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Sed last won the day on December 5 2019

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  1. When I was leaving my last practice, I contacted a student of mine who I thought would be a great fit. He had just graduated the week prior, and he hadn't found anything overly appealing yet. It took about 5-6 weeks for PANCE and licensing and another month before he finally started. It took another month or so for credentialing. I think that equates to about 2 months after graduation. I still haven't received a thank you card or beer for being matchmaker, damn it. Another student had a couple offers within 3.5 months of graduation and accepted one at 3.5 months out. Another had a job within 3 months of graduation.
  2. Does Nebraska state law outline specifics to work as a PA such as written agreement, job duties, performance evaluation, scope of practice, delegation of tasks, etc? If so, you could present this to your new employer, stating the state law requires these things to be in place in order for you to practice.
  3. As a job seeker: word of mouth and Google search. Most interesting postings I've found were on DocCafe and Indeed (via Google).
  4. Yep, I too have had a hospital system ask me if I've been named or if there is an active pending lawsuit.
  5. I am in a similar boat with my new job in CTS. And unfortunately, I am tied to the surgeons and their work so I don't have much in the way of protection except for what I do and chart. I hold myself to a high standard and being in these "sticky" situations doesn't align with my values, especially when the surgeons dismiss what I have to say. So, I'm actually looking for a new job. The pay and benefits are great, COL is low, and I'll owe money by leaving early, but my license and the headache aren't worth it. Working in a low litigious field is one way to combat that as is trying to protect yourself as best you can by doing your best, covering your bases medically, be likeable to patients and family, charting to the best of your ability, etc. A good friend of mine used to work at a law firm doing medical chart review who now also works with insurance companies doing chart review, and the single-handedly best thing she said you can do to protect yourself is chart to the best of your ability and NOT just chart by exception, meaning chart pertinent positives and negatives. Interestingly enough, early in my career, she mentioned that she reviewed a chart of mine and said I did great. Haha. She wasn't able to tell me who or what it was regarding, of course. I always think of her whenever I'm charting and spend an extra minute or two checking to make sure I put everything I think I should have. I ask myself, "If I got sued, what all should I have here in my note?" Unfortunately, anybody can sue for anything, so no matter how hard you try or how great of a job you do, it's always a possibility. This goes for other fields too. One of my parents is a cop and got sued by a criminal. It didn't go anywhere, but it drug on and the guy also tried to list my other parent and some other folks. How the hell were non-cops part of this case and able to be named?! One patient tried to sue one of my surgeons for lack of oversight on the pain medicine prescription they were discharged home on. Nevermind the fact that he had a terrible arm injury, had full recovery, and no history of drug use or narcotic abuse, but he tried to sue anyway. Oh, did I mention he represented himself and sent in his handwritten notice to not only the surgeon but the hospital, hospital CEO, county sheriff, and others from prison? All you can do is your best and nothing more. Work somewhere that supports you and continue to work on improving your skills and knowledge. If that's still not enough, try different fields or fields with lower patient contact/litigation.
  6. I'm sorry you're in a crappy work environment. It seems like some high-paying positions have to pay to get people because of that reason. And similarly with low-paying positions: it's a crappy work environment so turnover is huge and therefore they won't pay people. I'm not sure this will help since you're looking more to vent, but I figured I'd share: I've learned to "never say the number first" and "everything is negotiable." Sticking to that, I think it's worked out for me so far throughout my yearly negotiations and jobs. Sometimes they pin you down and you need to finally say something, the jobs have set raises, and the larger institutions are sometimes harder to negotiate with. But in my opinion, it never hurts to have a reasonable discussion about it. As for the screening process, I try to never say anything about salary if at all possible because you can shoot yourself in the foot before even getting in the door in two ways: filter yourself out by being too high or automatically pin yourself to a lower range by aiming too low. My answer would be something like, "Once I hear more about the specifics of the position, I would have a better gauge on the salary." And if they offer a salary range during the screening call that's not really up to snuff, I wouldn't necessarily say no right then either. I would hear them out and interview. And if I was happy, I'd see if they be willing to negotiate. They might be if they decide they like me enough to come up on their offer. But that can't happen unless you get into the door first. And I agree with Ventana about the rule of three's of which you get to pick two during your job search: location, specialty, and pay. Rural positions may pay more and afford you the increase you're looking for but if you're limited to a location and specialty, it may be difficult to find the pay you're looking for. That's not to say the trifecta unicorn isn't out there, because it just might be, but it may be extremely difficult to find. I'd encourage you to open up your search parameters and keep looking for something that will get you out of that situation. You could also consider moving to a lower COL area which would help offset some of the pay difference. With all that said, there may be a glass ceiling for PAs for both practice ability and pay. But you could continue to increase your earnings if you choose to switch to a higher paying specialty or do PRN work on the side. Good luck!
  7. https://www.ncsl.org/research/financial-services-and-commerce/medical-liability-malpractice-statutes-of-limitation.aspx According to this, it is state-dependent and the timeline of some states vary depending on discovery versus act.
  8. Like some of the old-timers on here, I started applying for jobs several months before graduation. I got mostly "no" because they wanted someone who had actually graduated, but hey, I tried, got the hang of it, and learned. I treated every rotation like an interview and gave my CV to each preceptor that I could see myself working or networking with. I got a job offer on a rotation two months before graduation (they were hiring another surgeon who needed a PA). Mostly luck of the draw, but had I never inquired, maybe it wouldn't have ever happened. My ER rotation was also starting up a residency-type employment situation and offered me a seat, but I turned it down since they were still developing it and I had nothing in hand guaranteeing employment. That preceptor eventually called me 6 months later asking if I was still interested in a job. A year out, my IM preceptor was expanding his practice and contacted me, asking if I wanted a job. Have you tried contacting your connections and networked? State conferences? Have you tried calling your school? My alma mater has some job search resources for alumni. They also boasted a particular "employment" percentage within a certain amount of time, which is another reason why I chose that school. But I digress. I and a dozen of my other classmates (out of 90) were fortunate enough to get job offers while we were students; this wasn't the majority. Others took the first job offer they got after graduation. A few took a little bit longer. Now, as a preceptor myself, I try to talk with my students about the job search, what to look for in a first job, etc. In fact, when I put in my resignation for my last job (and first job referenced above; stayed for five years), I contacted one of my students and recommended him for the position, which he eventually accepted. Most of my students, like you, wait to start their job search until graduation and had interviews and offers within a few months. The ones that took a few months were usually more particular about what kind of job and where. You have great experience, and so it's disappointing that you haven't gotten very many bites. As mentioned, graduation is a tough time to start looking for jobs. A PA job can take 3-6+ months from the time of initial contact to the interview, negotiation, and eventually accepting an offer. Someone else on this forum recently posted that it took them 8 months to accept an offer, but they were being particular about the job they were looking for. I honestly wouldn't worry too much that it's taking you this long, especially since you're limiting yourself to those states and rural locations. Hell, I recently switched from ortho trauma to CT surgery, and it took me 3 months from time that I started looking to the time I accepted an offer and I'm almost 6 years out with great references from department heads. After all that, however, I am led to believe something is amiss if you're applying to "hundreds of jobs" but have only received two interviews. I would encourage you to do some networking, and good luck!
  9. At my previous institution, I always did the H&P and short form update H&Ps. The surgeon countersigned the hard copy update H&P (which I filled out in pre-op) when signing the consent form, or if I dictated it electronically, they countersigned it when they got around to it. It was something like late 2018 when one of the departments started telling the surgeon that they had a chart deficiency and that they needed to complete the H&P, even when I had already done it. So I started having the surgeons cosign everything and the problem went away. I'm not sure if that helps. The hospital bylaws mentioned that a physician needed to see the pt day of admission (even for outpatient procedures), so maybe it had something to do with that.
  10. You mention your colleagues who are new grads are having difficulty. Are you a new grad, too? When did you start applying for jobs and when did you graduate? Are you following up every 48 hours to 1 week on emails and phone correspondences? What kind of prior, real-world work experience do you and your colleagues have? Undesirable, rural locations are not always the best place for a new grad who likely needs help getting up to speed than one who has been out for a year or two. Perhaps that may be a reason for lack of interest from potential employers. What kind of jobs are you applying to and what kind of experience do you have from rotations and pre-PA? These questions are meant to help elucidate areas of improvement when it comes to the job search, especially for a higher order one like PA which requires investment by the business in onboarding and training you, which is very expensive the first year, especially for licensing, credentialing, reduced productivity due to taking the time to train, etc. Some businesses aren't interested in hiring someone they don't want to invest money in or someone who is unproven (aka new grad with no relevant experience). And remember, being flexible in your location or area of medicine will increase your employability. You can consider taking a position in a different field, but one that will help poise you for your next job, while you are awaiting your desired field.
  11. A colleague has a full sleeve and full upper back/shoulder tattoo and she wears a white coat to cover it in her current job due to hospital policy. She was not required to cover it in her previous role in ortho. No issues with overall employability to my understanding. I also had a previous student with a full sleeve who kept it covered except for cases, obviously. I didn't require it but the school policy did. She didn't have issues with employability post-grad to my understanding.
  12. Something like that, yeah. It's intuitive and easy to use once you get the hang of it, especially with ICD10. It'll give you different procedures to choose from with certain diagnoses. For example, if I clicked a fracture dx, it would give me various treatment options like nonop fracture care, surgery, etc. I used Athena prior to that and it required a little bit more work on my end, especially for coding and billing aspects.
  13. Mod Med EMA offers lots of boxes to click and helps codes the visit for you based on what you click, so little actual typing and time spent coding is required. It's a great system and intuitive but can be convoluted.
  14. Ha, I trained with one of the physicians who was consulted for the show.
  15. Consider doing something surgical on the side to fall back on. It seems like surgical specialties are always looking for PAs. Surgical fields also allow you to fraternize with those of other areas such as internal med, critical care, trauma/vascular, etc, which can expand your network. Oh, and did I say... Network, network, network! And keep in touch with your network! Word of mouth is powerful when it comes to getting a job. Consider socializing with medical professionals at your facility or hospital or nearby areas and/or doing things like softball, mountain biking, hiking, golfing, trivia night, etc. I have met and befriended physicians over some of these activities. If your hospital doesn't have much of a social life, get involved and start drumming up interest. I have found that it's easy to meet others in the physician lounge, so if you have access, start making friends! And hey, if the PA field does fizzle out, at least you've made some friends, had some good times, and hopefully met enough people who can get you a job as a rep or something similarly high-paying. Ha
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