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Day in the life of a PA in primary care?


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Paperwork, paperwork, paperwork, patient following up for a post hospital visit, purely for paperwork.  Then someone with a medical problem that you have been trained to solve, but can't because you have so much paperwork, so you refer to a specialist, which involves paperwork, just not as much.  Then lunch, which you spend doing...you get the idea.

 

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7 minutes ago, ventana said:

i work in corrections

work is amazing - focused solely on providing appropriate care with a great nursing team...

 

yep it is a great field that can be made or broken by your administration...

What are your daily tasks?  What do you do most frequently?  What procedures do you do the most and least?

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admission H&P

chronic care follow up

acute care simple stuff

 

procedures include suturing, FB removal, joint injections, eye exams, splinting, wrapping

All these were learned before going to corrections

lots of nursing management as they are my extenders 

 

I run a jail with 200-250 inmates with an average lenght of stay about 8 months, everyone gets seen

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Yes, there is tons of paperwork, and most of it is an absolute waste of time...but, in my experience it is not as bad as thinkertdm describes.

I see on average 15-20 patients per day, mix of everything from URI to liver failure to orthopedic issues to DM2 to annual physicals, etc., etc., etc.  The majority of days go smoothly, but some days are a train wreck.

The day is filled in between patients with medication refills, responding to patient questions, reviewing results, calling patients if needed (but the vast majority of my phone calls are completed by my MA).

I can be more specific, just ask any questions you have.  The best part, other than building relationships with patients, is being done almost daily by 5:15pm with my desk 100% cleared and going home to be with my family.

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This is what I have seen this AM: Annual, depression, weight loss, insomnia, menorrhagia, hyperlipidemia f/u, abnormal gait in a 15 month old, movement disorder, and right forearm laceration in a 82 y.o. from a dog. 

This afternoon I have scheduled: B12 def, body aches, left ear pain, back pain, testicle "issues", ankle/wrist pain, GAD, sports physical. 

This is the best representation of Family Medicine. 

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I am Primary Care or more accurately Internal Medicine at the VA.

We don't have as much paperwork as we have computer communications - referrals, updates, refills, specialist consult results, etc.

I answer computer driven messages and documents a lot.

My day consists of annual exams on very complex internal medicine patients, mostly male. A problem oriented visit mixed in a few times and the walk-in issue that the RN wants me to see.  My max patient load per day is 14 with 30/60 minute appts.

My job is not for new grads. Period. You have to have time under your belt and prior exposure to a lot of complex medical issues to be in this position. It can be daunting and tiring - a ton of psychiatric issues and lots of polypharmacy with overlapping intense medical problems - CHF, DM, Afib, HTN, lipids, psych, thyroid, derm and a lot of ortho issues, a lot of neuro issues - all in the same patient. 

I am blessed with an LPN, RN and my own clerk. I have two PharmDs in my hall, 2 psychologists and several social workers. I am not alone.  

Private practice was never like this - Family Practice - cradle to grave - 25 patients a day in 10 minute or 20 minute slots with no nursing support and the same myriad of medical issues along with overprescribing of abx and 'soft' medicine where paying one's copay means getting the Rx of choice. 

I like my VA job a lot. Challenging, sometimes depressing but I am practicing medicine and feel valued for the first time in a long time. As a multigenerational military brat - I get to give back as I couldn't serve. That means a lot to me.

I still hold my tenant that corporate medicine sucks and volume does not ever equal good medicine.

Just my crusty old 2 cents.

 

 

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Reality Check 2 -I absolutely loved my VA primary care job, just like yours,  until they turned us into a walk in clinic and started 20 minute slots for the same complex patients that you mentioned.    Had our nurses quadruple-booked with nursing visits in addition to our new and same day patients.

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So far on today's schedule (college health):

Axillary/breast rash
Suture removal
Globus sensation in throat
Minor burn
Spots on penis
STI check
Ear and jaw pain

There is very little paperwork at my job; the occasional peer review and various forms patient bring in.

I go home by 4:30 in the summer, 5-5:30 in the fall, winter, and spring.

We do have to work 6 half-Saturdays a year during the academic terms.

The biggest drain and burnout contributor is seeing 20 ppd in the fall and winter; almost ALL colds, sore throats, and URIs. I hate sick visits. Hate them and their disgusting sick germs. Patients are sick, staff is always sick, I go through 20 masks and a half bottle of hand sanitizer every day.

People think the STI visits are "gross" but really they are easy peasy, I dont mind them at all. Just have to be anal (no pun intended) about doing things by the CDC book because big brother is watching.

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One patient since 7:30 (now 10:07 as I type this standing at the backdoor watching the world go by) and it was a teen snot/ST/cough.  Male with a “possible UTI” this afternoon.  We don’t see STI’s so unless it’s an obvious prostate, “see you later alligator”.  It’s  dead here in the summer with teachers out.

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21 minutes ago, GetMeOuttaThisMess said:

One patient since 7:30 (now 10:07 as I type this standing at the backdoor watching the world go by) and it was a teen snot/ST/cough.  Male with a “possible UTI” this afternoon.  We don’t see STI’s so unless it’s an obvious prostate, “see you later alligator”.  It’s  dead here in the summer with teachers out.

I want that job ? summers only and work from 9 am - 2 pm and leave!

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On 6/18/2018 at 7:53 PM, ventana said:

admission H&P

chronic care follow up

acute care simple stuff

 

procedures include suturing, FB removal, joint injections, eye exams, splinting, wrapping

All these were learned before going to corrections

lots of nursing management as they are my extenders 

 

I run a jail with 200-250 inmates with an average lenght of stay about 8 months, everyone gets seen

I'm a PA student who's really interested in corrections. I was curious how you got into it and if it's possible (or even a good idea) to actively seek out a corrections jobs as a new grad? Thanks! 

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On 6/20/2018 at 12:25 PM, runnerpa-s said:

I'm a PA student who's really interested in corrections. I was curious how you got into it and if it's possible (or even a good idea) to actively seek out a corrections jobs as a new grad? Thanks! 

In a word..no. First there is a HUGE manipulation factor in correctional care. Trying to get something they don't need or out of something they don't want to do. They complain to the medical board about everything at a rate that defies description. Do you want to be a new grad or young PA going after your second job explaining why you had 25 board complaints last year even if they were all unfounded?

Secondly they can be very difficult and complex patients having suffered a lifetime of medical neglect and self abuse. Quite frankly the complexity of these problems combined with the factors discussed above make this a very poor idea for a new grad.

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55 minutes ago, sas5814 said:

In a word..no. First there is a HUGE manipulation factor in correctional care. Trying to get something they don't need or out of something they don't want to do. They complain to the medical board about everything at a rate that defies description. Do you want to be a new grad or young PA going after your second job explaining why you had 25 board complaints last year even if they were all unfounded?

Secondly they can be very difficult and complex patients having suffered a lifetime of medical neglect and self abuse. Quite frankly the complexity of these problems combined with the factors discussed above make this a very poor idea for a new grad.

Thank you for your honesty and insight. Those are really good things to know!

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On 6/19/2018 at 10:34 AM, mgriffiths said:

Yes, there is tons of paperwork, and most of it is an absolute waste of time...but, in my experience it is not as bad as thinkertdm describes.

I see on average 15-20 patients per day, mix of everything from URI to liver failure to orthopedic issues to DM2 to annual physicals, etc., etc., etc.  The majority of days go smoothly, but some days are a train wreck.

The day is filled in between patients with medication refills, responding to patient questions, reviewing results, calling patients if needed (but the vast majority of my phone calls are completed by my MA).

I can be more specific, just ask any questions you have.  The best part, other than building relationships with patients, is being done almost daily by 5:15pm with my desk 100% cleared and going home to be with my family.

 

^^This, mostly^^

Me: Primary Care rural FQHC in the Colorado Rocky Mountains. Our clinic sees primarily Medicaid and sliding scale pts, commercial insurance is rare. Peds thru geriatrics, but mostly age 20s-60s,.We have a part time OB/Gyn whose in twice a month and sees as many OB pts as he can (typically self-pay, sliding scale only who have very limited options as to where else to go). We have behavioral health and dental in house (integrated clinic). 

PCPs: Me (PA) FullTime + NP (Fulltime, 28yrs experience in the clinic) + DO (My S.P., 40+yrs exp., PartTime 2d a week). We are adding a FullTime MD this fall.

I work 1.5d a week with my SP, and 3d a week with the NP. (SP  and my secondary SP's are all available by phone during that time). Some days the clinic is packed full (24pts/d) and sometimes its slower (16-20/d). Appt slots are 20min. However, as I am a relatively new PA and new to the clinic, I have 40min appts and capped at 12/day right now and that doesn't change until I'M ready, although they said they'd like to have me seeing more pts by the end of summer (3-4mo mark). 

It's a lot of autonomy but I never feel like I'm left out on my own. I suture, toenail removal, digital blocks, slit lamp, basic microscopy on wet mounts etc., EKGs, joint injections, etc. We take walk ins so some days it feels more like Urgent Care based on the pt complaints.

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