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rev ronin

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Everything posted by rev ronin

  1. Occ Med patients are more blue collar/less college educated than a general population, and I'm pretty sure that correlates to lower vaccine uptake.
  2. SLPs are important peer professionals. I couldn't do what they do. I'm glad they're doing well; I wish we had more of them, because referrals take a good long while to get in.
  3. My Occ med practice is ongoing, mostly unaffected by covid except for anything on my patients is considered 'elective.' My eating disorders job is booming, telemedicine almost exclusively, and they're currently paying me 1099 wages to do nursing stuff like take EKGs because they can't hire RNs in this environment. Perversely, I am as happy as I have been as a PA, even though Covid plus the Phillips recall forced the sleep center I worked at into bankruptcy.
  4. I only take Washington L&I, which doesn't have that rule, so I can't comment on commercial insurers. As much as I try to direct everything to the PO Box, I get the occasional shipment or postcard from Google at my physical address, which are simply left in front of my door (good thing I'm not ordering controlled substances!) or slid under it.
  5. 1. People are contrary. The current surge in popularity of the Anti-Vax movement demonstrates this, but it had been demonstrated in sociology of religion for decades: The more atypically you make someone act or dress, the higher their commitment to that faith. There are plenty of people who will sit in, for example, a mainline protestant church and not let their Sunday habits affect the rest of their lives, but you don't see that phenomenon among religious sects that exist at high tension with their surrounding society: from Amish to Jehovah's Witnesses, the weirder you are relative to the surrounding society, the stronger the adherence. 2. Who makes the rules? Whoever makes the rules gets to decide what society values. Maybe not just smoking, but what is the interaction between freedom to do avoidably dangerous things--skydiving, riding a motorcycle, having unprotected sex with a stranger, eating at Jack in the Box...--and rewarding or penalizing those things. 3. What role does agency play? We know the studies showing smoking is addictive as heroin, and as far as I know no one has refuted that. To the extent that human beings become habituated to harmful habits, what is the role of coercive monetary penalties in "helping" people? Are we penalizing people for behaviors that are a natural outgrowth of environment/upbringing and genetic predisposition? So, that's my 5 minute take on it. Was that what you were looking for?
  6. I don't know that to be the case. Obviously, we're going to have to charge less than physicians to be competitive, but the je ne sais quoi of why I believe I am successful as a PA is that I remember what it's like to be an adult without a medical clue. I didn't attend EMT class until age 35. I remember thinking my son's Nursemaid's Elbow was going to get my wife and I investigated by CPS. I remember what it's like to make a next of kin medical decision for my wife under anesthesia. People want someone who's medically smart, compassionate, and can speak plain English to them. Most MDs hit the first one and are iffy on the last two.
  7. I think these are both, to quote ZDoggMD's mantra, true but partial. We have an abundance of high glycemic load foods, and all of us can afford more calories than we need in a day: with hundreds of homeless in my county, they die from substance abuse or suicide, not starvation. We're optimized to seek out such foods, which came in handy in more physically demanding times, and maintain the same desires even with vastly reduced needs, as EMEDPA pointed out. But two things are missing: 1) Diet culture and the weight yo-yo, and 2) mental health issues. Diet culture doesn't try to lose weight legitimately, like by lifestyle changes, but by seeking out quick fixes, which the body typically interprets as starvation and essentially metabolically sabotages our efforts to lose weight. This is a gross oversimplification, but far less of one than "increase activity, decrease calories". Mental health issues, in our social-media-approval-addled society, disproportionately affect girls. What happens when you combine an unhealthy attitude about size, weight, and appearance with a comorbid mental illness? You get an eating disorder--pick the ED based on the comorbid mental illness! Anxiety? ARFID or anorexia nervosa. Depression? Binge eating. Borderline personality? Bulimia nervosa. Again, an oversimplification, but this is what I see every day in my clinic. Fewer than 5% of patients with an eating disorder seeking treatment in my partial hospitalization program do not have at least one other diagnosed mental illness. The 40+ BMI female who will freely acknowledge that she intentionally gained weight to reduce the possibility of ever being raped or molested again is probably 1.5-2x more common than a patient with ONLY an ED--which in those cases is almost always anorexia nervosa and almost always has a family history as well as a plausible environmental trigger such as gymnastics or dance. If I had one ask--and this is going to be touched on in my doctoral capstone project--for every primary care clinician, it would be this: Screen for a eating disorders before you give any patient diet or exercise advice, and if positive refer for treatment instead.
  8. My wife's superpower is spotting deer while in a moving car. Doesn't matter if they're on the road or off, nor what seat she's in. She always. Spots. The. Deer. Probably has something to do with her older sister and both parents each having totalled multiple vehicles hitting deer in Nebraska when she was growing up. What's funnier is she's not the sort you would expect to be hypervigilant; she's an easygoing person, not edge-of-the-seat. Being bitten by a radioactive spider would have been cooler, I suppose, but oh well.
  9. Because patients and employers, but especially patients, hate it. It's ripe for a revolution, like DPC.
  10. You realize that was posted over 4y ago, right? Be great if you got a response but... don't hold your breath.
  11. That system is already collapsing, even as it expands. PAs will be essential to the success of the Direct Primary Care model, which is in direct response to the consumer demand for accessible, relationship-based medical care.
  12. I think Kettle's response has merit. We have a profession that's now 70% female, and graduation rates are more skewed than that. Many had been sold PA as a career as a way to get better work-life balance than medical school with residency, and this marketing approach has made it attractive to both women and men... but especially women, who have or anticipate obligations like child rearing or care for elderly parents which still fall predominately to women. As an established PA (9y, 4m in practice, but who's counting), I love my work-life balance... but I didn't get here as a new grad. My first three years were in a demanding family medicine environment where a full time job was about 50-55 hours per week--and that was a pretty good one, honestly, compared to what some others have to put up with. My next two years were spent in a dubious family med/urgent care setting which intentionally used MA students as actual MAs for cost control... among other cost-conscious choices. For the first several years, I spent my vacation on CME--I still do, really--to learn more and become more valuable. My insanely cushy position now is a direct result for me getting very good at things that most medical providers cannot stand. Were new grads sold a bill of goods? Quite possibly. Is there a way forward? Absolutely. Do you always get everything you want? Nope.
  13. The most unrealistic thing about House, MD or similar medical shows isn't the oddball diseases (the first three seasons could have been a board review course), but the fact that doctors are doing lab work or actually seeing patients, instead of just being stuck at a computer charting.
  14. 1. No. You can own everything. 2. You already have your PA license, so you should be good to go with the SP agreement. As far as not having a physical location, I can't speak to that. I have a $400/month incubation suite, and having a physical practice location, as well as a PO box, seems to be working well for me, even though I didn't see clients out of the space for a couple of months while I was working elsewhere and getting my paperwork all in a row.
  15. Remember, it's cost of labor that drives pay. If someone else can do your job for cheaper, you're just an interchangeable part, and nothing--not even a union--is going to help that. Malpractice rates are not very granular, and they don't go down for a PA based on claim-free years of practice, so the new grad can bill as much and doesn't cost any more... so why pay more for experience?
  16. They've BEEN flooding the market, but demand keeps growing. People who were junior to me in my Infosec career are now CISOs of companies I recognize. Still not going back.
  17. Simple question: Is obesity (that is, weight more than average, BMI >30) a disease, a symptom of other conditions, or a human characteristic that is not necessarily pathological?
  18. It's about group virtue signalling, not about medical sense. There are a number of medical professionals I've seen who try to talk sense in one such ministry forum, who are generally treated in decidedly un-Christ-like ways by the remainder of the participants, while any post about anything will inevitably draw "helpful" comments about essential oils.
  19. I use a health care sharing ministry. Biggest downside is 0 preventative care coverage. Cost is great, coverage has been 100% the three ER visits we've used it for over the years, red tape is less than traditional insurance. Biggest cultural mismatch is the number of superstitious people on the plan, which is encouraged by their alternative medicine reimbursement policies and their doctrinal requirements for board service. Trying to talk sense about any vaccines on their member forum is... Not pleasant.
  20. Any M&M? Did you call risk management on the NP? Nursing practice board?
  21. I will never break even as a PA vs. what I would have made staying in IT security: my first post-PA school salary was about $30k lower than my last year in infosec three years prior. My peers--and some of those junior to me--are now CISOs per LinkedIn, several of them at companies I recognize. But I'm making money in my own clinic, seeing patients where I believe I am making a meaningful dent on their suffering in both of my settings. Hard to put a price tag on that. And yes, with an outpatient practice, there's no good reason for me to go back for an MD. I may do a research doctorate after my DMSc, but we'll see in 2023.
  22. It CAN be stopped. Corporations are good at delivering products and services, but not any good at all at delivering relationship. If primary care medicine is a bio-psycho-social-emotional-familial-spiritual discipline--and I contend it should be, if not must be--then corporations can never truly provide it. ER or specialty medicine is different: relationship takes a back seat to competence in those settings. Direct Primary Cares are springing up all over the place despite issues with insurance reimbursement because patients would rather pay cash on top of their useless corporate plans that are essentially catastrophic care.
  23. I think it's fine to include credentials that are... - Separate. An MS, MPAS, MMS, etc. are part of your PA-C training - Significant. An ATC is, my EMT-B is not. - Relevant. How does the credential immediately tell others in the know that you have something extra that makes you a better caregiver? I would never put my CISSP on a white coat. I might on a business card if I were working as a HIPAA consultant. I would never put more than my highest religion degree on a card, even if I were functioning on an IRB or medical ethics context. Between IT, religion, and healthcare, I have enough legitimate postnominals to put any nurse to shame. I usually just use them in appropriate contexts. I don't, for example, have my Fellowship of the Academy of Wilderness Medicine on the signature line of my eating disorders email account--why would I?
  24. The real issue is keeping generations in balance, actually, and while most dystopian SciFi like Logan's Run focused on overpopulation as an existential threat, reality is a bit weirder in that we have (arguably) too many people, but not enough young people since the current generation has failed to achieve replacement status, in some places by so much that society is unsustainable: either it implodes and collapses without workers to care for the elderly, or absent children will be replaced wholesale with immigrants of differing cultural background and values.
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