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About mackjacks

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  1. I went to a lecture put on by malpractice defense attorneys (had to for a discount) and one of the things they said was that you can do everything exactly right and might still get sued, and it will be a terrible and stressful experience, but that is what you carry insurance for, and you probably won't lose your license and life will go on, and worrying about the possibility now won't do any good. Somehow, thinking about the possibility in that manner helped me with my job related stress. Why are you so stressed and why do you think it is increasing over time instead of decreasing as you become more experienced and ideally more confident? Do you have supportive coworkers you can run a case by if you are unsure? Is anyone pressuring you to treat things you are uncomfortable with, either long term or by not sending cases to the ER? Stress/anxiety tips: try to avoid it (consult, send to ER, if you work for some superhero doc who wants to treat everything in-house find a new job), exercise (highly recommend yoga or anything you find calming), no caffeine after noon, keep a regular sleep schedule, talk to your PCP and try Vistaril before bed if you feel like you're going to have poor sleep from worrying about a case, see a counselor to learn CBT for anxiety, take an online course about tactics you can use to lower your chances of being sued
  2. I have seen some (edit: 2) fungal TMs with a silvery appearance. If the TM is intact, it shouldn't hurt to try an antifungal ear drop. Let us know if you figure it out!
  3. I really like FP too - only 3 years in but (knock on wood) nowhere near burned out. I like the long-term thinking and keeping up on when their last mammogram/colonoscopy/etc was, and teaching people that if they can get their A1c even 1% better their chance of ending up with -insert scary complication- drops. I like seeing moms, dads, aunts, kids, and knowing who is related to who in a neighborhood clinic. There are some really horrible entitled people, but luckily our corporate is ok about us telling patients to be respectful and laying down the law - if the patient doesn't like it they can go somewhere else. For me, helping get a 20 year old DM1's a1c from 13 to 8% is worth it. If you go into family medicine, remember that some people truly don't know how to best treat a viral URI/may just want to hear from someone in a white coat that they are going to be ok and abx aren't the right choice. Teach them to target their specific symptoms with flonase/sudafed/mucinex/tessalon/robitussin/tylenol/USE A HUMIDIFIER/whatever. I tell them if they start getting any worse or get a fever call me and I'll call in abx - 90% don't call. If you do any chronic pain, know your comfort level and make the patients aware ahead of time that if their pain requires more than a certain strength/number of opiates you will have to refer them out. I do a TON of I&Ds of abcesses - this is great fun if you like popping pimples/can smell horrible :) I HATE being sick with URIs myself all the time. I hate manipulative, lying patients and that I often can't prescribe the best medication for a condition due to insurance. Oh, and HATE coumadin management. Medicaid in my state is terrible and it's borderline impossible to get a medicaid patient on a novel anticoagulant.
  4. Regarding patient #3...I had a patient ask me for a few Catapres to "help a friend pass their job physical". NO.
  5. Family practice clinic, M-F 9-5, no weekends, no call. I like clinic and I'm in it for the lifestyle as everyone in my life also works "banker hours" New grad year 1: 87.5k + 5k a few per diem urgent care shifts Year 2: raise to 95 + 10k from urgent care Year 3: raise to 100 + 12k from urgent care
  6. I do walk-in family medicine, almost all Medicaid. It varies from 8 on a slow day to 38 (my personal highest #) on a busy day -- several of these were probably peds. 75% of the time it is myself and another provider, so the 38 could have been a comfortable 42 (21 each) if we had two providers on schedule. I had to tell those last 4 to come back another day, as myself and the staff were already staying late. One day this week, 21 was a nightmare with complex patients with multiple complaints and comorbidities - no way I could have seen 38 solo on a day like that.
  7. If you can, it might be good to review some of your SPs charts to see how they do things before you start. Every clinic has its own weird quirks. For example, my doc loves the old TCA Sinequan for sleep/anxiety and I'd never heard of it in school or on the PANCE.
  8. If your car isn't reliable or you live in a northern state with potential for crazy driving weather or your family can drive you nuts, I would consider living at school for the first year. There is something to be said for being able to walk to class, have the library easily accessible, and having your own quiet space. Lots of people rack up way more than 36,000 debt so if you don't have dependents/a mortgage you can pay it off pretty quickly after school. Keep in mind this is coming from someone who started with 185K debt....
  9. It is realistic, but not easy. I am on track to pay off 190K in 5 years, but this is at the cost of only contributing 5% of salary to retirement accounts. I pay 3,800 monthly towards loans (recently increased, the first 1.5 years wasn't paying quite so much).
  10. I had a similar case once and tried to order a D dimer. The office didn't have the right color tube top in stock, or it had to be a stat lab pickup on ice or some other reason that the lab/our office wasn't able to accommodate. Not sure if every lab works that way. Just another consideration that makes me more likely to send such pts to the ER for eval.
  11. A friend had a similar situation after working at an urgent care for 6 weeks. They were able to purchase themselves a "moonlighting" occurrence based policy that covered 500 hours in a calendar year for a reasonable price. I think through CM&F.
  12. I'm one of those, but am a super-planner. I remember laying in bed at 15 planning on 18-22 in college, being a PA at 25 or finishing family med residency at 29 and weighing the pros/cons. Currently 27, looking forward to the day around age 30 when I am debt-free and instead of putting 3500 per month toward loans I can invest it, sometime between 50-55 I should have saved enough that I could retire. At that time, I hope to be in good health and be able to work 3 days per week or do per diem/locums and travel the country/world, garden, hike, and enjoy life outside of work. Theoretically. In actuality, I'll probably get married and have a couple kids and only work 2-3 days per week when they are young, but as long as I don't marry someone with less earning potential than myself and we structure a budget based on one salary of 100K (even if they make much more) some form of this plan should work out. Barring no traumatic health issues/etc/what the heck will college tuition for those potential future offspring be like?! Aiyiyi :)
  13. 12 mile noncompete seems excessive unless maybe it's very rural area with few practices in the 12 mile radius. Regardless, it should only be for the specialty you are in. If you want to go to surgery next door in 2 years they shouldn't be able to stop you. My noncompete is 5 miles (in an urban area with dozens of practices within 5 mile radius) for only family medicine/internal/peds.
  14. Interesting, thanks! Chennai is where we'd probably end up if a move happens. My SO is in software/IT.
  15. Maybe you can get someone pre-PA to work as a MA for a couple years while they go to school part time or gain clinical experience before applying to PA school? A few friends from my PA program did that, and I interviewed with a cardiology group who has a few "lifetime MAs", older with a lot of experience, and a few younger ones who are pre-med or pre-something. They ask the younger ones to help them recruit a new MA from their pre-professional school cohort to pass the job along when they're ready to leave. If you're rural this might not be doable.
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