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Acebecker last won the day on July 23 2017

Acebecker had the most liked content!

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About Acebecker

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  1. Heavy advice to consider. I appreciate it. It's taking a lot for me to say no. I like this model and how much this model can serve the underserved population in our area. Would it change any of your opinions if the offer was not a job but a partnership in the clinic? That is on the table here. Andrew
  2. A lot of my current colleagues to refer to it as concierge primary care. I actually am not certain if that is the accepted nomenclature or not. What this guy does is to offer a subscription to his clinic - a flat monthly fee. For that fee, you get as many visits as needed and most procedures are included. If there is something above what would be included, the costs are transmitted to the Pt without markup. He does not accept insurances. He also has been able to get medications at markedly reduced cost such that they are cheaper through him than through pharmacies and with insurance. I would not be billing for my time and would not be on a production basis. It would be a flat hourly rate.
  3. All - Is anyone working under this model at this point? If so, I'd love to PM a bit back and forth. Here's my situation: currently in private practice, internal medicine. Made $120k last year. Love my job, love my patients. I have a physician friend and colleague who wants me to work in his DPC practice. The only problem at present is that he doesn't know what PAs in DPC make, so the job offer is a little poor. Can anyone point me in a direction for PA salaries/benefits in direct primary care? Thanks!
  4. My CP is an internist. She is an excellent teacher so has many students who are pre-med, MS1, and MS3s. One of her pre-med students was told by another physician (not my CP) not to go to medical school because PA school is essentially the same and in primary care PAs will replace MDs within the next 10 years. My CP disagrees with that, as do I - I always tell my pre-PA students to consider medical school if they are young and don't have a bunch of commitments (family, kids, debt, etc). I would not ever say, "Don't go to PA school." I love my job, love what I do. But for some people medical school is better. At any rate, my CP has asked me to discuss this with the pre-med student in question. The interesting part is that my CP also believes that medical school is better because of the handholding in residency. She says that PAs are expected to hit the ground running from day one with little or no supervision and that it's really hard to do that. I did clarify with her that it is ingrained in us that we need to ask when we are not comfortable or don't know for sure what to do. I just thought it was interesting.
  5. I'd say that your gut reaction is reasonable. It's funny the excuses we get sometimes. I just had a guy who ended up with unprescribed methadone in his UTOX, confirmed on GC/MS. I confronted him and he said, "I was out of it from the kidney stone pain and a friend of mind gave me meds but mixed up my meds with his." It's tough to know what to believe and how to help patients like this. In select cases, I have a 1 strike rule. If this ever happens again with any substance, we're done prescribing for you. Again, YMMV.
  6. What I mean is that when a sample comes back positive, that should be sent out to a reference lab so they can do gas chromatography/mass spectrometry on it to confirm that the substance that turned the assay positive is actually cocaine and not something else. 2 positive tests on the same assay are not confirmatory. If he says he didn't do cocaine, I would give him the benefit of the doubt if your assay has known imperfections with regard to false positives (and IIRC all point of care Utox testing does). YMMV
  7. Needs confirmatory testing, most likely. I don't know what substances might elicit a false positive on your urine tox assay, but it's worth looking into on behalf of a patient. I give them the benefit of the doubt one time - make sure you understand your assay's sensitivities thoroughly. IMO this is one of the drawbacks of a Utox - not specific enough to the substances we're looking for.
  8. This one was a 64 year old badly hobbled by rheumatoid arthritis. Indelible spirit. Very tough - not gonna' let the RA keep her down. Needed a knee replacement, even with her risk factors, was not going to be scared away from having a good knee to get around. Did well with the surgery, but died 10 days following that. She was a patient of mind only for her wounds - wanted me to get her healed in time for the surgery. Which I did. So many others...
  9. That's fine. I hope you do well. I also hope that you develop a more solid understanding of the history of the PA profession and the challenges we have faced along the way and what we face going forward. You have no framework of reference here - you are a pre-PA student. And here is my word of advice for you as you embark on your endeavor: Your final comment is dismissive of me because you perceive me as young (I'm not) or lucky (I'm not). If you are that dismissive and disrespectful of people you disagree with because of your perceptions, you are going to face immense challenges in the future both with actually learning anything and with practicing medicine in a compassionate and effective manner. I want to restate the opening to this post: I hope you do well. Don't read everything else and forget that.
  10. Every patient of mine who passes away hits me like a ton of bricks. Every single one. I have not had any that have passed due to my failures to diagnose or treat. All have been related to surgery complications, sudden cardiac death related to pre-existing disease, or accidents. Thankfully. Someday I suppose that may change because we all miss stuff. Regardless of those things, though, every single one hits me so hard. I feel it like a weight pushing on my shoulders. I am thankful to be where I am, to play the role that I play. I would not trade this for anything. It is hard, but worth it. Andrew
  11. People have all kinds of reasons for not doing things. Reasons for not doing things are also known as excuses. Look at the portion of your reply that you underlined. The definition of "willing" is very closely tied to the definition of "committed." Thus it makes a ton of logical sense. Being willing to move is demonstrative of commitment, and those are the people we are looking for. We are *not* looking for people who want to take the easiest route through PA school that they can find. I understand that there are barriers to PA education and I'm telling you that I want people taking care of my family who fought tooth and nail to break those barriers down and who made a sacrifice to be privileged to practice medicine. I do not want someone taking care of my kids who picked the PA route because it's lucrative and because he had easy access to the program. I don't want the PA who sailed her way through rotations primarily shadowing and just getting passing grades. Do you? And absolutely moving = skin in the game. How could it not be the equivalent? You'll note that I did not say that "not moving = no skin in the game." Not having to move and uproot your life and define yourself by the curriculum you want to take means you have less skin in the game. Less skin in the game means less value and less willingness to sacrifice to get the job done. Andrew
  12. I give fluids in my office all the time and in the back of the ambulance. However, when I have a Pt who has chemotherapy induced vomiting to the point of significant dehydration and I want her to receive 2 liters of crystalloids, I cannot order it through the same day surgery unit of the hospital because of credentialing. It's the dumbest restriction I have ever faced. It's a hospital thing, not anything to do with our practice.
  13. Many reasons. The primary one is that my kids were young and I didn't want to miss their younger years. I would not give up those years for anything. Medicine as a PA is the same as medicine as an MD. Same standards of care, same guidelines, same consequences. There are unnecessary restrictions on me based on the system in which I work - hospital will not credential me for same day procedures (IV fluids, transfusions, etc). So, I collaborate with the docs I work with and they cosign and my patients get what they need. It's a very rewarding field, a very rewarding way to get to practice medicine. I often point out, though, that if I could go back and do medical school before I was married, I would consider it. Andrew
  14. Kilian, First - good luck, hope it goes well (and I truly do). Second - I don't know you. I don't know any of the students in your class. What I know about online programs and the associated baggage that comes with them comes from my limited experience with online programs and from my experience with NPs who attended online programs (your anecdote about ACLS is not the point). And this is largely the same as what the general public knows about online programs. In general, they turn out substandard practitioners. Whether Yale's will or not really does not matter at this point. What matters is that now there is an online path to becoming a PA whereas that didn't exist before. Now PAs can get degrees online, same as the NPs can. And *boom* just like that the PA profession was dropped to the level of the NP profession as far as quality of education *when we talk about it from the public's perspective*. Third - the nature of the program (online vs. in person) is not the only factor that determines quality of practitioners. I will grant you that. You, as an individual, may be very engaged and very dedicated to paying wholehearted attention to every point in the online lectures. I applaud you and I'm sure you will be a good PA (see point #1). But your classmates who are less than dedicated, who applied to the program that was the *least inconvenient* and the *easiest to get into* are not the people who benefit from online education; I anticipate huge learning gaps in this population. The people who have that mindset benefit most from being required to sit in a seat and receive instruction live, where they cannot fall through the cracks and cannot develop such learning gaps. There are NP students who have done well with their online programs and are good clinicians because they were very dedicated and didn't just shadow for their 600 contact hours. There are NPs who are not good, though, and in general this is the standard that I see when an NP student comes to me from an online program. They don't know basic exam maneuvers, they don't have skills, they don't know differentials or how to read EKGs. Now - my hope is that your class does not have the same lack of skills that these NP students have had - you will be doing clinicals to the same level as your PA colleagues. But this goes back to #2. It is my experience that online programs turn out substandard clinicians. Listen, I do not want you to take this as a personal attack on you or that I think you are going to fail because you are in the inaugural class of online learning for PAs. If you are dedicated, if you pay attention, if you work your butt off (and I know you're ready and excited to do that), you will probably do just fine and you will be a good PA. My major concern is about point #2. I'm also annoyed that Yale hasn't listened to anyone else on this, but that's another topic for another time.
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