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Colorado

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  1. Colorado

    favorite physical exam finding/sign?

    RAPD. Walk in to my FP clinic a few months ago. Quite a good finding to show our student that day.
  2. 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!
  3. 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!
  4. 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.
  5. Colorado

    Do you get sick a lot?

    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
  6. 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
  7. Colorado

    Who told patients...

    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?
  8. The cheapest that'll get the job done. Very few situations in which you'll need one after school. Sell to the incoming class when done.
  9. To clarify, since some may get the wrong impression, when I say I could've had my pick of job near the school I attended, its mostly to do with the number of openings and only 2 local schools. Less to do with me thinking I'm the best thing since sliced bread
  10. I would agree with most of the above. If you want to be in a specific competitive market or specialty - Very difficult without a foot in the door. For what its worth, my first offer came from a rotation site. Had I wanted to stay near where I went to PA school, I could have nearly hand selected whatever job in almost any specialty I wanted. That is the power of a reputable program in an area of the country where PAs are well recognized, respected, and strongly desired. Unfortunately, I have had more difficulty because of significant other (whose unable to relocate) and family requiring me to move to a very high COL area with a competitive job market (in Colorado)
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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
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