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About TheDude

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  1. Here's my unfavorite patients from both of my specialties... Cardiothoracic Surgery: The 20 y/o somethings where we replace their valves from all the meth use "I promise Ill get better"....find significant other injecting them post-op with meth...then they demand pain RX's out the ass, come back 2 months later with endo again.... The 4 month post-op that demands pain RX's....tells me that pain is a vital sign....(thanks nursing admin for making this a prob.) The "my "insert family member" is a nurse and said you should be doing this The "I won't follow your post-op instructions....my friend had this done" and then 3 weeks later sternal dehiscense...yay Urgent Care: The 2'fer, 3'fer, and even 4'fer....somehow the visit goes from one person and multiplies....usually with snot nosed bratty kids To echo everyone else, the "I know whats wrong, you just give me what I want" crowd Smelly people.... I call these folks "allergic to soap" Obese people with arthritic complaints...lose weight, it may help some (call me an asshole I'm just being forthright) Narc seekers who think we are stupid "I need the "Lorco's????" Oh you mean Naproxen? The patient with cold symptoms for literally 1 day.... and sore throats that they swear is strep...but its not...here's your bill The patient that has a family member in healthcare, I serve a UC right next to a major college campus, hald the kids I see on the weekends have a parent who's a "doctor"....AKA had one who's mom was an NP....in derm phone in during the visit and was on speaker the entire time tell me that my diagnosis of gonorrhea (confirmed by labs) was only a UTI.... her angel wouldn't do that....and addressed herself as Dr.... not trying to start a battle so whoever reads this and gets their panties in a wad chill out.
  2. @SHU-CH the ROSS is a great option but you have to find a surgeon who's been trained in them and as you stated, experienced. They are becoming more rare due to other techniques chosen and lack of training unfortunately.
  3. Im current CV Surgery, have been whole career. With his age, I'd go with mechanical. Now here is the devil's advocate part, can he be trusted taking his "thinners" and maintain good iNR's? This is always a conundrum with younger patients because no matter how well they have their head screwed on, there is always a concern.
  4. Recently, a facility I do PRN stuff at (EVH, 1st Assist Cardiac) was bought by the large corporation I used to work for. I left there on good terms and went to a private practice group of CV Surgeons and have never looked back. I had to go through credentialing again and all was well and was credentialed. I recently did a case with no concerns but was alerted by my former office manager as well as another PA I worked with that my previous surgeon (and I use that term loosely...I'll explain later) wrote a very nasty and scathing letter to the credentialing board to not have me credentialed. Fortunately for me, 4 surgeons and all the previous surgeons were contacted and the letter was disregarded. I've posted on here in the past about the abuse I withstood from my previous surgeon, and I have had ZERO contact with his since I left over 2 years ago. He's been asked to leave his current group for very sub-par surgical care and what not. I won't knock him in the dirt, but I can say he is not a good surgeon after working with excellent ones since I left him. I can not for the life of me figure out how or why he sent a letter against this facility credentialing me. I've had a surgeon say that this is an offense that needs to be dealt with legally, and I've had one where say leave it alone. In my eyes it's his way of continuing to bully me for reasons unknown. In some of y'alls opinions, what should I do? Call him out? Leave it alone?
  5. 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
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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 :)
  11. 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.
  12. 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?
  13. 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...
  14. 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.
  15. 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.
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