ohiovolffemtp

GMOTM, I'm an EMS instructor in Ohio. Ohio at least has it's own process for certifying EMS (and firefighting) instructors. For EMS, you can teach at the level of the EMS certification you have, but are required to have current National Registry certification at the time of getting your instructor certification. RN's and PA's don't have to have current EMS certifications. You still have to take and pass an 80 hour instructional methods class and pass the "knowledge test" - EMS knowledge. For Ohio, the NAEMSE certification doesn't matter. Each state has their own rules on obtaining certification as an EMS instructor. However, in Ohio, you do not have to be a certified instructor to give lectures or help with skill stations as long as a certified instructor is responsible for the course and is present while you are lecturing or helping with skill stations. So, before you spend time and money on a course, I recommend checking with the particular state(s) where you'll be wanting to teach.

I now work in a low volume variable acuity rural critical access hospital. I feel so much better, even though I'm a nocturnist. My wife feels like I'm back to being me, vs the constantly stressed out barely communicative person I was before. That said, I'm the only provider in the ED from 20:00-08:00 and the only one in the hospital from 20:00-07:00, when the inpatient docs round. So, if anything comes through the door, I'll start it unless it sounds very minor and it's the last 10 minutes of my shift. However, signouts are expected unless the patient will be ready for discharge a few minutes after the normal end of your shift.

A whole lot of what you can expect to get is determined by the local market. While the salary surveys get you state data, there is considerable variation within each state. See if you can some local perspective - from your state PA organization, your school - if there in this state. That said, ask if medmal includes tail. Ask for enough CME to do 1 conference a year. You made no mention about medical/vision/dental insurance or retirement. Ask about them as well

The hand surgeons I used to consult would have us ronguer bone ends, loosely close, start pain meds and abx, and arrange for office follow-up in a few days for finger amputations. In reading their notes they rarely even did a revision. Usually, they just monitored the healing. Even for flexor tendon injuries they typically waited a few days to see, usually for the swelling to go down and to get a scheduled slot in the OR. Pretty much the only things they saw and took to the OR immediately where high pressure injections, compartment syndomes, and massive hand (not just multiple fingers) injuries.

I was never very good about getting out on time at my old FT job either. I felt that averaging (pt + procedures + 30 min increments of critical care time) of 2/hour was plenty. Don't know what your total hour compensation is, but I found that in my last 90 minutes of a shift I did best if I only picked up patients that wouldn't involve much of a workup or likely need admission. In my last 45 minutes, I'd only do level 4's & 5's, and no procedure that wasn't simple.

Some techniques I use to help focus and shorten the H&P: After the patient has talked about what happened I interject a question asking for more details about something they already mentioned, e.g. seeking more information about the pain. That tends to put me in control of the conversation and I can begin asking more focused questions. My standard response to "how long till I get better/how many days will I need to stay/etc. is "your body will answer that question".

@Kadiah, Reading between the lines it sounds like you can get an EKG in your UC - so you can see if there is a STEMI. However, the overall chest pain workup includes a chest xray - which you say you can't get during all of the hours you're open, stat blood work, including serial: initial, 3, and 9 hour troponins to revaluate for non-STEMI's, plus possible CT's for PE or dissection, etc. You aren't going to keep a pt in the UC for even 3 hours and you don't have all the tools needed to do the workup. So, if you think the chest pain may be cardiac, they need to be sent right away to the ED.

I'd recommend asking if you can shadow a PA in the surgery practice for a day or 2 so you can get a really good feel for whether you'd like it or not. Surgery isn't for everyone (for example I lived on ibuprofen during my surgery rotation - standing that long for cases wasn't for me). I'd say an offer deserves a Y/N response within a week. I can't speak to your overall job hunt - it's very much location, specialty, and person dependent.

Somewhat similar to UGoLong: Undergrad degree in computer science. Total of 29 years doing corporate IT. Most of that time I was a volunteer FF/EMT or FF/EMT-Advanced. Got my paramedic at age 44, started working as a parttime FF/medic in addition to the IT work. Took early retirement buyout at age 49, continued to do the PT FF/medic and taught EMS at a community college branch of a state university. A flight nurse friend recommended PA school (I also looked into DO school). So, since I could take 1 class for free for every one I taught, I completed my pre-reqs (med school and PA school pre-reqs are the same). Ultimately chose PA school over DO school largely due to my age - I didn't want to spend 4 years of med school plus 3-4 in an EM residency. Started PA school at 53, got licensed at 55, been doing emergency medicine ever since. My advice: if you and your family can survive the time you'll be spending in school and the lost income while you're doing it, go for it. Don't get too hung up on the lack of prior medical experience, the 22-24 year olds applying to PA school don't have much either. Just get enough to be sure that practicing medicine is what you'll really be happy doing.

Or, the view from my back porch

I have a classmate who does peds ortho as part of a practice owned by the local children's hospital. She loves it. It is general peds ortho - not just sports medicine.

4 pts/hour is only doable if they are very simple visits: acute visits for straightforward conditions or simple med refills.

Also, if they are providing benefits, consider staying and then picking up a PT UC job once you have some experience.

I've been getting many emails from this group. Before I consign them to my SPAM folder, does anyone know anything about them? Are they worthwhile?

I believe that the collaboration agreements are still required, but do not need review/approval/filing with the state. They just need to be kept at the practice location. That makes what I do for my work in Indiana similar to what I do for my work in Ohio.