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printer2100

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  1. I am not here to say these tests are perfect or ready, but coronaviruses don’t lie dormant or sequestered from the immune system like hepatitis or HSV. When the evidence isn’t available, we should at least rely on the basic sciences to bolster claims. Other coronaviruses generate immunity for 2-4 years after infection. Even in the setting of asymptomatic exposure and a weaker immune response, the general theory is that memory T/B cells are stored and would provide a quicker and more robust response to reinfection (provided there isn’t some crazy mutation). The differential rates of antibody positivity geographically also lend some credence to their specificity for COVID-19. Rates in the California FB study for seroprevalence were ~3%, while rates for the NY study were ~20%. That superimposes well on to the backdrop of known infection prevalence, respectively. Like I said before, this needs rolled out in an already high risk group and not to the general public. High risk group X can’t really avoid exposures, but we can certainly then study them for PCR confirmed infection rates versus their already known antibody status. The research wouldn’t even take very long in a hot zone, given that we have some data on average rates of healthcare worker COVID contraction. I really can’t wait for some data on convalescent serum treatment also. Some of these antibody tests measure the exact same antibodies that we are using as neutralizing antibodies in therapy.
  2. There are more reasonable tests on the market. Tests with sensitivities and specificities in the high 90s. That still results in a lot of false positives with such low seroprevalence, but you simply need to just repeat the test twice (not unlike HIV testing). We also effectively have no specific treatment and thus some immune response is obviously occurring to allow people to have disease resolution. The most likely situation is that immunity last 2-4 years, like other corona viruses. Sure, that isn’t to say that these specific antibodies are the ones that indicate immunity, but a test where antibody generation is corresponding temporally with prior PCR positive testing is likely to be accurate. The real issue is the roll out to the public. This should go to front line workers first, with the knowledge that they may be a false positive or still have some amount of risk. Even that amount of possible risk mitigation (I.e., I am potentially immune) could go a long way for me feeling safe taking care of regular old non-COVID people.
  3. What a tangent we are on... haha. But an interesting conversation! Thanks for partaking. I think we established earlier the hypocrisy of practicing medicine under the guise of preserving some historical life. There is a nasty underbelly to it all. I feel now that you are building a straw man argument around population-based abortion ideals (which are riddled by sampling bias to begin with). Our patients can have whatever view they like. They can tell us not to vaccinate them. The medical provider, an expert in their field, shouldn’t employ such views to their end (I.e., to not vaccinate). Pay attention here in that I am not saying that they can’t hold them. I also made a case in my first post about others placing these orders for providers with objections to a particular sort of care. In an effort to legitimize the OP to employ their views, you are also straw manning well-known medical dilemmas (e.g., CTE risk from youth/high school sports head trauma) with anti-vaccination (I.e., something the medical community has almost no controversy about). In these situations, I think we are all granted the right for our morals to inform our care. That is the nuance. I disagree wholeheartedly that “religious thought” is our only medium to inform our moral compass also. You can study morality just as you can study mortality. You can look at how evolution and genes have influenced our behaviors as a species. We have continually advanced science, and with that you’ve seen us constantly shedding religious dogma from our lives. The goalposts simply move from year to year for religion. The better we understand fetal development, consciousness, and pain/suffering, the more likely we are to send this argument about the sanctity of fetal stem cells to the toilet. Yes, you will always need to define “sanctity”, but our definition of that will certainly shift for any given topic when we have a better understanding of that topic. I do think we are talking some circles now and I am seeing some emotions flair up. I’m going to bow out going forward. Best of luck in figuring out your internal dialogue Aunt Val!
  4. That people may have differing views regarding the sanctity of life. That patients are likely to not share your ethics and you are still willing to impose them on the patient. The equating of science and religion with respect to moral authority. I understand that there is a ton of nuance in how science and morality shape each other, but we are not talking about nuance here. My concern is when any doctrine clashes so diametrically with what are considered core measures of medical care. Vaccinating appropriately will save more lives than all of your years put together assisting in cardiac bypass, treating diabetes, managing hypertension, etc... I worry that there is also a large appeal to authority factor at play in a situation like this. A couple big name celebrities, some physicians and APPs that are anti-vax, and we have a whole population of people that are provided credence for their fringe beliefs.
  5. I am allowed to be intolerant of those who are intolerant themselves. You don’t get to hold extreme views without repercussions. Thinking you are doing the right thing ethically and actually doing the right thing ethically are two different things. Religion doesn’t give you a pass to make bad decisions, especially about other people’s lives. Religion also doesn’t allow you to hold some moral high ground regarding the sanctity of life. People want to be able to hold and act out their own views, but don’t find it fair that other people can hold and act out theirs also. Freedom from religion is just as important as important as freedom of religion. The Hippocratic oath has me placing higher value on those students/providers who will do less harm, especially over a career. In fact, I think the Hippocratic philosophy is driving me here more than anything. What irony!
  6. I worked in a clinic with a physician who would not prescribe contraceptives due to religious objection. All the other clinicians simply worked around it and sent her OCP prescriptions for her. It was a pain in the butt, but patient-centered care still occurred. I do think it only fair for any clinic to be clear to patients that they will be seeing a provider that holds fringe views with respect to standard of medical care. I would absolutely not have visited the physician in our clinic given her views. I share so few values with that type of physician/provider, that I would be worried that an individual’s capacity to make other logical and evidence-based decisions would be compromised by their belief system. It is important to recognize that this is not the same as skepticism of medical literature, it is a moral position based on an unfounded religious doctrine. Were I a medical director/clinic, I would probably even take it a step further and would never assume that any 1 patient would have enough medical literacy to recognize any treatment plan that is far removed from standard of care. While maybe extreme, given the case, I would argue pretty heavily to never hire a provider with such views. Especially not a new graduate. At least not in a clinic that isn’t already fringe in its care. To go 1 step further, I think I would even favor this individual to not be accepted in to a PA program. I don’t think you ever get that granular of detail about applicants, but I do think it important to recognize bias at the door. Kiddos can change and grow, but there are another 100 solid applicants waiting to take that individual’s seat. A PhD in philosophy, theology, research, or possibly public health administration may be a good avenue to take your views to try and change policy or create better products, but it is not moral to take those thoughts to the front line (IMO).
  7. I think my grievance is twofold. Past medical experience really only represents a small advantage when it comes to being a provider. The duties of a nurse, paramedic, or scribe don’t fully encompass the breadth and depth of being a primary care provider or to work in a subspecialty. It is why you see such variance in quality on the other side that seems pretty independent of past medical experiences. Smart people and hard workers will always lead the pack. The threshold for entry in to PA school is also so much higher than for NP school. I will every single time choose the person who was top 5% of their class versus the person who happens to have nursing experience but wouldn’t be accepted to any PA program. Note that I am not equating the nurse in PA school to a top 5% student. That isn’t generally who we are comparing though.
  8. As much as programs and students seem to chalk up PANCE pass rates to how well a particular program may educate you, a whole lot more of passing the PANCE is self directed. You will pass if you can keep up with the studying and grind. The people who coast are the ones I see failing. I agree with the poster above too. Are both programs getting people in to good clinical rotations and in the areas where they would generally like to be? I would worry a lot about a new program in that regard. Rotations are really tight and hard to secure right now. You learn a lot of stuff during a good clinical rotation too that you will never see on the PANCE. You also get job offers and make connections that way. Financially, you may save money being at home, but not if it cost you 30-50k in lost revenue because you have to spend 5 months finding a job and pay to move across the country to start.
  9. I think the problem is that you have no leverage at all when there are 5 NPs waiting to step up next in line for any job. They aren't coming out of school riddled with debt and going from making $25 an hour to $40 an hour is a big gain for evening courses, hanging out with friends for clinical rotations, and an ability to continue working over a 2 year period. I have some leverage with my work history, but a new grad PA can't prove themselves any better than a new grad NP. The reality is that this is happening right now also. The PA program that I attended has had several new graduates really struggling to land jobs months after graduation. These are excellent students, several who have been clear that they are willing to go anywhere for a position. I am not sure how we compete when it is so easy for NPs to just flood the market and drown us out of existence. We need to prove that we are more valuable to a system. I suspect that some sort of residency will soon be the expectation for the primary medicine fields.
  10. I suspect the advantage from Duke would be rotational placement. They have an extremely large alumni network and that may get you good rotations, place you in situations where you are offered a job, and place you in an area you would like to live/practice. That is not negligible, especially considering that 2nd year placement is becoming more and more challenging for all programs. Most of your didactic learning will be done on your own time. Bells and whistles are nice and may help out here or there, but I would encourage you to focus on tuition cost, prior PANCE pass rates, and rotational placement/job placement after graduation.
  11. It is easy for me to think about the past and how I should have left my job years before I did, but it is simply the case that hindsight is 20/20. This is totally a you call. I think that I probably could have done well unemployed, but I suspect that everyone would just need to weigh the current stress they are under versus the stress they would expect to have without an (2nd) income. I think what you are seeing with these responses on the forum is a population that knows how awful that day-to-day grind can be in a subpar or seemingly abusive situation. I do think that there are far less good jobs floating around, but maybe that is my slightly pessimistic view of medicine spilling over. I don't think/doubt it is much better as a physician.
  12. I enjoy it quite a lot (and work at a large, state institution). I worked for several years in a community health setting with low rates of health literacy and high rates of morbidity and, compared to that, student health has been really refreshing. I almost never get bothered about not giving antibiotics. I almost never get whiny students. I have never had a parent call and complain. If you treat them like the adults they are and don't assume a snowflake complex, they are really some of the best patients I've ever treated. While the stressful stuff is sometimes complex, it occurs with enough frequently that there are systems in place to limit the confusion (though they are still exceptionally rare). You will still see medically complex things also (e.g. acute abdomen, neurological disorders, unique infectious disease from international populations, travel medicine, psychiatric illnesses, etc...). I imagine your mileage may vary, but don't go in with a bad attitude.
  13. I was unemployed for nearly 6 months 6 years ago after graduation. There are markets that are saturated and markets that are just dominated by 1 or 2 major hospital systems that put limits on hiring at times. While a residency is a good option, there aren't exactly a lot of of them and they tend to not have a lot of slots for students. I suspect the problem is also that there simply aren't a ton of family medicine, cards, psych, or women's health jobs generally. In the new graduate PA job world, I see a fair number of postings for jobs that aren't in generalist fields (e.g. surgical sub specialties, pain mgmt). I would recommend that you reach out to your school and see if they can connect you with the alumni base that are currently working in your fields of choice. They tend to have insider info about jobs that are available or soon to be available. On that note, if possible, be ready to move!
  14. I used the EMRAP Crunch Time series. They are 1-5 minute audio segments on several diseases organized by systems. They have a complete ER focused set and a lot in their primary care focused set. It isn’t free, but you get a year subscription to a great podcast also.
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