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LT_Oneal_PAC

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LT_Oneal_PAC last won the day on June 28

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About LT_Oneal_PAC

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    PA-C. EM PGY-2

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    Physician Associate

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  1. It depends on the day as I could be managing 8-10 rooms or things may be flowing and I’ve got everyone nice and packaged, but 2 hours prior to sign out I’m only picking up patients that I can get a good start on. Levels 3 typically that don’t say “history of renal transplant” or something else I know is going to require soul crushing specialist consult as these people are notoriously slow to implement their plan. One hour before I’m only picking up people that are young level 4. There is almost no such thing as level 5 here at my tertiary care center. I try force my myself to get the HPI and physical done before I see my next patient. I often don’t because I’m working with an off service intern and have to pick up the slack of them seeing only 6 in a shift. When it works out though my charts are easy at the end of the day. I’m almost always staying late though to wrap up patients for the next team, as I feel too guilty to hand off work to another resident who is just as overworked as I am. like Emed, I’m done with this rat race and can’t wait for my low volume high acuity rural job.
  2. 4 per hour for an entire shift is crazy. Things WILL be missed. No one I've ever seen is good enough to do that volume well. Not even the best or BC EM docs years out from graduation do a good job at that pace. I've seen really good, not lazy, docs quit jobs over having to see 18-20 a shift every shift in the main ED, saying its unsustainable. That's how I was scheduled in FM, 4 per hour, but I always ran behind to do a good and thorough job, so it was never really achieved. Sure if it was all 18 year old runny noses and coughs, it would be easy. I could crush 50 a day and make it home on time with a template note. Belly pain, dizziness, pediatric/geriatric fever, lacerations, vaginal bleeding, not to mention the sepsis, STEMIs, encephalopathy, drug seekers with pan positive ROS, traumas, take a lot of time. Is it possible these people are cherry picking cases? I've seen that. I wondered how some people always seemed to have a bunch and handle with ease or how they were always able to be free when that sick level one came in. I realized they were chart stalking. Looking at things before they signed up and if they saw it required transplant surgery or some other service that is known to take forever with tons of work, it would sit. They also had learned to time what they were picking up with the expected transfer list. I can manage 8 beds at once, but that is as a senior EM resident with a over a year of training and off service rotations under my belt. Even so, it's usually because things in multiple beds are at a standstill because I'm waiting on specialty recommendations or a MRI that is taking 2 hours for the read to come back. I'm constantly running my list to make sure nothing is forgotten. I feel like a fraud all the time, especially in my first year. Everyone seemed so smart and fast. I still do sometimes when I watch certain people work. But then I catch a few of their bounce backs and realize nobody is perfect.
  3. As an ED resident (almost done YAY!) and prior family medicine, I would say if you are really thinking ACS, then send to ED. Never order troponins from clinic. If you have that high of a suspicion, send them on. This does not mean every chest pain needs to come to the ED. I think DVT rule out, without signs and symptoms of PE, can be done in the urgent care setting if the patient meets outpatient criteria for treatment. I'm not doing anything extra than an ultrasound and sending them home on lovenox or DOAC. I'm doing a history and physical, a formal ultrasound, and sending these people on their way. I do tons of DVT r/o myself with POCUS. One could possibly do this with PE meeting HESTIA and PESI criteria, but no one would have the balls to do that. RUQ US studies, I don't see why not. Did them all the time in FM. If you are concerned because the patient is hemodynamically unstable, jaundice, or fever with RUQ pain, then obviously no. Send people you are concerned about for obstructing stone, portal thrombus, ascending cholangitis. Again, I do a lot of these by POCUS when it appears to be simple cholelithiasis and if I'm really concerned because of the previously listed, I'm usually either getting the CT or the formal RUQ US.
  4. I’ve worked with 4 different entities and never had to do that.
  5. Good point. I don’t know what the army does and can only speak for the Navy.
  6. While part of military experience is dealing with a young healthy population, the majority of Military PAs work in family medicine seeing ages 2 months to 99 years, though I often saw less than 2 months out of necessity for urgent problems. Being deployed sucks, for obvious reasons, but you also have to spend extra time keeping up skills
  7. I don’t minimize what you do, psychiatrist do. I have called for psych to come down to see a patient and state “their is no such thing as a STAT psychiatric emergency” or “call me back when all the labs were done.” I’m sure lots of lives are saved by you, but seconds definitely don’t matter. I don’t diminish what therapy is and does. I do think that the majority of psych that clogs the system can be handled by primary care with a psychologist for CBT, they just don’t because they don’t want to take the time to learn it. your obvious lack of understanding of EM practice goes to show that you have no advice to give outside of psych. I am EM residency trained with physicians specifically so I could practice at rural positions without oversight. My hospital actually does advertise this, actually. Right by the front door, as they are happy to show that they will be cared for by a specialist in EM. I’m not proud to be a cowboy. I’m proud that I’ve spent 3.5 years outside of PA school in formal training (2 in anesthesia and 1.5 in EM) and 3 years informally (family medicine/military) to work as independently as I do today. Ive made my point that independence is not practice level issue, only an administrative one. You continue to want to be offended, so I’ll spare you any more disconcertion and walk away from this.
  8. Your mileage may vary. Unquestionably you will have more opportunity to grow in the military if you are willing to put in the time and effort. I spent a great deal of time studying, taking leave so that I could work with specialists in my hospital to expand my procedure list, reviewing specialists charts and correlating with texts and literature to reduce my referral rate. You certainly will have more autonomy to practice to the top of your comfort level in the military. I had great mentors in FM, but I was at a FM residency. You could be sent to any number of clinics that may or may not have good mentors. It is most certainly going to be better than UC though, where the only option is to move the meat and make them money. If you want to be the best kind of PA, I do highly recommend my path of military practice and then doing a residency in a field of your choice. But I'm biased
  9. Getting rid of collaboration will help equal the playing field on a administrative level, not a practice level. The picture you painted depicted that our clinical scope was affected, but it’s not affected anymore than NPs, and that’s the point I’m making. I’m not triggered, I’m attempting to clarify inaccuracies I see for the OP and future readers. I’ve not attacked or denigrated NPs because there is no evidence that they provide lower quality of care. I do know that many feel unprepared, as I did in my 3 semesters of NP training, hence why I tell the OP I’ve never regretted my decision to go PA. As far as practicing without a physician, I have practiced independently in family medicine and on deployment without a physician for thousands of miles. I practice in solo ED positions where I run codes, placed invasive lines, started pressors, intubated, all without a physician. I’ve done far more high risk things independently than up someone’s Zoloft, start zyprexa, or do a Columbia suicide assessment (done those too), so I’m not sure what you expect that to change in my perspective.
  10. Your post was briefly about money. The rest was a diatribe about how independent you are, which speaks more to your specialty than being an NP. Right off the bat, if you work for a group or hospital, those running the place determine your level of autonomy. The NPs in my state are independent, but have no more autonomy than I do at my hospital. In the military, my privileges exceeded the NPs in family medicine. So whether it’s admin or a physician, someone else is determine your autonomy. The only way around this is to open your own shop, which no one should do Day one after graduating because of inexperience and most people can’t afford until 10 years into practice. The obvious path of least resistance and financial benefit is a RN becoming an NP, but there is more to life than money. There is certainly more to patient care than the path of least resistance. I welcome you, as an NP, commenting here. I encourage you to do so. But your going to get push back when your off base. I agree that it’s financially prudent to be a NP if you are an RN. I think your math is a little off, but not tremendously. I agree that you have a FEW options not open to PAs when it comes to opening your own practice, though I have faith this gap will be closed in the future, as it has been already in North Dakota. It should also be noted that NPs and PAs open there own practices at the same rate. Both about 5%. So the OP just has to decide what he wants. Understand not wanting to be at the bedside. It can be grueling. Personally I would transfer to the ICU. The floor doesn’t give you time to really learn and OR experience will help with surgery, but this is a small portion of PA school. I don’t think it will be seen as lesser experience for an application, but being on the floor or ICU will help you learn concepts to make PA school less of a burden.
  11. Yeah, this paints a rosy picture that isn’t exactly reality. I don’t have to get a physician to do anything either in EM. I have a solo ED position and no one is calling shots but me. I’m sure you can better dictate your terms of employment, but that’s psych and not being an NP. I have PA friends that do the same in psych. Though if the OP is wanting psych, I certainly agree that NP would be the smarter choice because it requires very little experience and little knowledge of general medicine. And to say that the only replacement for a psychiatrist is a NP is also disingenuous. If you are implying that a PA can’t perform your job, you’re wrong. If you mean only you can go into the sticks and open shop to help the truly needy rural population, then yes, but not you or anyone else does this.
  12. As a RN who went PA, go PA. I’ve never regretted my decision.
  13. While Ms. Dorn had some unpopular opinions, I’ve heard from people in the know that she really turned around the finances of the AAPA, putting us back in the black. If there is a PA who is qualified in running the business of a large nonprofit, in all for it, but we need a CEO with good business sense first.
  14. In my residency, if you sign up for a patient and they need a procedure, you do it. Simple as that. If another resident wants it, even if senior to me in PGY year, you have to give it up. My residency was very up front that I’m not different from the physician residents. It’s expected that I get all the same experiences and have the same expectations. If something happens that diminishes my residency experience, I’m to bring that up to administrators. So I don’t have to worry about “protecting” my procedures any more than other residents do with each other, because I’m the same as they are, a EM resident.
  15. They offered me $35/hr 1099 at the university to teach ACLS. Haven’t looked many other places
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