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BruceBanner last won the day on July 6 2017

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About BruceBanner

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  1. I think you have to break it down into 2 discrete areas: 1) the job 2) the location Being a PA in Michigan feels the same to me as being a PA in any of the other 3 states I've worked in. Michigan is a PA-friendly state in terms of legislation, but it all boils down to the job. Regional pay here is good, not the best not the worst. Competitive area due to NPs and saturation. I cannot recommend living/working in Michigan. I'm in Ann Arbor which is a major university town, but i am REALLY having a hard time with the weather here. Outside of the city there is some beautiful countryside, but also a lot of economic depression and dilapidation.
  2. Great video, I saw it on the reddit PA forum. So pertinent and true---burnout is everywhere. But so many of us suffer in silence. There is a sort of professional pride in medicine where you just keep taking it until you are at a breaking point. The culture of "see more, chart more" is everywhere. It's in academia, it's in commercial medicine, it's in private practice. And I might revise my statement earlier in this thread about not caring about patient's problems. I want to--especially when it counts for someone. But the demands make almost impossible sometimes. You cannot see 30 pts a day, or 5 an hour, and care about each and every one of them. You are just trying to survive. You get calloused, angry, bored, cynical, resentful. Cutting back my hours has really helped, but this is a systemic sickness in western medicine. I'm not sure what it will take to change the culture. We cant all go part-time or just "find new jobs".
  3. Yeah, I see the ones that bill insurance going belly up and transitioning to the retail model, which may flood the market enough to get the DEA involved and start shutting them down.
  4. Wear a mask with ALL sick patients, even ones that might be sick. Sanitize your hands after every visit like you have OCD. Sanitize your stethoscope and laptop if you use one, at least twice a day. Dont wear it around your neck. Wash hands with soap and water every day before you leave work. Anecdotal, but I find 1,000 mg vit C and 8,000 units of vit D (i live in MI) helpful. I take vit C year-round. If I feel something coming on I load up on 3-4 grams a day. Placebo? maybe, but it works for me. Aside from that, after 1-2 years at the same clinic you should have pretty stout immunity.
  5. Fraudulent billing. There is no medical reason to have a person back in your office for an E&M once a week for what is a fairly straightforward diagnosis. An office I used to work at did injections for some patients and it was billed as a nurse visit injection (not sure the code). Provider doesn't even see them. At most your office should be seeing them every 3 months, but 6 months is the norm. Then you can do your H&P, exam, etc. But anything you are coding for on those weekly visits is made up. Are you doing the injection? Or other staff? As I'm sure you know by now, retail testosterone clinics are a very shady business. The new trend is online men's clinics. They charge a flat fee for "membership", fee for labs, dont bill insurance, use only compounded meds, prescribe high doses and "ancillaries" like HCG and aromatase inhibitors, etc. Not putting you down at all. You needed a job. I almost worked for one! But that is fraudulent billing.
  6. I was an IC for a while. It's not that complicated from your end, as the contractor. Save 35%, and no less, of your income. You will need it come tax time. Your rate should reflect this. I had a CPA do my taxes and there were no problems.
  7. 4 weeks is not enough to prepare you work solo unsupported (not having another provider on site is essentially unsupported). This practice either has no experience with new grads or they dont have the resources to train you properly. Shadowing is a complete waste of time. You need to see patients. The best way to learn is to start with 1-2 straightforward pts per hour, with another provider on site and willing to help you, and gradually work up at your comfort level. Even for your first year of practice you should have someone else on site. Unless you can get this in writing, it sounds like this job would be a mistake.
  8. Supply and demand. When I graduated in 2012 there was something like 12 PA programs in Pennsylvania. A lot of my classmates who were local were getting terrible low offers---65k, etc. Now in Michigan we're seeing the same thing--7 or so programs for a relatively small catchment area of work, static salaries of 85-95k. You're somewhat protected as a tenured PA, but even still saturation drives market rates down. Employers get it, and they do not GAF. They have a stack of 50 CVs on their desk they can pull from. I harp on this all the time here and probably sound like an old man, but PAs are revenue-generators for employers, and by paying us more they lose their profit margin. Say you had an FM/UC practice. You would logically want to staff it with a couple of a docs (part time or contractors preferably), and maybe 6-8 PAs/NPs who do the brunt of the labor at a fixed market rate. I'm all about upward mobility for PAs but we cant outrun economics. The best pay will always be in demand areas.
  9. I agree with you, it's just not the market norm, BECAUSE we are revenue-generators. By paying us a nominal static market rate, the rest of our production goes to profit. I was represented by a major union with Kaiser and while our salaries/raises were very fair, they were set in stone. We were absolutely generating revenue for the corporation and I'd venture to say still profitable despite the overhead of union-mandated benefits.
  10. Who told patients we can do anything about their cold/flu symptoms for 2 days...
  11. All due respect---"know your worth" is great motivational talk but increasingly salaries are non-negotiable. For example if you work for a union, a university, or a major hospital system there is usually a tiered salary structure that is not negotiable, at all. The other problem with that is that why would any private employer pay YOU 140k when they can pay the next person in line 90k?? Might be more helpful if you told us how you got that rate.
  12. Oh yeah it sucked, balls. Our program was very "exclusive" as Joelseff put it and almost looked for reasons to cut people. 2 fails and you're done, mandatory B average, etc. I almost didnt make it my first quarter. I'd been out of school for a while and the volume/difficulty just steamrolled me. Staff was soft-prepping me for dismissal. But I pulled through, and ended up getting one of the highest board scores in the whole program (2 of my genius buddies got perfect scores).
  13. My experience with frustrations like this is they come in waves. You'll feel used and underappreciated, stressed, think about leaving, then things will settle out for a time until the the next opportunity admin has to make changes at your expense. But it wont get better. In corporate medicine you are at the bottom of the hill (which I've always found odd since you are the one generating revenue), and sh!t, as the saying goes, rolls downward. So yes, you should start the wheels in motion for leaving. But think about maybe a different direction than urgent care, since they are all corporate or commercially-controlled.
  14. Man, I could have written that post myself 3 months ago. I finally had to advocate for myself and drop my FTE (hours). Our organization mandates 80:20 clinical/administrative time, so I dropped down to 36 hours per week and put my admin time as a block on the same day. What that equals is four 8-hour days a week. So, never more than 2 days in a row. So far it has been a game-changer. High volumes will kill you. I was seeing 4-5 an hour plus 1 Saturday a month, and was completely fried. Nobody cares, nor understands unless they are doing it too. Admin doesn't care nor will they ever unless you abruptly leave. And then they will just go into crisis mode until they find a replacement. You have to advocate for yourself if you want to last in this profession, especially FM/UC where all employers care about is volume. It may be that you cant do that at your current job---commercial urgent cares are meat grinders for providers. If you gotta leave, you gotta leave. Oh and any snot-nosed punk who says they're seeing 5,6,7+ an hour "no problem" just hasnt been working long enough. It will catch up to them. One other thing: stop caring about people's problems. I care about making good decisions and not missing things---workmanship, so-to-speak. But IDGAF about patients' innumerable problems and their laundry list of needs. It's callused but you have to be to survive. If you just have the objective of making efficient, up-to-date clinic decisions you'll still do right by most of them.
  15. There are actually a lot of PAs making ~90k a year. Sadly, this hasnt changed at in at least the last 7 years. I was getting $45/hr offers when I graduated. What's really shameful is the PTO. 2 weeks?? The checker at Target probably gets more than that. If they were offering you 45/hr plus 4 weeks PTO, 1 week CME, 401k, good health, etc, it might be a better offer for a new grad.
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