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Sed

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  1. Sed

    Medical Model vs. Nursing Model

    Treating a person with a disease requires some level of compassion (regardless of which camp you came from) in addition to an astute understanding of the actual disease you are diagnosing and treating and how it may affect the person afflicted by it. Some providers have a better bedside manner than others, which can be construed as compassion, but treatment and prevention is a goal of all. The "nursing model" is a mode of training that stems off a nurse's previous training and experience in nursing, executing doctor's orders, and patient care at the patient's bedside. This is where the "whole person" treatment mentality comes from. The traditional "medical model" teaches you to understand the disease process and it's manifestation (i.e., how the disease develops and the effect on the patient), thereby allowing you to diagnose and treat a patient's ailment and address any social issues (work, ADLs, family, emotions, etc) that may arise from that diagnosis and treatment. Understanding the intricacies of the disease process also allows those providers to pick up on nuances and variations of the disease that may not follow typical presentations. Six is one and half of a dozen of another. It's not necessarily a matter of which is better or worse because we all have our role in healthcare and level of experience and training. I think your question is more of a loaded question that the interview board would use to gauge you. So answer wisely. For me personally, I wanted to learn, train, and think like a doctor, so I went PA where I would train alongside medical students and then work closely with a physician. NPs arrive via a different route and now in some states without the need to work alongside a physician which has its own benefits and risks.
  2. You've received good feedback thus far. A few other things to consider: -Peds ortho is a lot of casting, office visits, and a lot of worried parents that sometimes won't accept that fractures will somewhat correct themselves in peds. Some will freak out on you that you would even dare to think about not making it look perfect. Also using your lunch as travel to another office? No set schedule? This is recipe for burnout. It's tiring to drive multiple facilities in one day and to do that everyday can get really old really quickly. Why is he hiring another PA? Is trauma call floor call, peds ortho call, all ortho trauma call, or ER call? Expected to round also? Pay seems low, especially with an up-in-the-air schedule, which will be hard on you and your family. -Ob tends to pay lower to my understanding, so beware that the bonus structure may not be attainable. Never having a PA is a red flag, but having had students will hopefully give him realistic expectations. Why is he hiring a PA? Getting busier, working on retirement, or on his way out? No 401k is crappy; negotiate an extra 3+% for this. Four 10's is awesome!!! Option to moonlight, so can do UC to keep skill set. No call is awesome!
  3. Interesting topic. In our private ortho trauma practice, we have a large portion of Medicare and Medicaid, about 60% of the practice. And compared to the experiences above, the vast majority are compliant and show up. We'll get a few bad apples periodically, but most are actually very respectful. And oftentimes the no-showers are actually the elderly SNF patients with dementia, not the Medicaid patients. Although we work harder for our money since we collect so little, it's very rewarding to have patients who are grateful for our service. But I suppose it does help that we have a nice office space that we rent and not a typical "Medicaid-like" office filled with "Medicaid-like" staff. There's a saying that "trauma is a disease" and the saying is true for the most part. It happens to a particular kind of person who happens to also typically be un- or underinsured. But someone's gotta do it. Maybe it's because patients can't imagine not using their limb and fixing broken bones is viewed as healthcare as a previous poster suggested. But I always try to impress personal responsibility, general health care, healthy eating, alcohol moderation, risk reduction, and smoking cessation on all in hopes they'll take that to heart. In our field, there's no way we could ever get rid of our patients who have government-supported insurance because we'd have almost no patients and with call contracts and EMTALA, we can't refuse service. So it's a necessary "evil" we've learned to work with and take care of.
  4. Sed

    Patient education

    I don't have any for GP stuff, sorry, but for physical therapy and other various ortho handouts I use https://orthoinfo.aaos.org/en/recovery/
  5. Sed

    New grad 1st offer

    Great offer. Check into 401k match as others have stated. Non-compete? Tail coverage? Other things to think about: Working with one or multiple surgeons? Are they open to training and/or have worked with new grads before? Is ortho an actual interest? If not and "just a first job," beware that it can pigeonhole your skills...
  6. Sed

    Surgery anxiety

    I second the above. Your anxiety could be stemming from something completely unrelated to surgery but somehow being projected onto or manifesting during surgery. On another note, idk what "a good while" translates to, but are you working a lot? Maybe it's burnout quietly starting to creep in. Take some PTO, burn off some steam, work out, etc.
  7. Sed

    Scheduling

    Three 12's would be my choice (36 hours per week, 4 days off). Four 10's would at least give you some time after work (40 hours per week, 3 days off).
  8. Good thread; very informative.
  9. Sed

    Too Early to Apply?

    Agree with the above. Also think about your overall PA student training. Yes, a month in the field would be nice to get a feel for the field and company you may want to work for. However, clinicals are also your chance to experience other fields without the recourse of employment. Do a rotation in something you want to do before graduating. If it's trauma, then go for it! Just remember that there's always that chance they will hire someone else.
  10. Sed

    Malpractice??

    Ask your employer for a compromise: 1. They pay for occurrence and take the difference in cost between claims made and occurrence out of your paycheck/salary. A little over the top, I'll admit, but at least you have that piece of mind. 2. Decline their coverage, have the cost added to your salary and then buy your own. Have you consulted a malpractice or contract lawyer? Honestly, this would be your best bet. They could give you counsel on which avenue to take and coverage requirements in the event you leave, and then they could also review your contract at the same time. I almost had a similar situation to the one you're in, but thankfully they switched over to occurrence before I joined. Otherwise, I was just going to bite the bullet and hope I wouldn't end up leaving and having to pay for the tail later. Interestingly enough, I'm still here four years later.
  11. I've never heard of this setup actually in practice for surgery nor ortho, but I've actually thought about this. As someone who is pretty much always "on," having the opportunity to be completely "off" is like a golden ticket. Anyways, even if you end up working 12-hour days for each "on" week, this breaks down to 42-hour weeks, so pay actually seems good compared to a normal 40-hour workweek. This seems like a good offer overall, especially if no weekend surgery. Two weeks off per month plus 24 days PTO plus 5 CME days? Where can I sign up? Lol. Any word on 401k, health, boards/fees? Also, will you be required to take all calls (floor, office, etc) during that time? Getting multiple phone calls each night for a week straight might weigh on you... Clinic also? If you're expected to cover the above in addition to inpatient management and surgery, I would definitely ask for more. Location?
  12. There's been good advice offered thus far, and it sounds like you still have some time before signing any contract. If you have loans, they will likely enter repayment soon, so keep that in mind. My two cents are to look for and take the job that will be the best first job for you, wherever or whatever that may be. Once you get your bearings and first job jitters out of the way, you can reevaluate. Restricting yourself to a certain geographic area does limit your options, especially as a new grad, but with some sheer willpower and networking, you can hopefully end up where you want. Additionally, people often quote this rule of thumb regarding employment: You can choose two of three: location, pay, or specialty. Good luck with PANCE and your job search!
  13. Robert Frost is the man.
  14. Untreated? Aspiration is diagnostic and therapeutic. At least temporarily. Now if the OP didn't aspirate or start antibiotics, then yes, untreated. Everyone is fixated on starting antibiotics. Yes, that is a second part to treating a septic arthritis. However, to TREAT septic arthritis, you must also perform serial aspirations or debridement. One aspiration plus antibiotics will temporize but won't likely completely treat. Aspirating, starting antibiotics and then waiting 4 days for cultures to come back (which may NEVER come back positive, BTW) also won't treat and will allow time for joint destruction and possibly sepsis. I hope ortho was called for a possible surgical emergency prior to ID or hospitalist. I didn't see this mentioned... Obviously this is an internet case that only the OP examined. None of us set our eyes in this patient. I'd also be interested to know more info, particularly what the RBCs were, especially given blood-tinged aspirate, since WBC can spill into the joint via hemearthrosis and create an artificially elevated WBC. There's a calculation you can use for the corrected WBC. Also, any documented fever in addition to feverish? Anyways, just thoughts from a busy ortho trauma PA whose job includes deciding what to do with the infections, osteomyelitis, and pseudoinfections that others admit or punt Keep these cases coming. I enjoy the discussion and literature searches.
  15. Sed

    Coping with Anxiety

    Psychotherapy, why you're there, vent session, guidance, coping skills, homework assignments... you name it. Some may guide the session while others let you guide it and then give feedback. Consider making an appointment with your PCP to get started on meds to help get a hold of things, and then consider weaning off once things settle down as others suggested. Think of the etiology for your anxiety (missed dx, patient worries, etc) and the aftermath (racing thoughts, sleeplessness, anxiety, worry, etc). Write it down. Bring your notes with you to help you during the session.
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