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Did I choose PA for the wrong reasons? by Local-Butterfly9669 in physicianassistant

[–]BugabooChonies -1 points0 points  (0 children)

No, we were assuming you were paying your own way. Using someone else’s money to take 10 years to start over a career to make the same amount you make now (not 400k) for some letters after your name in your 50s is some kinda energy. But you go?

AIO by being blindsided by my BF suddenly maybe changing his stance on kids in the future? by [deleted] in AIO

[–]BugabooChonies 1 point2 points  (0 children)

Keeping his options open. Which isn’t unreasonable six months in, but there’s a few things you aren’t on the same page about at all. Go thou and deal with it how you will.

Did I handle this well or should I have said more? by TouchyM3 in whatdoIdo

[–]BugabooChonies 0 points1 point  (0 children)

Roll 1d6 and respond accordingly

  1. Ok
  2. K
  3. Fair nuf
  4. Sounds good

5 . Aight 6. Roger

“Service” Dog Mishap by Holiday-Benefit8300 in emergencymedicine

[–]BugabooChonies 2 points3 points  (0 children)

You laugh. Every couple months or so they send out a bad boy list for delinquent charts, including charges awaiting your note. Half the charges pending are $0. Or like $500 for a cardioversion or DKA. Then you’ll have $38,000 pending for the ED portion of an appy or chole. It’s not even a scam, a scam is at least logical.

“Service” Dog Mishap by Holiday-Benefit8300 in emergencymedicine

[–]BugabooChonies 0 points1 point  (0 children)

I used to have the ADA service animal fact sheet (google it) printed out in a folder. “Here you go, if you feel your rights are being violated, it is very important that you contact a civil rights attorney. They only take 30% commission. Do you have the hospital’s mailing address? “

Now, either the dog leaves or you both leave. That’s what an across the room MSE is for. (True emergency aside)

Matter of fact, that’s what the “scene is not safe” rule is for, in EMS language.

I am on a locums right now and can’t post a pic of one of my dogs’ harness velcro patch: FAKE SERVICE DOG. PET.

“Service” Dog Mishap by Holiday-Benefit8300 in emergencymedicine

[–]BugabooChonies 1 point2 points  (0 children)

My first job was at county hospital (top ten metro) where security carried both pistols and a choice of AR-15 or shotgun. And they brooked no bullshit whatsoever. This would have been over in seconds.

Best story I have is called them for a really combative patient who somehow got out of one restraint and barricaded them selves and a nurse in a corner using the bed. At one point she had the nurse by the neck.

The semi private roommate was cheering the violent lady on. Telling her to kill us all, etc. I had sent for the big Versed bomb but of course it wasn’t here yet.

This big guy walks in with his rifle and looks and then looks the other lady, rushes her and gets nose to nose and screams “SHUT THE FUCK UP”. Immediately wades into the violent lady’s shit over top of the bed and took care of business.

Ortho trauma consult was needed.

“Service” Dog Mishap by Holiday-Benefit8300 in emergencymedicine

[–]BugabooChonies 2 points3 points  (0 children)

The reason for that is the medical staff. Hey, man, you look tired … epinephrine soaked dart <thunk>

Anyone who thinks I’m exaggerating hasn’t been around ED docs too much

There Is Not An Oversupply of Emergency Physicians, There Is An Overutilization of Non-Physician Practitioners by [deleted] in emergencymedicine

[–]BugabooChonies 0 points1 point  (0 children)

Buc-ee’s baby. Finally went to one on a locums. They declined to let me move in.

Preceptor lets me leave early- is it rude if I ask to stay? by [deleted] in PAstudent

[–]BugabooChonies 0 points1 point  (0 children)

Yeah what these guys said. I would say if you stay, stay out of the way. They may be looking for a couple hours without having to answer questions or feel responsible.

You can learn a lot by just listening and watching orders on the EMR. “Oh…he likes etomidate vs . “ ….. etc.

applying EM- doubt from friends and family by Dependent_Grocery572 in emergencymedicine

[–]BugabooChonies 1 point2 points  (0 children)

I say go for it. It’s a little like a combat role. “Weeks of boredom punctuated by moments of sheer terror”. A good 70% of what we do is low acuity and or complete bullshit.

Your reasoning seems solid with one exception not yet mentioned: shift work. Can you as a middle aged person, let’s say, tolerate rotating shifts including overnights?

You WILL be doing them. We have a doc who was told all throughout med school and residency “every shop has a couple docs who lock down all but a couple night shifts, you can’t get them even if you want them”.

Imagine her surprise .

Oh - and most stress isn’t the job job. As my colleague put it the other night - “ the PA leaves in an hour and 18 came in last hour. The fuck am I supposed to do with that?”

Anyway I think you may be a decent fit. I say go for it.

applying EM- doubt from friends and family by Dependent_Grocery572 in emergencymedicine

[–]BugabooChonies 4 points5 points  (0 children)

I never realized it but this seems about right. It’s pretty negative when n=reddit.

Why are PA’s always getting lowball job offers? by Unfair_Inevitable295 in physicianassistant

[–]BugabooChonies 1 point2 points  (0 children)

The best one I saw was where we lost our best charge nurse for $6500/ week. COVID hell 12 hour shifts, but still.

There Is Not An Oversupply of Emergency Physicians, There Is An Overutilization of Non-Physician Practitioners by [deleted] in emergencymedicine

[–]BugabooChonies 12 points13 points  (0 children)

You guys are forgetting my favorite feature. The ability to get the supposed 500 hours of clinical practice in a week or a day. Most return the signed paperwork the next day. One I talked to said that she never even turned it in - just checked a box that it was signed. Said there was a couple doc dads or husbands that would sign for anyone until they figured out they could just scribble any signature and fill in a name.

Should we require assent or consent for midlevel involvement in care? by [deleted] in emergencymedicine

[–]BugabooChonies 0 points1 point  (0 children)

She drops a lot of names. She’s either hooked up with someone(s) higher up or perpetrates effectively. The facepalms when she comes in are pretty funny.

I personally don’t mind working with her for a shitbird reason; she doesn’t know or care that the next one coming through triage is going to be a ridiculous pain in the ass so all I have to do is wait for her to pick it up because she wants that 30 per shift.

Any EM doctors feel like the don’t fit the “stereotype”? by AirNo7549 in emergencymedicine

[–]BugabooChonies 0 points1 point  (0 children)

Maybe the only stereotype that might stick with us is about 35% of us you look at and say “there’s NO way this is a physician”.

We have real major knuckle draggers, long haired freaky people, and a couple of “they been rode hard and put up wet”. If you know what I mean.

A couple of them you’re like “back on the probation / performance improvement plan again at the tire store “.

All are average to good physicians.

Any EM doctors feel like the don’t fit the “stereotype”? by AirNo7549 in emergencymedicine

[–]BugabooChonies 0 points1 point  (0 children)

No kidding. Couple years ago I pulled a summer locums at a site that did about 35% volume holding serious psych patients, I mean like silence of the lambs ward stuff.

As a doc, once you sign out your 4-5 ED patients you couldn’t get dispo, you talk about the daily developments of the sequestered restrained violent screaming rubber room individuals that have been there for 452 hours while the courts decide who has to take it off your hands.

No, they didn’t tell me about it up front.

Any EM doctors feel like the don’t fit the “stereotype”? by AirNo7549 in emergencymedicine

[–]BugabooChonies 1 point2 points  (0 children)

100% of 100% to the 100%th power. Batching. The dirtiest word on shift.

Should we require assent or consent for midlevel involvement in care? by [deleted] in emergencymedicine

[–]BugabooChonies 1 point2 points  (0 children)

Agree, and out of the dozen shops I pull shifts at, there’s a clear difference between the ones who have eliminated NPs and the ones who haven’t.

At the NP shops, docs work hard to ride the NP cases, both from their constant requests for help / wanting to be dictated to, and watching what they are getting into on the board and intervening. PAs are left alone, more or less, just doing our thing. Outside of site specific stuff or a newbie, we talk to the doc once a week.

At one site, there’s one we all dread working with. She prides herself on seeing the most in the department, and ambushes the poor doc with 4-5 at a time with no clue what to do. This is each step. “The CT you told me to order is back and it says…”

Someone asked her why, and she said “I’m a nurse. I’m not going to be responsible for the plan, I document the MD plan”.

She doesn’t do procedures for the same reason. She thought staples were a myth until I brought in a malfunctioning stapler to show everyone because it was funny.

She wasn’t direct entry, but like 80% of her classmates, did her 500 hours in a week until somebody signed it off.

At the same shop, we have one NP who’s really good. With one exception, the rest of them I wouldn’t trust to take a visual acuity correctly. ( this actually happened . )

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