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Everything posted by quietmedic

  1. Is that....I guess it's legal, but ethical? Got me wondering...
  2. Doesn't sound too bad...all depends on location. $55 per hour is considered a great PA income in NYC, but in other parts of the country, its considered too low to bother with. It's extremely relative.
  3. I don't understand why ANYONE does pharmacy. Six years for a PharmD...so you can stand all day in the back of a CVS and twiddle your thumbs? Boggles my mind. Go PA. You want to treat patients. Not push pills into bottles, or sit and watch teenage pharm techs push pills into bottles. You want pharmacology? That's what you do when you prescribe meds!
  4. It doesn't affect me so much personally...But maybe I'm just jaded from my time in EMS. It affects me more generally in the sense of seeing too much mortality, which is why i'd never work in an ICU.
  5. Having worked UC after a job in the ER, I might say UC might be a better choice than ER at least, for a first job, as long as you have at least some good experience from your ER rotations (i.e. you used them wisely). My ER job was not great, and i'm much happier in UC. It's not terribly difficult and especially if you have some support. There are some great UC youtube channels out there (John Bielinsky and others), and I'd also throw in Dr. Paul Thomas's pediatric channel, it's great for basic peds stuff that you will see. I'd absolutely get a copy of the book "Minor Emergencies" and read it front to back a few times, get the EM BASIC podcast archive (downloadable), and get yourself an UpToDate subscription. Some UCs are insanely busy, and that's probably not a great place to start, but if you can find a reasonable place that has an OK load so there is time for you to learn and the other provider to teach, that should be OK. As for clinical acumen a.k.a. gestalt a.k.a. the sixth sense, that comes with experience in any field, so you will have to ride it out and learn.
  6. Definitely varies. In greater NYC area, anywhere between 55-65/hour is typical for starting in UC, 60-75 with experience or so. But varies quite a bit with region of the country and proximity to metro area.
  7. Not in my experience, and UC in NYC is my experience. Maaaaybe 75 in a high end place or short-term locums or per diem. 100, not even in your dreams. Nobody is paying PAs 180,000 a year for urgent care in NYC, not even close. Where are you basing this on?
  8. 120K is pretty much absolute ceiling for ER/UC in NYC area. Standard PA starting pay in NYC is 75K-85K. Took me 5 years to surpass that. Hard to tell in your case but depends on the market.
  9. Yeah...when I diplomatically asked, I was told "it's not forever, but for the foreseeable future"...not the best answer...so it is what it is.
  10. Haha yeah, pretty much sums up my experience so far. In any case got over my anger, still at this job until something better pops up...at very least, a lesson in humility even in the face of absurdity, I guess. The paycheck is OK, so, whatever, I guess.
  11. UC tops out at around 120,000 in my region....55/h as a new or recent grad is not bad at all.
  12. Holy crap! That's nuts...just out of curiosity, is a pharmacist allowed to fill his own scheduled meds? All other illegalities aside...
  13. I keep thinking about telemedicine as a side gig....but just seems too medicolegally risky...what sorta gig are you doing?
  14. I've used one based in Texas called Consilium (for jobs on the East Coast), they are nice and were helpful for locums work...http://www.consiliumstaffing.com/
  15. Interesting question. Perhaps if the MA performs it in the lobby...you haven't seen the patient, but interesting question.
  16. I don't like wearong one, but I've been at jobs that actally DEMANDED I wear the coat on duty! I guess it's a compliment, in a way...
  17. Thanks all for the input and letting me vent here (I'll try to limit that....). Yeah, it's so belittling...I mean, I have the time, but do I really need to ask him for approval for giving a little zofran to a nauseous person (he actually is against that because it's an "ER medication", but that's a different story...) I wonder if it's because he isn't used to PAs, but state law or not, that's what he demands. I guess I can tolerate it a bit while it's slow, but if I stay, and things get busy, Hell no. I was wondering in part if anyone else has to put up with this sort of thing, or if it's totally uncalled for (seems it to me). Anyhow thanks all.
  18. As I've posted elsewhere here, I'm at a crappy medical organization where I was hired for Urgent Care and then was told that for a while I'm going to be seeing mostly Primary Care until they build up enough Urgent Care patients. Fine. And I was told that I'm going to have to cover call every 8 weeks for the primary care patients, which was not on the contract, but they said there shouldn't be any phone calls, so fine. And, we are required to go over every chart to make sure they are coded right for the billers, which involves about 15 minutes per chart of ICD-10 research, CPT coding, reassigning procedures to their proper ICD codes, improving the charts so that they can be upgraded a notch for EM coding ,and the like. In addition, theres about an hour a day of chart review where they nitpick my charts critiquing my primary care documentation(which I was not trained in or hired for), but fine. I can live with that. Yesterday, my supervising physician just informed me that I am going to have to present all Urgent Care patients to him, to review my plan, before I treat and discharge (our patient load for the time being is low). Now that would be appropriate for a student or fresh outa school practitioner, but I'm a PA with almost a decade of experience, and years of experience in Urgent Care. It was all I could do to not walk out of the place when I was told this yesterday, and now I'm considering going in and saying that "no, I will not be doing that". What do you all think?
  19. for those still reading... Now it gets even more fun. My supervising MD (a family med trained doc, not EM) has been calling me in for daily chart reviews. Part of it, of course, is to get me up to speed with Family Medicine (which I wasn't hired for and never practiced)... But the majority of it is to train and retrain and reretrain me to write & code the chart right. Every single chart I write is printed out, and then there are comments, editor's marks and circles all over as if I'm being graded in grade school. If I mentioned a relevant FHx history item in my HPI, I am dinged as to why I didn't add it ONLY in the (laboriously annoying to navigate) FHX section, as it should be, because its not a *proper* chart otherwise. (using one of the worst EMRs ever written for this job). Oh, The providers here are expected to write the chart as billers...organize every action taken under the correct diagnosis code, add all the proper counseling codes, assessment codes, CPT codes that the MA missed, you name it. For each chart I write, I spend 15 more minutes reorganizing every thought, every order, every blood draw, and every piece of advice I have under the correct icd10 code. Then, I get 15 minutes of critiquing per chart to show me how I did it all wrong. Then another 10 minutes on what I should add in to make this a *proper* 99213 (or whatever). Then I have to fix everything, and send it all back to my Sup to make sure it's right. Then, maybe then, I can lock my chart. Is this really my job? Do any of you have to do the biller's and coder's job like this on every chart? And, to top it off, I was just told, every, yes, EVERY UC patient I see, I have to run by my sup primary care MD (who often disagrees with my "ER" style treatments which apparently don't fly in primary care) who is in the building. Even though I've been doing UC for years now (with very positive reviews before this). FML...
  20. Yup, Applied to quite a few. Got rejected from all. The rest of the nominees (we all interviewed together) were barely out of teens, barely out of school, and as green as the grass. I was the only one not young and not inexperienced, with plenty of PAing and EMTing under my belt. Needless to say, I was not called back, and one of the residency admins all but told me it was because they want fresh meat. Go figure... As well, did my decade as an intermediate EMT. Trauma, code resuscitation, mass-casualty-incident and solo-responsibility experience is great, but only goes so far. ER resuscitation are far different than field, the roles are very different, and as a PA in trauma or codes you are rarely anything more than an extra hand for a long time. And ER medicine is very different. As an EMT, your job is to follow the algorithm, follow the algorithm, and follow the algorithm, and if you can, don't kill the patient. And get him to the ER without killing anyone else. As an ER PA, your job to consider every DDX, figure out what might be going on, prove to the attending what ISN'T going on, get yelled at and torn a new butthole for a few minutes, formulate treatment plans, follow through, and do that on multiple patients at once...and then, get yelled at anyway for being so dumb. And do it all over again tomorrow, and not dare to be so dumb as to get it wrong the second time. Oh, and today's attending B expects a completely different treatment plan, thinks attending A is an idiot, and therefore thinks you're an idiot. Completely different skill set, setting, expectations and medico-legal realities than an EMT. About the only commonality is that both involve blood and it's always a hurry. (Sorry if I sound bitter....but my ER experience was horrible. And you two hit it on the head...correct, NYC). But anyway, enough venting...that was my experience with NYC ER residencies and NYC ERs. YMMV.
  21. Yup! Absolutely true. One reason I hate ERs that do this...slows you down, then the MD is pissed that you (1) didn't do it HER way and (2) that you are slowing HER down due to MD overread policy...and then they take it out on you. So in the end, the PA is ALWAYS screwed.
  22. Residencies are absurdly selective, and few and far between...they also want fresh, young, energetic meat right out of school, not anyone with experience or baggage (family, age, etc). For hiring, it's tough. In my experience, having EMT or Paramedic background is fairly useless...very different medical mentality from ER practitioner. The best I can say is BE READY....listen to EM boot camp 100 times, memorize it, read Tintinalli ten times, memorize it, then send out resumes weekly, make phone calls, apply your butt off...Took me half a decade to get an ER job. Also, realize that half the battle in many ERs is dealing with the generally criminally-psychotic and pathologically-abusive attendings and PGY3s...and only the other half is medical. If you are someone who cries easily or is easily hurt....gotta work on a thicker skin. You will NOT be treated like you were as a student. It will be far, far more vicious. (just speaking from experience). In the wrong ERs, you will be lucky to keep your soul and sanity. And not because of the patients. Then again, the further you are from a city, the more pleasant the experience, and the easier the hiring.
  23. Completely disagree with the above. In NYC, ER PAs start, in some city hospitals, at about $45 an hour! With experience, perhaps a bit more...In urgent care, starting about 55-60, maaaaaaybe 70-75 for well experienced in private place, but that's the absolute absolute max. NYC has too many PAs and can offer bottom dollar.
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