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ERCat

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ERCat last won the day on June 13 2018

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About ERCat

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    Physician Assistant

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  1. I would absolutely not test the patient for COVID-19. This wouldn’t even be considered in my hospital. Clinically I don’t think it makes sense (but would like to hear rationale for why it does make sense?) VERY very sad scenario.
  2. I work in the ER. Been a PA for 4.5 years. There’s no “requirement.” We have slower PAs and faster ones. The docs love us all equally - we all do a good job. But nursing staff and hospital admin? They like the fast ones. The speed of the providers does get brought up in meetings. We do hear complaints sometimes. But really, no one has been threatened to be fired for not being fast enough unless they were realllllly slow (I.e. one patient per hour slow). We’ve actually had more issues with providers (not PAs... NPs specifically... just being honest) who were way too fast and careless and ended up with bad outcomes. I work at one hospital where the patients are mostly old and medically complex. Sometimes takes fifteen minutes just to get a damn history! Usually these patients are admits or involve complex discharge processes (calling multiple specialists, involving the PCP, calling family, etc). At that hospital I am honestly busy at 1.5 patients an hour. At our other hospital we have more lower acuity patients. In the main ED, where I see a mix, I usually see 1.5-1.75 an hour. In the fast track I can easily see a little over two an hour and be good. Downside of being slow is we won’t hit our productivity target. We have a minimum target of RVUs we need to hit and beyond that we take in an extra 25 bucks an RVU. RVUs and patients per hour don’t necessarily correlate but on average, to hit the target and start making RVUs, it is around 1.5 patients an hour.
  3. Sorry if this has been posted before. I am involved in quality improvement at two hospitals and already review charts as a lead PA. Thought it would be cool to take a side gig reviewing charts. Anyone know any companies that would hire a PA? My Google search doesn’t come up with much.
  4. The abdomen was checked an hour and a half prior. During that hour and a half, I saw maybe five other new patients and talked to a few other specialists, followed up on labs, discharged old patients, etc. I did my initial examination and was in the room with the patient updating them on results and was about to reexamine them when the surgeon called...
  5. Of course I did my belly exam...this is the ER. I wouldn't have ordered a CT without doing a belly exam in the first place. This was an hour and a half later when everything came back. I was in the room talking to the patient about their results when the surgeon called me. He asked for a repeat belly exam, which I hadn't done because I had done my exam an hour and a half before and moved on to other things.
  6. The other day I was in a patient's room letting him know he had a small bowel obstruction and that I had put a page out to a surgeon for him. The surgeon called me while I was in the room, so I answered and politely mouthed to the patient "This is the surgeon!" I sort of stepped aside in the corner of the room to have my brief conversation with him but stayed near the patient in case I needed to ask the patient questions on behalf of the surgeon. The surgeon asked me a few questions that I already knew the answers to, and then asked me another question I needed to run by the patient. I told him, "Let me ask!" then quickly put the phone to my waist, asked the patient the question, and relayed the message the surgeon. He asked if the patient was still tender and I pushed on his belly and then told the surgeon over the phone, "Yes." Later on, he reprimanded me and said that it was "bad form" that I talked to him in front of the patient. Most of the time I don't, but as he had so many questions I thought it was okay if I was standing by the patient. He seemed really pissed about it. To me it's a matter of efficiency...instead of hiding in my office and running back and forth between my office and the patient's room to ask them questions. Plus I don't want to be rude by keeping the surgeon on hold!!! I feel like I cannot win. I suppose in some cases I should be better prepared by anticipating questions the surgeon will ask, but sometimes I don't have a free second to get all my ducks in a row before the surgeon calls. Any thoughts on if this is truly rude or not?
  7. I have not had any issues. My pay checks and my employee name at work is my legal married name. But my charts and prescriptions show up as my maiden name. DEA and NPI are maiden name. No issues.
  8. I agree that it is probably mainly about liability. When the gynecologist gets sued because he screws up someone’s toe after doing an ingrown toenail procedure the first thing that he will he asked in court is “What kind of doctor ARE you? A gynecologist? Is ir within the scope of practice of a gynecologist to treat an ingrown toenail...” I agree with you. But realize so many providers choose to “stay in their lane” not because they don’t care and want to shrug your concerns off; it’s all about FEAR of potential malpractice.
  9. HOLY CRAP. Are you joking me? You are the ONLY one for a good chunk of the day? In all honesty I can't even fathom that. So you're running codes, sticking in chest tubes, intubating, starting pressors...by yourself? One thing I lack as a PA less than four years out is critical care skills. Even though I work in the ER...I never have to do that stuff because the docs do it. I legit can't imagine. How long have you been a PA? Thanks, everyone, for the responses. Never thought about working in a lower volume facility but it sounds tempting and maybe worth the drive...
  10. So much of what you’re describing is... my life. I have been doing ER for three and a half years and still usually feel like I am running around like a chicken with my head cut off because there’s six things to do (I need to discharge room six, close the laceration over there, and crap - I am getting a phone call from the orthopedist). It’s like that all the time. I stopped eating on my shifts and am lucky if I get one bathroom break or a drink of water. I also get very annoyed when patients perseverate. You have the ones who seek needy and hold you hostage with questions... and you swear they’re just trying to come up with inane questions to keep you there (“So... Um. Do I ice or heat?Um... Um... like is it normal that it still hurts? Um... like when will it get better?”) Or you have the ones with the positive review of systems and you want to rip your hair out. Or you have the ones who tell every single detail (“I got up, walked to the kitchen, ate a sandwich, sat on the couch, turned on Golden Girls. Then my right knee hurt so I got up, walked to the bathroom, openee the cabinet...”) These patients make me so anxious because I want them to STOP because I have a million other things to do...and I then feel like I am pushing them out the door rather than connecting with them. People always ask me why I walk so fast - because I don’t have time - and why do all of the others have time to eat lunch, chat about their weekend...AND LEAVE FIFTEEN MINUTES EARLY? I suspect that you may be like me, trying to be very thorough in your history, trying not to blow stuff off, making sure concerns are addressed AND making bullet proof documentation. Don’t have words of wisdom but uh... I am gonna say you’re not alone and you actually sound like a smart, dedicated and hardworking PA.
  11. I just wrapped up a fourteen hour day today. I am frigging exhausted. My shifts are twelve hours, but I stayed late charting. I only saw about 26 patients, but a lot of them were nightmares and very labor and time intensive (huge dog bites on the legs, two distal radius and ulnar styloid fractures that required multiple attempts at reduction, a cervical laceration that would not stop, a hypotensive upper GI bleed... I could go on and on). I have been staying super late in the last year, and I am sick of it. Usually an hour, two in a blue moon. I think it all started when we started to get RVU pay. I make an additional 30 to 55 per HOUR just for the RVUs, so it’s tempting to try to pick up an extra patient here or there. We don’t get paid for the hours we stay late, but you’d assume the RVUs would more than make up for it. That’s what I have been telling myself but I am sooooo tired of staying late. I have been blaming myself for “picking up too many patients for the RVU” but here’s the weird thing; I am not actually seeing significantly more patients than I did before we got RVUs. So I am staying substantially later because... God knows why... I don’t know. Does anyone have any tricks for getting out on time? I don’t think what I am doing is sustainable.
  12. Thanks for this. Strangely it is comforting to realize maybe the expectation is I am a representative of the APPs rather than a manager. That kind of takes a little bit of the pressure off. Maybe I am the one creating unrealistic expectations.
  13. You are not a jerk! I am confused by what my role means. I think I am a little more than a scheduler, though. I do the interviewing and hiring (hiring with approval of the head doc, of course), chart reviews, working with the hospital to determine credentialing requirements, helping find coverage in emergencies, addressing behavioral issues, setting up educational lectures, those kinds of things.
  14. I have been the lead PA for my small group of ER PAs for a couple years now. I think I was chosen because I am smart, do a good job taking care of patients, I don’t miss things often, and I was the one who gave a crap about the group and going to meetings. Unfortunately I am finding these traits don’t translate into being a great leader because I lack other traits that matter. I am disorganized at times. Not very proactive. When I’ve tried to be proactive in the past a few times, I ended up making a decision that was overruled by the physician director, which has totally killed my credibility, and now sometimes my team goes above me for questions and concerns which kills me. Ultimately nothing is really up to me and gets overruled by the lead docs so I just feel like I am constantly deferring to them. Leaders hold meetings - I am not the type of leader to have meetings just to have meetings (but I check in with my APPs from time to time to see how they are, and we all attend the group meetings with the physicians so I feel like that counts). I make their schedules, which thank GOD, they seem happy about...and show up to meetings at the hospital where I provide zero useful feedback or insight. The way I would describe myself as a leader is lame. Ha. The worst part is I feel like a bad role model in that I am not the wonderful, professional provider who floats in and out of the ER with a smile on my face, drama free. I still get “talking tos” occasionally about the way I am in the ER. Once I asked that a patient with swelling of the perineum not be put in the fast track zone (which didn’t seem fast track appropriate and I am apparently allowed to make those calls) and did so in a VERY nice fashion (I will say for all my faults I am genuinely nice to coworkers) and I was complained about by the nursing director directly to the CEO who called me a bad role mode for refusing patients. Since then I feel like I am on nursing’s bad side. I have been also reprimanded for having long discharge length of stays (which I worked on) and ordering too many tests. Today I upset the charge nurse who said I was picking up too many patients (we are damned if we do and damned if we don’t) and therefore not going to the rooms to dispo in a timely manner. I also apparently walked away when she was talking to me - inadvertently, my mind was elsewhere, and she called me on that too, which was valid. But it only takes so many of things like this to make me feel like a scatterbrained, unprofessional idiot - NOT fit to be a leader. I had really high hopes for this leadership role but I don’t feel like I am growing much within it. It is getting easier but I still hate it - because who likes something they feel they are bad at? I fantasize about stepping down from the position and just being able to go to work just to take care of patients! Only crappy thing is I would lose control of my schedule and it wood also be like demoting myself. I really do want to be a good leader but it’s hard to to like it and be motivated when you feel bad about it. I have thought about talking to the lead ER doc about this but I don’t know what that would accomplishe. As an aside - this entire post seems self deprecating but I do recognize I have many qualities that make me a rock star PA. I know I am smart and have good intentions. There are just a lot of things that aren’t translating well into leadership. Not sure why I am even posting this but it’s oje of those nights that it kind of hurts and stings to think about and I guess I am just looking for some insight to get me out of this frame of mind and move forward (or backward if need be).
  15. Yikes, this thread is making me think twice about my documentation of EVERYTHING I do for the patient. My entire chart for every patient is CYA. If they have an allergy to penicillin and I am giving ceftriaxone, you'll see a note in there that states something like "reaction to penicillin is a mild rash; has had cephalosporins before" (even though we all know the low rate of crossreactivity - CYA!). If I have given a patient a narcotic, I document that they said that they had a ride home. I document reasons for delays in labs and CTs. Therefore it is obvious that I document anytime I spoke with a physician for advice and what they said, even if they didn't see the patient. Is that really bad? If I speak to my attending physician about a case and ask for advice on what to do, I will absolutely put in my chart that "I discussed this case with Dr. Bob." If I spoke to a surgeon regarding a surgical case, I will document everything he said and what his recommendations are. If I spoke to a pharmacist regarding antibiotic recommendations, his name is going in the chart as well. It is not so much about displacing responsibility (although it is nice to have my attending MD backing me up on a chart) as it is related to my habit of documenting very thoroughly, so that if anyone ever needs to pull my chart they can see exactly why I thought what I thought and acted how I acted. I was told once by a hospitalist that my documentation was "beautiful." What can I say, I am a beautiful documenter...or maybe an a-hole documenter!
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