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Everything posted by Acebecker

  1. Rev said it well. My wife is concerned about me as well, but the truth of the matter is that it is my job to take care of people. I signed up knowing that was the case even if they have Ebola and there's a 50% chance of me dying if I get it. Not everyone went to school with this commitment, but most did. I'd bet you did as this is your dream job. It's hard to say to your wife, "I'm sorry, but this is what I signed up for." But sometimes that's what we have to say.
  2. 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
  3. 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
  4. 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!
  5. 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 medic
  6. 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.
  7. 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
  8. 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.
  9. 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...
  10. 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 i
  11. 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 har
  12. 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 ta
  13. 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.
  14. 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
  15. 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. W
  16. Your level headed approach is good, but letting the real world sort out who the good PAs are is extremely tricky because the bad PAs wreck it for the rest of us and give the profession a bad name (just like physicians, just like NPs). The question is this: does the online nature of the program lend itself to excellence or mediocrity? If you look at the level of performance coming from in-person vs. online learning, the online programs in a vast majority of the instances where I have seen/done it only lends itself to mediocrity. I, you, we *can* learn stuff online, but should we just because
  17. I read the ARC-PA stuff last night. Thanks for pointing me in the right direction. My goals are several fold. First I want to address training gaps - some people (NPs specifically) come out of training with little procedural experience - some have never sutured. Some have never excised a lesion. Toenails, joint injections, trigger point injections, etc. I want to foster a training environment that is heavy in these areas to get my people up to speed. Second I want to improve PA and NP function within systems that are fragmented - we are multiple separate entities: Hospital (and all
  18. I am interested in creating a formalized training program for our new hires. In order to make it attractive, I would like it to be formal to the extent that we document hours of didactics, supervised clinic hours and Pt contacts, procedures logged, and have rotations through other departments in our system (specifically the ED), and at the end of the 6 month training program our folks will graduate with a fellowship status in urgent care medicine. I have seen some curricula for this and have an idea of what to teach, just not how to make it formalized to the point where the participant gets
  19. This. The patients charges will get paid at a higher rate if the physician can dictate that he was consulted on the case and laid eyes on the patient, concurring with the PAs POC. In a struggling practice, it makes sense to do. So, to whom is your commitment? The patient, the practice, or your career? Good luck.
  20. I wear one sometimes, mostly when I'm cold. Here's the thing - docs don't own the "graduated medical professional" status. We are graduates and if you elect to wear a white coat, do so. That said, they are a huge infectious disease vector. I guess if physicians want to be sole owners of that, they can be my guest.
  21. Every 5th weekend and I work 2 days (14 hrs total between the two days). We're hiring if anyone is interested.
  22. George, Unfortunately, I don't agree. I don't think that online learning is the path to excellence for the PA profession. Yes, it will put marginal programs on notice. Great that they will change their ways. But online programs make us look like buffoons. It's a lowest common denominator thing. We will receive the reputation of the lowest 1/2 of the Yale class, not the best of them. And Yale just removed barriers that kept unmotivated people out of PA school. Instead of requiring extreme commitment and making that a visible thing by requiring people to move to a new state and lear
  23. Yeah. I certainly don't mind doing the work and training the new people. I am invested personally in the success of this clinic. It is huge to me. But if the atmosphere is going to be so toxic that even the good ones leave, I am probably going to have to pull back and say, "Find someone else." It's not in my nature to just be an employee who sits by and watches stuff happen. I am always engaged and proactive about helping my employer in whatever way I can. It's just engrained in me. Maybe I need to start looking for a new job.
  24. Physician is female, junior PA is female, NP is female. I receive no extra compensation; I have just done it because I know how important it is to the long term viability of our practice. What bugs me even more: they are pandering to the NP partly because she does botox cosmetically. Ugh.
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