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About ohiovolffemtp

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  1. BP, At various times I've spoken with Barton, Weatherby and I believe 1 other locums agency. Like you, I work in the Ohio, KY, Indiana area. I've not found their hourly pay any better than what I was receiving from my primary W-2 employers. Weatherby awhile ago had an opening in Indiana where they were offering ~$80/hour but never got back to me on it - even though I was already credentialed in that hospital system. So, while there are jobs out there, I've not seen them be more attractive that what I could find on my own both FT and PT.
  2. I've talked to some of the NP's flying on the helicopter services in SW Ohio and the pay was about $50/hour - well below what working clinically in the ED pays.
  3. I agree, starting with verbal de-escalation, PO meds, or even IM with pt's agreement. I've got a pretty good line of schmoozing that's often effective. However, there are some patients, often with a combination of mental illness, substance abuse, and alcohol abuse, who are actively violent and who are either an immediate danger to themselves or others, e.g. staff, or with whom de-escalation efforts have failed where deception and/or force is required. When this occurs, rapid implementation with sufficient numbers of personnel and appropriate meds, sometimes with restraints until the meds take effect, followed by de-escalation as quickly as is safe is the most ethical approach.
  4. Don't just join SEMPA - go to their annual conference. There are MANY recruiters there. Talk to all of them about job prospects for a new hire. Talk to your PCP. They probably know at least some folks in their local ED's. They may be able to get you in contact with someone who at least knows what the local EM job market is like. Be prepared for few folks to be interested in you until you've passed PANCE. You're too uncertain until then. After you've passed, getting licensed is pretty much a given - though the time lag is state dependent.
  5. It's extremely important to remember that DVT (whether ruled in or out) does NOT equal PE. You can have PE without DVT and DVT without PE. I do POCUS US for DVT at my FT rural critical access EM job. It's just a preliminary data point. If the clinical picture makes PE sound likely (because PE is what I really care about as it's the real immediate threat to my patient) I go straight to the CTA chest which I can get 24x7. Based on clinical picture, I may give lovenox or a NOAC and have the patient return when full duplex US is available if there's less immediate indication of PE. Either confirmed DVT or confirmed PE means they start on a NOAC. However, just because a person with a confirmed DVT (or afib, or other clot source) is anti-coagulated doesn't mean that the PE risk is gone once they're at therapeutic anti-coagulation. There are other things to think about: Greenfield filters, clot size and location(s), whether the patient should be hospitalized, etc.
  6. Same as DizzyJ, extremely seldom, but do recall 1 time only - told a patient he was getting something other that Geodon when he was getting that, just to avoid another physical altercation. Patient had already broken a window with a chair trying to attack me. He was being medicated for everyone's safety, including his.
  7. At my former FT ED job and both of my current PT ED jobs we've had declines in census over the past 2-3 years. In each case, there have been cuts to the numbers and length of the PA/NP shifts. The worst was my former FT job where there was a 45% in PA/NP staffing hours per day vs 3 years ago. One of my PT jobs just announced cuts today. Some observations: In each case, the staffing co's cite a reported nation-wide decline in ED visits of 6% or more. At each site, the physician hours are being cut less, if at all. That seems odd to me because on average in the areas where I work a PA or NP makes about 40% what an EM doc makes. While Ohio requires a doc to be in the ED at all times, it doesn't require them to see all patients. There's a big push at all sites for the doc to chart a face-to-face encounter on as many patients as possible, so the visit can be billed at the 100% incident-to rate vs. the 85% PA/NP rate. It just seems odd that the staffing cuts hit us harder, even though our cost/benefit ratio is so much better. I've seen this behavior both from the large national staffing companies and small ones. Fortunately, at my current FT job - not in Ohio, I'm the only provider in the ED for the 12 overnight hours, so I'm not at risk of being cut since we all are travelers and the docs couldn't do successive 24 hour shifts. Are other folks seeing this where they work? Other thoughts?
  8. Don't know about the COL in CA, but that's the hourly rate I started at in SW Ohio, low to moderate COL, 5 years ago. Normal 401k match is $0.50 per $, so if they're putting in more than you, that's very good. CME is low, most EM companies do $2,500. Fast track only is very limiting. 2.5-3 pt/hour is very fast for a new person and overall can be brutal, because not everything that shows up in fast track is ESI 4 & 5.
  9. Could you present each of the fast track patients you're worried about to the attending? Standard presentation: age, gender, relevant hx /mechanism of injury , s/s, and exam findings. Then "I'm worried about A, B, C and am doing X, Y, Z to evaluate for that. Is there anything else I should do? Would you like to see the patient with me?" That way you can chart that you discussed the patient with the attending, including charting what you said to them. Hopefully, even if they don't want to transfer the patient to the main ED, they'll help guide your workup.
  10. I've seen versions of this posting on several locums agency's web sites and email. It's poorly written - not uncommon for these sites. Often these postings are "cut and paste" of some template they have. What you see may not reflect what the job actually is. Notice that this one mentions NP's, but then includes language about physicians. I've even talked to some recruiters who didn't really know about they job they were recruiting for. So, don't read to much into this ad.
  11. When I've had students I tell them that I'll quiz them often. I also tell them the motivation is that the act of recalling information tends to cement it into memory. I also tell them that the goal is to show progress over the course of their rotation. Embarasment is to be avoided.
  12. "Act" doesn't necessarily mean managing the situation yourself. It can and often does mean sending the patient to the appropriate resources. So, if you are doing a home visit and encounter something that needs further attention, you just start that process, whether it needs non-emergent OP f/u or emergent transfer to an ED.
  13. Amen to that. My PA school would not accept my cell biology course as filling their "biochemistry" requirements. The admin person who looked at the name of the course really couldn't penetrate the actual course syllabi.
  14. Two thoughts: How well you do as a new PA will depend significantly on how you and the hospitalist work together. Only you can assess how that relationship is likely to go. It will probably take 2-3 years at least for you to get up your learning curve. The lack of CME $ and retirement is a big issue. Don't know which staffing company, but in EM having a 401K match and some CME $ is standard. Lack of PTO is common - you're expected to handle vacations by schedule adjustments.
  15. Before you prescribe Narcan, remember it requires a (near) sober person to administer it to the patient. It's only when they are altered with respiratory depression that they need Narcan. It's only worthwhile to prescribe Narcan, which is pretty expensive, especially in some of the easy to administer packaging, if the patient is likely to have someone sober around when they're using. Make sure they are likely to be found by family, responsible friends, etc. before you go ahead and prescribe.
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