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  1. Thank you to both of you who took the time to read this and reply! I am definately taking this interview process seriously and am likely to take the offer. It is so very difficult to break into Emed locally in my region and this would definately be my best opportunity right now. A follow-up question: How do you deal with the feelings of guilt in leaving your current job? (My job isn't toxic, but it pays terribly and the commute is horrendous. Not to mention I don't think I can ever live in the same tiny rural town where most of the residents are my patients. I feel supported by my SP and clinic manager (theyre new additions over past 6mo) and the place has turned a new leaf in part thanks to my contributions and theirs ) I'm sure its normal to have feelings of guilt about leaving. But, I've also been told to never quit on a bad day, only on a good day. (ie: if things still are not what you ideally want even on a good day, then its a better informed decision than leaving when things are at their worse and you're in a rut)
  2. Good luck. I work in FP right now and searching for Emed jobs. I have multiple friends (physician and PA) that are in Emed whom Ive had lengthy discussions about alot of this with. My comments are food for thought and in no way should determine your choice. Figure out YOUR priorities and find a job to match them. It doesnt have to be a job that matches them from now to retirement, but at least fitting of your current goals and priorities for the next few years.
  3. Go for that Addiction Med repayment. If you are also in primary care doing MAT/Suboxone, you CAN double dip into the primary care loan repayment program too. This is the only time they allow you to be in both at once. Thats a lot of money. Not alot of people are probably applying for the MAT program so maybe youll have a higher chance. Just make sure your DATA 2000 is good to go and that your employer qualifies and has filed the correct paperwork. I believe there is an extra form they have to submit on top of the regular forms for the primary care site qualification registration. If I'm wrong about the double dipping please correct me, thats just what I interpreted from the website. Great incentives.
  4. So…. After months of searching for a job (currently in FP w/ 1 yr total experience), I had an initial phone interview today with the Lead APP at a Level 1 Trauma Center ER. I know my description is a bit lengthy but I hope it provides some details and leads to some feedback from all of you on this position and things I should ask at the next stage of the interview (by phone with HR and shadowing on-site in 1 week). Red Flags? Good, bad, ugly? Potential Offer: Metropolitan Area Level 1 Trauma Center, 70k annual volume, 38 bed ED (also addtl psych ED, peds ED, and 9-bed OBS unit), Attending, Resident and PA/NP coverage all day/night w/ residency program. Base Pay: Unsure. I do know that it’s SALARIED at “40hrs” per week, 36hrs actually schedule. If you work an extra shift, you get your salary rate turned to an hourly rate and paid that per hour. I should have more on this soon…. Note: A friend of mine has worked the Psych ER side for 1 year and is at $107K. So I’m guessing 100k-110K. Bonus is unknown. Shifts: 12 hr shifts, Required 12 shift per month, combination of 7a-7p, 11a-11p, and 7p-7a. (NP I spoke to there said they are typically in the department 36-39hrs, rarely more unless you picked up more shifts) Scheduling done by the Lead APP approx. 6 weeks in advance according to provider preference for days that everyone submits on a shared spreadsheet by the deadline. Typically able to accommodate requests for front loading/back loading weeks or specific days off without dipping into PTO) There are 2 FT night PAs that cover 6 nights per week (3/3), the remaining 1 night per week is split amongst the rest of the team. Typically I’d work 2-3 night shifts per month. No night differential that I’ve heard of thus far (I’ll ask) Acuity: Typically high (safety net hospital in state capitol). 50% of time in OBS unit/ 50% of time in main ED seeing Level 1-3’s. All the Level 4 & 5s go to the Adult Walk In Clinic which is a separate job title and department entirely (note: I also applied for an open position with that dept but haven’t heard back yet from that team). No peds ER coverage. No psych ER coverage. No Fast Track. Pts per shift: Average 15. Range 15-20. APP Lead states it’s not higher because of high acuity pts and not working fast track. The Day to Day: 50% Obs Unit inside the ED (7a-7p and 7p-7a shifts): Solo w/ RNs and Techs, attending SP and Senior Resident backup from the main ED. Sick/tricky complex pts, intoxicated pts, and actual obs of pts just being monitored until able to be discharged. 50% Main ED incl. trauma (11a-11p shifts): Attending coverage, working side by side with residents, PAs take Level 1-3 pts, Not involved in resuscitations or most “advanced” procedures (chest tubes, intubations) due to the residency program. Will suture, LP, paracentesis, the like. CME: “Money and time allowances” per job listing, however my friend in the psych ER states NO CME time off but CME $2,000 annually. Required to attend 1 M&M per month. Allowed and encouraged to attend all resident lectures etc. Training/transition: Limited. 6-12 shifts double coverage with another PA/NP, then you’re on your own. It sounded like this isn’t really flexible. (Will be asking LOTS more questions about this) PTO: 160 hours/year, accrued per pay period. (Essentially 4 wks PTO) Medical/Dental/Vision: 3 plans ranging from $66/mo in-house plan up to $177/mo for Highpoint HMO w/ Cofinity network for individual only. $0-$500 deductible. Max out of pocket 5k per individual/10k per family. Dental is Delta PPO (3 different plans. The option I’d chose to keep my same dentist is $2/mo individual and $4/mo for me+1. Sweet.) Vision available, I don’t need it. FSA available. Retirement: 401(a) Defined Contribution Plan (all employees contribute 6.2% of each paycheck (up to IRS limits) to an individual 401(a) plan instead of paying into Social Security. In addition, employer contributes a total of 3% (up to Social Security limits) of each paycheck on the employee’s behalf. In addition to the 3% contribution for the Social Security Replacement Plan, Denver Health contributes an additional 3% (up to IRS limits) on behalf of all benefit-eligible employees) 100% vested after 3 years. Also, an alternative 457b Deferred Compensation Plan w/ 3.5% match but higher dollar amount limits. (I’m not very familiar with either of these plan types…thoughts?) Malpractice: Uncertain. Possible FTCA coverage. (More questions to ask) Non-compete: None. Loan Repayment: None offered by the hospital. ER does not qualify for loan repayment. Per the NHSC and state program websites, the Adult Walk In Urgent Care there DOES qualify (I also have an application in with them, but haven’t heard back yet) Pros: -It’s a foot into the door of Emergency Medicine, and at a Level 1 Center in the main ED to boot. -I can continue to live at my current home and not have to move in order to get my feet wet in Emed -I will still be working with under served population (Important to me) -Pay will be at least a 30% increase over my current salary. It’ll take me another 5 yrs at my current position to make that. -Being in the main ED and out of fast track - 4 day weekends!? IF I can stack my days together. (I currently have 3 day weekends Fri-Sun in FP but I work 10-10-10-12 to earn it) -Daily RT commute is 1h20m. Might be able to make the bus system/bike work (free bus pass by employer) which is shorter than my current 2 hours/100 miles RT commute that’s killing my Subaru. This ER position would save me 4 hrs commute time, 220 miles driving, and 6-11 hrs of work time per week. Combined time savings: 10-15 hours a week & nearly 11k miles a year. As well as an potential $20-30k more per year in base pay) Cons: -OBS unit sounds like a potential Bermuda Triangle of the department. Will need to stay on my toes out there. -Pay not as great as other EDs may be able to offer, but then again our whole market here is below average in all specialties. -Salaried, not hourly. I swore after my current job that I’d never work salary again because although I’m scheduled 40 hrs per week, I never work less than 45-50. -No loan repayment -VERY limited training/run-in time. Due to volume and residency program, I’ll probably have to learn to swim fast. This is probably my biggest CON to this position at the moment (other than lack of participation in resuscitations and certain procedures). I have 5 yrs EMS/ER tech, my PA clinical training (included ER time at a similar Trauma center, CICU, trauma team SICU/Surgery, and the standard rotations), and 1 year FP in rural FQHC underserved population. I worry about getting stuck in FP if I don’t expand back out and start using my clinical skills on higher acuity patients and my procedural skills beyond IUDs, basic suturing/I&D, and skin bx. -I feel some guilt about leaving my current SP/patients/clinic. I finally feel supported by my current (new) SP and (new) clinic manager and I actually like some parts of FP but I’m still not super touchy feely like most of my colleagues. I kinda worry that my new colleagues and direct supervisors may not be as supportive or worse, it be a hostile work environment. Higher up in my current Admin, I feel fairly supported but they’ve specifically told us that there will be no significant pay raises for the foreseeable next few years. Limited 5k/year base salary increase and a bonus structure which will never be attainable for my position/pt volume due to rural location. (I started at 75k/yr, now at 80k/yr) OKAYYYYY....GO! Good, bad, ugly? Things I didn't think about that I should ask?
  5. At this point, we have some catching up to do with the laws that regulate NP practice. I used to naively think we should have SUPERVISORY Physicians but the reality is that we really just need COLLEAGUES. Routinely in medical practice, MD/DO/NP/PAs consult with their colleagues about tough cases etc. When I present a case to my SP on a challenging patient, it feels more akin to that, than some sort of a Mentor/Mentee hierarchical relationship. At this point, I'd have to agree that working towards obtaining at least the same amount of legal autonomy as NPs have is a priority. I recognize that there are many highly intelligent and well trained NPs out there and also that there are many stupid, lazy PAs as well. However, my recent experience with NP students at my clinic (they come mostly from a "hybrid" program where its completely online didactics and only 540 hours of clinical time, 45 hrs or so in each specialty; increasingly typical for NP programs in general) and recent experience with the two other, now former, NPs at my clinic has put a bad taste in my mouth about NP independent practice. I know we shouldn't be bashing our NP counterparts but my frustrations with the ones I personally encounter daily frustrate me to no end. -Explain to me how ONLINE coursework prepares you to be a PROVIDER. -How does 45-ish hours in each specialty prepare you to be a PROVIDER. (heck, I spent over 300 hours in one surgical rotation alone with all the extra shifts I picked up and extra time I spent in the OR) -Why were the NPs at my clinic (prior to my arrival and that of our new MD) practicing OMT, blind spinal injections, and prescribing an ungodly amount of controlled substances. (ie: S: "Tired this month after starting new job". O: Minimal documentation. A: Insomnia. P: Seroquel, Ambien, Klonopin for anxiety related to falling asleep, and MS Contin for those aches and pains of life that you notice when you lay down for bed" *pulls hair out* The honest answer, is because it was only the two of them at the clinic and no one was watching what was going on for 20 years. Thank God that I have a fantastic MD counterpart to work with now and we are working hard to undue the damage that had been inflicted on our population over the past 20+ years. It wasn't all bad, but boy when it was, it was disastrous. I don't claim to walk on water, but I know my limits and when to refer appropriately. Okay, back to the regular program. My goal this year is to be more active in pushing for more legislative support of our profession including holding our professional organisations' feet to the flames on this subject. Glad to see more people on board.
  6. That's great! What a far cry from the offers posted around here in Colorado.
  7. 1 of my pts is on prolia. The other was, but developed ONJ (osteonecrosis of the jaw) which is a rare but potential SE of Prolia, and is now on oral once weekly bisphosphonate therapy now. Orals carry some risk of ONJ from what I have ready but much less so than Prolia. I inherited both patients. I think prolia is great for the right patient but isnt first choice for everyone.
  8. I support the name change, OTP, and pretty much anything that pushes our profession forwards. I have been searching for a new job for months now and one of the primary reasons I've been turned down for "NP or PA" jobs has been because I am specifically not an NP. If I get the opportunity to explain what an NP and PA are and what PAs are capable of (Not to mention the amount of professional training we receive) I'm usually met with a blank stare and the questions "Well, we want someone who can be independent. You need a doctor don't you?" *UGHHH* Or, I don't even get the chance to explain. Sincerely, A very frustrated PA
  9. RAPD. Walk in to my FP clinic a few months ago. Quite a good finding to show our student that day.
  10. My first SP was a D.O. Which was interesting because he performed Acupuncture as part of his practice (had additional medical acu training) which per my state law, would allow me to train in and perform medical acupuncture as part of my practice. Kinda neat!
  11. I put my home address on my NPI paperwork (it specified that it wanted my personal phone number). Not wanting to screw it up, I listed my cell and I rue the day I did that. Robo calls out the wazoo. Check the site, your cell number may now be publicly available. Sigh, you live and learn. Good luck with the DEA app!
  12. Colorado. Small mountain town. 2 early season mild cases of influenza in unvaccinated teens. 2 recent mild cases in unvaccinated adults. 1 case of 10yo unvaccinated w/ pneumonia complication responding well to OP treatment. 1 case of elderly vaccinated w/ no complications. 2 vaccinated teens with uncomplicated cases. 5:3 UNvaccinated/vaccinated. Its here in the town but not too many cases, mostly mild.
  13. I have compassion for you. I am an active healthy person but I've been sick with NASTY colds twice this season (my first year in family med) that lasted for weeks. I just saw a family with the flu and washed my hands/forearms like I was scrubbing in to a spine case. Hand hygiene, obsessively. And some good lotion for afterwards. Avoid standing in front of sick patients. And when you do need to be in front of them, ALWAYS wear a mask. (This time a year, if my schedule is full of sick pts, I'll usually just wear my mask all day. I try to avoid it as it seems kind of sterile/hands off to my non sick pts, but hey, I gotta stay well) You can typically see the posterior OP/tonsils just as well by having the pt open their mouth and take a big breath IN instead of saying "AHH" and breathing out. Try it in the mirror at home, pretty cool. FOCUSED physical exams. ie: If classic Strep symptoms in a kiddo, take a quick peek in the throat, listen to the lungs etc., swab, treatment plan and GTFO. I do the Vitamin C packets w/ zinc on the regular. 1-3 grams a day when the cold season is ON. Oh, and make sure that whomever cleans the pt rooms after each visit is doing a THOROUGH job. You would be surprised by how many surfaces do not get thoroughly cleaned if you just watch people clean an exam room. Get them to clean the door handles as well if this isn't already being done. Alternatively, carry a lysol can on a hip belt and just spray it in front of you wherever you walk as if you're laying out the red carpet for yourself when you enter every room. XD
  14. Imo you did the right thing. You knew you had the skills to save that man's life and you acted. Now, If someone isn't confident in the skill required then I could understand a dermatology provider not jumping in to tourniquet and place an IV if you don't regularly practice those skills. I also think it's an individuals choice whether to enter a scene they may not feel is safe. Rescuer safety first. (I'm in mountain rescue but no combat experience) In regards to lawsuit, do what you can with the patient's best interest in mind and don't be negligent. I'm sure lawsuits have been filed in cases like this, I can think of one in particular that was quicky dismissed, but I think that's a tough case to try to bring against someone acting in good faith and within their training to save a life. Had the posters above who stepped up to the plate not done so, people would have died. So I'd rather be sued for doing the right thing ethically than for doing being present and doing nothing. Just in case some of y'all care, I'm of the younger generation of PAs. 1yr out of school and 29. There's Hope for our generation yet
  15. That would be one of my MAs. To this day she can't seem to grasp what a fever is. Anywho.... Who told patients that benzos are a sleep aid?
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