rev ronin

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rev ronin last won the day on September 4 2017

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About rev ronin

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    Physician Assistant
  1. I get that everyone has to make a decision for him or herself, but I would never work in such a manner. It's rewarding bad, threatening behavior, and by not failing them, you're helping enable putting these folks back on the road behind tons of powered, high-speed metal. I really couldn't live with myself for doing that, but I understand that may be the least bad option for your situation. Bullies don't like being stood up to. I would encourage you to take a course in 'dealing with difficult people' or something similar. Not just to grow your own assertiveness, but also your verbal jujutsu, how to deescalate hostile conversations. I would also like a "no refunds" policy made by the clinic, and so keep that out of your hands. Then, you can honestly plead that the driver needs to appeal in writing to admin, who should never actually give money back. High-stakes occupational medicine is a very different world than family medicine, and it really takes a different mindset.
  2. Yep--none of those are new to me, and I have the luxury of not having to do DOTs anymore, but here's my feedback: 1. That is the patient's choice; the cost of a sleep evaluation and/or treatment are just a cost of doing business. Many companies reimburse the costs for work-required stuff like apnea testing as a business expense. 2. Yes and no. Sleep medicine around here is no more or less backed up than any other growing specialty. I'd love to have more throughput, but right now I can get drivers in, tested, and qualified in about 2 months, start to finish, with 30 days of compliance data. REALLY hard to bring it much down below that. Now, if my own interps were good enough, I could cut another two weeks off of that, but right now we're still using insurance rules--board certified sleep medicine doc interps only--so I can't shortcut that further. 3. This is a failure to set expectations up front. You can't run a DOT medical examiner's office like a family clinic: cash-in-hand up front before the provider enters the room, every time. The driver pays, but he is not a patient, he is an examination subject--the patient is "society" and we examine the subjects (drivers) for the safety of society. For this reason, I completely agree that PCPs are fundamentally compromised in their ability to do FMCSA exams on their own folks. No, I'm not reimbursing anyone for anything, unless I was somehow wrong to order the screening in the first place. Rude or threatening behavior is inappropriate, and grounds for both dismissal (easier, since there's no ongoing relationship) and reporting to the authorities. Also note that there's a nice little box on the form ( that asks if a medical examiner's license has ever been denied. They need to know that if they are denied, they will be reported truthfully to a national database. 4. See #3. Yes, PCPs should screen for sleep apnea, but as you pointed out, a lot of truck drivers have made the choice to not have one. STOP BANG is really dead simple to administer, and 3/8 is a "screen", so even if they lie to you about the first four, BMI >35 and neck >17" in any male, OR one of Neck >17" or BMI >35 in a male 50+ are objective grounds for screening. So... What do I do other than saying "My way or NOT the highway"? (I crack myself up sometimes) First, I do a lot of patient education. I take 1/2 hour for a new patient sleep apnea intake, and I cover pathophys, screening, and treatment modalities. I'll talk about all the bad things OSA can do in addition to drowsy driving. I believe in sleep medicine and the health benefits, since I'm an AutoPAP user myself, so authenticity and enthusiasm aren't faked. Then, if they need treatment, I talk it up as a GOOD thing: we're going to put a stop to premature aging. I work with them, as do the RPSGTs on staff, to make the experience enjoyable--listening to what doesn't work for them, finding alternatives that do, basic stuff like that. Finally, once they're happy with the new therapy--which is well over 90%--I ask them to go out and evangelize all the CDL holders they know with a key message: - Sleep apnea sucks - CPAP is tons better than it used to be. - Give us time, come in early. The message IS getting out. I'm seeing more and more 30-50 year old blue collar workers, not just CDL holders, who heard from another guy that CPAP was a life changer. I'm really not seeing too many truly adversarial people in sleep medicine, which is probably their choice to not follow up at all. So... steel and silk: firm resolve as a CDL examiner to do the right thing, excellent patient care as a sleep medicine practitioner to get patients treated.
  3. I went to an established, reputable program WITHOUT a teaching hospital affiliation. We still got rotations at teaching hospitals, just not ones with PA programs. For a newer program, I would be a lot more skeptical that quality rotations could be found, and I don't think enough people care about this: PANCE pass rates are objective, easy to measure, and utterly useless in determining who is actually becoming a good clinician during the program.
  4. To answer the question posed in the topic: "The same time as everyone else does" Seriously, whether you're talking year-to-year, or month-to-month within the cycle, a previous graduate degree doesn't help enough to change the recommended timing.
  5. You say that like it's a bad thing. 24% of adult men need OSA treatment; having truck drivers be double that doesn't seem unreasonable. CPAPs are far more workable and humane than they used to be, and when initiated early in life are preventative medicine.
  6. I completely agree. I would joke with patients, making fun of the requirement by saying "I've never heard of anyone going 'ow, my hernia!'" while pantomiming turning a steering wheel to the left, in order to lighten the mood a bit.
  7. Also: Hernia checks on all male (95%, in my practice) drivers, just in case you needed another reason to hesitate. :-)
  8. There is NO downside to being older in PA school, or as a new grad PA. Starting practice at age 41, no one batted an eye. I can count on one hand the number of time I've been rejected and a 'real doctor' sought out instead. In IT, age was a liability; in medicine, it's an advantage. Grey temples rock. I echo keeping family the most important thing--I made many sacrifices in PA school to keep my wife and kids as forefront in my priorities as I could, and it worked out. It also makes sense in many (most?) cases to have kids before PA school--it's not easy to do PA school with kids, but neither is putting a budding career on hold to have kids, and too many of my female friends have put school first, then career, and now are looking at never being able to have kids. :-(
  9. I think six months prior to graduation is the earliest I'd start looking. Three months prior to graduation is the LATEST I would start looking.
  10. I've done it and love it. Malingerers are far outnumbered by real people who have disastrous problems that have never healed right. I'm one of few providers in my area who will take on "old" cases--I have plenty that are a dozen years old or more.
  11. I'm going to start deleting these threads pretty soon. Really, pre-PAs: READ THE DIRECTIONS and post in the Pre-PA section ONLY.
  12. I am, of course, entirely aware of the pedestrian use of "nontraditional student", and make a point of correcting those who choose to use a broad definition within the context of PA school applications, because a "traditional student" is not the same thing as a "traditional PA student".
  13. Nothing surprising to us, but worth a read, and worth sharing with people considering careers in medicine.
  14. No apology needed, and don't you dare think you can't disagree with me just because I have an admin job around here. If I'm that petty that I can't learn from a colleague in another specialty, I don't deserve to have it.