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charlottew

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charlottew last won the day on February 27 2016

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About charlottew

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  1. charlottew

    Pulmonary angiography

    Yep, many of these patients just laying them down flat puts them in a mild respiratory distress due to the weight of the chest and sometimes the protuberant abdomen compressing the lungs. And that's without a clot...
  2. charlottew

    Pulmonary angiography

    If there's a high suspicion of PE one might argue for just starting the heparin gtt empirically, unless there's a contraindication. And if there is a contraindication, why would you work it up anyhow? Because there's nothing you could do about it. (thrombectomy? tPA? both very high risk in this patient, I would think) For inpatients with suspected PE, often we will do a bilateral venous duplex of the lower extremities. If it's positive, then probably a PE. If negative, then less likely. I too have never had a patient with a BMI that high. Yikes.
  3. charlottew

    Residency for CCM??

    Yes, the best preparation for a critical care job is a critical care residency. There are a few of them out there. Good ones will have protected time for didactics and broad exposure to disciplines. Some pay what MD residents would make, I know of at least one that pays new hire starting salary (but longer hours than starting).
  4. My BLS and ACLS recerts have to be with American Heart Assn, per my employer. Both require an in-person component. I pay for it with my CME $. I don't know about ATLS and PALS. I'm also highly encouraged to keep my FCCS and ENLS certifications current - FCCS is in person only, I think ENLS you can renew online?
  5. charlottew

    New Grad CCM Job resources

    Critical Care Medicine? An accessible and comprehensive reference is Marino's ICU Book. Although keep in mind it's written from a personal point of view, not all of the info represents generally accepted views.
  6. charlottew

    Excited & Terrified

    I went back to PA school later in life, with kids in elementary school. I had a supportive spouse with a slightly flexible schedule, as well as a sitter (OK, a series of them) and some afterschool programs. I would say it is do-able, but you will need support to get the household stuff and childcare taken care of. Your middle schoolers are probably fairly self-sufficient, but the seven year old will need support. Also the tween/teen years tend to benefit from a stable home life with supportive people around and Present. As far as I know there is only one online PA program, and that is Yale's (just started). I imagine it's competitive to get in. A little research shows that Univ Wisconsin has an online-ish program, but you need to be in the area, it seems. If you cannot move (I was in the same situation), then in addition to Yale you will have to research programs that are a commutable distance from you, see exactly what their requirements are. Go and visit. Speak with some of the admissions staff to see if you are in the ballpark of their acceptance criteria. Didactic year is a time sink. Probably less of a time sink, if you aim for passing instead of top grades. Clinical year time requirements vary depending on the rotation. Some can be fairly mellow (like a regular 9-5 job or maybe even a bit less demanding - but use your extra time to study!); others can be punishing in terms of time demand (overnight shifts, 12 hour shifts, high intensity environment). I just kept telling myself, "I can put up with ANYTHING for 4.5 weeks". It IS a bit crazy. And it is certainly expensive (not only tuition, but the lost income from your current job). It can be done though. I did it, and am now happily working as a PA (of course, I picked a very demanding specialty, but that's a whole other story...).
  7. As an alternative to a pension, I think you can convert your 401k savings to an annuity on retirement, that will give you a fixed income for the rest of your days, if that is the kind of arrangement you are seeking. Many (but not all) jobs with pensions make you 'pay' for it in some other way - reduced salary, more bureaucracy, less-nice working conditions. The competitive market really does work. So essentially my advice is, if financial considerations are driving your decision to leave a job you like (and 7% match on 401k is very very good actually), maybe you could consult a financial advisor to explore your options, before you make a move. (fee-for-service advisor preferred over commission-based)
  8. charlottew

    Benzos

    I agree there are no absolutes. I had a 102 year old (!) family member, who had been on xanax for YEARS. For the last ten years of his life I tried to suggest to him, gently, that the xanax was a fall risk, and that he should try to stop, or taper. Nope. No how, no way. He wouldn't give them up. I saw him on a regular basis, he never seemed overly sedated to me. Of course he was frail in his 90's (who isn't?), but the germ of the matter is that he had some significant and long-standing anxiety, he was dependent on the benzos to alleviate this, and he wasn't going to change. In the end, he fell and broke his hip, it was terminal since no-one would take him to the OR for repair at 102. Actually it's probable his hip broke , causing the fall. I guess what I'm saying is, I know The Guidelines say benzos are contraindicated in the elderly. Certainly when I treat older folks in the hospital, I avoid starting benzos (in the context of delirium risk). However, for people that have been on benzos for a very long time, it can be very difficult to stop. Anxiety and depression in the elderly is a very real thing. People self-medicate all the time for anxiety (EtOH), which has health risks too. I agree (as usual!) with UGoLong, try to see the entire picture of the person. Especially if they're an older person. Everyone deserves to be treated with respect - that includes making an effort to understand their individual situation. I tried to get my family member to stop taking the Xanax, but in the end I concluded it would upset him more to try to get him to taper, than was worth the theoretical benefit.
  9. charlottew

    What's this in jaapa

    Yep, my standard letter to primary care physicians asks them to call and ask for the "LIP taking care of Mr. Jones" if they have any questions. That is easier than writing 'resident, physician assistant or nurse practitioner'. And less smarmy than 'provider. Seems to be clear enough - I have never gotten a query about what LIP means.
  10. charlottew

    Another Doctorate program

    I agree the degree title is less than inspiring. I guess it is 'safer' however to not encroach directly onto the realm of Medical Science. This program has already been running for a year. I think there are some people enrolled in it. I have no idea what they're learning, nor do I have any idea what advantage/open doors having such a degree will confer (OK, aside from the ability to be director-level in a PA program). It certainly does not seem to be clinical training. I am starting to agree with some on this forum that predict a residency will become a more standard part of PA education at some point in the near-ish future. Maybe that will help counter the DNP wave.
  11. In my job I occasionally am asked to manage patients remotely (I can see them on a camera, I can talk to a nurse who is with the patient, I have access to their vitals, lab data and notes about them). I am not particularly comfortable doing so, I rely heavily on the nurse's assessment. I agree with the general sentiment expressed by mgriffiths above; if that was the full-time situation, I wouldn't feel that was appropriate patient management, personally. Everyone's tolerance is different however.
  12. If you're uncomfortable with it, then don't take the job. If you want a job that allows you to work from home, since PA profession is basically a hands-on clinical profession, you will run into some limitations. I Google-searched for literally 2 minutes and it appears that it is legal for PA's to write suboxone/buprenorphine prescriptions for addiction treatment (law passed in 2016 is in effect until 2021) for up to 30 patients. It seems like 24 hours of training/coursework are involved first - perhaps that would help you be more comfortable with the situation. Also, all presumably within the boundaries of local state law governing PA supervision (if these are not federal inmates, then state law would apply, I would think). That said, I Am Not A Lawyer. If you're uncomfortable with a job that asks you to (presumably, refill - or are these new prescriptions?) write for controlled substances, than don't take the job. I hope that helps - good luck.
  13. charlottew

    Seton Hall PA Program- PLEASE HELP!

    Not to nitpick, but it was six semesters. I guess we were busy both summers, so if an academic year is fall to spring, it was more than two academic years.
  14. charlottew

    Seton Hall PA Program- PLEASE HELP!

    The PA program I attended was 24 months, two academic years. Just another data point.
  15. charlottew

    Moving to Boston - Job Hunt

    There seem to be a fair number of urgent care opportunities in the immediate Boston area. Derm is tough to break into of course. Hospitalist positions I see fewer advertised - I would check the hospital websites of places you are interested in, directly. I have also found fairly good listings on Indeed. DocCafe is another possibility. If you are willing to look outside of Boston itself, there will be more opportunities. I agree with above poster that with 1.5yrs experience you will have an easier time than the typical new grad. If you are having trouble hearing back from places, then I would try to either 1) leverage whatever network you have; or 2) re-vamp your cover letter and/or resume to emphasize your relevant experience. Good luck!
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