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Everything posted by quietmedic

  1. looking for an opinion on a situation. sorry for the long write-up. I just signed up for a new job in Urgent Care. Everything seemed hunky-dory at first, but now that I've started they made it clear that they expect some extra duties. Firstly, I was just informed that since this multi-specialty clinic has a need for coverage, the UC providers will also be covering some Primary Care patients as time permits. Fine. But they have a complex patient demo and complex relationships with insurance, and the coding is far more complex with all sorts of extra regulatory and compliance and medicare/caid items, and we'll have extra coding/billing training. Fine, whatever. I'm not a medical biller, but ok. But then....I was just told that since there is also a need, the UC providers will now have to take a FULL WEEK of primary care call every 7 weeks...so for the entirety of that week, I can be woken at 3 a.m., every night, even with work the next day, and I have to be near a computer at all times. Well, umm...my contract did note I might be needed for "reasonable, occasional" duties, but no mention was ever made during the interview or contract that I would be responsible for perpetual on-call coverage of primary care patients as an urgent care employee. And it's one thing if the salary was extraordinary, but honestly, with my experience, the pay is moderate at best...I took the job (and left a better paying one) for proximity to home and benefits. I absolutely would not have taken the job if I knew there was a week of primary care call. I'm thoroughly pissed. Of course I can leave, but i'd rather stay and insist on the original contract terms. Anybody ever go through something like this, and what did you or would you do?
  2. Some of these responses are outrageous to the point that i have trouble believing them...>250,000 as a PA? Sorry, don't buy it. Even at 190 hours a month, that's $120 an hour! Just not possible. $150,000 for 36 hours a week? Not gonna happen within 100 miles of where I live. In NYC area, starting salary for PA in hospital setting is about 80K. A few years of experience and you miiiiiiight pull 95K-100K in a busy ER. Anything above 130,000 is downright OUTRAGEOUS for a single job in the region.
  3. As most of you will know, we are all already paying outrageous fees for the "privilege" of prescribing narcoticts. But what no one seems to be talking about it's a fact that the manufacturers themselves pay only pennies for the privilege of raking in millions. As far as I can ascertain, manufacturers are paying about $3,000 each for the rights to manufacture. $3,000 is such a low figure that is probably full to well below the average manufacturers toilet paper roll costs per year for their facilities. Yet as providers, we have to pay a figure that might be well near a half of a percent of our annual income. Why isn't any big deal being made about this? And at what point will somebody start fighting back? Should we wait until the DEA fees are $1,000 per year for provider before we say enough is enough?
  4. A few indispensable resources: "minor emergencies" read that damn thing cover to cover. Extremely practical, not your typical thousand page "quick reference". "EM boot camp" If you can get or afford a copy, listen to it 20 times. EMRA antibiotic and EMRA emergency medicine guides. Very useful. I Use 'em daily. Podcasts - many are too in depth for UC, but "EM Basic" is excellent. "EM Rap" great too. Get an Uptodate subscription. Now. Saves my butt daily.
  5. This is a young adult who was struck in the knee. Patient was ambulatory with very minimal antalgic gait. As you can see in xray (zoomed in over fibular lateral condyle), noted a very faint vertical linear lucnecy in the lateral condyle, nontransverse. Patient had concordant tenderness overlying, but no varus/valgus laxity or pain. Given the underwhelming clinical presentation and essentially minimal nontransverse fx with no avulsion, would you enforce knee immobilizer and crutches (to avoid LCL/ fib condyle avulsion)? Or could patient do with RICE and strict instructions to avoid anything but very gentle walking? Thanks all....
  6. Thanks. About the residencies, well...applied to two a few years ago in a specialty I wanted to transition to. Group-interviewed for one. There were about 10 candidates...nine were fresh meat, recent grads, barely out of teenagehood, and then there was me...I did not get the res. Seems all the ones in my area (big PA-heavy city) want the young and impressionable, even a few years experience was apparently a big negative...but that was a few years ago, so who knows. Just reminiscing.
  7. I was there once. There are non-clinical jobs as a PA, but you should know, when I was 2 years out, I also didn't know diddly-squat. It took until a lucky job in year 5 for me to start really having a chance to learn and prove myself. There is a lot you can do in the meantime...start reading text books, literally, in the area you want to practice in...medical podcasts...pretend you are taking the PANCE again and study when you can, it will build your knowledge. As well, start taking jobs that are leading in the direction you think you might want to go. Use every patient you see in your practice as a chance to read up all about what they had on UpToDate. There's still a lot you can do. While PA residencies are very far and few between, there is something that can help you if ever go in that direction...or, even if you don't, I highly recommend it: Therapy. Don't take that the wrong way. Unless I am reading this wrong, there's a lot of anxiety/self-doubt/confidence/hopelessness issues you are struggling with, and as someone not unfamiliar, don't underestimate what working through some of these issues could do to positively influence and reframe your professional life. We're not all meant to go this alone.
  8. In NYC you take ANYTHING you can get. Regular rules don't apply here, including those about trying to change the rules....if you are lucky enough to get a hospital job in NYC, you take it, and take it NOW.
  9. I don't know, ERs can be hit or miss. I didn't have a great experience in ER, but I did learn a lot. My feeling is in Gerenal if you are learning, can tolerate the colleagues, aren't being outright abused, and are making good money...just take it for what it is. ER Docs are a strange cast of characters, and if the worst they do is this sort of stuff, I'd just smile and brush it off. I stopped trying to figure them out ages ago, just too many DSM-V diagnoses to keep track of. Use it for the pay and experience and move on when you are ready.
  10. I remember going absolutely nuts during my first year, as did everyone else in my class...I can definitely literally remember saying "they don't care about us as students, everything is disorganized, etc etc..." It always feels that way. PA school is tough, it's drinking from a fire hose, and can e a three-ring-circus with practicing clinicians trying to drop in to teach you at ungodly hours, who are not, shal we say, trained and certified experts in pedagogy and scholastic learning styles. It's always like this. Mine was too. Once you get past that, take a deep breath, and do your damnedest to learn if it be from books, class notes, etc etc, you will be OKAY. Just realize that only you have your best, best interest in mind (the school can't always do that). Just plow through, realize that learning is always your burden even in the best schools (and the best jobs), and plow through it. You'll be fine. Clinicals are where the real learning happens anyway, if you make it your business to.
  11. Actually...yes! They have two years of clinicals plus four years of post-school training, (residency and internship/gap year/whatever), at a salary of about $20 dollars an hour. Compared to the average PA's measly one year of field time, six years is a lifetime of experience in training at near-minimum wage. Not to overaggrandize doctors, but honestly, we aren't anywhere near their ballpark at the time of PA school graduation. Other than applying for the NP spots, might just be worth it to stick it out for now...
  12. Very well put...I'd add that EM residencies are few and far between, and VERY VERY hard to get into, especially if you are not a new grad (they tend to prefer fresh meat)...so probably best chance is to find a nice ED crown at a not-so-buy, not-teaching hospital outside of "the city"...
  13. It all depends how the market is. If there are plentiful other jobs which guarantee you autonomy, then leave. But you are a new grad, and this may not be the worst thing in the world while you get your chops...we all had that first "training ground" job...if you are not about to face eviction from your apartment, and other jobs are not all over, might be worth the situation to use it as a stepping stone and put up with it for now.
  14. For me it was the best move, because the ER i was at was a terribly hostile environment...abusive Attendings, directionless administration. UC was like a breath of fresh air...get to go home at the end of the day without getting reamed out in front of my coworkers or having to take crying breaks. SUre, can be more patients, but the freedom and respect made up for it.
  15. My first PA job, in one of the biggest cities in the USA, less than 10 years ago, was $35 per hour. At the same time, PAs in this same state, but in rural areas, were making $40 starting, at least...and even as recently as 2 years ago, in a prominent hospital in this same city, experienced PAs started at $46 an hour. So I think it may be relative to where you live and what you do. $35 an hour to me does not seem unreasonable when you still know diddlysquat as a new grad, since you are still learning. Of course, within a 5-10 years with solid experience and expertise, that number should double, but still. If I was a new grad again, I would never ever turn down a new job because of salary...at least in this city, it is nearly impossible to find jobs as a new grad. Of course, if there are two offers on the table, that's a different story.
  16. Remember, for a first job, often you are doing a LOT of learning...in some cases you should be paying THEM for the experience (if they actually do a good job at letting you learn of course!) I wouldn't be too picky with a first job unless they are paying less than $35 an hour...
  17. Staffing agencies saved my butt a few times! yeah, sometimes the leave messages and emails for jobs I don't care about, but hey. The only downside I've ever had is that a lot work it out for you to file 1099s which are a pain in the butt, and in one case, the job I worked at couldn't pay the agency fees anymore, but never had too bad of an experience...
  18. In NY, back when we actually had paper scripts, the supervising docs name was ALWAYS on the script. No big deal. Never had a problem prescribing anything though.
  19. I think the most understated resources is...Uptodate. Personal subscriptions are 57 a month, and worth every penny. Besides for Cat 1 CME credit, it has saved me so many times in clinical practice. Might not be much to read beforehand, but read it late at night and review EVERYTHING you see, as you are able, and you will learn a ton. "Minor emergencies" is more urgent-care-ish, but a lot of crossover into primary care. Worth having with you/browsing at leisure. Don't go too nuts. A lot of learning will be too out of context now, makes a lot more sense when you can match study with actual patients...once you actually SEE it you will not forget it.
  20. I appreciate the response...I am wondering, though, would the Adult only be easier than the Primary Care? It may be similar to PANCE, but i'd love to have an easier time than the PANCE was...trying to find out specifically what extra peds stuff is on the Primary Care format, vs what sort of extra adult stuff is on the Adult format.
  21. Been searching the boards, and no one seems to know much about the test content...even called NCCPA today and they basically had no more information than the pretty much useless blurb on their website. I work Urgent Care with only a little bit of peds, but no one seems to know what exactly the nature of the extra peds questions on the Primary Care version are....meaning, is it detailed stuff about milestones and genetic diseases, i.e. non-clinical, not super-relevant stuff of that nature, or is it regular and applicable info like what I encounter in my daily work? And is the adult med exam also going to arcane intensivist stuff in place of the peds questions, or more like regular test material? Would I have a better chance of passing the Primary Care or the Adult med PANRE? Very surprised by the lack of information out there about this.... Thanks all...
  22. (1) PA school is actually one of the best jobs as far as bang for the buck...ratio of average early yearly earnings vs cost of school is pretty good, far better than social work school or even med school for the first 15 years. Guesstimate about $50,000-100,000 for the whole program, depending. (2) As much as you can get, assume something like hundreds or a thousand hours of general medical contact and 50-200 hours (officially, at least) of shadowing a PA...volunteer at local hospitals, take a medical assistant course and get a part time job in n medical office, etc etc...get as many names as possible, network. (3) Varies as far as major, probably sciences is best, but for coursework need to take all usual premed courses, same as doctor, usualy including organic chem. (4) typically 24-36 months. Of course, make sure medicine is what you really want to do!
  23. Yeah, NEEEVVVEERRR buy inkjets. The entire industry is a scam with cartridges that are programmed to display mpty when half full and which don't allow you to refill them with aftermarket ink...total scam. As everyone said, find a nice efficient laserjet, use economy mode if they have it (think most laser's dont)...
  24. Hmm. Of about 75 students, we lost about 17 off the bat during advanced premedical sciences semester (almost all of them were people who were not appropriate or prepared for program etc) , and then only about 8 of remaining 58 during hardcore medical semester (about half rolled back for personal reasons/life events; among the remaining few who rest who totally left the program, most decided PA wasn't what they really wanted; very few left for actual academic inadequacy). So we lost about 25 of 75, i.e. 33%, but ultimately among those who really were appropriate for the program, we lost very few people for academic reasons. As for the stress issue, well, it can be tough, though we didn't have too many witnessed breakdowns and such (though i'm sure there were many private overload moments, I had them for sure early on!!)...the first few months are a shock to the system, far moreso due to mental intimidation than actual inability to succeed, but everyone reacts differently....by month three a student should already see they can pull through even if they feel overwhelmed, as long as they take it a bite at a time...and the program should be supportive by then...
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