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About sunny2spot

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  1. When I was hired my shop hired new grads almost exclusively. I was fortunate to start where I did because they had a strong orientation process: new hires were started as extra/double coverage in the Fast Track area which is typically staffed by one PA and one physician. They had about 10 orientation shifts in FT and then started in FT where they would work for a month or two before starting shifts in the Main ED on overnights. This is still how we do things now, but we've put more preference in hiring ppl with experience in which case their orientation and progression to Main ED shifts were accelerated. If hiring new grads, speaking from experience, it would be VERY challenging to start in an ED with an "expose them to everything" approach. Eventually, yes of course they should be exposed to everything.. but starting out they need to get comfortable with the way their dept flows, how their attendings work, how to document efficiently, etc. before having to worry about the deep clinical questions on top of all that
  2. I would also caution against the accelerated combined route. I think the extra year or two w/ the traditional approach is hugely important in establishing maturity and "street smarts." I live near a school that offers a combined degree program and work with one of their grads; she is very immature compared to what one would expect of a medical provider. Honestly, as a patient or family member, I would feel uncomfortable having a 23-24 yr old taking care of me or my family. That's just my opinion though, acknowledging that the exceptions surely exist.
  3. I agree with EMED. In an effort to sell yourself, I would highlight your clinical strengths and efficiency (workflow, etc), but emphasize that you also know when you should ask for help. I don't know that they'll pimp you with case scenarios.. I think it's understood that you have a foundation of knowledge and will expand on that with practice. A pleasant personality and willingness to work hard (without recklessness) is what they're more interested in.
  4. The loop method for I&D of large abscesses was just presented to our PAs last month. We've used penrose drains, and we still have them f/u in 2 days for a recheck, then have the drain removed in 10 days with surgery if it's a large abscess, or in the ED otherwise. The rechecks I've seen have looked fantastic, much better than if it had been packed. Pt's have felt great too. There are some youtube vids demonstrating it. I recommend it. Otherwise, I don't usually pack, and if I do it's minimal packing just to keep the area open. I prefer just making a larger incision though.
  5. A couple thoughts: - I skimmed through this year's AAPA salary survey a month or two ago and found it to be far less comprehensive than past years. Has anyone else found this? There was no distinction by region, the numbers of respondents seemed way down, etc. - I hate the term midlevel too. I've seen a significant movement recently to cover both NPs and PAs under the term APPs (Advanced Practice Providers) which is appreciated. - $300/hr for physicians in FastTrack?? That is insanely wasteful. They could pay an experienced PA $75 and everyone would be happy.
  6. They're holding another one in July, but I learned my Vegas-in-July lesson already.
  7. Just got back from the Advanced Bootcamp and would say that the bulk of the conf was fantastic, but the EKG course was a little disappointing.
  8. To address any question of clerical error, that isn't the issue. The NP student herself told me "it has to be filled out by a doctor" when I asked why she sent her evaluation to the ED director. All correspondence from the school that I have seen (by CC) have come from nurse practitioners from her school. I appreciate your feedback, since I wasn't sure if my frustration was biased, and agree that bringing this issue to the ED director is a decent first step. Hopefully he will be willing to add a note to her school that the majority of the student's hours (keeping in mind that she was >1hr late to 3 shifts and a no-show for 2 other shifts) were with PAs. They should be aware of that if they feel that PAs are inadequate to train their students. As far as staking the claim that failing a student marks a failure on the preceptor's part, I don't think that can be universally applied. Anyone can imagine an instance where a student is entirely disengaged and absorbs nothing, no matter how fantastic the preceptor. I think it is the responsible thing to fail someone if they have not prepared themselves sufficiently to care for someone else's family.
  9. Hey all, I'm wondering if anyone else has encountered this issue before and if they're as irritated by it as I am. I coordinate students rotating through my ED (smallish community hospital, no residents) Historically we've only taken PA students, but one of the ED nurses had a sister going through an NP program and asked if she could get some clinical hours in the ED. So I arranged the NP student's schedule, gave her regular feedback, and spent a lot of clinical time with her in the ED teaching her how she should come up with a differential (which was shockingly painful) and so on. It is now the end of her semester and the faculty at her school have been emailing the ED director for her evaluation. He hasn't spent one minute with her! Her school won't allow PAs to evaluate or train NP students! This is crazy to me. When I was in school we trained with NPs, PAs, MDs.. everyone has something valuable to offer. I find it extremely juvenile for them to shut PAs out as if they're too good to learn from us. And now I have to sit back as if I didn't teach her plenty of valuable skills and have the MD who barely knows her sign all these documents (fraudulently, really) because my signature isn't good enough. It's maddening. And don't even get me started on how terrifyingly unprepared she is to begin practicing after this spring. So I needed to vent. That's all.
  10. Did you read any of what I wrote? I said PHYSICIANS are in triage. Your response makes no sense.
  11. The physician group for whom I work has had a Physician in Triage model for years. I disagree with the above -- I think it is hugely beneficial to the pt to have experienced eyes on them the moment their ED process starts. Labs, imaging, EKGs, meds can all be ordered from there to get the ball rolling. A nurse can't do that. And I've seen too many nurses send a PCI to fast track just because the pt mentioned they'd been coughing for a few days. I realize it's a sucky shift for the provider working that shift, but if properly rotated I think it's tolerable. It's for the good of the pt.
  12. This piqued my interest too. Still mulling it over. Timing isn't optimal coming right after Thanksgiving. Flights are at least $500 from CT/RI, a good $200 higher than usual. Buuuut I'll prob go anyway and just whine about it ;)
  13. I started in EM 1 yr ago fresh out of school, no experience at $50/hr plus bonuses, approx. 150hrs/month, $5k CME in New England. That's gone up to $55-57/hr with a new RVU-based model. I got other offers, one in primary care in Boston for $75k. Haggled my heart out and got them up to $76k. The AAPA salary report is a HUGE key to this whole process. I felt confident negotiating and eventually walking away from terrible offers because I knew the numbers down to the smallest detail (specialty, region, yrs of experience, etc). Totally worth $50 or whatever it costs. Split it with some friends and pass it around ;)
  14. I'm still pretty green, so my dictations are likely more lengthy than they need to be for FT patients. It really is impossible not to have charts leftover, though, when you're seeing 30+ in 12 hours. Inevitably mixed in with all the ankle sprains and sore throats there are going to be the pediatric fevers and sciatica nerve pains with new onset foot drop that require a more lengthy dictation. I don't get paid for time spent on-site if I am not actively seeing patients. That's the policy for all providers. I'm under the impression that most people aren't paid for charting time beyond the end of one's shift. Is that true?
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