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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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  1. 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.
  2. 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.
  3. 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...
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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).
  9. 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!
  10. Try dealing with this in the ER. The triage nurse CAN'T turn anyone away for fear of an EMTALA violation. So a patient will come in for something like an IUD removal (I don't do that...see a gynecologist), an MRI of the knee "because mine isn't scheduled till next Thursday," or a skin biopsy of a mole that has been on their arm for a year...he or she will be brought back...and will be told, by me, "There's nothing we can do here because this is an emergency department and these things are done on an outpatient basis...please see this doctor...okay...bye" and get the cursory brief physical examination because we all know this is not an emergency, and get discharged after four minutes... Then they walk out and pay their 250.00 copay (or worse, a lot of these people come into the ER without insurance and will undoubtedly be billed HUNDREDS of dollars for this crap). I had a guy check in with requests for a therapeutic drainage of his knee, which didn't even have an obvious effusion. He had knee pain for years and had plans to see his ortho for the arthrocentesis THE FOLLOWING MORNING, but "my wife is here passing a kidney stone and it's going to take a few hours for her CT to be done so I thought I might as well get this done now because I was just sitting there." He tells me he has insurance but a really high copay. I do my cursory knee exam, notice nothing wrong and this guy is walking around without a hitch. I told him there's no need for an emergency arthrocentesis and that he needs to just see his orthopod tomorrow. His response - "that makes sense...are you guys going to charge me for this visit?" Didn't have the heart to tell him that his misguided (and kinda delusional and self-centered, if you ask me... this is a freakin' ER) act was going to cost him hundreds. Yes, for us to do absolutely nothing.
  11. I am in shock reading that article. In shock. I have never believed that physician assisted suicide is okay, because it literally involves someone "playing God." Stop treatment if the patient wants, and do not resuscitate. But it is not a physician's job to end someone's life. I understand why someone might consider this if they had a terminal illness, but depression? In a SEVENTEEN year old girl? Her brain has not even been fully formed yet - how can she make a decision that she wants her life to be over? Not to minimalize her trauma because it sounds terrible, but many teenagers go through issues with anxiety and depression and we often grow out of it after we gain more experience, confidence, and wisdom. How a doctor could assist in killing a child because she's depressed, rather than actually help her with that depression, is beyond me. How a parent could consent to this...is disgusting. This is absolutely disgusting and horrifying to me. I feel bad for the girl, along with the system (and parents) that completely failed her.
  12. Wow... ArmyVetDude... I think “somebody has a case of the Mondays.” No need to be a jerk to BoatSwain. It seems you advocate for PA independence so that the nurse practitioners don’t overshadow us and take our jobs. But is it right to advocate for independence just because the NPs are doing it? No - not a good enough reason. How can a PA or an NP a year or even five years out of school practice without supervision? It’s ludacrous and dangerous. Personally I think the fact that we are supervised only adds to our credibility over NPs. Anyway, I am not independent and if I wanted to be I would have gone to medical school...
  13. They asked you for malpractice info?! I would have crapped my pants... like... why do you need that as a Good Samaritan?
  14. Pay off your own loans you chose to take out or pass the burden onto taxpayers? I don’t mean to sound judgmental, but if you think about it, that’s exactly what these programs do. The debt doesn’t just vanish. Of course the right (and probably wiser, especially given the uncertainty of the program) thing to do is to just pay off the debt meaning you just live within your means and make paying off debt a priority.
  15. Great post. I have been thinking about this a lot myself lately. Some of the stuff we do in the ER we know damn well is fluff but we keep doing it. For chest pain with URIs? I often don’t order any labs at all if the history suggests a viral URI and the patient is young and healthy, and looks well (ie doesn’t look like they have myocarditis... LOL) Usually just a chest x-ray, and sometimes an EKG for these patients (and a flu swab) but otherwise not a lot. For asymptomatic hypertension, you’re completely right but I cannot get away from ordering my EKG, BMP, and urinalysis. Nothing I ever find changes management. I feel like it’s more reassuring for the patient if anything. If their own doctor sends them in for management and I didn’t do jack it doesn’t instill a lot of confidence for the patient. Often times I check this stuff, it’s back in an hour, and by that time the BP is back to normal without any meds given. Then they just get to follow up with their PCP. First trimester bleeding with a known IUP? Yeah, I am always getting an ultrasound on that to assess fetal viability. If the patient does eventually miscarry even though there’s nothing that could have been done, it’s easy to criticize the PA who just checked FHTs and kicked them out. OB stuff is high risk territory and we are dealing with two lives and not one (sorry, one life if you’re in New York now apparently) so it’s not worth the risk in my opinion. Epigastric pain - I always do check labs like LFTs, pregnancy test, and lipase...if the patient is truly NOT tender, the story is reassuring, and there’s no history of worrisome symptoms like fevers or emesis then I might not image them either. I completely agree with hitting the cyclic vomiters hard off the bat. I usually slam them with two liters of fluids, Reglan, Benadryl and a GI cocktail right off the bat. Plus capsaicin cream on the belly for the cannabis users. I do the same thing with migraines and back pain - why screw around? Migraines get fluids, Toradol, Benadryl, Reglan and dexamethasone early on and if that doesn’t work, Tylenol and IM Haldol (but usually it does work). Back pain patients usually get Toradol and Robaxin and a lidocaine patch! Usually feel better fast. Sometimes when I have a patient that may need multiple imaging studies, I don’t have a problem calling the radiologist to do a brief look over the images to tell me if anything is abnormal. So even if their formal report doesn’t come back for a CT scan of the abdomen for another half hour, I can already be ordering the ultrasound if the radiologist didn’t find an etiology for the patient’s belly pain on that CT (for example).
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