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joanna.nola

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  1. Has anyone done the VA Locum Tenens program? What did you think of it? From the recruiter's info, you need to make a 2 year commitment. Placements are 3 months and you need to do at least 2/year (so 6 months). You get federal benefits for that level of commitment. They pay your expenses (obviously). Seems like it could be an interesting fit for the right person. NOW, I'm actually doing a residency at the VA now, so I know the pros and cons of this setting. I do think if you *want* to do locums then knowing the EMR and how the "system" works would be nice as you go from place to place. There are a lot of VA locations and although there are no listings to show you where they are placing people right now, the recruiter told said there are 150 spots right now and that's always changing...
  2. JimJ, I hear what you are saying re: teaching. I was also a teacher in a toxic environment (a failing urban school system) in one of my several career paths before becoming a PA. As a PA, I feel like I have a lot more choices. For me a non-toxic supportive environment where I'm not working 60+ hours a week is my goal. I realize I may have to move jobs a few times and that perfect job may pay less than some others (most PAs making well over 100k have jobs that sound very stressful to me...then again there are plenty of low-paying jobs that are also stressful & toxic) but doing something meaningful combined with a nice life outside of work is what I want.
  3. The program has 2 residents in 2 classes in the year (one starting in January and one starting in June I believe). But this is a new program and they've only graduated 2 residents so far. This will be the first year I think they are aiming to have 4 residents (all slots filled). I think this residency prepares you not only for geriatric patients, but complicated patients. Right now I'm at a FQHC. Some of my 40 year-olds have worse complications, like CKD, CHF etc, than many geriatric patients. Of course there are some rotations very specific to geriatric patients, but many rotations are internal medicine for complicated patients. For instance, I can do an elective month of endo that is basically DM bootcamp. I'm looking forward to that. You get 3 months of electives.
  4. I have nearly two years of practice under my belt at a FQHC, where I've learned A LOT (mostly trial by fire), but I decided I needed more mentor-ship than I'm currently getting. I interviewed at this program a few weeks ago and absolutely love what they have to offer. They've graduated two residents so far and I spoke with both of them--they both loved it! The faculty clearly feel passionate about what they do and are excited to teach. I guess they liked me, too, because I'll be joining them in January. I'm sure I'll give a report-back in the future, but for now, I couldn't be more excited about this opportunity. I'm sure it will be more than worth the pay-cut and one-year relocation.
  5. Requested 7 weeks, but said I'd like to discuss and agree upon a date in my resignation letter--was willing to do 90 days or anything in between. I've been a good employee, leaving for a fellowship, and they hope I'll consider coming back afterward. They gave me my requested last day. Only asked that I sign off all my charts and work to transition some of my more complex patients back to my SP. I've always had less than 100 charts pending (our criteria), so they know I'm capable of this. I told them I was already working with my SP on the transition. BTW I work in a community clinic (FQHC) so there are no "partners"--only employees like me You'll never know unless you ask.
  6. Thanks, Paula. Reading through info on contract law, so as not to be in breach of contract, I will try to appear as if I'm renegotiating this bit. I think I'm going to say: (in the first paragraph): I would like my last day of service to be October 31st. (and in the last paragraph): Thanks again for giving me the opportunity to serve our patients. Please guide me on wrapping up my time here so that there is a smooth transition. At your earliest convenience, I would like to discuss selecting a last day of service that is mutually agreeable to both parties, again to ensure a smooth transition for the organization. I think we can then agree on the date so that I'm not in breach. My administrator is a lawyer and a stickler on contracts.
  7. I'm in this position right now. My contract says 90 days. (90 days!) But another part of my contract says you have to give at least 30 days notice to receive your unused PTO paid out (making it seem like that's the thresh-hold, right?) I'm leaving a job in FM for a fellowship in another city (taking a big pay cut, too). I'm giving notice this week. I'll let them know Wednesday, so that'll be 6 1/2 weeks notice. Is that reasonable? I feel like 6 weeks is good, right?
  8. BTW...has anyone used the AAPA module on DM? It seems like something I'd benefit from--actual cases are a good way to learn. It's free to members and I'm currently not an AAPA member.
  9. yeah, sometimes I "inherit" a person on 70/30 who is not controlled. i usually try to switch them to lantus (which we can get cheap) because I feel like I can adjust that more easily. but this can sometimes be a difficult transition. Wal-mart has a very cheap meter/strips (the "Prime/Reli-on") which I usually direct people to get. walgreens has strips that are like $1/piece and that is insane. but some people seem to not understand how important it is to keep track of their BG, and I really struggle to convince them.
  10. I'm resurrecting this discussion because I need help with diabetes management. I work in a FQHC with a young SP who doesn't give me the time I want re: insulin management. He'll often answer--"yeah that sounds ok." or he just seems to suggest something random without explaining it. I've sought out other sources (docs/NPs/PAs), booted some patients to SP when necessary, but I'm still not full comfortable with insulin management. I do need to get much better at this and worry I don't know everything you've highlighted above. In terms of treatment, we don't use a wide variety of orals because of the high price. We tend to only use metformin OR metformin + sulfonylurea OR metformin + insulin OR insulin alone (IF creatinine too high for metformin). We can get Lantus/Levemir cheap at our pharmacy. We see lots of uncontrolled patients--and many that are complicated by some of the issues you describe above--ETOH use, elderly. Our population is particularly difficult because many or not exactly compliant, have eating schedules that are complicated by working overnight or not having access to food all the time, do not measure their blood glucose because they can't always afford strips, or are working multiple jobs where they can't use a meter. I realize it is dangerous to use insulin when a patient is not compliant, does not measure blood sugar etc, but I also can't stand by while their A1C is so high. In that case they usually are just getting a basal dose of Lantus/Levemir that is fairly low with little adjustment because they never have their logs for adjustment and don't f/u as directed. I spend A LOT of extra time with these patients, usually working through my lunch, having them meet with the nurse etc. I'd like to become REALLY good at DM management of our population (taking into account the variety of mostly social complications of being poor), because it is so needed and my SP and the other docs dislike managing DM and provide little education to patients, usually handing over the meds and sending them on their way (without really finding out if pts understand etc--I know this because I see their pt sometimes). We do have a nurse educator, and now have group visit classes, but that is not enough. What are the best resources other than aace.com? I think I need to become particularly adept at sussing out how to adjust around my patient's eating habits.
  11. I'm at a FQHC and waiting to hear back about NHSC. My salary is actually higher than many of my classmates in the region and I'm a new grad. Salaries in this region are low overall and I'm making about the national average. Do not settle for a lower salary for loan repayment. The work is hard, probably harder than what many of your friends will be doing who didn't go into Family Med in an underserved area. You have to want to do it. You also have to be OK not getting loan repayment. I have no idea if I will or not.
  12. How do you log it into NCCPA and get your credits? I have a private subscription and have over 200 CME hours logged (all from my first few months of practice & when studying for boards!) but I'm not sure how I translate that into CME. I bought it straight out of PA school. Uptodate gives you a deal as a trainee. I got 2 years for 400ish. A lot of money for a recent grad to shell out, but I reasoned that i could use it on the go with both my Iphone and my Ipad (at one time, a colleague walked in and I was on my desk computer entering in a chart, simultaneously looking up something on my Iphone and Ipad and I had my laptop there ready to carry in a room). At the time I wasn't sure where I'd work, but I was arming myself to be the best prepared I could be. You can download to your devices and use it offline. I work in a FQHC. Our internet has gone down a few times (so much for online uptodate or even EMR in those situations!) and it has helped me look things up without internet access. So I think it was money well spent for my first couple years out of school.
  13. i've been in practice for almost 3 months and though i'm scheduled for up to 18, the most i've ever seen is 15 (huge no-show rate), and usually more like 13. i know this is low, though it is sometimes overwhelming to me. seeing all of you list 20+ makes my head spin. my SP (who is just an employee like me) sees 20ish. i work at a FQHC and we are in a lot of transition and understaffed support-wise at the moment. for instance, i do not always have my own MA. also, as its a FQHC, our pt population is extremely complicated and high need. i diagnose DM at least once a day. i'm curious how many pts folks saw straight out of school and in that first 6 months, first year etc. am i on track?
  14. I work at a FQHC and we have optometrists in our clinics (not mine but one across town). I'm not sure if they love their job or not, but I guarantee you they are not pushing products. They see a LOT of diabetic/hypertensive patients with our pt demographic. All our pts who are diabetic get free eye exams. I'm sure they don't make as much as other places, but my salary as a PA is not too bad compared to the other options in town, so maybe it is on par. You might even qualify for loan repayment.
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