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zeusfaber

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  1. It was my fault for disclosing it - I shouldn't have. They have a comprehensive health history form as well as a form that a provider has to do - and it's the standard "military physical". I'm too honest and answered yes to the question "Have you ever sought counseling?" The doc who filled out my physical form, where he has to comment on my health history, noted that I sought brief counseling, it resolved, the end. They then came back with requests for details, where I had to disclose the diagnosis, which was MDD. Multiple colleagues (PHS and non) have said that I should not have disclosed it. The doc who did my physical in retrospect said I shouldn't have disclosed it although at the time he didn't comment either way, as he also did not think it would be an issue. He is PHS and used to do military physicals when he was in another branch of service, so he would know. I also had used my work insurance to pay for it, and had previously disclosed the counseling on my background check, so I figured lying about it and then getting caught would be worse (perjury, etc). I was then informed that the PHS simply don't have the manpower to cross check and they would never have known. So to summarize, I disclosed it bc I was scared of lying about it and then getting caught since I felt it was "traceable" but it seems like I shouldn't have disclosed it and it would have been fine.
  2. I don't think it was the right thing to do for me. I was trying to be proactive about my negative mindset, but had I known that I would be "labeled" with MDD and in the future be denied career opportunities, I would have just worked through it on my own. I wasn't in any danger of harming myself or needing medication. It "cleared up" as soon as I started working again. Seeking mental health care has hurt me more at this point by getting in the way of my USPHS application more than it helped me at the time. In fact, I would strongly discourage others from seeking mental health services unless they have sustained symptoms, SI/HI, or psychotic symptoms. Or at least, I would advise them to go outside their medical home and pay cash. I disagree that MDD is "a part of me." I don't think that 4 visits to a therapist over 3 months because I was fired from my job and recently dumped should alter the course of my career to this degree nor should it define who I am. What did help me was starting a new job where I fit in well and felt valued. I did try to argue about whether or not the criteria for MDD were met - according to the therapist, they were - because of answers to questions I was asked, such as "do you feel sad most days" and "are you sleeping more or less than normal" (I was sleeping more bc I didn't have a job to go to...). My friend who is a psychologist disagrees that the criteria were met and would have called it Adjustment Disorder since it was less than 6 months and resolved once the stressor was taken away (unemployment). This friend even wrote a super great letter as part of my appeal expressing his disagreement and indignation regarding the disqualification on these grounds. However the therapist was sticking to his diagnosis per the DSM, knowing the implication of keeping this dx on my record, and that was that. MDD or not, I fail to see how this temporary issue which is now completely resolved makes me unfit to serve in the PHS. My boss was in rehab (!!!) when she got into the PHS with a 3 year "probation", my acquaintance has seen a therapist for years but "forgot" to put it on her application, my other colleague has diabetes and is overweight x years but somehow has managed to stay in PHS. One of the PHS nurses has ADHD (he went off meds to be able to stay in PHS) and severe tremors (he does not function as a nurse anymore). So compared to these things I don't know how my situation is so much worse that I'm not fit to serve. I think it's the injustice of this that has me more upset than anything.
  3. Hi all, I just wanted to vent/write this out and maybe get some feedback. I have been working at the BOP since 9/2014, and almost immediately I began the process of trying to get into the USPHS. I had gone through a couple of bad private sector jobs, and finally I felt like I found my calling with the BOP and with the prospect of USPHS service. My whole department is PHS: Both my bosses, the physician, dentist, pharmacist, nurses, and they have all been very supportive in helping me convert - writing letters of rec, etc. In August of 2015, I had finished the interview and was seemingly awaiting my date for OBC when I was disqualified medically. In 2014, I had gone for therapy for about 4 sessions over 3.5 months, when I was feeling bad about being unemployed and also dealing with a breakup. I hadn't taken any meds, wasn't hospitalized or anything - I had just needed to talk to someone and regain a positive mindset. Well, that decision to be proactive about my mental health was apparently the worst decision I ever made. My therapist diagnosed me with Major Depressive Disorder, and when the USPHS medical board got this information, I was disqualified. I was permitted an appeal for the decision, which included more letters of rec from my SP (the clinical director), my boss, the warden of my facility, and another personal statement. I tried to get the therapist to change his diagnosis to Adjustment Disorder (he said no, that I met the criteria for MDD and that was that). He did write me a letter saying the condition was resolved, there is no follow up indicated, etc. The answer from USPHS after I appealed: Still no. In the aftermath, I realize I just shouldn't have disclosed my having gone to therapy to the PHS. It was such a non-issue that now has slammed the door on the career opportunities that I would have had through the PHS. I love my job at the BOP but it doesn't pay enough, doesn't have career growth opportunities and I can see myself outgrowing it soon. I feel very lost right now. I am disappointed that the PHS - an organization of health care workers - can't see the nuance between someone who went to therapy briefly and someone who is truly mentally ill and not fit to serve. Also, it is known that the BOP needs PAs and has a hard time recruiting qualified providers. I've lost a lot of respect for the PHS, to be honest. My colleagues are all equally shocked and disappointed, since I'm very highly regarded in my department and they all went above and beyond to support my application and my appeal (while also agreeing that I shouldn't have disclosed the therapy). I feel like I poured so much effort into my PHS application - possibly more than my PA school application - and also had excitedly told family and friends about PHS when I passed the interview portion and was supposedly awaiting an OBC date. I just feel lost now, I feel like the rug has been pulled out from under me, and I'm not sure what my next career steps are - since I had big plans with the PHS and was hoping to go out on deployments, eventually work at the CDC or FDA, etc. Perhaps I shouldn't have made these plans, but it's hard not to think ahead when you spend over a year applying for something like this. Anyway, I guess I'll be working at the VA or something in the future, and that will be my life path. Sorry if this post sounds overly dramatic - this has been one of the biggest, most frustrating professional disappointments I've experienced and I just needed to vent. If anyone has any info about how to still try to get into the PHS, I'm all ears - doesn't sound like they have any wiggle room on the disqualification though.
  4. It's pretty easy to find addresses and phone numbers by internet search of a person's name. I have a unique name (I'm likely the only person in the world with my name, definitely the only one in the country) and if you search me on google you can find my entire extended family's names and their home addresses, including my parents' home where they live with my brother. It definitely frightens me, especially since I work in corrections. Not a whole lot I can do about it, unfortunately.
  5. I asked a colleague psychologist about the diagnosis; we went over it together. According to the DSM 4, my original dx (Adjustment disorder) would also have been appropriate; however my therapist changed it apparently due to the length of time I had the symptoms (my colleague disagrees with this reason.) According to the DSM 5, I did meet the criteria for MDD (single episode) which trumps Adjustment d/o. My colleague is helping me draft a letter to my therapist asking if he would consider changing the diagnosis. He probably will not do that though. I'm still not sure what my 'angle' should be. If I can't really challenge the diagnosis, what should I even say as part of my appeal? Write a letter begging and pleading? Should I see another therapist to pronounce me "normal"? And do I even have any chance of being granted this appeal? As a sidebar, my therapist is salaried by my medical group so he doesn't have an incentive (or at least not as much as a typical fee for service outfit) to label me with MDD.
  6. Hi all, I thought I was right up to the finish line in the 9 month process of applying for the USPHS. I currently work at the BOP as a civilian and am trying to convert. They recently sent me a letter that I was medically disqualified due to receiving 4 months of counseling last year and receiving the diagnosis of Major Depressive Disorder by my PsyD therapist. This was the only time I have ever had therapy, and it was in response to a confluence of some negative life events. Didn't take meds or try to suicide, just needed to talk to someone for a few sessions. Now I'm fine. The therapist has already reported to them that the condition is in remission. I have the opportunity to appeal the decision, but they didn't tell me any details of what I should submit as part of an appeal. Should I just have my therapist write another letter saying I'm okay now? Does anyone have experience with this process? What is my chance of successfully appealing this? If it's a hard line in the sand since I'm now labeled with "depression", I won't bother. I've heard conflicting things. Thanks for any info!
  7. I am from the bay area, and moved back here after graduation because my family is here. Biggest mistake of my life. I left behind two lucrative offers in another great city and then it took me 5 months to find my first job because no one here will hire a new grad. I ended up in the ER where no one wanted to supervise/train a new grad, then at a private practice which was a disaster. I finally got a fantastic (although underpaid) position with the federal government, but it took 2 years and a lot of downtime (and lost income) for me to get here. There are just not that many PAs here and as a result many private practice docs here don't even know what our role or scope is but want to hire a PA because someone told them about the financial rewards for their practice. I would not go NP vs PA (2 years vs many more to get from start to RN to NP) but I would be extremely cognizant of the market for PAs (especially new grads) here in the Bay. If you are willing to go/commute to the Sacramento area or central valley then there will be more opportunities for you, but the Bay is tough. If I had any advice, I would say definitely do PA, but try and do some rotations out here and/or build up contacts so that you can have a head start when you graduate and are ready to move back. Or go to one of the schools around here. Also understand what your options will be. Larger hospital systems and academic centers here seem to only hire PAs with 3+ years of experience, Kaiser and Stanford are black holes, and private practice is a crapshoot in terms of working environment and your role. Other locales seem to not have as much of an issue with hiring and being willing to train a new grad. You don't even get paid more here as a new grad compared to other places with a lower cost of living. Just telling it like it is based on my experience and also those of my Bay Area colleagues. Sorry about the negative slant but starting my career here was a pretty negative experience.
  8. I would not accept the 65K offer at all. It's way too low. Productivity should be a "bonus", not an excuse to underpay you and then make you chase a carrot. Primary care is notoriously low margin with notoriously high "admin" work that will be uncompensated such as lab sign offs, insurance forms (prior auths/pre-auths, explanations about why you rxed this or that), pharmacy phone calls, patient phone calls, review of consults. I would guess it will be nearly impossible for you to make up the difference in salary with a productivity percentage in a non-surgical or procedure-based specialty. You will feel overworked and stressed from trying to squeeze in more and more patients to make productivity, then work after hours to finish charts leading to burnout. Don't settle. You still have some time until graduating and passing boards, I'd keep looking around. Also consider larger hospital systems or academic centers (more structure) or government (no productivity/profit pressure). I work in primary care in a government facility. Slightly underpaid for my metro area (83k), but I work my 8 hours and leave. No one cares if I see 2 patients or 15 patients. Average 10 patients a day and it's plenty because they can be extremely time consuming. No insurance/billing. Limited formulary pharmacy is 5 steps from my office in case either of us has a question we just shout down the hall. No phone calls from anyone. Feel free to PM me for details.
  9. I'm going to agree with the "keep the -C" camp, but for a different reason. It's nice that you've made plans for the next 10 years, but life has a way of throwing out curve balls. Example: my friend's healthy, active, late-30s husband passed away unexpectedly of pneumonia. Yes, pneumonia. She has two kids under 10. She had kept her nursing credentials active even though she was basically a SAHM. Worked three evenings a month at an urgent care clinic just to get out of the house. So now her husband's gone and she has a mortgage, car payments, and 2 kids. She used the clinic experience to first get more hours there, then quickly transition to a full time position with benefits. If she had given up her credentials and not worked at all, who knows how long that would have taken and if she would even have been able to support herself? I'm just saying, you have to be ready to take on these unexpected challenges, not make plans for the rest of your life and then get caught with your pants down. Even if you don't "plan" to return to medicine, keeping the -C would make it a lot easier in case you needed to, and it would be extremely difficult and stressful if you let it lapse.
  10. To answer some queries: Regarding the discharge summaries, I did what I thought was effective at the time - I asked my SP. We did not have discharge summaries in the office but I would have easily researched at the hospital if I knew my SP's advice was not enough for me to do it the way I needed to. It wasn't until I got complaints that I asked a colleague. The other PA - yes, I did call her off and on, but since she was on mat leave, I hesitated to call her and bug her for every little thing. Most of the time, I didn't know I was doing something incorrectly until it caused a problem. She definitely is a superstar, and I do think it was a little unfair that I was thrown into her job without being trained in the non-standard office procedures and expectations at this specialty practice. Like I said, my SP was a really good guy and wanted me to succeed, but also didn't know how the PA did her job so he couldn't completely walk me through lot of things, or maybe I was expected to be smarter/more resourceful and figure them out more effectively than I did. Problem solving/initiative: Definitely need to work on this, as well as not let myself get frustrated and de-motivated so easily. Also need to find a way to organize my responsibilities and come up with methods for fulfilling them. Need to be more aggressive about asking for help when needed. Hopefully therapy will provide some guidance. I've had similar issues at other jobs prior to PA school so hopefully will find a way to address it soon. Future jobs: I'm definitely going to stay away from private practice. I need to be in a place with MAs, admin staff, and other PAs since I clearly cannot dive into admin duties without training and support. I'm thinking of more general practice (IM/FP/obgyn) at large academic centers (hard to get into in my area), as well as the VA and Correctional Medicine. Occ med like someone suggested or community clinics are also on my radar, which seem like they would have more basic medicine and less "other" duties and facets of the job. Thank you everyone for your feedback. I really appreciate everyone's thoughts and words of advice. I'll be continuing to check in here and will respond to queries, and I think everyone has been super helpful, respectful, and encouraging even with the well-deserved tough love. I appreciate everyone reading my very long-winded and repetitive explanations, too. :)
  11. I think you are definitely onto something there. In reflecting on this, I do think that I have a subconscious image of myself as a lowly, unimportant person. I never compromise patient care, but I do see myself being lackadaisical about getting other work done on time because in my head, I feel like it's not important (if it were, they wouldn't have made me, a relatively dumb person, responsible for it). I do think that a lack of confidence underwrites all of this. I am not confident about doing dictations, so I put them off or don't do them. I am not confident about the accuracy of my billing, so I don't do it. etc. I can't possibly be successful if I tried, so I'm not going to try. I don't know why in the world I didn't see the problem with this thinking or link it to what was going on at work. You're totally onto something and I really appreciate you telling me this. I already have an appointment for therapy/evaluation to see if I have a learning disability, adhd, depression, or something else that makes me feel unmotivated. I'm going to remember this component too. Thank you.
  12. Thank you everyone for your responses (and keep em coming). As for what school I went to, I don't want to say the name of the school because I already have a lot of personal identifying info here. I will say that I don't think this is at all my school's fault. None, zero, nada of my classmates have had this problem. I had one inpatient medicine rotation, but it was very "easy" and they did not challenge me at all. My surgery rotation was at the VA and my preceptor would really only first assist and then see clinic patients. The residents handled all the inpatient/hospital stuff. If he put in post-op orders and discharge summaries, I didn't know about it. He was kind of gruff and didn't really want a student (he was forced to by admin). My last inpatient component was with a bunch of residents who ignored me the whole time. I do think that a lot of this is because I didn't have a ton of health care experience prior to school. I was a career changer and worked in a primary care office for a few months prior. If asked, I would discourage schools from accepting people like me. I think it's doing the student and the profession a disservice. Billing/coding - I tried reading the book (it's huge) and also downloaded (and paid for) a few apps, but these were not really helpful due to the specialty, the apps and other resources were more for primary care type visits, and some other resources were for billers/coders, not providers. Was slowly getting it, but still needed to sit down with my rounding sheets and match my chart note to the right code. Really time consuming and didn't always get to this. I didn't realize how unprofessional my attitude about the above paperwork was. I was focused on leaving at the end of the day because I was mentally exhausted and frustrated. I was not staying as late as I could to finish my billing and catch up on documentation. I always thought I would get to it when I had a free moment, which rarely happened. I should have at least tried to prioritize this more than I did. However, even though they mentioned that I was behind in all these things and needed to catch up, I didn't realize I would be terminated for it (if that was even the reason). It wasn't like I never did them, I was just behind. I would have thought that if it had gotten to that point, I would have had a formal sit down or very clear warning. I just didn't take it seriously enough and I recognize that now. It could have been anything, since they didn't say. These are just the weaknesses I recognize in myself. I can learn from it and move on, but I want to make sure I don't fail a third time because I couldn't take it.
  13. wutthechris, Yes, you're completely right. I should have realized how important all of these things were but I just didn't at the time. Like I mentioned, it got to the point where I was just trying to get through the day and was so frustrated by the end of each day that I didn't want to think about work and had to attend to personal matters. I finally did find a colleague at the hospital to help me with discharge summaries. I would read up on procedures beforehand, but I felt like my weakness was not the medical stuff, it was all the administrative duties and keeping up with addressing tasks and phone calls as they would come up, then sign off on lab/path that came in, while seeing patients in the office, while checking which surgeries got added for the next couple days/week (seriously, how many times a day should I be expected to log into the schedule?) I'm not defending my procrastination on important things, which is definitely a serious issue. I was always so flustered and felt like I had way too many things to deal with and would almost "shut down" at the end of the day due to feeling overwhelmed. Billing/charting ended up taking a back seat and procrastination took over. I totally take responsibility for that. However, I am really concerned that I can't seem to handle the myriad administrative tasks that come with being a PA. I'm not a terribly organized person and that was a big problem here. If I had been able to handle the admin stuff, I wouldn't have been so behind on billing/charting, if that makes sense.
  14. JB, I really thought that's what this job was going to be. He trained/molded his other PA and said he wanted to do the same with me. He seemed pretty serious and I think he was being sincere. I just think he had very little time, and it didn't end up happening, or at least not the way I thought it would, or I wasn't assertive enough. He's a super nice guy, very soft spoken, patient, etc. I think the practice was really busy and I didn't get the opportunity to learn/reflect because I was busy rounding/charting, then going back to clinic and seeing patients there. Meanwhile, multiple calls about order clarification, weight bearing status, rx refills, pt questions, pt needs a piece of DME covered by medicare (took me a few days to figure this out), calls from other physicians, etc. No other PA in the office to ask. No one else knows how to handle these things. Takes me much longer to figure out answers than it would someone with more experience, leaving little time for other tasks. Then I started to get frustrated and de-motivated bc I felt like I was just trying to get through the minimum daily requirements and was not really able to devote time to learning, and let some things fall by the wayside. Missed a few important paperwork/admin-related things. Most of these things are normal PA duties, but there was a built-in inefficiency as well as a necessity to "drop everything" and address issues when my SP had a spare moment or a phone call came in. Would get interrupted frequently and tasks would be incomplete by the end of the day, but I'd still be mentally exhausted. Not an excuse by any means. Just an explanation.
  15. wutthechris, I did. The main thing that would happen is he would give me a very brief rundown verbally. Then, when it came to actually doing the thing, I would be doing it wrong, or incompletely. Example, when we talked about discharge summaries, he said something like "Oh no one reads them anyway, you just put date of admission/discharge, d/c diagnosis, d/c meds, and a brief summary of their hospital stay". So I breezed through them or didn't do them in a timely manner, and then when someone else would try to read them (like a snf doctor), they would call him and say my dc summary sucked. He said he would go over it with me but we never got a chance to sit and do it. Same with hospital rounding. I told him specifically I don't have rounding experience. He said that we would round together and he would devote some time to training me in this. Either this totally didn't happen, or he thinks it did (we rounded together a few times when we were at the hospital together, but no specific training was given - it was more of a tag-team approach so we could finish and go home). At my interview, he said he would train me in billing. 2 months into my job, I was waiting for said training, when he said that I was so far behind in billing that it was affecting my performance. I told him I didn't understand it, and he got annoyed. Bought me a book and an online course (that ended up being not useful). (I even bought myself several apps and tried to read online.) So either he was not training me, or he thought he was training me and it wasn't sticking. Or, he was training me and I was so far behind where he was starting from that it didn't take.
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