of the point. This is going on...we need to be aware of it, and we need to be involved and have a seat at the table with these discussions taking place. Haven't seen you since the Academy. Trust you are doing well?
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