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Grinder993

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Grinder993 last won the day on January 6

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  1. I have been taking care of patients for 25 years. Navy Corpsman, Paramedic, EMPA-C, it's been a long road. Probably somewhere close to 100,000 patients I have cared for at this point. BUT LET ME BE CLEAR! ....none of this matters. I am not a "Doctor". I have seen over and over in my time, Physicians extend courtesy to your face, only to cut down your profession behind closed doors. Lament the creeping decay of medicine that PA's and NP's represent to them. I have seen MD's make many, many mistakes....I always see their colleagues make excuses for them, report how "it could have happened to anyone", circle their wagons around the fellow MD. By the same hand I have seen PA's make strikingly similar mistakes and the MD cadre throw the PA under and the entire profession UNDER THE BUS! The case taken to Peer Review...further illustration of the incompetence of an entire profession who "want to pretend to be doctors". The culture of medicine is sick. Very sick. It is corrosive. I see the MD as the primary cancer. The body of medicine is changing. The needs of 300 million Americans is changing. This is a need that the MD CANNOT fulfill alone. Yet their innate egotism and reflexive territorial pissing just keeps on. At the cost of the well being of some 300 million just so they can protect their threatened fiefdom. Case in point....this happened to me just last night. I am a solo provider in a critical access ER in New England. I have a male child with an incarcerated hernia. The child has many neurological issues complicating his care. The mother REFUSES to allow me to attempt to reduce this because it will require sedation, she wants him transferred to the larger regional hospital where he already has relationships with providers from multiple specialties. I explain to her that "time is tissue", she understands, she wants him transferred. I speak to the on call pediatric surgeon, she tells me she refuses to accept this patient without me attempting to reduce the hernia. I explain the complicating factors of this case and most importantly that the mother refuses treatment at a small outlying critical access ER. The surgeon refuses to accept. I call in anesthesia and our general surgeon, they evaluate. Their assessment....same....transfer the patient. So our surgeon talks to the pediatric surgeon and now.....well....since another MD saw the patient, she accepts. Total delay of care for this surgical case 2 hours because why? The pediatric surgeon did not think a PA competent to assess this case? Nothing changed between my call to her and our surgeon evaluating. Just that the gravitas of the request came from another MD. MD's are killing people with their egos. To say I am at the end of my rope with medicine is an understatement. I am done with clinical medicine and transitioning out, I can make no meaningful changes on this side of the table. I have recently enrolled in Healthcare MBA. Maybe my many years experience and an MBA can lead to an office in the C-suite of a hospital. Maybe I can make some changes from there. Time will tell. I do more teaching now at a local PA program. I enjoy it, I like to pass on to the students all the things I wish someone had taught me when I was a PA student. But the hardest thing for me is to look into their hopeful dewy-eyes and now what heart break they are in for. To know that they will never be respected by the medical establishment now matter how good they are. No matter how hard they study, they won't have the right credentials on their lab coat to be heard. Doctors elitism, egos and arrogance ARE the problem with medicine.
  2. If you have a reason, you have a regret. Having a seat at the table is as good a reason as any, personally I am tired of being the dog eating scraps and taking sh*t. I teach at a local PA program and it is harder and harder for me to encourage anyone to go to PA school.
  3. Any PA worth there salt who says they have never had regrets about not going to Med school is lying. I can tell you I regret it. As an experienced ER PA, it infuriates me that I am handling the exact same cases the MD handles, I am intubating, RSI, chest tubes, central lines, consulting with specialists, etc..etc...etc.... I make 1/4th what the MD makes. Yes, I regret it every pay day. On the flip side, if you are a meek PA who wants to only see sniffles and colds and don't want to push the envelope or challenge yourself then you may be happy as a PA.
  4. Forgive me for a just a second...…hmmm-hmmmm……"I TOLD YOU SO!" There, I got that outta my system. I feel better. I posted on this forum around 2008-9 that this was coming. The nursing body has been meticulous, patient and effective in their battle to establish themselves as independent medical providers. This has been in motion since the 1970's, really picked up steam with the DNP becoming the graduating degree for NP programs. Next step is independent practice...FL is looking at passing this as well. This will be the nationwide standard in the VERY near future. Final checkmate move for the DNP will be 100% CMS reimbursement. With that understanding and albeit late to the show, I am glad to see that my fellow PA's are waking up. The AAPA is still quite slow on the draw here but discussion of name change is a positive step. We need to encourage the DMS or DMSc doctoral pathways for PA's. We have to match the title. Sounds petty I know but this a war of public opinion as well and the "D" matters. Fortunately in FL, it was an MD who went to bat to have the PA included in the bill that was being presented to allow the NP independent practice. Point here is we need to be more politically active as a group. I hope we get mad and get moving on this issue or we may find ourselves with a DNP as our supervising provider some day!
  5. I appreciate the responses, you guys have made me smile! ? "If you want to change the world, find someone to help you paddle." Adm. William H. McRaven
  6. If I could do it over again I would have stuck with my original direction which was to be a pilot. Fed Ex pilots make $300k/yr and only work about 10 days a month. Not a bad gig!
  7. I am just curious. I have been a PA for 13 years. I went the extra mile after school and completed a residency. I find myself long into my career, working in solo practice ER sites, doing the SAME job as the MD. As a solo provider....for 1/3 the pay. I find myself very aggravated with the profession, it's weak kneed leaders and general stagnation of pushing for it's rightful place among the medical cadre. I find myself bitter for having short changed myself by becoming a PA. I was 30 at the time...it made sense to go the PA route, I felt I was too old for MD school at the time. I was wrong. I have seen the overall dismissal the medical system has for us, from the attending MD to the specialist cussing you for calling them, to the administrators who don't feel anyone (MD, PA or NP) is anything more than a replaceable cog in a soul grinding machine called "Medicine". I now find myself when approached by staff who are considering going to PA school, telling them "don't". You know, you get approached by the tech, or the paramedic who wants to ask you about becoming a PA. I used to tell them "being a PA is great, blah, blah, blah..." I have found over the last few years, that has stopped, now I tell them "don't do it." I tell them that medicine is a nightmare that is only getting worse, we have a 3000% increase in administrators in medicine over the past 30 years, we are ruled by various BS metrics that rule our lives, everyone is miserable. If you are going to be miserable, at least make the most money you can for it......"go to medical school". I believe any PA worth their salt who says they have NEVER regretted becoming a PA is lying to you and themselves. So colleagues, I am curious, who still believes? Why?
  8. Just stunning how things change (and very frustrating at the pace). I have been calling for support and promotion for PA residencies with completion being awarded a DSc-PA for over 10 years. In 2008 I was deemed a heretic on this site for pushing the need for additional residency training, the doctorate title, and yes, independent practice. Now everyone is finally seeing the light. Well welcome to the party everyone....come on in! LOL!! And you better believe if we don't get moving on these things, we will be working for an independent practice DNP within the next 10-20 years. Snoochie Boochies!! :)
  9. It breaks my heart to see even brand new graduates taking jobs for less than $100k. Think about it, starting pay at $75K???? That comes out to about $37.50/hr, that is RN pay.
  10. As an ER PA, I don't get out of bed for less than $80/hr. One of my jobs is a solo provider in a critical access ER at $95/hr.
  11. You have two choices. 1) Approach the larger company that took over and express your concerns.....see what that gets you. 2) Do not sign the paperwork and immediately begin looking for another job. I have seen over and over again problems that arise with "non-competes", benefits reductions, hourly requirements, etc...when these larger staffing companies take over. Example: Large ER I worked at for many years was staffed with residency trained EM Docs, some of them were Med/Peds, IM etc. Many of them had worked in that ER for 20+ years. New staffing company came in, decided they would only employ EM residency trained MDs and fired all of the other docs. Most of them were outstanding ER docs but were let go b/c the company wanted to increase the "prestige" of the ER by only having residency trained ER docs. That was a sad day. Example: Another smaller ER lost all of it's MDs and PA/NPs when the staffing company that had the contract, lost the contract and a new staffing company came in. Due to the non-competes that they all had to sign with the original staffing company no one could stay under the new company and they all suddenly found themselves unemployed and scrambling for new jobs. It is my opinion that the only "safety" you have in medicine today is to be flexible and mobile. I am currently licensed in 6 states. I have a part time local ER job. I supplement doing locums ER work (which I really enjoy). Long story short I consider myself something of a "Ronin PA". I am loathe to become servant to any one employer as I do not want to get stabbed in the back when a corporate decision is made that suddenly leaves me in the cold. That's my 58 cents worth.....hope it helps.
  12. The DMS is one option. A necessary and appropriate option. Dave Mittman has been against Doctoral level PA training for at least a decade that I have been posting about it on this site. To say that going the DMS route admits that PA training is not good enough is a reason to not support the DMS is ludicrous. We have the word "assistant" in our title...ergo not good enough! LOL The very survival of the PA profession requires us to move toward independence. I have always been a huge supporter of PA Residency programs as well. I would like to see other pathways to DO/MD as another option. Currently the only option is the traditional full time pathway and that is just not feasible for most working people. The advances in technology and education make it completely reasonable to be able to complete the didactic portions of training online while requiring on site attendance for lab work. There needs to be acknowledgment of the value of the years of working experience a PA may have. I have been practicing for 12 years as an EM PA. I have logged well over 50,000 patient contacts. Is that disregarded? I currently work in a remote critical access ER where I am the sole provider. There is one hospitalist upstairs and that is usually an NP. That's right an entire hospital staffed by APPs! The doctors have said this would be a sign of the apocalypse but, so far ....no apocalypse, just patients being taken care of in an underserved area. We have to move forward, I am happy to see what the DNP is doing. They have the lobby and the money to push forward independent practice. They will get it I guarantee it. We will have to follow the path they have blazed or continue in this abusive relationship with our MD masters until they tire of us and put an end to our profession entirely. Riddle me this: if PA training is so "subpar" to MD training....why does CMS reimburse us at 85%? Doesn't that indicate our services are 85% that of an MD providing the same service? So are we only 15% deficient? Furthermore if we are only 15% deficient....why are we paid roughly 60% less than an MD on average???
  13. We have been over this ground before on this forum and I am still in favor of PA independence. We need to cut the apron string. Before I get flame sprayed let me be clear that I appreciate the collaborative relationship I have with my MDs. But I do not see our profession thriving into the future if MDs can legislate our practice. Cutting our scope anytime they feel a revenue stream is threatened. We have to break away at some point if we are to survive into the future. We as a profession are already behind the curve in my opinion.
  14. I know it does not specifically mention PAs, but you can extrapolate that we will be lumped into these crosshairs. Here in TN PAs can no longer given joint injections because of this kind of BS legislation/turf battle mess. It is not going to stop.
  15. http://www.medscape.com/viewarticle/820882 I am interested in the opinions here regarding this tripe. I am so tired of the old hyperbole from doctors that PA/NPs should be limited in scope "for patient safety". Read that as "I don't want to compete with this less expensive alternative who can do most of what I do." Also, when are doctors going to be required to actually produce EVIDENCE that the public needs to be protected from PAs? I can produce tons of evidence of MDs causing injury, negligence and harm to patients, should we petition to curb their privileges. Where is the evidence? This has nothing to do with patient safety, more of the cabal of MD/DOs protecting their check book! Sorry if this is discombobulated, I am irritated right now. I will check back in a bit.
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