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TheDude

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About TheDude

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  1. TheDude

    Considering Air National Guard

    Hey all, I am considering the ANG but wanted to pick some of y'all's brains about it. I have been a PA for 4 years and have spent all of it in Cardiothoracic and Vascular Surgery as well as UC and rural EM part time on the side. Where I am geographically located we have an ANG squadron here that utilizes PA's. I've done some basic research and understand that I would go in on a direct commission as a 2nd Lt. if my memory serves me correctly. Here are some of the questions I have though. 1.) Is the health services specialty officer program initial training in San Antonio for 5 weeks? I wasn't sure If my research was correct on this. 2.) What are the typical time commitments? 3.) What is the likelihood of being deployed? 4.) How long are deployments for PA's? I do apologize in advance if I should know the answers to these questions, just wanted to hear from some of y'all who have gone through it. Thanks in advance -TheDude
  2. I am echoing what everyone else said, but sh*t happens. CXR's can be clear as day or clear as mud. I look at tons of CXR's every day (CV Surg) and heck even my attending (31 year surgeon) has missed things. I think Sas said it above where looking for a rib fracture is damn near impossible unless its obvious, well, to add to that, so can a pneumo be damn near impossible to spot on occasion. You did the right thing and tried to contact him.
  3. That depends on the procedure and also the anticoagulant, as well as access to certain equipment such as cautery or silver nitrate. In CV we don't do hardly anything in the office. I can tell you this from experience. Plavix and Fish Oil are the worst in my humble opinion when it come to bleeding. We can bovie the snot out of things and they will still bleed. Fish Oil is a big culprit, but at the same time a necessary evil for some patients.
  4. I'm in Cardiothoracic and Vascular Surgery. I work for a fairly busy private practice group consistent of 4 CV Surgeons and 2 Vascular. I do about 80% OR and 20% ICU, no floor work or clinic-although I do clinic occasionally. I was told early in my CV Surgery career that it's not a career but rather a :"lifestyle" which is very true. Some days I am in the OR from 0630 to Zero-dark thirty (0030), and some days I am in and out and home by 11a. It varies and that will depend on your specialty. I take call, I work weekends, I miss family obligations here and there. It's not a 9-5 job, at least in my specialty and my group. We work hard, but we also take time off occasionally. I like to workout when I can, and sometimes a week will go by and I haven't seen the gym or the trails. Like I said before, there will be times you barely see your family all week, and others you will see them every day, its all in the specialty you choose.
  5. My first day in CV Surgery goes like this. Showed up at 0545 to round-this was after credentialing was approved and sat around my house for about 4 weeks so this was truly day 1 besides computer training and all. First patient to see was a pre-op for a thoracotomy. Reviewed all the notes, looked at his films, reviewed the consent. Time was about 0630 and went in to talk to him about the surgery, Had a somewhat altered mentation, and as a former flight paramedic I wasn't a total idiot, but had a bad gut feeling about this fella. Didn't feel comfortable signing his consent for the surgeon or marking the patient, walked out in the hall and another PA with the CV Surgery service was there. Asked her opinion on the matter, and was met with "not my patient, not my problem, you should know the basics before coming in on day 1. Good luck." and was said very snidely I must add. Long story short, the guy was having a brain bleed. I called my surgeon and told him, he told me he didn't care and to "sign the fucking thing." Went to OR with another PA (who to this day is still a mentor in my eyes and close friend) and his Surgeon and took vein for the first time, and felt a sense of accomplishment when I managed to have the senior Surgeon compliment me. Ran into the fist PA who was a B to me earlier in the morning, and she proceeded to berate me because my surgeon had to call her to go see a consult because I was in the OR. "I don't care if you were in the OR, you need answer your pages when called." I didn't have a pager yet and no missed calls or texts from my attending or anyone else Rest of the day was me sitting in an office overlooking the helipad and wondering if I made the right choice I stayed with this shit show for over a year and half and when I made the move to another practice in the same specialty, I made a vow to not being a d-bag to someone on their first day.
  6. Cardiothoracic and Vascular Surgery here as well as part-time Urgent Care and ER Base salary CV Surg is in the 130's working 25-45 hours a week depending on how busy we get. No extra pay for OT or call. Decent benefits and a pension with hospital as well as qualifying for loan repayment with 5 years of employment Cover CV Surgery call at 2 other facilities...1099 for payment, vein harvesting/1st assist fee of 350/case. Part-time UC and ER combined extra 25k/year with 1-2 shifts per month either 24 or 16 hour shifts. No benefits. I work my rear off now so I don't have to later. My wife and kiddos suffer sometimes in not seeing me, but each year I'm slow down some (at least that's what I tell myself). Located right north of Texas and south of Kansas....if you're geographically inclined :)
  7. TheDude

    Feel bad for this PA.

    Was actually talking with my supervising surgeon about this same topic this morning. I'm in CV and after the bulk of the case is finished, I do the rest-drying up, placing temp pacer wires, sternum wires and then the rest of the closure. The surgeon never leaves the hospital but will sometimes go back to his office which isn't that close to the OR or see patients and what not. I've had a few crash while closing or after we've wired the sternum back together or even better when the last suture is thrown, and we open back up and do what we have to do. Could I place someone back on CPB emergently? Possibly... can't say I've ever done it alone and so many variables go into place as well, like, is the pump set-up and ready to go again? Is the patient heparinized and the ACT satisfactory...the list goes on. I could see a surgeon throwing someone under the bus to save their own arse, but the hospital should have policy in place safeguarding the PA by their credentials. At one facility I cover, it is a vague credentialing policy regarding vessel harvesting and first assisting. At another facility, its down to the letter about closure and when the surgeon can technically "leave" the OR. I hope the poor chap has his ducks in a row with credentialing. Definitely feel sorry for the fella.
  8. Howdy all A local hospital has contacted me about coming on as a PRN CV Surgery PA with primary responsibility of vein harvesting along with some first-assist stuff. In the interview they asked me if I wanted to be 1099 or W2 and then also talked to me about salary vs hourly as well. They didn't offer pay rates as of yet as they have never truly had a PA on staff either full time or PRN so I am the first. I'm an FTE with salary pay at another facility so this will be on a PRN basis and weekend when not taking call at my main facility. This facility is also not very busy and rarely does weekend stuff. The call pay seemed quite low though at $3/hour and then if called in get paid for minimum of 2 hours. They said this is standard for the hospital and nurses (I had to remind them I am not a nurse). So here is my dilemma, is it worth my time and what should I ask for? Call pay-what should I ask for and what is the norm? I don't take call at my primary facility so I do not know what going rates should be. Hourly or Salary? If hourly set a minimum of time, say 3 hour minimum pay even if 1 hour of work? 1099 or W2?
  9. TheDude

    Surgical Procedures

    Most of the time I learned things while on rotations in school. And I've also learned some while on-the-job so to speak. And then I've learned a lot by being thrown into the fire. I'm in CVT Surgery and when it came time to learn vein harvesting, one of the other PA's in the group taught me the basics, and eventually got me comfortable to be on my own. Basic office surgical skills can be studied from books and all, but honestly doing them over and over and over is what will help. I don't think your school failed you, it's sometimes up to you to dive in when on rotations to get exposure. Learning to be eager and not arrogant to get to do something cool takes students a long way, as well as when you're a PA in general. Just kindly ask your attending to let you watch and then do a few things under his/her guidance to "help make me a well rounded PA" to better help when we get busy etc...
  10. TheDude

    Supplemental Income

    I sell drugs. I'm a friendly dealer, I stopped carrying a gun and I always give extra to get more customers... I do UC and Rural ER aside from my primary specialty of CV Surgery. And I also pimp myself out to other hospitals for EVH and EAH for CV Surgery. Word of caution, if you start making good money with the additional income, just be smart with it.
  11. I'll echo what everyone else has said and add my two cents. I have been doing UC on the side from my primary specialty of CVT Surg, but can say that if you have a bad gut feeling, send them. My attending I work with in CVT Surgery always tells me this quote and it applies usually to most that we do in all specialties, "If you're thinking about it, there's reason enough to do it." Meaning, if I think someone needs a CT or LP or something, I send them. Now that's not saying that every ABD pain goes or asthmatic or anything that starts with an A, but I am sure you get the gist if what I'm saying. I've had what I thought was simple stuff end up being much worse than what I thought. I even had an attending from a local ED call me and chew me out for sending him a guy with testicle "achiness" only to turn around and call and apologize after he had an ultrasound done showing a complete torsion. My exam revealed very little tenderness or masses, but something was off and my gut said don't take that chance. So if you can take away anything, use some good ol' common sense and also it never hurts to ask someone else. Don't let your pride screw you over.
  12. TheDude

    MA not PA

    Don't get me started on the family stuff. My wife and sister-in-law are both PT's. My sister in law's husband is a flight nurse. Anytime the family has a medical question, they call him, (I'm a former flight paramedic and have been in CT Surgery my whole PA career as well as rural ER and UC as well on the side so I'm only 3/4 smart.) and when he touts off the totally incorrect information, I just chuckle. My sister-in-law who is a total biatch asks me all the time "do you like get the doctor his coffee and take his coats to the cleaners and all" and my reply is "after I take vein out of someones leg or when I'm done placing a swan line or chest tube or closing a chest..." she knows differently but her husband the rocket surgeon brain scientist transplant helicopter nurse pilot do-it-all tells her all the time in front of me "he can't do that, only NP's and qualified RN's can do that.... I swear there are days I want to beat myself with a football bat when they speak. Best part, she calls me when her kids are sick and requests ABX's, I always say no for a multitude of reasons, but mostly because I am petty :)
  13. I work UC aside from my main specialty (CVT Surgery). The clinic I work at is fairly busy this time of year with the usual coughs colds and FLU stuff. A couple of weeks ago a young lady and her whole family show up for her UTI. I get the usual UA and HcG and off I go. The UA is completely clean, I mean its probably cleaner than mine. I go in to talk to the patient and get an exam on her. As I am talking the mom pipes in and says "just give us our ABX so we can get out of here to go eat, she always has these UTI's and that's what we always get." I acknowledge her and give her the results of the UA and that I need to do a good exam to make sure I am not missing something. She is febrile, has LLQ ABD pain that started peri-umbilical, then moved left, pain has been going on for about 2-3 hours. N/V/D, and pain on exam. I make the comment and suggestion that this is something that needs to be further looked at in depth in the ER and could possibly be her appendix or her female reproductive organs. The mom stands up and starts berating me on how I am stupid and that she always gets these "UTI's" and that I just need to give them their f'ing ABX now. The "boyfriend" in his wife-beater gets between me and the patient and says "You want it in here or outside?" I play dumb knowing that he's about to threaten me. So of course I say "what?" He then proceeds to say he's going to beat my ass one way or another. So I open the door and say "this visit is over, I have offered suggestions to which your daughter may have and that we do not have the ability to treat here and that she needs to be seen in the ER." The all get up, daughter can barely get off the table, The mom making a scene saying she will have my license blah blah blah and throws the doors open and walks out. They go to the local ER. The girl had a ruptured appy, the ER attending calls me to get the story. He gives me a similar picture that they waltzed in with the same complaints and then bam, she has a bad appy, he told me "the idiot down the street said she a bad belly, but we know its a UTI and we want to see another doc." So the ER had another ER attending and the General Surgeon see her, they still wanted to take her AMA but finally came to their small senses. They still filed a complaint on me with the UC and a complaint with the ER. I never heard anything else. Looking back on the EMR, this gal comes in about 2 times a month for variable Uro or Gyn issues and is always given ABX's and then I see they will call saying she's not better. I am assuming she doesn't take the full doses and has developed resistances and all. I'd rather deal with a narc seeker than this crap. This sucked and is becoming just as prevalent as narc seekers.
  14. TheDude

    Kaiser Offer

    GET EVERYTHING IN WRITING! Plain and simple. If it's not in writing, it won't happen or may never happen or may never be offered. This happened to me at my first job out of school. They will willingly screw you at any chance you give them. You- "Remember when we talked about xyz benefits?" Kaiser-"No, I don't recall that..." all with a smiling face. It sounds bad but remember, you have to lookout for YOU on these matters.
  15. So, in follow-up and after speaking with the surgery director (who actually agrees these are really idiotic rules, but has to abide by them due to the rules coming from the top down in a decent sized multi-state system), we are having a fake JACO survey and inspection next week. We have been all told, including the physicians, that we will be penalized if not compliant. I plan on doing what I can to essentially be "compliant" so that means I will look for small ways to skirt the law so to speak. Many Physicians and PA's have provided more than enough evidence to dispel what JACO and CMS and the AORN are wanting to do. I'm still frustrated, but I will continue to push the fight for common sense, which isn't so common anymore.
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