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Everything posted by quietmedic

  1. What do you mean by minimum requirements? Will the school actually check your insurance policy to see that you are covered to their standards? There are "catastrophic coverage" travel plans that may be available in your state, wound not quite cover what you were looking for in terms of coverage.... Where do you live? And where is the rotation? In all honesty, $300 is not that much, Obamacare here in NY is like minimum $450 for a plan like what you describe...$600 dollars is not a while lot in the grand scheme of things...just saying.
  2. I agree with the above, but I think it also depends where you live. In New York City, where it is extremely extremely extremely difficult (did I mention difficult?) to land an ER job without tons of experience, and where there are very very very few ER jobs that will ever even remotely consider a recent graduate, I say that the offer is too good to pass up, if you are truly ready for it ( busy inner-city ERs are known to be brutal places to work, let alone attempt to learn, and if you don't move fast, learn fast, and know your stuff inside and out, your soul will be eaten alive). however, if you're an a part of the country where ER jobs are not hard to come by, and many rural places are desperate for and are always hiring PAs, then yeah, perhaps wait until you have more experience and medical street smarts.
  3. 55 patients in a 12 hour shift???? That's insane...the busiest Ive ever had is give or take 30 patients in 8 hours, which I suppose extrapolates to 45 in 12, and that is absolute chaos if there is anything more complex than a URI...one or two procedures, and forget it. How on Earth do you see that many (unless the MAs are doing the bulk of the work for you)?
  4. So, I admit, I'm a little confused. After being covered in an institution, I have had several jobs in several clinics one after the other, each with their own malpractice coverage for me, which has always been claims-made. Now I'm a bit confused, or perhaps a lot confused. Firstly, I understand that claims-made is only for the policy period, not like occurrence, which covers you forever and ever. Now, if one goes from job A to job B, and both have claims-made coverage, and one gets sued while they are at job B for an incident that happened at job A, is it correct that one is not covered? In other words, does Job B's insurance cover you ONLY for incidents arising at Job B, even if you are working at job B when a lawsuit comes down for something at Job A? As a followup, if one has been at 20 different jobs in succession, if in fact one is only covered at each job by each individual insurance WHILE they are at that job (IOW claims-made at job B doesn't cover a suit against you while you are at job B for something that happened at job A years prior), does that mean you need to buy tail coverage twenty times, spending tens of thousands?? And furthermore, if one has already gone to Job D or E, do I now have to go back and buy tail coverage for each job I ever had, years after the fact, just to be safe from any possible future lawsuits, Gd forbid? I'm really confused about how all this works. Hope y'all can help.
  5. Oh and of course document everything!!! most importantly document why you are ruling out serious conditions.If a patient with shortness of breath comes in, make sure you write down why you don't think they're having a PE. Always always if it's something you wishing that you think could potentially be serious, but pretty sure is not, make sure you document very clearly that you thought of everything else, you have to cover yourself at all times so that later on nobody can say anything even if a serious outcome happens.
  6. Read Minor Emergencies. Then read it again. Hopefully some will be familiar to you from your. EM clinicals...Get a subscription to UpToDate!! and use it! Can't stress that enough... Let's see...make sure you keep reading and learning. Like anythingelse, so much is gestalt and experience...make sure you know your rules and criteria ( CENTOR, PERC, Canada head rules, Ottawa joint rules, croup score, etc...). Read some good articles onruling in and out ACS (tintinalli is good) but there especially is an area that comes down so much to clinician gut gestalt more that simply rules and ecgs...try to trust your gut (but always cover your butt!)...Get the EMRA antibiotic guide, it's great....EMRA also has a EM mini guidebook that's good for quick ddx thoughts...take notes of everything when you observe otherproviders there, if you have that opportunity... Typical stuff I see in UC: URIs URIs Did I mention URIs Cough Sore throat Rashs (allergic, fungal, eczema, zoster...) Pediatric rashs (coxsackie, exanthems, seborreah, candida) Earaches (a lot more serous effusions than you would think!) Headache/dizzy (make sure you can do fast full Neuro exams!) Chest pain Nausea/vomiting (zofran is your friend) Diahrreah/constipation Lacs Abscesses Nail injuries Red eyes School/work physicals Vaginal discharge Asthma Backache Weird stuff And...make sure you work for a supervising Doctor Who is friendly and is okay with you calling when you have questions!
  7. Lol yea see stuff like that all the time, often stuff switched from Physician ads, like "Requirements: Board Certified/Board eligible" But I love the downright crazy stuff, like "5 years Urgent Care experience required"....Urgent care hasn't even existed in parts of the country for more than three years. Just inexperienced/uninformed recruiters thinking they understand the ins and outs of what medical training and experience really implies, and how much is really enough...
  8. Well, technically, very few places actually use paper charts, almost everything is electronic now. In some institutions, supervising docs (or just whatever attending doc is supervising your department) may review your charts, and click something like "Agree with PA's evaluation and treatment of patient". That would be as tangible as cosigning gets today. My actual, "on-paper" SP (supervising physician) at a hospital I was at never reviewed my personal charts, to my knowledge. Other docs may just skim your chart as it passes by (without actually clicking or "signing" anything). In some cases, your SP may do neither of the above, and just trust you did your job right, if that level of trust and experience is there. At least in NY, I do not believe there is a legal requirement for a SP to actually physically review/click or sign something, though I could be wrong. If there is a legal requirement, the significance would obviously be to fulfill the law; Where it is optional, it may be done for billing purposes, or more likely because the institution just wants PA's charts to be reviewed to ensure adequate evaluation & treatment; but it's more likely done for adequate legal protection ("CYA") so the doctor is another step in protecting the institution from lawsuits (heck, that's 90% of why I overchart so much anyway)
  9. Yeah, actually I used to do stress tests as a PA. Perhaps i'll have to work as a PA to avoid any legal pitfalls...
  10. Wow, that's quite an experience to the OP....
  11. Basically, I was offered a side job as a cardiac stress technician...running stress tests. Obviously, this is sub-par work for a PA, but at the moment it would help for some extra cash between clinic shifts. Obviously, this is well below my scope of practice, and I assume I would not be covered by the company for PA malpractice, (unless I could, or must, legally negotiate that somehow). Also assume i could only do it in the sates I am a PA in, though if I am out of state...could I practice as if I was not a licensed PA (in that state) and just act as a cardiac stress technician? A little confused by the legalities involved. What do y'all think?
  12. To be honest, you are going to have a very hard time finding ER work as a new grad in NYC. I was in the same boat, and it took me years to find such a job...and I went to school in NYC. Too many PAs, hospitals have the pick of the litter...There are exceptions, of course, for exceptional PAs, such as if you were the emergency room deity on your rotations in a major trauma center, and can prove so with glowing reviews from top EM docs, but otherwise...you are far better off trying EM somewhere in the reachable vicinity (upstate NY, Connecticut, New Jersey, etc). And even if you find a position, NYC is a rough environment; many ERs have their hands beyond full with overworked attendings trying to teach to teach residents AND see endless patients (with many hospital closures in past years, the remaining ones are constantly slammed), and as such, helping a new grad learn the ropes of EM is not a top priority. If you can get into residency (NYP Cornell or North Shore (aka north-well) Staten Island University Hospital, or other not-so-distant ones in upstate NY or Philly), that's the best way. Keep in mind that the number of residency spaces are VERY limited, and you better be very well polished and dynamic, but humble and eager, to win a shot at those. If you have some Urgent Care experience either in fast track from your ER rotations, or otherwise are half decent at family medicine/clinic, there are a lot of Urgent Care places hiring in the NYC area; UC is a great way to learn a lot of EM-oriented stuff, and in some ways an even better job than actual ER work, for some. You will have to be prepared to hit the ground running, but that is a strong possible route. The most likely and realistic scenario is you work your way up for a few years in enough fields to give yourself a decent resume that shows potential, perhaps in Urgent Care, family med, internal med, ICU/CCU, cardiology, etc. If you can get a leg in at a hospital doing anything related (IM, CCU/ICU, etc...not dermatology clinic), you may be able to transfer laterally at some point. As this is NY, you will likely have to accept that the pay and all on your way up will not be necessarily stellar, but that this is a journey. Unfortunately in NYC you simply cannot have it all (good pay AND your chosen field AND etc etc) at once...but you can get there with time and effort, and the journey on the way will be beneficial for well-roundedness in the long run. There are exceptions, of course, for exceptional PAs, such as if you were the emergency room deity on your rotations in a major trauma center, and can prove so with glowing reviews from top EM docs, but otherwise...you are far better off trying EM somewhere in the reachable vicinity (upstate NY, Connecticut, New Jersey, etc).
  13. it's kind of hard to say without knowing more specifics. I don't think anyone would fault you for leaving a job that you feel is a bad fit...in terms of your resume, I think people understand, if you just explain it to them. Or you could leave it out of your resume altogether.ultimately you have to trust your gut, if you've had enough varied experience in your three and a half years to be able to vouch that your gut is correct, then perhaps switching back to the other job would be the best move. On the other hand, I started a job once that was not great. In the end I stayed for quite a while, not for the job, but because I enjoyed my co-workers, which is no small factor. Though, at the time, I was always trying to get into my field of choice, and used that job as a hold over. If you already have found your field of choice, I'm curious why you switched... If you find yourself at home and the other job that you did not take, perhaps it would be a good idea to go back and take it. Just wondering why you made the switch....was it a financial decision? Or do you want to try to Branch out into a new field?
  14. I agree, in an ideal world... But in the market where I practice, they can go to half-a-dozen Urgent Cares literally around the corner, where they WILL get what they want, (probably from a Moonlighting non-PA practitioner who just doesn't give a damn). Perhaps it will take making antibiotics a controlled substance, to make people understand the severity of this, because when I explain it to them they just don't get it. And unless practitioners start worrying about ethics violations on their licenses, they will keep giving it, I think. Hell, I like that controlled substance idea... P.S. I wish they made sugar pills that look like a z-pack. I would prescribe it without hesitation!
  15. Knowing precisely what you are talking about, I wouldn't necessarily turn down the job... A lot of urgent cares are like this, it's just the nature of the game today. But what you say in the interview doesn't necessarily have to be what you do in real life. sure, I have given the fact that patient she didn't need it... But at the end of the day, after I explained very carefully the differences between bacterial and viral infections, explain to them that theydidn't need it, and all that... And they still say they have a big week coming up and they really would like to knock it out with a zpack, I saand prescribe it to them... Look, if you don't give it to them, they will go across the street to the other urgent care, and get it from them. if I prescribe it, I do question them and say give it a few days and if there is no change, then take the medication. I have had patients who were in fact not necessarily relieved to not need antibiotics, but were pleasantly surprised to learn that almost all of these are viral, and didn't push the issue. but then I have patients who know exactly what they came in for, and it wouldn't matter much what I say. like I said, they're going to go across the street and get it anyway, so I feel like if I give it, at least I can give full perspective on it to them in person. and I would answer something similar on a job interview... Say, I would do my best to educate the patient that is not necessary, but at the end of the day if they insist, it's the lesser of two evils.
  16. Without knowing what you want to switch to, it's a little hard to comment...I had the same fear after doing four years in one very specific specialty, the like the other posters mentioned it does come back to you... resources like up-to-date are absolutely invaluable, as well, without knowing the specifics of what you want to switch into, there are a lot of resources for pre-education...lecture series (I'm thinking of em boot camp in the case of emergency medicine, I'm sure there aresimilar things for other specialties) , podcasts, and Specialty CME weekends, you can even do a PA exam review weekend what's will give you a crash course review in just about everything, so they are a little bit more tailored towards test-taking then Street medicine. would you mind sharing what you are switching into?
  17. A few important questions first... Is this your first job as a PA? How long have you been a PA?
  18. Try posting in the Surgery Specialty sub-forum...
  19. I would say, based on my experience, while this may seem like a huge challenge, it might be just the push out of your comfort zone that you need to get you to the next level of practice, acumen and skill. Of course, if you feel totally unprepared, that's one thing, but if you fell like MAYBE you could hack it, it's a great way to push you to become a better and more 'independent' practitioner. The one caveat I would push for is that you can be able call your SP or mentor at any time with questions. If they are fine and happy with that, it may be worth the challenge. Of course, if you feel totally and utterly unprepared, thats a different story. But sometime s a challenge is good for building clinical character.
  20. Haha wow. Location, location, location. In NYC a PA would kill for a starting salary of 40 an hour just out of school. 65 an hour? maybe after ten years, unless of course you are in surgery. No just out-of-school PA in their wildest dreams makes more than 85K a year in NYC, in my experience, unless some kind of special circumstance. 100K, maybe after 5-10 years of experience. Hehe, that's NYC for you...
  21. That's so strange. Incidentally, isn't Nacogdoches where the majority of the Columbia Shuttle debris came down? The name rang a bell to me (way up here in the Northeast).
  22. Thanks for the replies. I will have to inquire further about the billing. Are there any heads up in terms of medico-legal issues that can arise, i.e. avoiding suing, things beyond usual office practice and typical CYA activities?
  23. @Gordon, yes, medicare based @ventana, I think they will have a billing person, with that person know to do this (perhaps there wont be a billing person)? Also, they said even if I go to the house, and send the patient to the hospital, we still bill for a base level visit....is that what you mean by trip fee? Thanks
  24. A doc I know is recruiting PAs for a house-call sort of practice. The doc is someone respected and a good guy, and I don't consider anything nefarious. Just wondering, are there any pitfalls/things I have to watch out for in terms of joining this sort of service, in terms of medical, legal, things to watch out for in terms of my license? Anyone else out there every do this sort of work? Thanks all...
  25. Thanks for all the thoughts. Some more of my two cents... It's strange to me that something that should be so straight forward -- i.e., either yes or no -- is so murky. I find the concept of "legal but ethically problematic" a bit strange. I can't think of too many definitive things that a medical provider can do, in typical practice, that are unethical but legal, present discussion aside; medical ethics is strongly present in the gray areas that really crossover into philosophical/spiritual questions ("when does life start" when does life end"; life support issues; and the like), but questions of objectivity...honestly, I see these as fairly clear cut, legally. If your own parent is begging you for oxycodone, or your boss demands you prescribe to him or he fires you....that sure is a lot of pressure...but if it's medically justified, then so what? It's legal. And if it's not, if it is inappropriate treatment, it's malpractice, and illegal. I don't see a gray ethical area here. Just a legal question. Furthermore, about the idea of treating self and family in general...we are trusted to make decisions about strangers, or perhaps people somewhat familiar to us, but suddenly when a family member walks in, it is assumed we lose all common sense and lose our backbone? If we are trusted as professionals, then we should be trusted. Controlled substances aside, If I think my kid has an ear infection, I don't see where the ethical problem lies. Just as with any patient, if I think ABX are appropriate, then that's my clinical gestalt. If I think they are not appropriate, then I certainly wouldn't want my child to develop antibiotic resistance, and I wouldn't prescribe it. If my signif other may leave me unless I prescribe them Bactroban, then...I think there are bigger issues that have to be dealt with, likely urgent psych assessment. (And then again it would be quite impressive if they figured out a way to abuse Bactroban...) Certainly concerning myself, the same would hold true. Specifically, putting controlled meds aside, it's highly unlikely I'd suddenly have the urge to start abusing amoxicillin and Zofran, and to my knowledge, the black market for albuterol and 2.5% hydrocortisone cream is not sizable. I'm a bit lost to imagine how this would really be a legal or ethical concern. Yeah, maybe I will prescribe myself a hundred tablets of synthroid and sell it to my bodybuilder friend to abuse, but then again I could just as well write him (or her, I suppose) the script. It would be the same legal exposure. Sure, I could be mailing lots of self-prescribed amlodipine to a cousin in Russia, but...again, it would be an odd thing to risk my license for, and something they could get for themselves fairly easily. Granted, in this paragraph, depending on the state, I'm fighting city hall; not any previous commenters. Yet it does boggle me why it should be an issue. I understand for police, to investigate family, there would be a real dilemma...but that sort of matter is a course of action which may determine someone's freedom or life, not determine if they will have some diarrhea relief for a few days. Even the concept of "an established/genuine patient-doctor relationship" seems vague, as I mentioned. If I go to Urgent Care once, the provider may never see me again, but they can prescribe me a medication. I don't call that an established relationship. Family should be no different; If I do a history, do a physical, and write a full chart, then I have done my part and established a medical relationship. If they withhold information out of embarrassment, or what have you, it's their problem. It was their free choice to come to me as a provider, and they could just as well have left out pertinent facts (or outright lied) to another provider. The onus is on them, not me. No different than any other patient. Perhaps I'm playing a bit of devil's advocate, but I definitely want to raise the issues that others here have also echoed, many of which I too am unclear about.
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