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Lightspeed

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Lightspeed last won the day on August 26

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  1. I think it’s rare to escape the paternalism. But physicians as a whole, when they are arrogant, are like islands of arrogance. They are better than you, me, other physicians (even their practice partners), neighbors, staff, patients, the guy who details their car. Even the ones that are dialed in to listening to their patients still tend to carry with them the idea that they are right about what they want to do. I feel fortunate to have dealt personally with quite a few who have humble hearts and acknowledge to themselves that they aren’t capable of grasping everything that crosses their minds in a given day. I’m running into more of these kinds of good docs as time goes on. What you have with a physician executive is he same thing you see in just about any executive... nurse executive, business executive, etc.... so double whammy. It could be the physician in them causing the frustration, but it’s just as likely the boss in them. I can’t tell you how many times in my career as an RN that every boss I had would basically develop their own version of “thank you for your opinion but go F yourself... I’ve got this figured out.” That kind of treatment was more of a daily thing, rather than a monthly or quarterly thing, and it was at every level of the food chain. And they had their own meetings where they had that message passed down to them from their bosses. So...is this what OTP looks like? Physicians still in charge? Or worse.... nurses in charge by means of delegation? Yay for the future! Looks just like the past.
  2. So much can happen from the time you start school to when you finish. I come down on the side of maximum flexibility, especially considering the market is high, renting out your house is a crapnshoot, and you might end up with a sweet deal waiting for you in a different place. I think that peace of mind is worth more during the stressful school years than the meager income you’d get out of the house. You don’t get ahead in life with just one rental property anyway. If you want to play in real estate, get into it when you are done with school. Now really is a great time to sell. I’d be selling right and renting until the next downturn if I could right now, but I’m in a house that’s so insanely affordable that it would be a bad idea. I like it a lot as well. I bought it.... during the last downturn... because I wasn’t stuck in a different house. Cash out. There’s your rainy day fund. Boatswain speaks truth.
  3. He/she graduated in August. All of the above are good suggestions. As an NP, I’m a different species, but there are some similarities, as well as some observations from the other side. My gut belief is that with the level of education and training that you folks come out of school with, it’s a shame that you would then need to go find a residency just to set you apart. Its certainly not an idea anyone can knock, but I prefer to suggest just holding off on that until you’ve tested the waters. Of course it’s resume enhancing, but it’s a lot of work that might not be necessary if you work all the angles beforehand. You could go ahead and get started on the paperwork for a residency just in case. First thing... PA training is fabulous, so recognize your worth. Right out of the gate you folks have some advantages against NPs. I hear Michigan has some favorable laws recently passed, and California might be on deck next. Those might be the only places in the county where PAs stack up against NPs as good if not better as far as regulations. So you are going to be valuable, or else quickly can be valuable to an employer. Go forth with confidence. Second.... network... with everyone. Have no shame. Be unapologetically optimistic. Be transparently eager for work. At every rejection, ask for leads for any other jobs. When I was looking for jobs (granted, psyche NPs have been hot for a while), I was telling everyone at the sites that I did clinical at that yes, I wanted a job. I wasn’t coy. My problem later on became too many job offers, and too many kind people wanting to help me out. It’s hard to tell people “no thank you” when many of them went out on a limb to try to work something out for an eager student. Even when I was really forward, I had some folks straight up tell me that they had nothing to offer right then, and I responded back with something like “well, if it’s all the same, just keep me in mind and watch me work in case something changes, or in case you hear of something you can recommend me for”. So network without shame. Attend drug rep dinners, approach clinic systems and the middle men and assistants that guard the gates to the providers, and be pushy in a friendly way. Everyone will tell you to apply online, and resist dealing with you face to face if they can. That’s fine, but also insist on leaving a card and a hard copy resume. Admit vocally that it’s a tough market and you want to make some headway. If it doesn’t work, you still made an impression. That kind of tenacity helps you stand out because it’s applicable to taking charge to get stuff done when there are roadblocks... ie pharmacies that are causing problems, or just some other hiccups during a days work. I liked the suggestion to contact the state PA society. People want to help people more when they meet in person. Recruiters..... Social media groups that are specific to your location or circumstances. Do some internet research of different places that appeal to you. A caveat to the networking is don’t be weird. I stressed above about being eager, but that mostly works if you have life skill and can read people, and respond appropriately. Presentation involves as much about what you don’t say vs what you say. I found I didn’t impress people as much by anything profound that I said in front of them as much as what I exhibited through my restraint. I’ll turn this back a bit to the PA vs NP dilemma out there. With many new grad PAs not having health care experience like they used to have from a prior career, theres a disadvantage to nurses who know how to press the flesh and network. Nurses have seen it, done it, and perfected it. Even the new ones have done it at least once to get their nursing job, and have seen how professional interactions and networking works. They also learn it OTJ in quick fashion once they start working as RNs. Nurses know they can wait for the right opportunity and skip places that are offering them bad deals. Often, they spent their whole time in NP school working on networking and setting up where they would land upon graduation. I don’t know how to counter that specifically other than through actually working on people skills. My workplace has enough students flowing through it that I can see the difference from the provider perspective. Even NP students that are young or older ones that lack confidence wind up in the same boat. But a PA with prior experience and confidence turns heads. So maybe I just reversed course on the residency idea just now and didn’t realize it. That might be how you turn the tide in your favor. But overall, I’d try a lot of things before I dove in for more training.
  4. I’d take this advice and also commend the Op for being willing to change gears.
  5. Probably no need to even discuss it. If it comes up, explain the situation in general terms. Having applied to and attended RN school myself, I can say that it probably won’t come up unless you mention it yourself in a personal statement. Usually there are no interviews. If you wanted to mention it, a brief “I started out PA school, but before long realized it wasn’t for me, and that nursing would be a better fit”. That’s mostly true if you consider that the school and circumstances helped you realize it wasn’t a good fit and sent you on your way. So there you go... enjoy nursing.
  6. You are right. I’ll explain where RNs come into the picture. There are a lot RN interventions and billing that surrounds hospital stays that RNs are better suited to. Provider billing can be very straightforward by comparison. Billing associated with home care visits and floor charges for supplies are the nickels and dimes that insurance likes to keep tabs on to avoid getting fleeced. That kind of fraud-ish potential requires someone who can spot the BS charges, like for wound care. They know that it doesn’t take X many dressings at $35 per dressing to do Y procedure Z many times per visit. They have already been able to get a handle on provider charges to the best level they can, and they are usually out front and cut and dried... those are either a “we can’t prove otherwise so yeah they needed it” or “no, that wasn’t pre authorized and we don’t think they need it”. You can reject preauth requests using a flowchart. Now it’s time to get the blood out of the stones, so to speak, and watch over the minutia.
  7. I call it independence when I’m discussing it here, because it cuts to the chase. But you are right, I use the term FPA when I’m out and about IRL. Haven’t had to use it amongst politicians because we have FPA/independence in my state. And yes, I think PAs need FPA too.
  8. I feel like OTP will be PAs reward, and independent practice will be NPs reward next year. OTP doesn’t threaten physicians.
  9. I know more than “a handful of Nps that are good medical providers”. I count myself as decent, and I work with several others who are phenomenal... in fact, I’ve seen exponentially many more NPs that are good than I’ve ever seen that were not. This smells like a troll post from someone who joined last week and has this as their first post. Even taking your post on its dubious merits, I’ll just suggest that the ship has passed on all that. That’s not going to change PAs lots in life with that approach. How many times has this come up here? Recruiters and HR don’t care and aren’t interested in listening to you. Go read the other threads where PAs have talked until they are blue in the face to try to advocate for themselves at the ground level. Start your own private war against NPs, and see where that gets you. You wouldn’t be the first. You also won’t be the last PA lamenting state after state that allows NP independence while you settle for being supervised by your practice where you lobbied unsuccessfully at the grassroots to exclude NPs. That’s old school, and it’s got you this far.... and no farther.
  10. I’ve heard urgent care can be lucrative. It’s nearly that good where I’m at, but I’m hearing it seems to be heading that direction.
  11. Despite potential pitfalls, salary can be a sword that cuts both ways. If your office doesn’t work nights, weekends, holidays, after (say) 5PM, or have any mechanism in place for anyone to be on call, then sometimes you benefit from getting paid for more than you work. Call isn’t my thing. Not having it has driven that home for me. Don’t care how easy it is, or how rare it’s utilized, or even how much it pays (it’s never enough). The gigs that pay $48k per year are rare enough that I’ll never get them, and the lower they pay, the bigger the struggle to decide when the turning point is where I feel comfortable being a glutton for punishment. It offends me that I’ll gladly be someone’s call prostitute for $28,000 per year, but not $20,000. So I avoided the whole struggle and looked for jobs that didn’t force me to play “would you ever”. In psyche, I’m seeing 1099 work above $120/hr. $100/hr is really the minimum anyone will even entertain, if posts on social media groups are to be believed. W-2 would be great at that rate, but I’ve not personally seen offer that high in that classification. However, my NP friends working on their own.... there are some crazy numbers there. Had an acquaintance inquire if I wanted to come onboard. Problem was that before deciding to expand, we had a conversation where I got the gist of how much they were making. Fast forward, and it made to easy to calculate how much they wouldn’t be paying me, and keeping instead. Came out to enough that it was clear that before I’d be signing in for something like that, I’d just go out and start my own practice. But then I’d essentially have two or three jobs, so that takes all the appeal back out of that again.
  12. It might not be a great option for many of us, but lots of folks might be up for the adventure. My priorities are family, time, money, and job satisfaction. I can knock out the last one pretty easy by having a job that makes the first three easy to manage. But it might be that the first three aren’t in the picture to compete with the last one for you. Plenty of folks have unconventional commutes. The conservative approach suits many of us well. Does it suit you?
  13. I like your logic that you had no patient release document. That’s pretty strong right there. I guess their answer might be that you need to get one to use their pharmacy. That kind of development is an entirely new approach to care... changes everything about prescriptions.
  14. Here’s a side not to what you mentioned is your comment: My understanding is that the reason that “nurse anesthesiologist” took in that title is because Anesthesiologist Assistants are now being referred to as anesthetists, especially by physicians that are trying to promote the profession as a dependent provider to them that is in direct competition to CRNAs. The Florida BON allowed the title on a one time basis, and there was some good logic used in making the case. Apparently there is a brewing struggle about names in anesthesia and people are chaffing.
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