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rev ronin

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rev ronin last won the day on November 30

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About rev ronin

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  1. I'm a wee bit irritated tonight. I spent about 20 minutes today sitting next to one of my eating disorders patients while she was having a panic attack, talking her through it, calming her as best I could. This particular patient is on medicaid, from an historically oppressed/disempowered minority, and has a number of health challenges that takes more than two hands to count. I'd given her a small list of things I wanted her to talk to her PCP about, because hey, I like to stay in my lane, and those were really general health issues, that I would have wanted a specialist to refer back to me if I was in the PCP role. The PCP appointment happened yesterday, and nothing--literally nothing--got solved. While this PCP may not have known that this patient had previously set a 'do not exceed' weight, above which she intended to end her own life, that PCP knew or should have known that this patient was actively under care of an eating disorders program. So, the first thing the PCP does to my obviously large patient this visit is to weigh her, tell her the number, and chastise her for exceeding that 'do not exceed' weight--the one she'd previously purposed to kill herself if it was crossed. I don't know what was actually said, because the substance of that visit has been filtered through my patient, with her own fears and biases, but it certainly wasn't helpful. Thankfully, I work on a team with awesome therapists, a psychiatrist, and a dietician. My only real job is to keep their electrolytes and QTc's in range, but because I was the one available in the moment, I'm the one who sat with her in her crisis. Honestly, I do NOT expect to use my Fire Chaplain skillset in a medical setting on a regular basis... yet there I was. Can we please treat patients with weight problems at least as well as we treat patients struggling with addiction? Because that's what it is. No, instead, more often than not I hear of other medical providers treating patients with eating disorders as if it's a big moral problem or willpower failure. I know none of you would ever do that, right? Right?
  2. Still, that's huge. The Ortho's around here never give more than 5 mg Oxycodones, although they're quite likely to give #60 if it's a big surgery.
  3. Your GPA needs work. Until and unless you can get your cGPA and sGPA to 3.0 each, I wouldn't waste money applying. If you want to be a PA someday, you need 4.0 on everything here on out. With that said, I know LPN employment comes in waves: some places hire them, then replace with RNs, then replace with LPNs... MLT is probably more stable, but also likely dead-end and not patient care experience. Ultimately, it will be far easier for you to go from LPN to DNP while working. It'll take years, but it should be a more gradual progression, rather than trying to get into a PA program after years of hard labor just to bring up your GPA. Nursing programs are non-selective, compared to PA programs, and many programs are designed for working professionals, while PA programs are not.
  4. I think this is spot on: for emergency response, fire-based EMS works to get sufficient trained practitioners on-scene soonest. On the East Coast, with older buildings and inadequate alarms and sprinklers, actually having a fire department do just fires makes a bit of sense. It doesn't make sense at all on the West Coast, because fires simply aren't often enough or big enough to justify the expense of maintaining a fire department, absent the rescue and EMS components. When there's nothing going on for a combined West Coast fire/ems agency, what happens? Disproportionately fire stuff: pre-incident planning, public education (fire-based, of course), code enforcement... Given that the mix between EMS and Fire is about 80/20 on the West Coast, why on earth aren't most career fire/EMS folks doing as much proactive EMS stuff as you would expect based on that 80/20 split? Tradition, I suspect.
  5. (And before anyone asks, no, this topic didn't get censored off of Huddle. I never brought it up there: since Huddle is an AAPA-owned forum, it would place the AAPA in a difficult position with respect to their peer organizations. Plus, NCCPA and ARC-PA have impacts on all PAs, not just those currently members of AAPA. I know of no other national, all-PA forum in which this could be appropriately brought up and discussed by all)
  6. I am not proposing to have ARC-PA or NCCPA strip out their physician-organization delegated seats. Since they are self-perpetuating boards, that would be particularly difficult to do. BUT, designating those seats for PAs, including PAs-turned-physician, would be a step in the right direction, and a reasonable, manageable, incremental step toward asserting PA control over PA destiny at the national level.
  7. While talking with a friend and PA faculty member a week or two ago, I was reminded that the PA profession is not PA-led. While AAPA may be, several of our other key organizations are in other-than-PA hands: http://www.arc-pa.org/about/arc-pa-commissioners/ of 24 ARC-PA commissioners, only 13 list PA-C after their names. https://paeaonline.org/about-paea/board-of-directors/ Of 12 PAEA directors, 11 list PA-C (although I suspect one of those 11 should actually say PA-S) https://www.nccpa.net/Board Of 18 NCCPA directors, 11 list PA-C after their names I understand the historical reasoning behind this: the PA profession was started with the advice and consent of several organizations, several of which maintain voting seats on two of our most key professional bodies. At one point, there were no PAs who could serve to govern the PA profession, and certainly no PAs who could serve as delegates from the American Physician Association, AMA, or AOA to the NCCPA. At the same time, I want to call out the FSMB for nominating Peggy Riley Robinson, PA-C, as their NCCPA representative. By now, there are enough PAs who have gone on to medical school that the AMA, AOA, or other physician organizations could nominate former PAs now practicing as physicians to the seats reserved for them. It's time for all organizations historically given a seat at the PA leadership table to follow the FSMB's lead: ONLY PA-Cs, retired PA-Cs, or former PA-Cs now practicing as physicians should have voting status on any PA organization of national or profession-wide significance. (with the exception of 1-2 student directors who may be current PA students) Non-eligible representatives from organizations may still be sent as observers, with floor privileges, but those observers would not have a vote in the respective organization's leadership. We, as PAs, have little direct power to effect these changes. NCCPA and ARC-PA appear to have the constituent organization seats built into their organizational charters. So, my fellow PAs interested in the future of our profession: - Is mandating PAs govern the PA profession a good idea? - If so, how should we go about accomplishing this?
  8. Since no one else has answered, I'll give you my responses, although mine are 7 years old. Yes, I was prepared to learn during my clinical year, but the current students are quite a bit more prepared than we were. My locations were mostly in Oregon and Washington, because I requested to stay closer to home with my family, and they were able to do that. Others go all over the country--to Alaska, Hawaii, and all across the west, with stateside rotations as far east as Ohio. I did a tropical medicine/medical Spanish rotation in Costa Rica, but that precise international rotation is no longer an option. Preceptors were great overall. There was one I didn't click with, for my inpatient rotation, but that was the worst it got, and he still passed me for the rotation. Everything was very 'hands on' except my surgery and cardiology rotations at Madigan. I did clinic for both, with attendings following my exam, but in the surgical suite, I was mostly just holding the camera, closing skin, and the like. There was a TON of cool stuff to see... but with a ton of residents around, we would jockey with the med students to get close enough to really see. Not a whole lot of open cases where we needed to hold retractors, either--everything possible is laparoscopic... so I held the camera a lot. I was expected to do H&P from day 1 of every rotation, and worked into procedural skills as I demonstrated myself to be competent and trustworthy. The specific subspecialty is not reflected in the individual course titles: 'surgery' could be general, ortho, trauma, cardiothoracic... and I still have no insight into how they specifically allocate rotations. This allows a good bit of customization if, for example, someone wanted to do pediatric surgery, pediatric EM, pediatrics for primary care... within the ARC-PA limits. But back to Madigan, I told the clinical coordinator at one point I had worked for the Coast Guard and was quite familiar with combined military/civilian organizations, which I think is why I got assigned to Madigan for my first rotation. I know that some of the rotations had prerequsities, such that (I believe, I may be mis-remembering) if you wanted to do trauma surgery, you already had to have emergency medicine and inpatient rotations. Six week rotations seemed ideal, because it takes about a month for preceptors and staff to understand who you are and what you can do; I found some of the coolest things I learned were in the last two weeks, and while I would have liked to have even more different experiences, I think six weeks was a great balance, and that's probably why the program hasn't changed the rotation *length* in years. Now, they have changed the particular type and number of rotations, but not the overall length. Logistics are on the student's own, but reflected in the cost of attendance for the clinical year, so your loans will cover the Craigslist or Air B&B. Many established rotation sites had known safe/appropriate places to stay passed down from one class to the next. There were a few horror stories about last minute changes--we had one preceptor die!--but the clinical team always managed to come through. Does that help?
  9. The maximum allowable are already defined as part of the NCCPA website, up to the actuals spent, which in my experience have never matched those defined maxima.
  10. Have you run across one that DOESN'T require an MPH first, but will let a DHSc/DMSc/whatever with a strong public health component and maybe a bit of leveling count?
  11. EMS services should be using PAs for follow-ups and frequent-flier diversion; EMT/PAs and Paramedic/PAs know how to function appropriately in a prehospital setting, while your average nurse does not. And yet, LaCOFD just announced using NPs in this role.
  12. Wow, good to know that GI symptoms seem to be more prevalent than typical this year. I've not yet seen a lot here in the PNW, but the state health department says Flu is here in Washington...
  13. Because the OP is an assistant, duh! Oops, wrong thread.
  14. All: Since Huddle is not currently (no longer?) censoring discussion of the specific alternate professional names mentioned in the survey, will will no longer do so either. Members are feel free to continue to discuss things in generalities if they prefer, but we are never going to be MORE censored/moderated than Huddle. @LT_Oneal_PAC@EMEDPA@ventana FYI
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