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Everything posted by quietmedic

  1. I agree, it would be very helpful if you spoke to some PAs in person....and your questions are sort of random and indirect. That being said, I'm bored and was a directionless student once, so..i'll bite, briefly...on the assumption you actually are trying to find a career direction. And this is a month later, so hopefully you got some answers from PAs in person. ----------------------------------------------------- What is a typical day (or week) like for you? Same as most medical providers (Doctors, PAs, NPs, etc). A few 12 hour weekday shifts, a few 8 hour weekend shifts, some free weekend days, some time spent at home finishing charts, otherwise the usual daily life. No "call" in my line of practice, meaning no emergency patient calls at home. What do you like most about your work? That I get to practice medicine and help people feel better. In Urgent Care, I get to do it very quickly as well with rapid results and improvement. What do you like least about your work? Like everyone who will answer....charting. Writing complete, legally defensible patient charts. Necessary but annoying. What kinds of problems do you deal with? Same as any medical provider in Urgent Care...the full range of minor emergencies and acute illnesses, colds, diahhreah, abscesses, wound stitching, chest pain, ear infections, you name it. What kinds of decisions do you make? Same as any medical provider, important decisions that affect the heath and outcome of my patients....diagnosing patients, care in the moment including ordering medications to be given in our clinic, performing procedures like stitching, writing prescriptions. How does your position fit within the career field? Don't know what that means exactly. A Physician Assistant is a medical provider, doing roughly the same thing a doctor would be. How does your drop affect your general lifestyle? I assume you mean job? Well, it pays me a salary, which is important! Otherwise, being a PA can be very busy or very light, depending what specialty you do (Surgery vs dermatology). Not hard to find a specialty that suits your desired lifestyle. What current issues and trends in the field should I know about/be aware of? Couldn't begin to address that here. Read the rest of this board to see some of the hot topics. What are some common carrer paths in this field? Every medical specialty. Uregent Care, cadiology, gastroenterology, etc etc etc. What kinds of accomplishments tend to be valued and rewarded in this field? Not sure hoe to answer that....if you do your job and help patients, that is valued. What related fields do you think I should consider looking into? Only you could answer that....NP, doctor, podiatrist, dentist, etc. How did you become interested in this field? Always wanted to be a medical provider....a doctor, originally, but PA was a better choice. How did you begin your career? I was a volunteer EMT; many PAs were previouslyEMTs, CNAs, respiratory techs, Xray techs, MAs, other things in the field.
  2. Rules are rules. It was his responsibility to get to his PCP. I've heard anecdotally of doctors who will pass without referral for DOT, if a second resting blood pressure after a few minutes is under 140/90. I forget if a second "relaxed" pressure is officially sanctioned in the DOT manual, but I can certainly understand someone might have a slightly high BP at first pass... I don't recall if those anecdotals were passed for the full two years or just for one year...but I could sort of understand that sort of laxity. But in his case, look, he certainly had enough time to visit PCP. Nothing to feel guilty about.
  3. Yeah, it does seem totally crazy, and I appreciate your thought out response. Just called around and it looks like employment lawyers in my area want $400 minimum just to glance at my contract! Jeez. I guess it's better than getting screwed later on of course. I could always just try to reason with the company directly, but I do want to have some facts on my side and be able to say if this is reasonable or unreasonable, in my particular region, and that I believe only a lawyer would know....
  4. Hey folks, I was wondering what experiences you guys have with Urgent Care restrictive covenants. I'm looking to sign a contract at a new job, but they are demanding not only a 10 mile radius, one-year covenant, but are also demanding I certify, now, that "I vouch that this will not pose a hardship later." Firstly, that 10 mile radius in my area is a bit much, in my opinion. I'm in a fairly dense area outlying a major city, and a 10 mile radius is literally 314 square miles...An area not only including a dozen other urgent care clinics that I would be then locked out of, but also one so busy that 10 miles actually means 30 minutes of driving...not exactly local competition. This seems to me to be just too wide an area. And that second clause about "guarantee no hardship" seems like a trap so that they could sue my butt off, if I ever break it, even if it truly is a hardship. What do you all think, specifically about that radius for a busy area, in Urgent Care, where I'm not exactly going to steal their patient base away even if I work down the road, and as well, that second "trap" clause? Thanks all.
  5. It's a bit of an art... learning how to take the machine interpretation for what it is. As others mentioned, with low voltages and noisy baselines, the machines go absolutely nuts and are useless. Other times, they might even pick up something subtle that I wasn't looking for, like an extremely borderline High QRS voltage by some criteria (for whatever it's worth). The actual algorithms the machine uses to recognize things is complex, I have seen the sort of pseudo programming algorithm online somewhere, but if you just go through wikipedia or life in the fast lane, pretty much all the numbers are there, as well as the most common criteria used (LVH for instance has more than a handful of calculation methods, so it varies). As someone else mentioned, it's great to try to figure out in reverse why the machine is reading something... Usually you can figure out with one of the two sites above, but of course, part of the art is learning what to ignore...for example, EKGs tend to reeeeealy overread "anterior infarct" on a massive scale in my experience, so you kind of have to eyeball it and say, oh, I see what it was reading in V1 and V2, but it's nothing. Like I said, it's sort of an acquired art, it definitely helps to have a cardiologist or electrophysiologists around to run it by, so they can give you the real-world reality on what to ignore and what not to ignore.
  6. I recently got a call from a recruiter for an urgent care job in a large multispecialy clinic. After some preliminary questions and seeing that it might be a good fit, she told me I will hear from them soon. About a week later, I get an email from somebody else at that company, with no other communications in between, sending me an itinerary for my scheduled interview. It's going to be a marathon interview with three or four doctors and management types from the place, in succession, taking place at least partially in some restaurant near the practice, for the entire morning from 8:30-12. Now, I was never asked my preference for interview days, and, as they have this scheduled this for an early morning about 2 weeks from now, it's a bit late to ask for a day off from my current job, so I would have to lie and call in sick. Furthermore, I won't be able to eat anything at that restaurant, due to dietary restrictions. I've experienced something similar once or twice before..the last time, it was obviously an extremely expensive restaurant, and the main interviewer was obviously trying to sell the lifestyle...he and every doctor who interviewed me were dressed for a high society cocktail gala, they were trying the usual "nearby fishing, skiing, outdoor lovers dream, great place to raise a family" line, really in an incredibly drippy way...as a down-to-earth, non-fancy, city boy, I felt very, very uncomfortable with the whole hard sell and cash flashing. But anyway, back to today's offer... Crucially, I was never asked for a day preference whatsoever and it seems incredibly presumptuous, for this new place to "schedule me" for an early morning marathon interview, running for 3+ hours, complete with itinerary, in a restaurant I can't eat in, without even asking me for any preferences regarding days. I was wondering if this sort of thing is industry-standard, and if I'm being oversensitive/old fashioned, or is this a bit unprofessional, pretentious, presumptuous about my availability and diet, and an inappropriate way to start a relationship with a potential employee?
  7. What's wrong with good old diphenhydramine 50mg QHS? With trazadone there is the risk of possibly dangerous priapism requiring intrapenile epinephrine, and rare risk of penile necrosis (seriously, look it up) which you have to warn patients about... Not sure if quetiapine is contraindicated, but in low doses 25-50mg QHS it works well for sleep and has no tolerance I know of...
  8. Sorry if I overreacted. Situation is stressing me out and no one around me seems to really know the best move...if there is any.
  9. I don't think you understand my post. I am not going to a bad job, I am at a bad that job which I have already taken and turns out to be bad. Furthermore, your comment about moving and planning is a little bit insulting. This was not a result of poor planning, this was a result of Life Changes, and the fact that we cannot move now because of my spouse's job and have to wait a year. really not sure what the point of your answer was, as it does not seem to address a single question I had or point I made.
  10. Hey all...I already posted a similar question, but disappointingly got very few answers...and I have some more detail. So I apologize if it's repetitive. I've got 5 PA jobs listed on my resume in the past six years, including my current job (in reality, it's 7, but I left out two irrelevant early ones). My reasons for leaving the prior jobs are 100% legit...changed specialty, locums contract ended, I moved states, etc. The job prior to the current one, I spent a year at, so i'm not a flake. I've been at the current job for about 6 months. Alas, my current job is horrible, gosh-awful, and I simply cannot continue there as I might actually lose my mind. I've gotta jump ship. If you are curious, it's a new clinic, which sees zero patients per week....yes, zero...this absent patient load has not increased one bit and there is no chance that it will ever increase, due to a horrendous location and foolish "novel" business plan...so I sit 12 hours a day in a back office doing absolutely nothing (besides YouTube) with almost no one to converse with. Every shift. Shift after shift. Week after week. I literally cannot remember when my last patient was.) But...here's the thing. Spouse and I are planning on moving about an hour north, some time in the not-too-distant future, and unless I can find my dream "forever" job, right now, halfway between current town and future town (or otherwise reasonably located), I might have to add yet another job to the list...namely, my immediate next one...thus making the list even longer (6 jobs) well before I finally try applying for my "forever job". My alternative option, of course, is to continue working and waiting it out (or quit and wait it out, really considering that one, that's how mind-numbing this job is), even if it takes months, so that I can limit the ever-growing list on my resume. of course, it's quite likely i'll go nuts at this place if I wait it out, but that's the risk. At what point will prospective employers look at my job list and go "hmmm...what's this about" without even giving me a chance to explain at interview? Are 5 jobs in 6 years, or what will likely be 6 jobs in 7 or 8 years, a true "red flag" in this day and age of job-hopping and post-depression economic upheaval, or is it not uncommon? And as well, considering I am still early in my career and have legitimate reasons for non-establishment (recently married, moved states, trying to find our place)? Is it enough of an issue that I should really wait it out, just to keep the list shorter? Thanks all.
  11. Oh yeah, EM Rap is cool too (www.emrap.org). I also very much liked the EM Basic (embasic.org) podcast. But I definitely also upvote EM Boot Camp, first and foremost, above all.
  12. Admittedly my ER experience was awful, and I'm (apparently!) still bitter 'bout it. Anyhow, I digress...excellent point about the "it hurts" rule...treat the patient, not the film/ECG/etc.
  13. EM boot camp is great, but it can be expensive. Some ERs have a copy to lend out to prospective employees. But if you can get your hands on a copy of it, listen to it as many times as you can bear. Take notes on it too. If you will be starting out in "fast track" or low-acuity, (or even if not) get the "Minor Emergencies" Book, and start watching videos to refresh you for basic procedures...suturing, I&D, pelvic exams, etc. Watch a video on the basics of the slit-lamp (it's simpler than it seems). Either way, get the EMRA antibiotic guide, and EMRA emergency medicine guide. And get a subscription to UpToDate if they don't have one on-site. The most important advice I can give you in the ER is: (1) carry a little notepad, or index card spiral, or whatever, and keep, keep writing...best treatments for X, each attendings pet peeves, frequently used phone numbers and departments, etc. The worst thing is to be told something by an attending and not have that info handy the second time. It will be noticed. (2) ER docs can be among the most brutal, ruthless, heartless, soul-crushing humanoid creatures known to mankind. Be ready for it. Don't let it get you down. Just make sure you are doing your part and what you are supposed to be doing. And document any serious negative encounters with any ER staff so that you have the ammunition, should you need it. (3) ER attending are not there to be your friend or suggestion source. Come to them with a tentative DDX including what might kill this patient and why it isn't that, and come with a tentative plan. Believe me, even if you are wrong as hell, better to appear to have thought each patient through. Do not look to ER attendings for suggestions for your DDX or plan, ever, unless they offer it. (4) Don't be lazy about doing tests. If there is an eye complaint, whatever it is, you darn well better have done visual acuity with Snellen before you even think of talking to an attending. Same with anything else...full cerebellar exam, full cranial nerve exam, etc. (5) Now is the time to brush up on your physical diagnosis book. And learn clinical decision rules...Ottawa knee, Canada Head CT, CENTOR, PECARN, Ottawa foot and ankle, Well's, PERC, etc etc.
  14. Hey all. Thankfully, at that point where I can start seriously interviewing the interviewer at prospective new Urgent Care job. Wondering what a diplomatic way would be to ask some of the following crucial questions...without sounding suspicious, picky, defensive or as a weak candidate. Admittedly, some of these are obviously from past personal experience which I did not enjoy and would like to not repeat... (1) What's you ACTUAL typical volume, not your worst-case-busy-Saturday-night-volume...don't just tell me the standard "4 patients per hour" or "40 patients per shift". Give me an idea of the daily flow here. (2) What's your supervisory style...will you call me after every patient and nitpick my chart and treatment choices, because they aren't your exact style, or will you let me practice as I consider appropriate, usual and customary and respect my clinical style as long as it is reasonable? (3) Are you the kind of supervisory doc who will stroll in on Saturday night after your golf game, when I may have 2 laceration repairs in progress, an I&D waiting in another treatment room, two URIs waiting down the hall, a dehydration victim I'm rehydrating, and a bunch of antsy "I-need-to-be-seen-now-because-this-is-Urgent-Care" type of people in the waiting rooms, and start yelling at me because I can't wrap up all three procedures in 12 minutes total? Or are you the kind that will jump in, say "darn, that's a lot of procedure work, let me help ya out and knock one out for you, as I see you are up to your knees in it!" ? (4) Are my suggestions, advice, thoughts on improving the practice and suggestions to fix problems going to be ignored because "this is just the way things run and you're a small cog", or will my input, based on experience, actually mean something here? Thanks all...
  15. As mentioned it's a pain in the butt. You are expected to treat the presenting problem and ONLY the presenting problem. if they come for workers comp backache and they happen to have a nail sticking out of their head, you will get on your bosses nerves, as well as piss off the WC patient's boss off, if you dare to address it. Furthermore, often lots of annoying paperwork to fill out. Then, you have to start making up rules...the WC forms often ask detailed nonsense about "Mr. ____ may lift no more than ___ lbs to chest height, ___ lbs to shoulder height, may be on his/her feet for ___ hours continuously..." There is no clear guidance or rule I have ever seen on these, and most docs just make up the numbers as they fill out the form. In shorts, it's a pain in the butt, unless there are VERY clear guidelines of EXACT limitations per presenting problem, and the MA or front desk takes care of most of the paperwork for you.
  16. 1. Read "Minor Emergencies". Then read it again. https://www.amazon.com/Minor-Emergencies-Philip-Buttaravoli-FACEP/dp/0323007562/ref=sr_1_4?s=books&ie=UTF8&qid=1535075781&sr=1-4&keywords=minor+emergencies 2. Get a subscription to UpToDate!! and use it! Can't stress that enough 3. know your rules and criteria ( CENTOR, PERC, Canada head rules, Ottawa joint rules, croup score, etc...). 4. Get the EMRA antibiotic guide, it's great....far simpler than the overcooked Sanford manual, MUCH easier to use. https://www.amazon.com/EMRA-Antibiotic-Guide-Brian-Levine/dp/1929854455/ref=sr_1_cc_1?s=aps&ie=UTF8&qid=1535075648&sr=1-1-catcorr&keywords=emra 5. EMRA also has a EM guidebook that's good for quick ddx thoughts. https://www.amazon.com/Basics-Emergency-Medicine-3rd-Ed/dp/1929854471/ref=sr_1_cc_4?s=aps&ie=UTF8&qid=1535075648&sr=1-4-catcorr&keywords=emra
  17. Let's see...first job was a bad fit (let go, essentially, but kindly, with good recommendations), second job I left to change specialties after a few years, third job I was essentially laid off as department was downsizing and management was cleaning house of new people, fourth job was locums and I finished out the contract, fifth job I left after quite some some time because I moved to a different state.. So I guess that's one locums.
  18. 1. Do people tend to work with one agency, or do you move from agency to agency? I've worked with more than one agency, though not at the same time. Nothing wrong with taking jobs from wherever they come. 2. Any preference regarding W2 vs 1099 status? I hate 1099, quarterly estimated payments are a pain in the butt. That being said, i don't think locums are big on W2. So throw an accountant a few bucks to help you out, and keep pay stubs and meticulous financial records. 3. I've been in contact with Comphealth and Barton- any comments on experiences with either? Nope. I've used Execu-search and Consilium, both of which were fine. I'd personally always prefer an agency that gets paid a lump hiring sum rather than gets paid an hourly wage on top of yours...the latter is a higher risk of the actual job getting tired of paying fees, rather than buy you out in one shot. 4. Insight on hourly rates and housing reimbursement for San Diego and Los Angeles? I'm looking mostly at FP, clinic IM, and UC positions. No clue, sorry. UC on the East coast is anywhere from $50-80/hour, usually around $60-70 with experience.
  19. Hey all. Just wondering if it's "still a thing" not to have too many job jumps? I've left five jobs in 8 years (four of those eight were my choice, and all for good reasons...either changed specialty, moved to a different state, locums contract ran out, etc).. I'm looking to jump ship again from what has turned out to be a crappy gig in too many ways (promises not kept, extra duties outside contract, no attention to my professional desires, excesive supervisory micromanagement, poor corporate environment, etc). I'm just wondering, does it look OK on a resume to list so many jobs as a PA? Or is this the "new normal"? I'm almost debating staying longer just to prevent my resume from getting longer, but I hate the current job...Looking for my "forever job" which I thought this would be, and it has fallen far short... Thanks all.
  20. Honestly, nothing wrong with some meds and therapy, in that order...we're all on them. Get a consult for low dose antidepressant for anxiety control...to take the edge off, then therapy to work on calming techniques so you can get off the meds in a little while. Just my two cents. Maybe a little bit of Klonipin or Ativan to help sleep with acute episodes.
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