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Everything posted by JMann

  1. This is a nice wide ranging discussion. We've got climate change, preferred pronouns, abortion... and it's all been fairly non-combative thus far. Well done! I read the original article earlier this week or last when it came out. I read it as the author becoming increasingly tired of the social issues having a bigger piece of the educational pie in med school. Reading between the lines, he also disagrees with anyone other than MD stipulating educational goals in med school, thus his rants against educational doctorates driving the model. Can't say I disagree. I view a persons sexual preference as irrelevant unless it impacts their complaint (ie rectal foreign body..). Frankly, those that wear their sexual preferences on their sleeve are quite annoying. We had a 2+ hour class in residency at Iowa on LGBTQ stuff. They discussed preferred pronouns, advocates, clinics specifically for these issues etc. Not being originally from Iowa, I was surprised at the seeming prevalence of alternative lifestyles. I soon realized that's mostly confined to around Univ. of Iowa, Iowa City and the University hospital. While I don't personally agree with the lifestyle of any of those letters, I did find it useful to have been exposed to that education and way of thinking. My personal feelings don't affect the care I provide and we should all treat each others a good humans anyway. That being said, I'm still trying to understand how seeing yourself/identifying as a different sex isn't a psych issue. I've had numerous psych pt's commited for less in my ED... Perhaps this is a manifestation of some other emotional trauma or just a call for attention. I know this is a touchy issue for some and can be difficult to discuss.
  2. I work solo coverage rural EM in Iowa at a few places. My primary job is W-2, 0.6 FTE, and I get $102/hr for that. Also get free cell, state pension, benefits, CME etc. Only caveat is that I work overnight most Sat/Sun nights, 12hr shifts. That rate is an anomaly for this region I believe. My other jobs pay ~$25/hr less with minimal benefits. Other, slower shop I work at is $70/hr W-2 with 24hr shifts. Third shop is $75 or $77/hr. I forget because I don't work there as much. It's W-2 as well. Like others have said though, none of the jobs I have are for new grads. Minimum would be significant previous EMS/EM experience, but most likely needs residency training like I had or years experience.
  3. My GPA in PA school was like 3.5 or so. I did have 9-10 yrs of experience as a paramedic before school so that definitely helps. Getting the interview is the hard part. Once you get an interview, it's all about personality fit. Definitely use your Iowa connections if you apply there!
  4. Interesting. Kind of counterintuitive. Initially, you would think larger blade for more square inches to move more tongue out of the way. Really does make the viewing window smaller though. Good tip!
  5. Good reminder. Always gotta examine with fresh eyes and as little bias as possible to avoid this situation! Very humbling.
  6. When I certified there, it didn't take long. Maybe 4-6 weeks. Wasn't too bad. If you think TN is frustrating, you should apply to Florida...
  7. I was thinking PE from the start... Interesting case. Sucks though!
  8. This sounds similar to the Baylor program in Houston. Like others have said, if there are not rotations outside of the ED, move along. Unless you were planning to work at this place anyway, then get an actual job with better pay!
  9. I had a 6 month gap between graduation and residency and wrestled with this question as well. I decided against working and just spent the time being a stay at home dad and getting our house ready to sell. I did have a job lined up before grad, but figured I would end up working approx. 1-2 months after credentialing and HR orientation and whatnot. I figured with the difficulty and time suck that residency is, my time would be better spent investing with my family. I would absolutely do it that way again. I do have to explain that 6 month gap on every credentialing process, but that's no big deal.
  10. This is huge!! Have great references. Really strong experience can overcome "okay" letters, but that's the minority. You need good recs! If you don't have big EMS or ED experience prior to school, then take extra ED rotations to show your commitment. These residency spots are limited and programs aren't going to award them to someone that's not committed to EM. Be willing to relocate for residency. Apply broadly, say 5-10 programs, but do your homework and know why you are applying to each one. Also, search this forum as this question has been addressed here several times and you may find other advice that way.
  11. Awesome! A swan?! Didn't even think about getting to do that while I was there. Of course I didn't want to do a MICU elective rotation either... You'll likely need that if you do the ICU coverage. Don't worry, wilderness medicine won't be nearly the hours and is much more fun. I'll prolly be helping out with that one.
  12. I seem to need a refill on my popcorn for this discussion... I'm for improved supervision rules and removing barriers to PA practice. I'm not opposed to independent practice, but I'm not sure what opening that can of worms will bring down the road. Guess it can't be worse than what we have now and falling behind NPs further.
  13. In my experience with 1099, though somewhat limited compared to many of you, the pay rate is not usually worth it in many areas of the country. For instance, there is one place I work solo coverage at a critical access as a 1099. Rate is $75/hr (low for 1099, but on par for the area). I usually do 24 hr shifts and withhold 32ish% for the man. That sucks! Doing that same work at 1.5x that rate would make it worth it, but then they could just pay more FM providers and not have to worry about having someone on call when I'm there... Got a new part time W2 gig starting early next year. Same solo, rural, critical access coverage. Same rate. Don't have to deal with the headache of quarterly fillings and that nonsense. I'm looking forward to that!
  14. To do over again (aka the "what if" game)... If doing PA over again, I would do it the same way. Public, local program (1st year of program which was a mess!) followed by EM residency. But, if I was really doing it over again, I would have listened to my undergrad advisor and taken that human gross anatomy class in the summer, gotten the same EMS experience and then gone to med school and residency trained in EM for the same reasons EMED mentioned previously. I work at a few critical access places and have the same constraints on traumas and other scenarios as mentioned. If you really want to work the full breadth of EM, go to med school. I tell folks interested in the way I've done PA school and residency this all the time. PA is fine for half-way or fast track stuff, but to really do full breadth EM unencumbered, go to med school! To really do it over again, I would probably join the Air Force, or one of the other branches, get pilot experience and later become a pilot for FedEx or do it privately for executives.
  15. This is the crux of all the above hypotheticals. Work hard and you'll succeed. That being said, I was a medic and had to work to overcome some of the bad habits SHU-CH mentioned earlier. Given my background, I think all PA school students should have significant medical experience like RN, PA, RT etc. But that is my experience and bias and I'll own it... In my class, I had the most experience hours by a long ways. There were several 21-22 yo recent college grads who should have been in med school, but they chose PA school instead. They are doing fine with their shadowing and MA experience before school. It seems that selecting quality applicants regardless of experience is a tough job. A job I don't want! I work in EM and chose to do a residency. Does everyone need to do that? Not yet, but I do agree with earlier comments regarding that being the wave of the future in certain specialties. This could be argued to death and funding will be the deciding factor. I can see a future in hospitalist medicine and EM, especially as budgets get tighter and medicaid reimbursement lowers, where physicians are simply the "supervisors" of the workforce and PAs and NPs are doing the "work."
  16. I did my last recert on these with a similar company who also have the "for life" option. I was skeptical of the site not being around that long, but perhaps that's just me being paranoid... I went with the two year option and will reassess next time. I guess if you get 2-3 recerts at the price they have on the site then you haven't lost anything.
  17. Congrats! -Join SEMPA for the reasons noted above. Things I've used and found helpful: -EMRA antibiotic guide app- best app/guide I've found for easy abx guidance if needed -medication app- I like Micromedex- and learn how to use it! -WikEM app- mostly for differential thoughts though it's useful for work up if your new and not sure (don't knock it because it says Wiki! This app is run by EM docs and sites sources. It helps that it's set up in the Wiki format.) This is easily my most used app. -Use uptodate if your institution has it, but I wouldn't pay for it -Subscribe to EM:RAP- a plethora of info and CME resources- it's really a deal if you consider the amount of info and CME you get for the price -Listen to every show of EMBasic podcast- this will give you insight to EM thinking in the most common presentations -bookmark googlefoam.com and do regular searches and learning on your own. This search will gather results from most of the popular FOAMed sites and greatly assist your education. Good luck! Don't forget that it's SO important to keep learning. Residency taught me that it's not what you see/find on any given pt, it's the stuff you don't even know to look for or ask about that can really make or break a case.
  18. This is huge knowledge to have on hand when negotiating! This info isn't so useful when negotiating with rural/critical access places since production isn't really possible. In those instances it's more about them wanting to have a qualified person on hand. A critical access hospitals opinion of the value of a qualified provider(PA vs MD of any variety) varies widely. I talked to a recruiter at one of the large ED contracting companies back this summer about a rural coverage position- solo provider every other weekend from Friday 7pm- Monday 7am. They wanted to pay $70/hr and using the low pt volumes of 4-5 pts/24 hrs as justification. This was also a 1099 job. Crazy! It would have been like $48/hr after state and federal taxes. When I did push him for more $$, he also told me that they have FM providers come in from outside the area to cover the ED for $90/hr as a 1099. I suspect that was a lie, but you never know. Told him thanks, but no thanks.
  19. That's not the norm where I am. Seems to be $65-85/hr around the state. Sure there are outliers, but overall that's what I've found. Also depends on 1099 vs W2. Lots of the places around here don't pay that much more for 1099 which is incredibly frustrating, especially in a state with state income tax.
  20. Correct. I think when I started at Iowa, pay was $52k/year. Interestingly enough, they pay all their residents monthly. Not sure if that's similar in other residencies.
  21. ED work. 3 yrs out of school. Completed ED residency. Primary job is ~$120K/yr for 24hrs of coverage/wk at a critical access hospital. Mostly weekend overnights. Midwest area. Also do locums at varying amounts. For this survey, let's say around $20k for this year which is about 5-6 24hr shifts.
  22. If you are <30 and have no kids or other weird life situation, go to med school. Hard stop, end of talk. The plusses far outweigh the minuses in the long run. Most docs I know are happy enough with their decision. Sure being a FedEx pilot is definitely more ideal! If your >30, have kids/spouse or other life responsibilities, then you gotta look at pro vs con of time, $ etc. I was 35 when I started PA school. I looked into med school, but wouldn't have started until 36. Having 3 kids <10, I didn't want to miss large chunks of 4-5 yrs of their lives. Going the PA route, I still missed 2yrs for school and another 1.5yrs for residency. I'm happy with how it turned out, but had I been younger or different life circumstances then med school would have definitely been the route I would have gone. I also knew I wanted to do EM which plays a factor in that thinking I guess.
  23. Look heavily into the logistics of doing this post graduation. As mentioned above, finding a job outside of your place to let you do this will be tough I think. I think you end up working CCM and moonlighting/locums in EM long term unless you stay where you are since the splint like they have at your current place is unique. I do like the thought of this. You will be uniquely prepared. You'll just have to find an environment where you can utilize those skills.
  24. All ACGME required weekly conference time should count as Cat. 1 CME if it is an ACGME EM residency for physicians. You should have well over 100-150 hours from that alone. The residency should be able to give you a printout of this whenever needed. When I finished residency at Iowa, I got a printout of every hour I attended weekly conference and had around 150 hours.
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