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Everything posted by greenmood

  1. Well, if you need children to teach you maybe we don't need to start on a big mountain. We also have plenty of trails for shoeing. Or ice fishing, if freezing your nuts off in a tiny hut on a frozen wasteland is more your thing.
  2. Great Hospitalist opportunity. Come to delightful Minnesota! Work with autonomy and respect! We welcome new grads! I will help you shop for a winter coat and my kids can teach you to snow board.
  3. I would even offer that perhaps there is a majority of PAs who do NOT take call, so I'm curious if the OP is just being exposed heavily to folks in subspecialties in specific hospital systems or regions where this is the expectation. I have "call" but it's just a backup day where I might be asked to work a shift when someone calls in sick. It's not carrying a pager at home.
  4. This. You need to earn their trust and respect without being subservient or a pushover. The way to do that is be being a genuinely solid person and treating their concerns as valid. The new nurses who panic page every half an hour will eventually be seasoned nurses, and they will remember how you treated them when they were scared and new.
  5. Just to add to the echo chamber, no, you are not functioning as a hospitalist. I work in a very large academic hospital and I work autonomously. There are a lot of resources here but I don't have to use them unless I feel I need them. I see my own patients, write my own orders, and decide my own treatment plans. There is a physician on my team - we split the patient volume equally - but he/she is not there to supersede my decision-making. Find a better place. They do exist.
  6. I get frustrated. Then I get bored and sweaty and more annoyed because I'm so sweaty. But I'm taking care of people who have it, it's not some theoretical discussion anymore. I have found a silver lining. When they get sick enough a lot of them do cave and start asking about the vaccine. Not all of them, but a lot of them. And if they make it, they're usually a lot less feisty about the whole thing. And I've found they're so traumatized that many are willing to become vaccine-evangelists. The only way to get through to some people now is to get a mole in there, a trusted source with a change of heart. I saw a photo on the Social Media a while back of a patient's ICU room door, where the nurses were tallying how many people had gotten the vaccine because of his illness.
  7. Talk with your program. You aren’t the only one having problems, and they can’t help if they don’t know. Demonstrate good judgment and get help. If something terrible happens and you try to explain this after the fact, you will get a heck of a lot less sympathy. We had a problematic peds rotation when I was a student. I personally didn’t have a problem letting the preceptors bullshit roll off my back, but you can bet I still told someone about it and backed up the reports of the other students there.
  8. It's hospital employee, W2. Level 4 trauma center. Volume is 60-80 patients per day. There is no fast track/main ED, it's too small. The ED is staffed by a single physician 24/7 and has day/evening coverage by 2 PAs as well. No nights. Per my discussion with them, I would be expected to see "everything" and manage it on my own, but in practice they were frank that many of the more serious issues that come in are turfed to the physician assuming he/she is not already busy with something else. But they were also careful to mention that the physician is sometimes truly busy with that something else, since there is only a single hospitalist covering the medical inpatients (and another for OB) and the ED physician is expected to pinch hit in the case of multiple deliveries, for example. They told me their flat rate for PRN staff is a $56 and some change per hour. I was very surprised. That is significantly less than I make in my full time position, which also offers benefits and PTO, etc.
  9. Like it says on the tin. I am keeping my full time job and don’t need/want bennies from this position. I don’t have ED experience but I’m 8 years out with mixed hospitalist/surgery experience. The gig is at the county hospital. The AAPA salary report has too small of a sample size to be much help; for what it’s worth, $60-70/hour is what’s on the report. Trying to gauge where my expectations should lay.
  10. Most of us who work in hospital medicine have weighed in over the years in this forum, if you skim and search a little. Find the right place, ask the right questions during your interview to test the culture. I have a great relationship with the physicians in my group and work at the top of my license.
  11. Bolding is mine. This is where your frustration is coming from, and I think it will help if you reframe your thinking after taking in the comments from previous posters. It's not required, but may make you stand out. Just like a 4.0 GPA is not required but may make you stand out. Many programs list a 3.0 GPA minimum but their matriculated class average is much, much higher. Should we be angry at them and call them out for selecting more competitive applicants? Or should we see that for what it is - an opportunity for an applicant with a lower GPA to get through the initial selection process and then shine in other ways? Like with shadowing and HCE.
  12. I just want to add, OP be careful with the x, y, z part here or you may lose your listener. I don't want to hear about my 41 year old female's broken bone from 5th grade unless the leg was amputated and she's here with an infection in the residual limb. Consider. You: Mrs. Smith is a 41 year old female here with right pyelonephritis. She has medical comorbidities significant for poorly controlled type 2 diabetes and morbid obesity. Medical history is notable for recently treated chlamydia and childhood history of VUR. She noticed dysuria and gross hematuria about 3 days ago, and developed fever and flank pain last night. Me: What else is going on with her? You: Well, her hypertension is well controlled on lisinopril, and she's been on a stable dose of zoloft for the last 10 years for depression. Me: Great, keep going. You: [ED findings, pertinent labs, PE, plan of attack] Me: Wow you're the best student ever. You even identified that she's high risk for atypical organisms due to her recent chlamydia and antibiotic therapy, and because you have great bedside manner she felt comfortable enough to share personal details with you and we can check her for other STIs. Good job you.
  13. Depends on what grade you earned. But let’s address your assumption that community college is automatically easier than wherever you are now (it’s not). Why would that impress an admissions committee? You need to demonstrate the ability to handle the course load of a rigorous PA program. So figure out what the problem is and then attack it. Show some growth!
  14. It sounds like there was an attempt made to bring this up during the rotation at your midway review, but it perhaps was not direct enough since you left that discussion not thinking their concerns were especially serious. Presentations are hard, and there is an art to them. It's very challenging to master, and made more so when you don't have control over your anxiety. @Carolina is right, practice often helps. I find many students try to cram too much information into the presentation, which makes everything worse. They don't remember the important parts and I have difficulty helping navigate the clutter. You didn't mention what specialty this was, but if it was primary care (or internal medicine) consider a more minimalist approach. That will allow you to sound firm and concise, and you can then add information or answer questions. Regarding the knowledge content, that's a tough one. You're so early in your clinical year and again I don't know the specialty. I remember my pediatrics preceptor was outraged I couldn't do metric dose conversions by memory, which I thought was especially unfair since everything was weight based and I didn't want to OD some tiny infant on ibuprofen. But in his mind that was a basic ability I needed in order to be efficient and effective in his office. There may be things that they felt really strongly you needed to understand - think back. Did you make an extra effort to look for the information yourself before you asked the question? Did you demonstrate that you had read and considered the topic? If so, maybe their expectations were a little off. If not, it's something to work on. Preceptors want to see independent learning and effort. In any case, you're getting a second crack at it. After you've had a minute to lick your wounds, please make sure to go back to these people or your clinical coordinator and get a really firm, concrete understanding of where they felt you went wrong. You need to know if there were specific content areas where they found deficiencies so that you can study and correct them. And start practicing your presentations, on video, with a partner. And watch the video. It will be excruciating, but you will learn so much.
  15. Depends. Many/most PAs work for health systems and don't set their own prices for care, visits, labs, testing, etc. The only part they can control is what they actually bill for. But a clinic can set its own prices. So a primary care office in rural Minnesota might bill a patient $100 for CPT code 99392 (well child visit, age 1-4). The same visit in another state or office might be billed out at $250. There is no rhyme or reason, it's whatever the clinic can get away with. It's the same reason spaying your cat costs $300 in Chicago and $25 + a firm handshake in rural Iowa. Some providers who regularly see uninsured patients will underbill if they know the patient is financially vulnerable. Or offices will offer a sliding fee scale depending on income or other factors. Generally speaking when we hear in the news that PAs provide less expensive care, they are discussing the cost benefit to the health system, not the individual consumer/patient. Although there is plenty of research that shows PAs reduce costs overall that way as well (preventing hospitalizations, etc).
  16. GPA doesn't help land a job. That's down to the interview, your resume, your letters, etc. Many students are hired before they even graduate, so as long as you pass even the PANCE scores don't matter. I'm not sure about residency. I assume if they are weighing two otherwise identical new graduates GPA might come into play.
  17. You have a single withdrawal on your transcript after two years of college. So try to stop there. Reconsider your class schedule for the coming semesters. You know yourself as a student now. Don't sign up for a course load you are unlikely to manage well. You cannot withdraw from a class that has already been completed - whatever grade you got is there now, and you will have to own up to it. Retaking the classes later and doing well can show growth, but the lower grade is still factored into your overall GPA for the purposes of CASPA.
  18. My experience is a very soft lateral mobility. I started as a hospitalist within a subspecialty surgical population (mainly liver, pancreas, upper GI malignancies with coverage of the breast and endocrine surgical services). So I only took care of postoperative patients who had undergone these often massive, dangerous, operations for aggressive high mortality cancers. I got very good at managing a lot of niche things like pancreatic leaks, fistulae, acute liver failure, short gut syndrome, and breast/neck hematomas. But I also got very good at managing sepsis, GI bleeding, pulmonary embolism, ileus, etc. I got very comfortable eyeballing someone and deciding how critically ill they were and how urgently I needed to move. Those skills translate really well into other areas of medicine, it turns out. After five years I moved into practice as a traditional hospitalist working with medical inpatients. The thing was... to get to the OR, my surgical patients had to have all of their chronic medical conditions controlled with microscopic precision, or they would just not make it through surgery. So in those five years I had seen patients with COPD and CHF, but very few with exacerbations. I had seen DM but no DKA. I had seen the alcoholics with HCC, but very few cases of withdrawal syndrome in the hospital. I had never taken care of a patient with advanced dementia. But if you know how to assess the acuity of a patient, it's just a matter of exposure and experience to get your comfort level up. So I've been a medical hospitalist for three years now.
  19. Basically, we have a "doc of the day" who is responsible for triaging admissions requests from the ED, outside direct transfers, and ICU transfers to the medical services (we have 14 medical lists, each carrying a census of 14-16 patients typically). It's based on a mixture of census and geography. Several of the services are for special populations, so sometimes it's based on those criteria as well. We have a rotating team of admitters (PAs, NPs, and MDs) who do all of the admission work, leaving the rounding teams free to focus on the established patients. When the admission is complete, the patient is signed out to the primary hospital service. We don't really have a "step down" unit, but one of our services does take a capped number of those patients depending on acuity and bed needs in the medical ICU. Each service is run by a physician and an NP/PA who split the census evenly between them.
  20. My shelf. I found the little green/yellow Lange Hospital Admissions very helpful when I started, as well as the Pocket Medicine guides.
  21. For real. And way to haul in here and resurrect an 8 year old thread on your first post. Look back at school-me, giving advice like a boss. But seriously it stands today. PT aide is great experience, especially if you work in a hospital setting where you get to see lots of patient variety and acuity. If all you're doing is outpatient sports medicine with healthy 20 year olds it's a different kind of experience.
  22. See my bolded responses above. HCE isn't less important than PCE. It's a different kind of care. I like UGoLong's suggestion of dividing some of this up into almost separate job descriptions. You did a lot of stuff. The thing is... I know you don't like the idea that this doesn't count towards some CASPA definition, but it's still impressive experience. I don't think you're going to do yourself any favors by trying to pass it off as something it isn't. Admissions committee members can read a job description. They know what PCE is. So regardless of how you categorize it for CASPA, someone with a brain and experience is still going to look at this and understand what you did as a medical assistant.
  23. Move closer, seriously. My commute was an 45-60 minutes, but it was on a lovely, quiet, commuter train where I could study and sleep and be a person. If I was driving I would have never survived that. All that time lost. Yuck.
  24. I got married during the break between fall and winter quarters of didactic year. It was fine. I was back in my seat 48 hours after saying my vows. We took our honeymoon after I graduated and passed the PANCE, and I started my job when I came home. What helped was planning as much as possible before I started school. Got my vendors lined up and everything. Then I delegated the SHIT out of the daily grind. My now-husband took care of business - it's his wedding, too - and my sister helped.
  25. It depended on the rotation, for me (this was 2012-2013). On my OB/WH rotation there were easily a dozen of us in that little clinic, taking turns seeing patients and doing Paps and generally being treated like shit. But only myself and the one other PA student (the rest were MS) had appropriate paperwork at the hospitals, so we were the only ones delivering and scrubbing. There was one other MS and a handful of actual PGY1 residents I was thrown in with on one of my hospital IM rotations. I got to teach them how to draw a blood gas (which I had never done before either). One other student on my infectious disease elective, one other student in surgery (but I was always the only OR assistant). I was alone for peds and family med, alone for my hospitalist elective. So a mixed bag.
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