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narcan

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narcan last won the day on February 17

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  1. I view a "good" raise as 10-15% and a great raise as 15-25%, so somewhere in there would be an off-the-cuff answer. But if you have friends in the same organization who are also in an adminstrative role, consider asking them how their compensation changed. You can also ask for comp-time to be built-in, so additional hours you work covering providers who are sick or doing extra admin work outside of 40 hours generates PTO for you somehow.
  2. The larger the organization, the less strongly I would feel about it, i.e. an academic center probably is complying with all regulations and they're not likely to adjust the contract anyway. Small groups or private practices definitely need to be looked at by an attorney.
  3. The advantage to low volume is that the docs actually have time to teach. If you're constantly just trying to keep your heads above water seeing everyone coming through the door, you'll inevitably end up seeing what you're comfortable seeing, i.e. the low acuity patients, and the docs won't have time to help you learn procedures, talk through cases, etc.
  4. Clarify if you don't have access to the 401K as in you can't contribute your own money, or it simply means they won't contribute or match until a year in. Most places contribute from the jump, but you often aren't vested (meaning their money is theirs) until 1-5 years.
  5. Sounds like it would fall under "several liability", and yes, it should be a thing. If it hasn't been tried by a plantiff's attorney, I'd be curious if it just hasn't been considered or if the juice isn't worth the squeeze, i.e. it's a lot easier to win a judgment or settlement from an individual practitioner than from a large corporation with large corporate resources. https://www.alllaw.com/articles/nolo/medical-malpractice/multiple-parties-liable.html
  6. Do you guys recommend having your own policy if provided by your employer? I ask for those of us who have switched jobs over time.
  7. I definitely agree there is a space for this. Check out Dr. Peter Attia for a lot of interesting, nerdy information on body optimization. I would assume find an MD who's in the same community, e.g. crossfit, triathalons, etc. My friends who practice independently pay their SP a flat annual fee for services but depending on the requirements of Washington, if they have to review a certain number of charts or see certain patients, then you could have a sliding scale somehow. Keep us informed. Feel free to message me.
  8. Had another tPA gone bad case this week. 82 yof, relatively healthy, with NIHSS of 5 and given tPA. 3 hours later when she gets to my ICU, she acutely developed right hemiplegia. Massive left hemispheric ICH. Discussed with the neurointensivist at our referral hospital who recommended against TXA, so we just gave a 10-pack of cryo. I did find this review by EMRA that at least talks about all of the options while admitting there is no data for any of it: https://www.emra.org/emresident/article/management-of-post-tpa-intracerebral-hemorrhage/
  9. It took me about 8 weeks if I recall. More frustrating than other states I've dealt with. Make sure to call and follow up with them. My initial application was missing something, and no one told me until I called a week later to check on it.
  10. Does anyone else not object to the name "physician extender"?
  11. I just followed up. Family transitioned to comfort care given fairly devastating neuro prognosis and underlying comorbidities.
  12. I just had this patient last week. Patient had a massive embolic stroke followed by life-threatening bleeding after tPA. We transfused a 10-pack of cryo and a loading dose of Amicar (aminocaproic acid) prior to going to the OR (long story), but I think TXA would have worked just as well. Decided against FFP as the patient was not warfarin anticoagulated and the INR of FFP is only 1.6. I think adding PCC/Kcentra or Factor VII would have been reasonable things as well if you need to "throw the kitchen sink at it".
  13. The only argument I see for using morphine is that it comes in 4mg/1mL vials, so the nurses don't have to waste (i.e. as they would with hydromorphone or fentanyl unless you're just the candy man), which saves time and makes them like you more. From a purely physiologic/kinetics standpoint, I don't see any reason to use morphine over hydromorph or fentanyl depending on desired duration of effect and patient hemodynamics. I know that the anti-opioid folks argue that PO morphine has the least euphoria of the PO opioids and thus is "safer" in terms of prescribing, but I don't know if that translates to IV dosing, and I suspect it does not. And I second the use of morphine for palliation in the dying dyspneic patient. Just my 2 miligrams... (pun definitely intended)
  14. It's now HR 5506 the Physician Assistant Direct Payment Act. If you don't know your local representative's information or don't want to have to draft your own letter of support, the AAPA has a website up: https://www.aapa.org/news-central/2018/04/legislation-introduced-authorize-direct-pay-pas-medicare/
  15. God, I hope it's a troll and not someone representing us out there with that shitbrain thought process.
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