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heck considering starting my own practice (again) and the trip fee for a house call (just to get me to the house) will be $100 Hmmm, have you considered being a plumber or an appliance service person? They get that much just to show up.

I recall talking with a PA coworker who had also been a medic for a number of years. Our joint opinion what that coding a patient was easy - we'd done it for years. The hard part (or new part) as a PA was what to do if we got them back, i.e. post-resuscitation support, because other that simple drips like dopamine, amiodarone, or lidocaine, that was all new to us - and also far more complex.

Maybe the tone of the reporting on COVID-19 will change after the election - maybe. For those of us who actually deal with it and understand the stats, it won't change until the massive distribution of an effective vaccine lowers cases counts significantly. I don't expect this before next summer at the earliest. For better or worse, the news media sells hype to get the attention and viewers/readers to make money by selling advertising. So, it will take something else being more interest grabbing to divert attention from COVID-19 and the political environment.

I've not seen this (EMS experience in particular paramedic experience) being seen as a strong plus for admission to PA programs. Even on these boards there's at least 1 PA program faculty member who isn't at all positive on paramedics as PA students. When I went to PA school the most common demographic was a ~ 24 y/o/f current athletic trainer with some ortho experience. On the other hand, in my experience it's the former fire service (or other 911 service) medics who are most eager to dive into the higher acuity patients in EM and are excited by the most gnarly injuries and procedures. I think it's a mindset (and experience as a team leader) that drives this.

Just adding the percentages you've listed comes to 150% - sure hope that isn't/won't be true. I think 10% bump is minimum. If the facility won't go for that, go for straight hours plus OT. Key question to consider before taking a job that will be a major stressor like this: is the institution willing to change on those factors that are making the current PA's unhappy.

Join SEMPA, go to their conference (when it returns to in person). They also have lots of very good workshops both at the conference and separately. For ultrasound, I've found Ohio ACEP's class as good or better than others and tends to be cheaper.

I think that it's your wisdom that's making you nervous. You're not going in blindly to EM, you know what you're getting in to. I think the best thing that you'll have is a supportive environment. If you'll be working with other PA's, they'll be a great source of teaching. They'll help you learn how to do more complicated procedures, when to involve the docs, how to manage typical patients, etc.

Another thought and a "story": As a new PA, I was embarrassed to call consultants, thinking that calling someone for advice vs just giving them an admission meant my knowledge wasn't what it should be. After doing EM for awhile, I saw how often attendings call consultants. The consultant: certainly knows the subtleties of their area of medicine better than EM or IM (hospitalists) will may well know that patient from treating them for that or a related condition will often know when it's time to punt to a higher level of care. So, it's good practice to consult specialists. The story: The greenhorn was sitting next to the old cowboy in the bar, asking him how he handled a bad situation very well. "Good judgement", said the old cowboy. "Where does that come from?", asked the greenhorn. "Experience", replied the old cowboy. "How do you get experience?", asked the greenhorn. "Bad judgement" was the answer. Your judgement is getting better through the normal process of getting experience. Just saw your message. No residency, though I admire folks who did one. I needed to get back to family and income. I've had my share of "experience". Yes, absolutely, I've had times when I felt responsible for a bad outcome. Went through those periods at least 3 times: as an EMT, as a paramedic, as a new PA. Still feel that way sometimes. Disease, injury, and patient stupidity are incredibly creative in terms of what they can surprise you with.

I do EM at at CAH and respond to needs from our in-patient floor at night. However, our in-patient unit is a med/surg that will take some step-down level patients, not ICE. I feel for you. Especially as a new grad, you were in over your head. That's NOT a criticism: we all have to pay a learning curve. It sounds like you are actually doing pretty well. As folks have said, ICU patients are for the most part very sick. The ones you've described sound like rapidly evolving sepsis. They were already at the edge of the cliff. You didn't kill them - they were actively dying already. You just missed a small chance to possibly save them. Whether they would have survived with perfect care is unknown. The only thing that is certain is that you wouldn't be beating yourself up if your care had been "perfect" and they still died. One thing that medicine (or EMS) will teach you is that all serious cases have an element of "cluster ..." in them. In time you'll re-calibrate your standards to "I did all the major stuff right, the misses probably didn't matter, and whatever happens is mostly because of how sick or injured the patient is". I think you've learned 2 things: what sepsis looks like and how quickly it can go bad what the boundaries of your knowledge are and how you need to quickly call for help Those are critically important lessons for the future and will guide you well. You could even talk to your SP about how to get used to these things. I bet he or she went through this in their residency.

The best data you can get is from folks who have just done what you're worried about. So, talk to the folks who just graduated from your school.

I wish I had considered several things more: How the program helps towards getting a student toward the final goal: a job as a PA. There are really only 2 things that matter: PANCE pass rate (1st or 2nd time - not as much as the 1st time pass rate they beat their chest about). Frankly, almost all programs are pretty good, e.g. 95%+ Availability of rotations: as the contacts you develop are very helpful in the job search, sources of informal opinions of the student as a candidate. This is hard for a prospective applicant to measure. You can get a handle on what rotations are available, where they are located, etc. How well the program prepares you for the learning curve in your 1st job. This is not the same as preparing you to pass PANCE. Again, hard to measure. The best data will come from talking to recent graduates. On a practical basis: getting your license and 1st job is what really matters. That's where you will really learn your trade. Pick the least costly way to get there.

Are the times when the doc has you in her office and on the phone times when you can ask her about patients you've seen and learn from the doc on how to manage them?

In PA school part of our pharmacology was taught by a pharmacist who'd worked for the VA. He said that when the VA looked at medication compliance for patients who received their meds for free from the VA it was only about 60%. So, while cost is a factor, I've seen major compliance issues in the ED who just don't take even their low cost medications, e.g. meds in the $5-10/month range.

A caution: be certain that your "advisor" is a CFP, better yet, an IRS "enrolled agent". These are folks who aren't just salespeople like many "financial advisors" are. They can give you the correct advice on this.

Actually, no. I pick forums where folks are receptive, e.g. a group of fellow retirees from the Fortune 50 company I retired from, who are receptive to medical information,; educating my patients, etc. On a practical basis, who have we seen on these forums who's changed their position?