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narcan

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narcan last won the day on February 17

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  1. One thing about this I haven't understood is how are there no restrictions on other areas of practice? I'm an NP, so I can just start practicing cardiology independently? Can I do surgery and critical care? I get the argument for primary care, but any specialty should have some barriers in place.
  2. There are three emergency medicine residencies in NYC and one in critical care. What's the objection to applying for those?
  3. THIS. Have a good foundation for when you start. Know the red flags and what you can't miss. Know the basics and you'll impress upon your attendings that you can be trusted not to kill anyone. Also, subscribe to EM:RAP and/or UrgentCare:RAP. The EMRA antibiotic guide is a good, pocket resource as well. It's not step 1 or even step 3, but attending an ultrasound course or learning ultrasound procedures as mentioned above is requisite moving forward for new grads and experienced providers alike. For a dose of reality, be sure to read Bouncebacks. https://www.amazon.com/Bouncebacks-Emergency-Department-Cases-Returns/dp/1890018813/ref=dp_ob_title_bk And if you don't have a good handle on ECGs, read Dubin (https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065/) and then get advanced knowledge from Steve Smith's blog (http://hqmeded-ecg.blogspot.com/) For FOAMED sites, be sure to check out ALIEM (www.aliem.org) and Rebel EM (www.rebelem.org).
  4. This wouldn't change the liability of the attending, would it? With so many CMGs running emergency medicine now, if the attending on shift can avoid co-signing a chart, perhaps the "corporate physician" can become the co-signer/collaborating physician of record and thus take away the biggest source of anxiety for EPs who feel less than excited about working with APPs on a daily basis. While I am not looking forward to the increase in malpractice premiums, if we're seeing patients independently with no physician involvement, we really need to own the liability for disposition. The only way to raise the standard is to raise the standard.
  5. I've done multiple interviews on Skype prior to committing to flying out for an in-person interview. Screen jobs the best you can and then schedule a few over 2-3 days. I'd highly recommend going and seeing the facility and meeting the docs you'll be working with face-to-face before taking a job. Like others have said, don't quit your day job without something in place unless you truly can afford to go 6 months or more without a paycheck. Definitely find a good therapist/counselor. I don't know much about the online apps, but it might be worth it in the short-term, especially if you're so overworked you can't make it to traditional appointments and need the day-to-day availability of someone to talk to.
  6. If you finish PA school at 36, that gives you 30 years to work as a PA. That's millions of dollars in income. Sounds worth it to me compared to what medics usually make.
  7. Agree with ohio; I'm careful not to pick up complex patients near the end of my shift. Also, you should look into whether you can finish your charting from home via VPN. It's a lot nicer to finish those charts in your own environment with a cold beer than being stuck at the hospital under fluorescent lights.
  8. I did speak to my state chapter the other day and was basically told, "well it's a private organization, so we can't do anything". What they did offer to do was generate language to take to administration to ease their burden in changing the bylaws. I'm still waiting to get a copy of the actual bylaws, so I can see for myself what's fact and what's not and go from there.
  9. Yes, it gets even more ridiculous. I'm pretty tempted to contact this company to see what their angle is and how much they're paying as they also hire untrained scribes (i.e. premed students). Still, perhaps a reflection of how tough the job market is actually getting out there. https://www.indeed.com/viewjob?jk=aa675f934f00c1d7&tk=1dbrik24t0mt7000&from=company_2pane
  10. Does anyone have any experience with getting an employer or agency to convert you from a W2 employee to a 1099 employee, so you can take advantage of some of the tax benefits of self-employment? It's a bit confusing that if you're 1099, you can deduct a large number of expenses but as a W2 you cannot, it seems.
  11. There are some PAs inpatient, mostly in ortho and CT surgery. This is in Virginia, where NPs do now have autonomy starting next year if they have 5 years experience and some other criteria, but I think this is unique to this hospital system's bylaws, and I'm not sure the problem yet, except that perhaps the leadership team is looking out for their own. More to follow.
  12. If you know what area you want to go into, I'd recommend looking at a residency too. It's a tough market out there for new grads.
  13. I've been discussing a new critical care position with a CMG that is taking over for a private group at a mid-sized hospital in my area. They posted the job as NP or PA and I had a great phone interview with the regional medical director and have been keeping in touch with the recruiter over the past few weeks as they schedule interviews for the site director prior to conducting APP interviews. I received an email yesterday that the hospital bylaws "make it nearly impossible" for PAs to practice in the ICU, as in they would need orders cosigned before they would be active, would not be able to do invasive procedures, and that these restrictions somehow don't apply to NPs. I know there are PAs working in the hospital, specifically in ortho and cardiac surgery, but it is a nurse and NP heavy institution. I've reached out to my state organization to see if they have any guidance on this, but in the meantime, no interviews with PAs are being scheduled. I'm not sure there's any other recourse for me, but I wanted to throw it out to the group and see if others have had similar experiences. I've heard of hospitals being regressive on both NPs and PAs but I've never encountered an institution that specifically favored one over the other in terms of autonomy and credentialing.
  14. There's nothing wrong with the concept, although their price list is somewhat interesting. $325 for an MRI but $650 for an STD test (nucleic acid amplified). I think we'd all care less if they didn't intentionally exclude NPs and PAs. But we should also use this opportunity to examine the other side: there are a lot of docs who don't like working with us, not because we're not good clinicians or don't ease their workload, but because they don't like cosigning charts and taking on liability on patients they didn't see because the corporate overlords make them.
  15. Marino: ICU Book Owens: Ventilator Book Farkas: Internet Book of Critical Care (www.pulmcrit.org)
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