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Everything posted by jdenning

  1. There are several threads on this - do some digging through the archives. Come up with a plan that works for you and your family.
  2. jdenning

    Neurology Job

    I'd be quite interested Mike but moving my husband and family from Portland is probably a no go. Hard to find PAs with broad neuro experience. Maybe AAN for advertising?
  3. The "physician must sign" home health orders makes me crazy on an a daily basis
  4. Wow! Super impressive. Writing sounds like good therapy.
  5. Sounds like you've been able to get a good compromise Mike. Good for you. What are you writing?
  6. I've seen more people get into trouble with tramadol than many other meds.... although I work in neuro so I'm probably seeing a bigger percentage of folks with suboptimally controlled epilepsy than most
  7. My first job as a PA was for a private practice hand/plastics surgeon. I was a certified hand therapist (OT) before PA school and knew the physician because I had treated a lot of his patients. On paper it sounded like a good fit. The truth was that he didn't know how to use a PA and I was a new grad PA and not assertive enough. It didn't work and we parted ways after a few months. He was a really difficult guy to work for. What did I learn? 1) don't work for anyone who hasn't had a PA before, especially if you're the PA and a new grad 2) stand up for yourself and what you can do 3) prior relationship is no guarantee of success Good luck
  8. I am a mom of 3 boys and I work a 0.9 FTE position. I'm extremely fortunate that the group I work for lets me work from home 1 day per week. We have a unique arrangement that allows me to do that and I doubt it would exist elsewhere. My life is a constant juggle. I have lots of days that I feel like I should be around more for my kids and other days I feel I'm not at work enough. I managed PA school with a toddler, then started my job when I was pregnant with second child, and then had another while still at the same job. I do long clinic days (10 hrs) 3 days per week. The thing that made it work for me was that I worked my tail off full time when I first started. Prove you can handle a load. Doing this will pay dividends for when you want to ask to work part time because you're already considered valuable. This worked well for me but I'm in an all outpatient/no call practice. It may not work in other types of practice. A lot of PA jobs are "full time or no time" so there may or may not be any negotiating room if you're applying for jobs WHEN you're pregnant. A few things to consider while pregnant. One is what you might expose your unborn child too (radiation, toxin exposures etc) and how you are during pregnancy. If you're struggling with morning sickness it's pretty hard to get to a job where you're rounding at 6 am. Plus you're tired. Lots to think about. Good luck
  9. I usually dread progression of dementia but it can actually be a godsend for the patient with terrible anxiety because they suddenly seem to settle down when they forget they're anxious. I recommend hospice now much earlier for many of our patients with advanced Parkinson's disease. I tell them that dementia is a terminal illness. Also tell them that hospice is not a one way street and sometimes patients can improve. I'm never surprised to hear about a patient passing away. I'm usually relieved and I always do a personal condolence call.
  10. welcome to my world.... the heartbreaker is the calls from family with the reports of the weird and delusional behavior and them asking what can be done to fix it....
  11. Burst out laughing with the Lucy reference! Also wondered who else would get it! RC I already guessed you and I were of the same vintage from another thread :-) 1968 was a good year I think
  12. The crazy bus actually makes a daily stop at our office, but perhaps things get a little more wacky around full moon time. I work in neurology so there's a whole bunch of psych overlap
  13. I use topamax a lot and it can be especially useful for patients who have both epilepsy and headache. It can be a great med for some and awful for others. The cognitive issues are just one of a myriad of other possible adverse effects. Especially important to monitor for metabolic acidosis and can cause hyperammonemia especially if used in combo with Depakote. If the cognitive effects are disabling it's really best to switch to an alternative
  14. I get garbage like this all the time. Drives me crazy. Patient is seen once, then doesn't show for follow up, then all of a sudden there's some urgent need for something. this has nothing to do with you caring or not. If they cared, they would have called YOU sooner and explained their insurance situation and then you would have come up with some kind of arrangement for them to be seen. This is nothing but guilt trip tactics from someone who is clearly not the brightest crayon in the box trying to guilt you into doing "something" for her. I too am getting jaded by these folks. Your documentation should cover you just fine. BTW, I thought you weren't practicing anymore - or did I miss something?
  15. You obviously had to work hard to become a DPT. Why not work as a PT in different areas - inpatient, outpatient, peds etc for a few years and get some loans paid off before thinking about PA school? The clinical experience you gain in that time is valuable and necessary to get into PA school. If you apply without experience you just look like someone who can't make up their mind and that won't do you any favors. Lots of PTs and OTs go on to be very good PAs
  16. Given the presentation the highest priority is getting the cards workup. The neuro stuff is sort of interesting, but in a patient with generalized anxiety disorder (BTW what meds is this patient on for that? Anything that might have QT interval issues?) I have a higher degree of suspicion that the "seizure" may have been a non epileptic event. TIAs rarely present with twitching, shaking, eyes rolled back etc. Neuro workup including EEG could be done inpatient if the resources are available or on outpatient basis
  17. How long have you been there? Ask your director for a meeting and review the salary averages. I'm also in Neuro and yes you seem underpaid for what you're doing. I doubt your group did that intentionally however and I'll bet they just don't know what the salary range should be. If they've never had a PA in the group before (I was in the same situation a few years ago) then they probably just went with what someone thought sounded good. Go in armed with what you do, and if possible some idea of the revenue you generate, and how you save the physicians time. For complex neuro patients 10-12 is a busy day. If you've made yourself invaluable then the group should be willing to negotiate with you. That's exactly what I did.
  18. Every single day. Doesn't seem to matter what diagnosis/condition being treated either. Almost every day I find myself saying, "well, the best medication for your seizure type would be x sodium channel blocker, but your insurance won't cover it until you've tried and failed 2 other sodium channel blockers" which by the way have pretty intolerable side effects as well as a really unfavorable long term side effect profile... MS meds same thing. Sleep meds same thing. Headache meds same thing. And ICD10 is making all of this so much more time consuming.
  19. I work in a neurology group and only the neurologist does Botox. Period. I'm surprised the neurologist would be ok with an MA doing it. I would check state practice act whether that procedure is allowed to be done by an MA.
  20. Well Oregon isn't exactly warm and sunny at the moment....but I'd way sooner stay here than go to Winnipeg where the wind blows straight out of hell - love that song :-)
  21. Manitoba looks like the first province to get things going and things look promising. Scope of practice seems to still be an issue in the other provinces though. If Alberta can get their act together I would think about going back. It's unlikely though because my American family would have something to say about it....
  22. I feel like I get harrassed on a daily basis just by my patient load and the shear volume of phone calls and e mails and prior auth requests....it all gets even more fun when there's calls from the ER too. Sigh. We had a situation a few weeks ago where we had to terminate a really sick and psychiatrically unstable patient who would call and harass and berate our staff and threaten to blow up our building among other things. I'm not usually scared by patients but this guy really unnerved a lot of us. The VERY NEXT morning our whole campus was on lockdown with reports of a suicidal guy with a gun. I was sure it was our patient. Turns out it wasn't. Whoever this was got his wish and the police shot and killed him. Pretty unsettling way to start a work day. Now I still get to worry that our terminated guy is going to show up at our office again and who knows? Maybe he'll have a weapon. Police say there's nothing they can do
  23. Our group tends to go provider by provider. Most will refuse to see patients who are more than 15 minutes late for a 30 minute appointment. I am usually the one who almost always sees people who are late. I see a lot of patients who come on medical transportation or with a caregiver and I get it that it's difficult. Our parking is horrible and traffic in our area can be completely unpredictable. I'm always more accommodating for people who are coming from a distance. But I usually cut things short. Almost always I start running behind and then it just snowballs. Wish I had a better backbone sometimes.
  24. Before you negotiate you should really think about whether you want to stay. If the type of work or amount of work doesn't change, is more money really going to make it better?
  25. I used to spend more time on this forum looking for case reviews, professional discussion, etc. More and more the posts are "what's the least amount of work I can do to get into PA school?" I guess I'm getting cranky in my old age...
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