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  1. Rural jobs seem to pay okay and have more opportunity for loan repayment but I will say that I work in an underserved rural clinic and I both get paid poorly and was turned down for both state and federal repayment programs despite our site qualifying and doing the applications correctly. I wasn't counting on the loan repayment so it wasn't a complete surprise.
  2. I already see job postings around Colorado that specifically list NP and when I contact the company, they insist they really do mean NP and not PA. These are jobs in FP, urgent care, peds, oncology, specialty clinics, and even some surgical positions. Although I will not that most surgical, EMed, and procedure heavy specialties still seem to prefer PAs. I see a lot of "we want an NP to staff our rural primary Care clinic because they don't need a doctor around to supervise them" When I have taken the time to explain what flexibility "supervison" actually allows for in most states, I'm usually met with "well that's great but it still seems like more of a hassle than we are looking for". Sigh... This is really not an us (Pa) vs them (np) fight. This should serve as a warning call, even if it's not happening in your state or locale right now.
  3. The MAs at my clinic have the diffuse going some days, but we run it mostly for the pleasant smell. I typically counsel my patients of the scientific (lack of) evidence of essential oils, but tell them that if they anecdotally feel better (ie: lavender relaxes me) and are using the oils appropriately (ie. a diffuser not potent oils directly on skin)....then go for it. I'd rather them use lavender oil in their diffuser every night than pop a benzo if it helps to alleviate their symptoms. None of this "Flu vaccine in a bottle" nonsense.
  4. I too am in a small rural community. There is one other small primary care office in town. Other than that, patients will need to drive about 45min to 1 hour to the next clinic. The other clinic has recently cut down on these prescriptions and now we, as the community health clinic, are seeing patients looking to transfer care. Luckily, the organization I work for is very explicit in not allowing ANY new chronic narcotic patients to receive Rx's through us. We can see them for their other care though and work to get them resources (pain management, MAT program, behavioral health, addiction recovery, or specialty referral if warranted) for their pain. I do my best not to kick the can too much by getting fed up and referring them out if I can avoid it, but I also know my limitations. Funny enough, the more of these conversations I have with patients, the less chronic pain patients I see. And my pediatric and Gyn patient panel is on the rise!! So maybe it will all settle out after a couple months. I'll try to keep ya'll updated.
  5. Fav pocketbooks (although I mostly use AAFP, UTD, and other web based resources now): Tarascon Primary Care Pocketbook Tarascon Pocket Pharmacopoeia Sanford Guide to ABX Therapy
  6. How have others dealt with the transfer of care of patients from a provider who is leaving/retiring? Warning, there is a bit of a rant in this: There is a provider at my clinic who is retiring next month and is feebly transferring patients to myself and another full time provider. The retiring provider has been at the clinic for almost 30 years and has a HUGE panel. Nearly half are on chronic narcotics. Granted, she has worked most of them down over the years to </= 50 MDE but some are still around the low 100's MDE. Additionally, many are in their 50s-70s and many are also prescribed benzos and/or stimulants. When I have inquired in the past about these med combinations, esp in older patients, she replies something along the lines of "well, they're doing well on them/they work". Or, if an outside provider prescribes the benzo or stimulant, she claims the "head in the sand" excuse of "Well, I"M not the one writing those prescriptions". This aggravates me to no end. Okay.... so you may not have written them, but you wrote your Rx for their narcotics with the full knowledge that the patient is taking other potentially dangerous medications. I mentioned her feeble attempts to transition patients because she is continuing to see many of her patients for follow-up of routine care despite telling them that she's leaving and that they need to transfer care to another provider. Some of this may be the patient's preference, but its frustrating because they tend to be complex patients that require more chart review prior to my first meeting with them. I simply don't know them as well because they've been her exclusive patient for 30 years. I feel that she should be transferring more of these patients over to us other providers prior to her final day. When I asked her about this, she happily gives me some of the patients from her schedule, but typically keeps the above-mentioned type patients to herself for now. I have met with some of those former patients of hers, but after having a discussion about the potential dangers of their med regimens, they often return to see her and plan to until the very end. I foresee a metric shitstorm coming my way come next month when she finally leaves. Not to mention, a lot of initial visits with those patients are going to be difficult as we discuss their med regimens. They get quite upset when I talk about reviewing and considering changing their controlled substances. Thoughts on how to make these transitions smoother? I feel that for one, starting to transition patients earlier is ideal. I am also curious because I myself may be voluntarily departing this position in the near future as well. (again, sorry for the rant. I am genuinely curious on how others have dealt with transfers of care when providers leave)
  7. I work up in a rural mountain town in the Rockies. The only "drug rep" I see is our vaccine reps for flu and shingles season. As I type this, its 3F outside and snowing, with a foot on the ground already. I doubt my little clinic is that enticing for them to battle the winter to get up here. XD I do remember some of my best lunches were thanks to pharm reps during my training in OB/Gyn while on clinical rotations though....
  8. Colorado

    Failed PANCE twice now.

    Consider reaching out to your PA program and seeing if they offer any assistance or guidance? Even just talking with a mentor at the program may lend some insight and provide some help.
  9. Colorado

    New grad bargaining power?

    Thanks for your input, always happy to learn. I was and am fully credentialed. Unfortunately no part of the education system and definitely no part of PA training (for my program at least, doubt its much different elsewhere) was focused on the actual business of medicine, reimbursement, etc. It's been challenging to drag this information out of management and I'm always a little suspicious of the information that I am given. I'm working on figuring it out on my own with available resources, but appreciate the input from others who have been in the field longer. Best advice to the OP is IMO as you said earlier, don't sign a 3yr contract. And don't get bullied into taking significantly less pay than you should be paid (AAPA salary report etc.), be ready to walk away if you can.
  10. Colorado

    New grad bargaining power?

    You DO have value as a new grad, even without additional job specific training. Not as much as someone with experience, but you will still be making the clinic/hospital/group money. As a new grad, I bring in about $30-40,000 in reimbursement to my employer each month and this is my first job as a PA, and I'm only in month 3 of employment. I've already generated enough money to cover my salary and benefits package. Think of it that way if it helps. You have value, you bring value to the practice even if youre only seeing a suboptimal number of patients per day to start.
  11. Colorado

    New ER PA, stressing out

    I appreciate your input. I work as a new grad in rural Primary Care in a small mountain town. I try to avoid sending pts to the ER unnecessarily unless warranted, such as my pt w/empyema 2/2 pneumonia on Thursday. I follow-up on those that I do send so I can get feedback either directly from the ER provider (of which there are 3 total; 1 on duty at any given time) or from the discharge summary etc. so I can a. Determine what workup the ER did, and get an idea for how those providers operate, b. If my referral was appropriate/not, c. Was there anything I could do differently or learn. I appreciate my fellow ER providers as much as I hope ya'll appreciate us out in primary care trying to take care of the masses and keep em out of your ER. ?
  12. ^^This, mostly^^ Me: Primary Care rural FQHC in the Colorado Rocky Mountains. Our clinic sees primarily Medicaid and sliding scale pts, commercial insurance is rare. Peds thru geriatrics, but mostly age 20s-60s,.We have a part time OB/Gyn whose in twice a month and sees as many OB pts as he can (typically self-pay, sliding scale only who have very limited options as to where else to go). We have behavioral health and dental in house (integrated clinic). PCPs: Me (PA) FullTime + NP (Fulltime, 28yrs experience in the clinic) + DO (My S.P., 40+yrs exp., PartTime 2d a week). We are adding a FullTime MD this fall. I work 1.5d a week with my SP, and 3d a week with the NP. (SP and my secondary SP's are all available by phone during that time). Some days the clinic is packed full (24pts/d) and sometimes its slower (16-20/d). Appt slots are 20min. However, as I am a relatively new PA and new to the clinic, I have 40min appts and capped at 12/day right now and that doesn't change until I'M ready, although they said they'd like to have me seeing more pts by the end of summer (3-4mo mark). It's a lot of autonomy but I never feel like I'm left out on my own. I suture, toenail removal, digital blocks, slit lamp, basic microscopy on wet mounts etc., EKGs, joint injections, etc. We take walk ins so some days it feels more like Urgent Care based on the pt complaints.
  13. Colorado

    Overwhelmed

    I'm still looking stuff up ALL THE TIME. I did very well in school, but struggled with dosing too. Now I'm 1 month in to my new job. You'll be fine. Your preceptor should understand a bit more perhasps.
  14. Colorado

    Health Insurance as a student

    I found myself in the same position after my job ended for school. School insurance was about the same as OPs, I could buy full priced crap insurance off the ACA but didn't make enough money to qualify for the big discounts on premiums, or I could apply for Medicaid in my home state (one of the most expansive and inclusive states for the program). The first year of school I had recorded about 6months of FT pay on my taxes because I had worked January thru June before school started in August, so I actually had great ACA insurance for about 70 a month because I made enough to get the big discounts but little enough that I qualified for it still. Check out your states ACA and Medicaid program requirements and limitations so you're not breaking the law or falsifying your qualifications. Fyi, state Medicaid is pretty much restricted to the state you reside in. So if you attend school in another state, you will not be covered while there unless you change your residency. (with few exceptions)
  15. Colorado

    LARC symposium/Nexplanon Training

    Upcoming LARC training, full day with hands on (Training maniquins), troubleshooting etc. And Nexplanon certification. Keystone, CO-- April 25th 2018 Durango, CO--April 23 2018 Free to colorado providers. Breakfast and lunch provided. Check CDPHE website.
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