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  1. I had every intention of paying mine off as fast as possible (which with every cent thrown at it would have been about 5 or 6 years) i still have this intention but I took a pause for about a year to do something different ....I decided I wanted to start investing in some passive side income so I dropped my loan from standard ten year plan to the IBR plan to drop my monthly obligation to it, owe no other debt, and purchased an income property that now brings in almost $2,000 income to me monthly from tenants. Of course there’s costs and repairs associated with owning property but I’m still quite net positive. I continue to pay MORE than the IBR plan requires each month and now have extra money to put towards the loans and retirement. (Not to mention the home’s value continues to grow in a hot stable market) This wasn’t an easy decision to make and can go horribly wrong for you especially if you have a lot of consumer debt or lack the discipline to keep attacking your loan debt (easy to spend extra income on toys restaurants etc) Its not for everyone but just something to think about.
  2. I work in rural FP and have only MA staff. It's a constant battle to get them to help with all of the above bullet point items you listed. When I have the time, I'll do some of it myself but usually I do not. I've explained why it's in everyone's best interest to lend a hand and everyone do their part. I've certainly won some favor because I rarely run behind in clinic and rarely keep staff there past 5pm, our closing time. Our other provider is often running an hour behind and keeps staff late daily which they hate about as much as I do. Try to work with them and explain the reasoning why instead of just saying "it's not my job it's yours".... No matter how true and how frustrating that is. Good luck.
  3. Solid offer. If the location is where you want to be, even if for only a few years, I'd strongly consider accepting that offer.
  4. Some more urgent referrals are ER generated (ie: to ortho for f/u after an ortho injury/fracture for those that can wait a few days comes to mind) but for non-urgent referrals such as this patient in question (referral to neurology for recurrent migraines apparently not responding to typical 1st/2nd line treatments who has repeat ER visits).... this referral should appropriately come from the PCP (not urgent ergo not the ER providers responsibility. Not to mention if insurance/CMS is involved, which typically always requires PCP generated referrals). I understand your frustrations.....I'm currently working in Family Practice/am a PCP for many. Now.... if the ER providers get sick and tired of seeing this person and the pt refuses to go back to their PCP, maybe an ER provider with time on their hands (not likely) would spend the time to get the patient seen by neurology either by arranging OP follow-up or convincing some poor soul in neuro to see them in the ER briefly. However....no guarantees that the pt will go to that outpatient neurology visit either (which also reflects poorly on the ER provider for wasting their time and the neuro's time on a referral/consult and the pt will likely be back in the ER again) And round the world goes.....
  5. Agree. There is no reason that PAs should be treated any differently than NPs in regards to having the independence to practice. We have been left in the DIRT by NPs and admin has taken note for years and now other providers are as well. I find it nearly impossible to even get an employer to CONSIDER my applications for a job because "Oh, we are looking for an NP only not a PA" This even goes for jobs listed for "PA or NP" All the hiring managers and administrators that I've encountered recently here in Colorado have a strong, if not singular, preference for NPs only and specifically quote NP's independence and PAs dependence (on SP/CP whatever we are calling it these days) as the reason why. (Yes, I've only been in practice for 2 yrs but I have great patient outcomes and performance reviews and employers aren't stating my lack of experience as the reason but specifically NP preference) The medical boards get their undies in a wad even discussing OTP with PAs, and definitely kick and whine about independence because MDs are the MEDICAL BOARDS' "Shining Stars". All the while, the nursing boards govern themselves and promote their "Shining Stars" which are their NPs. We will never be held to this level or promoted by the medical boards in the manner that the nursing boards promote their NPs unless we have some major changes soon. Ive gone to AAPA and my state chapters and asked questions, pushed for answers.....no response. So I try to provide education to everyone I meet about PAs, our capabilities, our breadth of practice ("No, we dont need a doctor to hold our damn hands"), and the state laws regarding our practice. As someone with 6 figures of PA School debt (common these days) and unable to obtain another higher paying job to afford my loans due to NP competition due to lack of our independence....something has to change. Maybe I'll get one of those online NP degrees everyone raves about......
  6. "What is the justification for granting autonomous but not independent practice to a PA with more training (6 years and 45 weeks) than an NP who can practice independently?" Preach
  7. No health,dental,insurance. No retirement benefits for 2 years. *Unacceptable in my book for a professional job. Even a 1 year wait time for retirement benefits is not great. You could at least put your own money into an IRA during that time. They aren't compensating you well enough with your salary to make up for no insurance. Hours: 8-5 pm with a 30 minute lunch. Monday-Friday. holidays and weekends off. No call. *Standard hours. If you're the only one at that clinic, who covers for you when you are sick or on vacation? What does your support staff (RN, MA, front desk clerk etc.) look like and what happens when they are out sick or on vacation? Is there an office manager for that location or will you be expected to wear multiple hats? $90,000 salary. *You are already paid VERY low for your work experience of 5 yrs right now, counter with 6 figures. Do not accept less than that. I'd counter with $110-115. Get the AAPA report, show them, discuss it. I second considering locums, moonlighting, etc. Regarding "My problem is that if this is a bad offer and I counter with 120,000, will they just say no and hire someone else? If thats the case then when will I get a decent paying job?" *They could absolutely do that, but they are unlikely to just turn you down flat out. Most likely, they will counter with a less than ideal counter or just he same original 90k and theyll give you a bunch of excuses why they wont offer more. I can't answer your question as to when you'll get a decent paying job but I will say that if you accept a salary thats far less than you feel like you deserve (and you do deserve more than 90k) and thats less than you need to support your family....your current burnout is only going to transfer to the new job and you'll be soon looking for yet another new job in the near future. One way or another, you have to fully investigate why you are burned out and the answer is hardly ever "I just need a change of scenery from my current job" There's usually some very specific things that trigger your burnout (ie: the front desk cannot figure out the scheduling so they're always overbooking me and that stresses me out -or- my MA is incompetent but they;ll never replace her because shes been there for 15 years -or- my SP sits on his ass all day while I work mine off -or- They dont give me CME time and money so I dont feel like my employer is invested in helping me become the best provider I can be -or- I cant succeed at goals in life (save for home, save for retirement, pay off debts, investments, buy a boat, etc) because Im simply not paid enough dollars)) Its important to know what specifically contributes to your burnout so you can ask about those things and avoid them in future jobs. Just some thoughts. Best of luck!
  8. If you and your supervisor/coworkers are on good terms both professionally and interpersonally, then there can often be NORMAL bittersweet sadness when someone leaves. Those people may feel sad or a sense of loss of a team member when you are leaving but are just as likely to be happy for your next opportunities. Your employer... Yes, they trained you but they HAD to train you, just like they would have had to train anyone else for that position. Perhaps you needed more time as a new grad but the training investment is what is expected of any employer of a new employee and not unique to our profession. Not even a seasoned PA can start a new job without some training on that specific workplace. You should try to not feel guilty for leaving an employer. Ultimately, this is a professional and business transaction in which you work for them by performing skills (medicine) that brings cash to the company and then they give you a cut of that income that they make. I tend towards the more emotional/guilty feelings when I leave a job so I can understand and which is why I try to force myself to force myself to think about the aforementioned more practical/transactional approach to the relationship between you and your employer. That being said, we also work in a unique profession where we have these intimate relationships with patients which I think contributes greatly to a sense of guilt when we leave a job (except for maybe terrible toxic jobs). Check out some youtube videos and articles on the guilt that teachers face when they choose to leave a teaching position for similar personal reasons (such as low pay) and you may find some common ground in their feeling of obligation to their students. Best of luck!
  9. I'm also interested to see how much this is different between the varying graduating class years etc. but this should be interesting. If this has been done recently elsewhere on the forum let me know.
  10. Congrats on finding a better offer than what you've been getting and after your last experience. Seems pretty solid
  11. I live in an area with an unusually high number of NDs etc. and see a TON of this. I'm not saying that all NDs are terrible. I think that naturopathic practice and allopathic medicine can coexist and be quite beneficial to the patient, but only in the right situation. There's a few main groups of patients that I see who come from these practitioners near me: 1. Thyroid: Dessicated hormone therapy, specialty compounded blends of thyroid supplements, often with lab values far outside the normal. ("Ma'am, your TSH has never been abnormal until your ND started you on high T3 compounded/ dessicated replacement therapy and since then your T4/T3 have been through the roof and your TSH nearly undetectable" Pt: "But its natural. Oh, and my ND has a list of labs they want you to order and draw for them (hands me sheet of paper...because these "practitioners" cant even order their own labs) *face palm*" 2. Chronic Lyme Disease: These are often pts tx'ed by one-off GP and Internal Med MDs gone awry. AKA "Lyme-competent physicians" per patient lingo. They are cash only and like to place patients on unfounded treatment regimens like daily double ABX therapy (ie: Cipro and Azithromycin at max doses per day every day, planning for years if not lifetime of treatment) and often use independent labs for testing, because as one pt recently stated "Your lab, Quest or Labcorp or any of the hospitals really, will show false negative testing" *face palm* 3. BHRT: Weird dosing on compounded BHRT. Unopposed estrogen therapy, etc. There's a lot of gray area in the science and even the guidelines leave room for discussion, but overall are pretty clear on how to manage the above patient populations. I explain to patients that I follow current evidence based guidelines and do not practice medicine that I have legitimate fears would introduce more risk than benefit for them. I explain the R/B/SES and current reasoning to them as much as they will listen. Encourage them to use other natural, evidence supported, treatments for things (think zinc oxide sunscreens, fish oil, ginger tea for nausea, exercise and diet to reduce their cholesterol and blood pressure if their #s are safe enough to go that route, etc)
  12. Probably unlikely that a lawsuit would come of those few days but you have put yourself at significant risk by participating in patient care in that manner. I have not encountered this before but you might think about speaking with a malpractice insurance company about retroactive coverage of some sort. Best of luck. I have done a shadowing day during an interview process, but I don't do anything with the patients other than introduce myself as the person who is job shadowing the PA and that I am just there to observe and I specifically tell them that I will be playing no role in their care for their visit. Then I shut up and watch. I dont even so much as touch the patient, tie their loose gown strap, listen to an interesting murmur that the PA heard etc.
  13. I would recommend choosing something that hits one of these points: -A specialty that you may be interested in, but were not exposed to in your core clinical rotations. (ie: Nephrology, Dermatology, etc. I chose Cardiac ICU which I LOVED and helped me feel more confident handling sick, complicated patients) -Build more upon a field that you are definitely interested in. (ie: If you loved the ER and know its for you, then consider a Peds ER rotation, an Ultrasound ER rotation, repeat ER rotation at a different ER (think Rural v. inner city v. volume v. patient population differences), repeat ER at the same as your core (I did gen surgery and Ortho/trauma surgery at the same hospital and since they already knew me, I had the opportunity to have a lot more trust of my teachers and was able to do a lot more procedures because of it), or even trauma service because you may have more opportunities to do advanced procedures. There is benefit to working on different but similiar services at the same site. If you did trauma service at the same ER that you did your core ER rotation, you will already know how the operation works, whose who in the game, what the general roles of everyone are, not to mention you'll know your way around the hospital, and often its easier for PA Program clinical directors to set up rotations with elective specialties at sites they already have another student agreement with.) -Rotate in an area that you feel weak in or have not had much exposure in (For me, it was ortho. So I chose Ortho/Trauma Surgery as an elective)
  14. I have one for sale up on ebay right now. Welch Allyn 71050-C Rechargeable w/ insufflator bulb and spare light bulb. Item # 233211787719 Comes in carrying case. I replaced the battery with a new one in 2017. Starting BID $135 plus addtl shipping. Buy it now for $225. Take a look. It was perfect for PA school and is a high quality scope that would serve you well as a clinician too.
  15. It's not for a lead PA position. The Lead PA that I mention was the person I had my initial phone interview with. Although that may be a position I would be interested in eventually, it certainly is not what I am looking for right now. I appreciate the input though.
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