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  1. Hey everyone, New grad PA here and I have a couple interviews with the department of surgery at Jersey City Medical Center. I was wondering if anyone has any insight into the work environment/culture and pay at this hospital or within the RWJ Barnabas health system as a whole. Thanks in advance!
  2. Hello, I am a relatively new neurosurgical PA in Las Vegas, NV. Recently one of the hospital systems we cover (Valley Health System, UHS) here in Las Vegas informed me that in order to gain first assist privileges in their hospitals, I will be required to have a separate first assist certification. If I were to have gotten my privileges completed one month earlier, I would have just been grandfathered in. What confuses me most is that at a few of the hospitals, they are allowing me to have the first assist privileges until my next reappointment in over a year whereupon I will then need to have the certification then to continue having the privilege. At other hospitals within the same system they are not allowing me to have the privileges at all. I have reached out to the AAPA and they drafted a letter to send to several people within the organization, but I have not heard of any response yet from anyone within the Valley Health System. Has anyone else every seen/heard anything like this before? In my opinion it does not make sense and downplays any surgical training we get during school or thereafter. I appreciate any other thoughts, idea, or opinions.
  3. Hello all, Long time reader, first time posting. I recently secured a job at a vascular surgery practice working with 2 different surgeons. The job includes working in all clinical settings (OR, inpatient, ICU, and clinic), but I am especially excited to be in the OR. My start date is at the end of August so I will have some down time before my first day. I was wondering if anyone had any recommendations as to how I can prepare so I can put my best foot forward when I start. Books, online material, videos etc. (I am open to anything really). I do understand that the first year, as a new graduate, can be tough especially starting off in a surgical specialty. Any and all advice is greatly appreciated!
  4. So I am working on my CASPA and have run into a wall. I submitted my transcript because that was always the first thing I was told to do. But my semester ends in two weeks and I do not believe I will have my application ready to submit by then. Will I have to reorder my transcripts to send to CASPA? Or should I just update my grades for those courses? Also, what do I do about future courses where I do not know how the course title will look? Is it ok if those are not perfectly matched to an official transcript?
  5. Hi all, I'm a new grad starting out in ambulatory surgery-- I'm super excited because I love being hands on in the operating room. I was just wondering if any of the Surgical PAs could give some insights about ambulatory surgery? The site I'm going to be working at has 12 surgical subspecialities (list below). From what I gathered through the interview process, I'll be able to get experience in all of them. That being said I'm worried about being prepared and knowledgeable for cases. Anyone have any tips of how to study up, or even get more comfortable once starting? I have a little over a month before start date so any resources are welcome. Thanks in advance! List of subspecialities/ topics to brush up on: Bariatric surgery Breast surgery Colorectal surgery General surgery Head and neck surgery Minimally invasive gynecologic surgery Neurosurgery Ophthalmologic surgery Orthopedic surgery Pediatric surgery Podiatric surgery Sports medicine surgery Urologic surgery Vascular surgery
  6. Hi Everyone! University of Florida PA Surgical Residency is having a panel to talk about the post-graduate residency and answer any questions you may have. If you are interested in becoming a surgical PA or are interested in PA school and learning about different specialties, this would be a great way to get some of your questions answered! The panel is this Thursday, 10/1/2020 from 6:30-8:00pm EST. Pre-register with the link below! https://ufl.zoom.us/webinar/register/WN_-mtC55QfROqsJ3kLO5TAXw PA Surg Res Panel flyer.pdf
  7. https://www.fresno.ucsf.edu/actspar Wondering if anyone has any experience/information/thoughts UCSF Fresno, specifically this ACS/Trauma Surgery Residency. Considering relocating for the opportunity. New grad, I liked what I saw during the visit. Not looking for some one to make a decision for me, but any information would be great. Thanks
  8. I have been a practicing PA for 4 years working in adult acute care medicine (ER, ICU, transplant cardiology). I was recently approached by a recruiter for PA position in pediatric cardiac surgery, which would involve OR and ICU clinical work. Even prior to PA school, I had an affinity for pediatrics and loved my pedi rotation. I had always imagined going into pedi cardiac crit care. My professional life took me towards adult care, and unfortunately has not permitted much in the way of pedi exposure. Has anyone made the jump from adult acute care to pediatric acute care? From chiefly medicine position to surgery? Can you tell me about your experience and any additional insights? It's a helluva jump, I am not naive, but just wanted to see if anyone else has any experience with this. Thanks!
  9. Hello-- Looking to get an idea of what percentage/hourly rate of compensation to ask for. I will be working one day per week in a combined clinic and surgery cases. Currently have 3 years plastics experience including micro. Anyone have any suggestions about what to ask for in terms of reimbursement. This is also a practice that I would consider joining full-time in the future. Thanks!
  10. All, Has anyone experienced being undermined as a PA? I have been a Cardiothoracic surgical PA for 2 years now. And in this new hospital I work at, PAs are not represented much. I believe most of that’s because management is not familiar with what PAs can do, how they can bill, their autonomy, etc. Due to this, their structure has always been having NPs on the floor to round on the post op patients, and RNFAs (nurse first assists) in the OR. The surgeons don’t get involved as much because they‘ve compartmentalized the two groups, and have a head NP and head RNFA who leads their counterparts. But since I’ve joined, and my credentials give me the ability and knowledge to do both parts of the job, I’ve been dealing with a lot of power trips and a lot of them seem to be threatened. And I can’t seem to find a median between being respectful and being assertive. (Especially since I’m still fairly new in my career) I want to work here but I don’t want this to be the issue why I can’t enjoy my job. Thoughts?
  11. Interested in Surgery? An introduction to the OR team By Robert M. Blumm, MA, PA-C, DFAAPA Whether you are a PA student scheduled to start a surgery rotation or an NP interested in moving into surgery, an understanding of the surgical team is beneficial. This article outlines the hierarchy and operation of the typical surgical suite. The Surgeon The surgeon is the attending physician for the surgical patient, responsible for his or her care and treatment while in the operating room (OR).1 Among the responsibilities of the surgeon are to examine the patient, order and interpret diagnostic tests, and to formulate a preliminary diagnosis and a differential diagnosis. The surgeon then consults with the patient to explain the problem and the best approach to it. He or she obtains informed consent and answers the patient’s questions prior to admission to the hospital. Under no circumstances should your personal conversation with the patient contradict the surgical plan previously discussed with the surgeon. The surgeon will be your supervising physician and mentor during the procedure, therefore be prepared to answer questions related to this procedure. If you have a pressing question, ask at the time of closure. The Registered Nurse The operating room is controlled by nurses who have many responsibilities both inside and outside the OR. Nurses are responsible for sterile process in the selection of the proper instruments, packs and gowns. You will encounter many nurses in the perioperative role, and it is important to know their function and how you may best learn from them. Surgical nurses are responsible for the day-to-day safeguarding of surgical patients. The OR Supervisor The OR supervisor has the skills necessary to intervene in all technical problems involving his or her staff, OR instrumentation and equipment and sterile procedure. He or she is the senior nurse who books and schedules cases, assigns rooms to surgeons and acts as coordinator with every other department with regard to the preoperative holding area, the OR and the post-anesthesia care unit (PACU). The OR supervisor is also the nursing officer in charge of preoperative testing. The Preoperative Holding Nurse The preoperative holding nurse is responsible for the timely preparation of the surgical patient. This responsibility begins 3 days prior to surgery by telephoning the patient and communicating important information about admission. This nurse then supervises the gathering of all laboratory results and radiologic tests, patient information and consents. Upon the patient’s admission to the hospital, the preoperative holding nurse interacts with the patient, checks the chart again for completeness, and assures that all consents, notes and orders are signed by anesthesia staff and the surgeon. He or she also starts the IV and administers ordered medications. This nurse is critical to the timely flow of surgical procedures. The Circulating Nurse The circulator is responsible for the acquisition of all supplies, sterile equipment, machines and sets needed for surgery. The circulator then works with the scrub nurse or scrub technologist to set up the case and assure that all necessary equipment and supplies are in order. The circulator then gathers all the necessary equipment for the administration of anesthesia. After placing the patient on the OR table, checking the patient‘s ID bracelet, verifying the patient’s surgeon and the scheduled procedure, the nurse in this role reassures the patient and may provide warming blankets. The circulator then assists the anesthesiologist in the administration of anesthesia and helps dress all “scrubbed personnel.” The patient must be in a specific position for surgery. The circulator works with the anesthesiologist, the surgeon and the first assistant to achieve the required position and documents all safety measures. The circulator then prepares the patient’s surgical site with the appropriate preoperative washing agent and prep materials. Prior to the start of surgery, the circulator calls a time out in which the name of the patient, his or her condition, the site of surgery and the procedure is verified with the surgeon and all in the room. As the case commences, the circulator supplies the sterile members of the team with additional sutures and supplies, oversees the sterility of all the members of the team, communicates with all departments and facilitates the acquisition of emergency equipment and additional supplies such as blood. The circulator is the manager of the OR record and is available to help any member of the team, particularly in an emergency situation, such as the onset of cardiac arrest or malignant hyperthermia. The circulator performs an important final step: He or she orders a count of all sutures, needles, sponges, lap pads, etc., and confirms the count is correct. He or she applies dressings and assists in the extubation of the patient and the safe transfer to the PACU.2 The Scrub Nurse The scrub nurse may be an RN or an LPN. He or she has specialty training in surgery and surgical technique and instrumentation.3 The scrub nurse gathers supplies prior to the case (along with the circulator) and plans for additional supplies that may be needed. The scrub nurse then scrubs for the case and the setup of all sterile equipment. This person is the sterile staff member and supplies the surgeon and assistants with sterile instruments, sutures and other supplies. The scrub nurse is an excellent source of information for PA students or NPs who are new to the surgical suite. The scrub nurse has the authority to note a break in technique and to request that sterile scrubbed personnel change gloves or gowns. The scrub nurse anticipates the needs of the surgical team. At the conclusion of a procedure, the scrub nurse may assist in applying dressings and the safe moving of the patient from the table to the OR stretcher. The PACU or Recovery Room Nurse The PACU or recovery room nurse accepts the patient from the OR and immediately provides a secure environment for proper airway, oxygenation, suction and care. This nurse is an expert in critical care and is responsible for the safety of the patient while he or she is in this area as well as the safe movement of the patient from the PACU to any other area of the hospital. The PACU Nurse can be a source of information for postoperative orders and medications and your right hand if an emergency occurs. The Surgical Technologist The surgical technologist has the same responsibilities as the scrub nurse, but he or she has less responsibility in an emergency because he or she is working under nursing and has limitations on the ability to administer drugs and blood products. The surgical tech is a trained (often certified) member of the team who can provide insight into the needs of the surgeon, his or her approach, his or her mannerisms in surgery, his or her areas of intolerance, and the specific requirements of the first assistant. The Anesthesiologist The anesthesiologist is a physician who is an expert in pulmonary medicine and the science of providing sleep and analgesia for the patient who is undergoing surgery.4 The anesthesiologist consults with the patient prior to surgery to discuss the planned procedure and anesthetic.5 He or she determines whether the patient should have local, regional, spinal or general anesthesia. This decision is based on the patient’s medical and surgical history, family history and psychological status. The anesthesiologist maintains constant awareness of the cardiopulmonary status of the patient. After entering the OR, the anesthesiologist checks the IV line and makes sure that all preoperative medications have been administered. He or she connects the patient to cardiac leads and assures that the patient’s cardiac and pulmonary status are being monitored prior to and during the course of anesthesia. He or she attaches a pulse oximeter and blood pressure cuff and ensures that all necessary equipment and drugs are available to perform intubation. During the surgery, the anesthesiologist maintains an open airway, proper breathing and circulation and keeps the patient in a highly oxygenated state to administer drugs as needed. The anesthesiologist is also responsible for positioning and evaluating both the intake and output of the patient. The second anesthesia provider is the certified registered nurse anesthetist, physician assistant anesthetist. These professionals are experts in managing a patient under anesthesia.6 They have obtained graduate-level education in this area.7,8 The First Assistant Numerous types of “first assistants” exist in the OR, and they include surgeons, residents, interns, medical students, family physicians, PAs, NPs, certified registered nurse first assistants, registered nurse first assistants, perfusionists and certified surgical technologists–certified first assistants. The responsibility of the first assistant is to be the assistant surgeon during a procedure. This requires knowledge of anatomy and physiology, surgical handling of tissues, surgical instrumentation and surgical procedures. In addition, the first assistant must be skilled in suture techniques, positioning, sterilization, sterile technique, prepping and draping, pre- and postoperative care, and the use of suctioning equipment, splints and casts. The first assistant must have well-honed decision-making skills that can add to the successful completion of surgical procedures.9 Physician assistants who specialize in surgery have a specialty organization, the American Association of Surgical Physician Assistants (AASPA), which provides continuing education and networking opportunities.10 The surgical PA orders tests, interprets test results and writes admitting orders, progress notes and postoperative orders. Surgical PAs determine when a patient may ambulate or be discharged, write prescriptions, perform discharge summaries and plan postoperative follow-up.11 Nurse practitioners may also function in this role. All hospitals establish criteria for who may “first assist” and on what cases. NPs apply for credentials in the same manner as PAs and must specify a supervising surgeon. This requires the NP to have a relationship with a surgeon or surgical group. For information on advanced practice nurses transitioning to a first assist role, see the following article: http://www.medscape.com/viewarticle/499689. Preventing SSIs There is no better manner in which to conclude this overview of the OR team than to focus on prevention of surgical site infections. Surgical site infections affect 750,000 patients every year in the United States.12 These infections can increase length of stay in a hospital for up to 10 days. Increased length of stay adds $20,842 to the average patient’s hospital charges.12 These excess charges are now absorbed by the institution, not the insurance company. Appropriate implementation of the perioperative role can render these infections preventable. Visit www.AORN.org, the website for the Association of periOperative Registered Nurses, to find advice for preventing surgical site infections. Pay specific attention to recommendations for hand washing, hair removal, prepping and draping. Additional guidance is available from the Centers for Disease Control and Prevention at www.cdc.gov/handhygiene/24. Robert M. Blumm is a surgical physician assistant who lives in Amityville, N.Y. He has served as president of the American Association of Surgical Physician Assistants, the Association of Plastic Surgery Physician Assistants, the New York State Society of Physician Assistants and the American College of Clinicians. He is a member of the editorial advisory board for ADVANCE for NPs & PAs. Blumm has completed a disclosure form and reports no relationships related to the content of this article. References 1. Kurzweg FT. The patient, his surgeon and the record. In: The Surgeon’s Handbook. Garden City, N.Y.: Medical Examination Publishing Company , Inc.; 1982: 3. 2. Position statement of the Association of periOperative Registered Nurses. One Perioperative Registered Nurse Circulator Dedicated to every Patient Undergoing a Surgical or Other Invasive Procedure. http://www.aorn.org/Clinical_Practice/Position_Statements/Position_Statements.aspx. Accessed Dec. 27, 2011. 3. Centers for Medicare and Medicaid Services. Conditions of participation for hospitals: surgical services. http://www.cms.gov/manuals/downloads/som107ap_a_hospitals.pdf. Accessed Dec. 27, 2011. 4. Sweeny F. Who’s the person giving my anesthesia? In: Sweeny F. The Anesthesia Fact Book. Perseus Publications; 2003: 3-12. 5. University of Cincinnati Residents, Berry S. The Mont Reid Surgical Handbook. 4th ed. Mosby;1997. 6. Sumpter R. Anesthesia. In: Labus JB. The Physician Assistant Surgical Handbook. W.B. Saunders; 1998: 19. 7. All about anesthesia. American Association of Registered Nurse Anesthetists. http://www.aana.com/forpatients/Pages/All-About-Anesthesia.aspx. Accessed Dec. 27, 2011. 8. Facts about AAs. American Academy of Anesthesiologist Assistants website. http://www.anesthetist.org/factsaboutaas/. Accessed Dec. 27, 2011. 9. Weis MK. The first assistant and collaborative practice. In: Rothrock JC, Seifert PC. Assisting in Surgery: Patient-Centered Care. Competency & Credentialing Institute; 2009: 387-405. 10. American Association of Surgical Physician Assistants website. www.aaspa.net. Accessed Dec. 27, 2011. 11. Blumm RM, Condit D. Surgical physician assistants help solve contemporary problems. Bull Amer Coll Surg. 2003;88(6):14-18. http://www.facs.org/fellows_info/bulletin/2003/blummcondit0603.pdf. Accessed Dec. 27, 2011. 12. Manz EA, et al. Clipping, prepping and draping for surgical procedures. Managing Infection Control. 2006;August: 84-97.
  12. I have a friend who is a fellow new grad PA, and she is considering a 2-year residency program in psych. She has a passion for psychiatry and could see herself making big differences there, however she is worried that she may begin to forget general medicine if she only works in psych for 2 or 3 years. Her other passion is ortho surgery (and other general surgery). She has also considered pediatrics and inpatient neonatal as other close-2nd choices. So, I'm wondering if anyone has had to decide between two fairly distinct specialties or switched between the two, years down the road. In particular has anyone here gone from a psych residency program to another specialty (or moonlighted / floated elsewhere)... or any other residency program to something else? In general, how difficult is it to find a general medicine or even surgery job after working only in psych for a while?
  13. Hi there! I am a new graduate that recently accepted a general surgery job from a local metro hospital. I will have the opportunity to perform a lot of procedures and with time a lot of autonomy. I am excited, but I am also aware of all that I don't know and still have a lot to learn. Is there any advice or textbooks any of you could give? I was a scrub tech for years before attending PA school, so the OR life is like home to me.
  14. Hello, In my pre-pa club a member asked a question about surgery for PA’s. The question was “Is it true that in order to assist in surgery you need to do an extra year of schooling after your PA program? Do this require you to pay more for school? Is this included in your PA schooling years or would you need to reapply for that surgical year?” I thought it was an excellent set of questions, which I would like more answers for.
  15. Hey yall, Im facing a bit of a dilemma. I got a new grad offer for a Surgical Position that is offering me the package below in NYC 105K Base Salary 10% Night differential 20 PTO days, 8 paid holidays, unlimited sick time, 12 weeks of paid salary for sick leave 8-10% Increase every year Health package as well The reason I am conflicted is id like to make a counter offer for more but dont know how to go about it. A friend of mine got a similar deal but 5K more out east without negotiating in the same system. How should I go about negotiating it? What are some tips you can provide to get it higher salary or a better benefits package. Why would would there be a discrepancy between both?
  16. Hello All, Our Cardiothoracic Surgery Group at St. Joseph's Hospital in Tampa, Florida is looking to add another PA. We currently have 3 Surgeons and 4 PA's. Salary is based on experience. If you or anyone you know may be interested, feel free to shoot me an email. Thanks! Paolo Calizo, PA-C paopaocali@gmail.com
  17. Hello All, Our Cardiothoracic Surgery Group at St. Joseph's Hospital in Tampa, Florida is looking to add another PA. We currently have 3 Surgeons and 4 PA's. Salary is based on experience. If you or anyone you know may be interested, feel free to shoot me an email. Thanks! Paolo Calizo, PA-C paopaocali@gmail.com
  18. I started a new job in orthopedic surgery 4 months ago with an orthopedic surgical group. Some of the surgeons allow residents to train under them in the OR and clinic. So far, the residents have been cool and I’ve learned some stuff from them. However, I sometimes get the sense I am jockeying for position as the first assist. Ultimately, my role is to assist the primary surgeon. For instance, during shoulder scopes the resident will stand at the head of patient (lateral positioning), then the surgeon, and then I’m towards the feet of the patient. I noticed I’m pretty useless down there. Last week, I was respectfully assertive and stood at the head so I could actually assist. Total joints are a different story...I’m across from the surgeon and the resident is next to the surgeon by the head. My question is, what should my approach be? Should I appropriately establish myself as first assist? The resident and I will sometimes switch as to who is the main assist. I’ve also found myself be a little more in tune with opportunities to be steps ahead of the primary surgeon ready to be there to assist the next move...but I’m not in the main position and I watch the resident miss an opportunity. I would imagine that as I gain more experience and earn the trust of the surgeons, maybe my role will be more clear? I want to do my job well but not be a d***. Any orthopedic PAs or surgical PAs work with residents in the OR? How do handle things?
  19. Thumper was a respondent on the Becker site and "Optimal" in this setting refers to optimal exceeded workloads which many of us have. Not unlike Thumper, I agree that this is an issue that has ramifications such as this study but affects many more caregivers such as the different techs, nursing assistants, PAs and NPs in the hospital setting and emergency room clinicians as well as surgical staff, including the surgeons themselves. The nurses are the first to suffer as a large group as they are understaffed and instead of a 6:1 ratio of nurse to patient, a night shift nurse can have a 16:1. Did the patients magically change their admitting diagnosis or are these the same patients with the same problem and the addition of poor sleep in their surroundings compounded with post-operative pain. They are under-treated, seen ,perhaps twice a shift,even if they are hitting the call button. From a NA standpoint,patients are not turned, properly fed or soiled beds or diapers are not changed adding to skin and soft tissue breakdown and decubitus ulcers. The nurse needs to be "The Flash" to dispense medications and these type of errors can be deadly. Yes, personnel costs money but the litigation's and need for additional time in the hospital at its own expense is far more. My mother-in-law was a DON at three hospitals and found this happening in all three and was frustrated by administrations refusal to hire more people. Surgical personnel are more scarce because so few are trained in this discipline and it is not unusual for a surgical nurse, surgical technologist, surgical PA or NP and the surgeon themselves to work more than 80 hours to a hundred hours per week. Let me prove this as a malpractice attorney and I would have a field day of serving the institution and the caregivers who legally are working while intoxicated due to lack of sleep. Do we really care? If these providers started a pact and documented these atrocities ,hospitals would be put out of business. As a PA who cares, I would join the pact because our patients are failing because of lack of revenue to pay employees but fat paychecks for administrators.
  20. Surgical PAs! I'm curious to know how your schedules are structured. I'm hoping to gain insight on how similar practices operate and hopefully create a more efficient structure for my own group. I'm currently part of a hospital based neurosurgery group consisting of 7 PAs and 7 surgeons (when fully staffed, + 2 surgeons who are there part time). We also have a residency program. PA responsibilities include call (6a-6p), inpatient, clinic, and OR. We work 4 days a week with a rotating day off to keep us under/near 50 hours/week, and 1/8 Saturdays. We are, as a whole, looking for a more 1:1 relationship with a physician to improve continuity/sanity and gain autonomy by predominately working with one doc. I have thought about how to accomplish this for hours upon hours, but run into significant road blocks each time. I'd love some fresh perspective! Thanks in advance.
  21. Although I’m not a PA yet, I hope posting in this forum is fine, as I’m seeking info on existing surgical PA’s. So, what’s your specialty? I’m very interested in surgery, but I also would like to have a decent lifestyle outside of work. I’d also prefer to do more lower-risk surgeries versus something like trauma patients. The only PA I know personally specializes in urology. She works a normal schedule, is married, and has a child. I love the aspect of surgery, the idea of savings lives, and even working weekends when they need me - I hope I don’t give off the vibe that I don’t want to work. Any PA’s out there in surgery that care to comment on your work-life balance? Any insight is very appreciated!
  22. Hi, everyone. I’m going to attempt becoming a PA and need some advice. I have a good idea on what I’ll be doing to attempt getting into programs, so I’ll go ahead and give you my estimated credentials when applying to a program, sometime in the next 4 years. Bachelor of Science in Psychology with a minor in Health Sciences from Arizona State University. 3.6 GPA Standard GRE scores (haven’t taken any yet, but to play it safe, I’ll just say I’ve hypothetically scored average or slightly above average) Surgical Technician degree from a local technical college with ~ 2,000 hours clinical experience with ~ 500 hours of volunteer hospital-related work. Seeking to become a Surgical Physician Assistant. My main concern is that I’ll be attending ASU Online. I live in Georgia, so I’m sure the topic will be brought up and if I moved here, took online classes, etc. I’m completely content with online classes and don’t think they’ll harm my chances. I’ve inquired to PA programs near me, and they have all said they accept online programs like I’m pursuing, but that doesn’t let me know if someone would be deemed more competitive if they had similar credentials as me but in a physical campus. For my labs (required for PA program acceptance), I will actually have to fly out of state and attend those in person in an accelerated fashion specifically designed for out of state online students, so I’m still getting that physical lab presence, and it’s from a highly respected university. With all that being said, I currently have a job in aviation with a Fortune 500 company - I know, totally different world. My point is that I make really good money for my age. I’m 24 and made a little over $60,000 last year, which is very good in Georgia. So I don’t want to leave my current job to pursue school in a more traditional sense. I’m actually attending two colleges simultaneously - the local tech college for my Surgical Technician degree and ASU. I’ve just started on my ST program, which will take about 18 months. In this time, I can continue to go to ASU Online, work towards my bachelor’s, and save up as much money as possible from my job. After I complete the ST program, I’ll leave my current job to gain some clinical experience. I’ll have about 2-3 years left for me to finish my bachelors, which will give me plenty of time to rack up those required clinical hours. Sorry to rant, but I just wanted to get everything out there in a single post. Do you guys think I’m on the right track? How do you feel about me getting an online degree from ASU while simultaneously working for clinical experience? Does getting a degree part-time look less competitive than someone who’s going to college full time? How do you feel about my credentials? Answers to any questions are highly appreciated! Thanks again.
  23. Postoperative Wound Monitoring App Can Reduce Readmissions and Improve Patient Care Patients gave universally positive feedback about the app’s ease of use and the ability to have wounds monitored CHICAGO (January 19, 2018): A new smartphone app called WoundCare is successfully enabling patients to remotely send images of their surgical wounds for monitoring by nurses. The app was developed by researches from the Wisconsin Institute of Surgical Outcomes Research (WiSOR), Department of Surgery, University of Wisconsin, Madison, with the goal of earlier detection of surgical site infections (SSIs) and prevention of hospital readmissions. The study results appear as an “article in press” on the website of the Journal of the American College of Surgeons ahead of print. WoundCheck is a HIPAA-compliant, user-tested iOS app that enables patients to transmit daily surgical wound images from their home to a clinician. Image courtesy of the Journal of the American College of Surgeons. SSIs are the most common hospital-acquired infection and the leading cause of hospital readmission following an operation.1,2,3 Due to the prevalence off SSIs, the WiSOR research team decided to see if postoperative wound monitoring could be effectively achieved by having patients upload photos through the WoundCare app and answer a few brief questions to gather information not easily captured through images. “Patients cannot identify [infections] and frequently ignore or fail to recognize the early signs of cellulitis or other wound complications,” study authors wrote. “This drawback leads to the common and frustrating scenario where patients present to a routine, scheduled clinic appointment with an advanced wound complication that requires readmission, with or without reoperation. However, the complication may have been amenable to outpatient management if detected earlier.” Forty vascular surgery patients were enrolled in the study. There was an overall data submission rate of 90.2 percent among participants, and submissions were reviewed within an average of 9.7 hours. During the study, seven wound complications were detected and one false negative was found. “We set out to come up with a protocol where patients could become active participants in their care and allow us to be in closer communication and monitor their wounds after they leave the hospital,” said lead study author and general surgery resident Rebecca L. Gunter, MD. . “This approach allows us to intervene at an earlier time rather than waiting for patients to come back in after the problem has already developed past the point of being able to manage it on an outpatient basis.” Patients were enthusiastic about the app’s ease of use and the reassurance they felt having their wounds regularly monitored. The nurse practitioners responsible for reviewing the submitted images attested to the value of the photos and patient satisfaction, although they also noted it was difficult to find time to review the submitted images on top of an already heavy clinical workload. Study authors note that the success and sustainability of a post-discharge wound-monitoring protocol requires a dedicated transitional care program and not simply adding a task to the current staff workload. This protocol also has a cost-savings component, in addition to the patient safety and satisfaction aspects. Study authors note that SSIs are the most expensive hospital-acquired infection, costing an average of nearly $30,000 per wound-related readmission and an estimated $3-10 billion annually. “If you could imagine saving the cost from the number of patients whose readmission you were able to prevent, that result could provide significant savings to the health system,” Dr. Gunter said. Although capturing specific numbers related to cost-savings was not part of this study, Dr. Gunter said it is an important area of focus for future studies. A limitation to telemedicine protocols that call for the use of smartphones is that not every patient has the necessary technology or knowledge to upload images on their own. The WiSOR research team addressed this issue by having participants undergo tailored training to learn to use the WoundCheck app. They provided each patient with an iPhone 5S and an accompanying visual reference guide to further assist in using the phone and app. Dr. Gunter said they were very successful in giving patients knowledge and access to technology so they could participate in the study. She said this is a model easily adaptable to other medical centers, whether through providing participants with a phone, having a rotating supply of phones at the hospitals for patients to borrow, or relying on a patient’s personal device. “We have demonstrated that a population of complex and high-risk patients, many of whom are older adults and novice smartphone users, can complete this protocol with high fidelity and satisfaction,” the researchers concluded. Study coauthors from the University of Wisconsin, Madison, include Sara Fernandes-Taylor, PhD, Shahrose Rahman, BS, Lola Awoyinka, MPH, Kyla M. Bennett, MD, Sharon M. Weber, MD, FACS, Caprice C. Greenberg, MD, MPH, FACS, and K. Craig Kent, MD, FACS. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. Support for this study came from the Agency for Healthcare Research and Quality: AHRQ R21 HS023395. Dr. Gunter is supported by the National Institutes of Health: NIH T32 HL110853. This study was presented at the 13th Annual Academic Surgical Congress, Las Vegas, Nev., February 2017. Citation: Feasibility of an Image-Based Mobile Health Protocol for Postoperative Wound Monitoring. Journal of the American College of Surgeons. Available at: http://www.journalacs.org/article/S1072-7515(17)32152-X/abstract. __________________ Wiseman JT, Guzman AM, Fernandes-Taylor S, et al. General and vascular surgery readmissions: a systematic review. J Am Coll Surg 2014;219:552-569.e2. Weber DJ, Sickbert-Bennett EE, Brown V, et al. Completeness of surveillance data reported by the National Healthcare Safety Network: an analysis of healthcare-associated infections ascertained in a tertiary care hospital, 2010. Infect Control Hosp Epidemiol 2012;33:94-96. Lewis SS, Moehring RW, Chen LF, et al. Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infect Control Hosp Epidemiol 2013;34:1229-1230. Chapter Robert M. Blumm, MA, PA, PA-C Emeritus, DFAAPA The year 2017 was an amazing chapter in our lives with many changes in leadership, politics, healthcare, the advancement of both the NP and PA professions, tremendously increased knowledge in medical education, the loss of at least twenty-five international personalities and, for a number of us, a year of unprecedented medical litigations due to medical errors, the traps of an EMR, informed consents and failure to diagnose. We have gained much in the ability to enter new fields of interest and to become pioneers in specialties, but all of this has a cost. We always will pay a price to gain a prize. We are now writing the first few pages of a new chapter with the hopes of improving our personal skills, our professional achievements, our outcomes with our patients and our overall success in life and in the marketplace. “The new year stands before us, like a chapter in a book, waiting to be written. We can help write that story by setting goals.” Melody Beattie In order to set goals, it is essential to know the facts and change the outcomes or the injury created by a faulty outcome. CM&F insures 12,000 NPs and PAs and serves them with diligence, respect, and instant access. With OPA becoming the buzz word for PAs in this new year, it is my hope that PAs with an eye toward future independent practice will become aware of the absolute need to have a personal liability insurance policy as offered by CM&F as the endorsed group for the AAPA. This could have an extremely favorable impact on premiums for PAs. There are so many positive aspects of independent practice for NPs, but payouts for malpractice claims filed against NPs are on the rise, according to a new report. The average payout was $240,471 according to studies from CNA Insurance which covers NP malpractice insurance. The highest area of claims is neonatal, which at only 1% of the claims was $630,411. Obstetrics, another high-risk area, had indemnities that averaged $417,500. The lowest of the three was emergency medicine with indemnities averaging $277,812. Though those three specialties accounted for the costliest claims, the vast majority of closed claims were related to four other specialties: adult primary care, family practice, behavioral health, and gerontology. It is surprising, as well as a hidden trap, that most of these were related to a failure to order a medical test or obtain an address that test result.* As I mentioned earlier, knowledge of the facts can dramatically change the outcome; the meticulous attention of the provider is essential. So my fellow colleagues, how will we write the 2018 chapter of our history? We can all hope for a greater future with less misadventure, fewer litigations, and healthier patients. But we must engage with the conscious reminder that we are caregivers and we are, therefore, vulnerable. Why carry that vulnerability on our own shoulders when the fear, anxiety, and burden can be shouldered by personal liability insurance? How empowering is the knowledge that we are protected from potential errors by specialists who are experienced fighters in this field of litigation? What do you believe? What price are you willing to pay to obtain security and peace? “Beliefs have the power to create and the power to destroy. Human beings have the awesome ability to take any experience of their lives and create a meaning that dis-empowers them or one that can literally save their lives.” Tony Robbins. Let us join hands together and make the latter choice. * Source- CNA and Nurses Services Organization (2017, October). CNA and NSO Nurse Practitioner Claim Report (4th Edition): A Guide to Identifying and Addressing Professional Liability Exposures, page 12. Retrieved from https://www.nso.com/Learning/Artifacts/Claim-Reports/Nurse-Practitioner-Claim-Report-4th-Edition-A-Guide-to-Identifying-and-Addressing-Professional-Liability-Exposures. -- Robert M. Blumm, MA, PA,PA-C Emeritus, DFAAPA Surgical PA, National Conference Speaker, Author, Suture Workshop Director, Former AAPA Liaison to American College of Surgeons, Past President four National Associations, Editorial Board Clinician1.com, Advisory Board POCN., AFPPANP Treasurer Information about my suture video. Information about upcoming live suture workshop
  24. http://www.beckersspine.com/spine/item/24235-the-role-of-the-pa-today-5-thoughts-from-spine-surgeons.html
  25. Has anyone here used NEJM Knowledge Plus to get CME? What is the best CME sources for surgery/trauma/critical care that doesn't cost an arm and a leg plus my left kidney? Thanks
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