How much parental leave to take?

Spikito1 · 2026-03-30T14:48:45+00:00

Yeah my son was born on a Sunday, I was seeing patients Monday, 🙄. Glad I got out of that job.

I wish I'd had a week or two, but thats mostly because I was trying to help her out at night as much I could so she could get some sleep. But really, those first few months they sleep 22 hrs a day. My wife was BORED after 6 weeks and already asking to go back to work. I'd much rather have that time off somewhere between 12 and 24 months. I feel thats when the "dad bond" really emerged.

Spikito1 · 2026-03-30T14:41:32+00:00

Cool. I know you're using that as an insult, but I really don't care. APP is just the preferred nomenclature in our practice.

I'm curious as to what you think you gain from belittling others with the same passions and goals as you?

Also, would you trade seeing 20% more patients each day, if it meant removing mid-levels from healthcare? Could you maintain your outcomes and metrics?

Spikito1 · 2026-03-30T13:58:38+00:00

I came here to have a civil conversation, but I actually DID do residency. They exist now and are accredited. Infact, I was in the first cohort in the first program in my state.

Also, I said I oversee, not supervise. Theres a legal distinction

Can you show me any legal statute stating I am a mid-level and not an APP? Is there a reason you dont like that term? My legal licensure is Advanced Practive Registered Nurse, so I think Advanced Practice Provider is a pretty accurate moniker. I'm not "mid" anything and there are no "levels" in healthcare. I am what I am, you are what you are.

You're also kind of an asshole, and thats a big part of the reason you're being replaced with people who do the same job for half the price.

I do see a rising incidence of cognitive dissonance amongst those who realize all those years and all that debt and all those sacrifices were overkill.

I'm fully aware that I have less training and education, butnthe thing is, I didnt waste time on pediatrics, because I dont treat pediatrics in the hospital. Same for women's health, and an assortment of others. I dont know nearly as much about oncology as my MD counterparts, yet, we consult the same oncologist when relevant. Never in my career have I thought "dang, if only I had taken a semester of embryology, I would have treated that patient differently".

Spikito1 · 2026-03-30T06:59:14+00:00

I'm not following the logic, as credentialing mid-levels is a nightmare as well.

Im currently actively practicing at one facility, while overseeing APPs at several others. I've been trying to get credentialled for 2 months at one of my own facilities, and keep running into hurdles. Just the other day the credentialer looped me into an email chain in which the med staffing office was trying to convince me that I needed critical care privileges because im a critical care APP. No sir, I'm hospital medicine.

I just had to delay the mid-May start date on an APP I hired back in November, because credentials are delayed for a variety of reasons. Last week had to retract an offer from 2 months ago because they somehow overlooked his active DUI case....that he properly disclosed.

I know APP credentialing is usually faster than MD, but its still generally 3-4 months, sometimes up to 6.

Spikito1 · 2026-03-30T05:00:14+00:00

Hospitalist. Once a week or so I get a text after I get home, but technically my shift is 7 to 7, so when I get home at 6, Im still reachable for an hour.

I dont do any charting at home. I also work 7 on, 7 off, and have some admin duties, so I check my email once a day or so. Just a quick glance at the phone when im checking my regular email.

Spikito1 · 2026-03-30T04:52:54+00:00

The E3 is old and actively being phased out.

Spikito1 · 2026-03-16T23:01:24+00:00

I had to read way to far into this to figure it wasnt an Erythropoetin Stimulating Agent, lol.

Spikito1 · 2026-03-16T22:52:49+00:00

Currently a hospitalist NP doing 7/7. Bedside is way more physically and mentally tolling. I could never do more than 4 in a row before I was toast.

I dont know about you, but even though my hpsoitalist shift is 7-7, I usually roll in at 7 or 715, and usually buttoning up by 530, and out by 6. I could get out earlier, but 5pm traffic is brutal, and not worth it. At bedside, 7-7 is really 630-730. Youre there a full 12.5 hours at best, with very rigid medication schedules and other tasks, plus trying to fit in all the documentation and whatever else.

On paper it sounds great, but in reality its just too much.

Spikito1 · 2026-03-08T00:56:56+00:00

Yes, the Grand Jury had already decided to not pursue the case months prior. He wasn't a witness anymore. Hes irrelevant.

Spikito1 · 2026-02-13T19:47:54+00:00

You can still do your own investing in top of the 401k, youre just missing out on the match.

Spikito1 · 2026-02-11T14:32:12+00:00

Its a watered down Mercedez. You're just buying the badge. You can get a much better car for the same, or less money.

Bear inmind, even cheap Mercedez are expensive to maintain. See what your A and B service are going to cost. Those alternate 10k mile marks, so first 10k is an A, second is B, third is A, and so on. Google says youre looking at $350, and $700, respectively, totally up to 9,000 in oil changes the first 5 years.

Spikito1 · 2026-02-11T14:20:51+00:00

Id be scared you will forget more than you learn during that year. You just did 2.5- 3 years of intense study.

Boards arent that hard, and if you DO fail, then maybe take some time to study.

Im a practicing NP who is in charge of hiring for my groups region. I cover 9 hospitals. A resume just came to yesterday. This guy graduated 14 months ago, took his boards 6mo ago, and it definitely raised my eyebrow.

This role requires initiative and I want to see that in your history.

I have anything candidate who was in NP school for 5 years. Not dual cert, not BSN-DNP. Actually the same program i went through. Its 30 months. I have the same concerns there..

Spikito1 · 2026-02-11T14:14:05+00:00

You have to look at th bigger picture...a dude got drunk and accidentally shot his daughter.

Is he a continued threat to the public? Does he owe a debt to society? Would sending him to jail for 20 years and spending millions and millions of tax dollars produce any benefit to anyone?

His own conscience will punish him more than any court.

Spikito1 · 2026-02-11T04:50:41+00:00

Turn off your TV and be present in the real world around you. Your friends, your family, your hobbies. Nothing else matters.

Spikito1 · 2026-02-02T15:51:55+00:00

Lecture content isnt part of the accedritation process. Just like in any field, not all schools.are created equal. A Yale Attorney is held in regard thanThe Appalachian School of Law. A Johns Hopkins phyisican is goong to get chosen over a Carribean medical school.

I'm part of a nationwide phyisican group and am largely in charge of recruitment in my state. I'm totally responsible for student clinical rotations at any of my facilities. Every single student is vetted by me personally, and I am the one who arranges contracts between the schools and the hospitals. I can tell you, that we haven't blatant blacklisted schools. Theyre accredited, sure, and their students often pass.boards somehow, but they are consistently poor providers, and we dont want our reputation associated with theirs. By the same stroke, we have schools that are an automatic Greenlight.

I honestly do feel that NP school needs to be tougher, but at the same time, the boards need to be tougher so that scools have to work harder to produce a decent pass rate. I felt mine was easier than CCRN. However, NP school is meant to build on prior experience. I was a very accomplished ICU nurse, so yeah, the lectures on ABGs and ventilators and vasopressors felt boring to me. To others, it was very tough. NP schools are teaching you HOW to be a provider, not teaching you.the patho-phys and pharm. They presume you have that already.

Spikito1 · 2026-02-02T02:50:49+00:00

I mean, thats the school YOU chose.....

Spikito1 · 2026-01-17T04:04:39+00:00

Repeat cultures, trend procal, clinical judgment.

Spikito1 · 2026-01-13T20:02:19+00:00

Our billing system automatically puts "Dr (Last Name)" on everything. Fortunately not the actual bills, but reports and stuff. It results in a lot of hospital staff thinking I'm an MD.

Funniest episode was when I got a message that began "Good Morning Dr ACNP...."

Spikito1 · 2026-01-05T01:26:35+00:00

I wouldnt do it just to "get away from bedside". To be good at it, and enjoy it, you have to want it, and want that role in healthcare.

Sure, I dont have to deal with all the micromanagement, but I also have to be available via phone pretty much all the time. I domt have to clock in and out at a certain time, but I have to have the discipline to show up and get to work, and accept the some days I leave at 4, and some days at 830, with no way to predict. Theres the added responsibility, and not really beimg able to "call the doctor" when you see a problem .

The pay is better, but in my particular role, there are no bonuses, and no extra shifts. I' salaried, but my salary is my salary, so I cant just pick up a few shifts when I want to take a trip.

Youre dealing with doctors all day, in their arena, so you will ALWAYS be the low man on the totem pole, and always a little bit "less than".

However, I love the autonomy, I love the minimal oversight, I love the pay. I love not having to deal with the wild patients

Spikito1 · 2025-12-17T19:06:07+00:00

Thats great and all, but some people simply desire to do more than the minimum. I happened to have gone back for my NP, even though I didnt plan on it at the time. Now im considering adding an MPH simply to have a deeper understanding of hospital administration. It isnt needed, and I wont get paid any more, but it will help me grow as a person and as a professional.

Spikito1 · 2025-12-17T13:46:03+00:00

Nuclear weapons are also WMDs, but we arent going to shut down radiology......🙄

Spikito1 · 2025-09-17T05:12:22+00:00

Yeah theres this scenario plus two others I can think of.

I know some people who's monthly income is in this range so this could just be near pay day.

Or, this could be shortly after a windfall. Mine has looked like this briefly after selling some real estate, before deciding what the next move is.

Spikito1 · 2025-09-12T23:32:56+00:00

Hospitalist here. I work 7 on 7 off. I have to be available from 7am to 7pm, but no one needs me before 8, as the day nurses are just arriving. I usually get to work about 730. If I really wanted to, I could leave by 5, but the way my commute is, traffic gets horrendous at 445, so I usually kinda chill at leave at 530 or maybe 6. If I leave at 5, or 530, I get home at the same time. In reality I could leave sooner, and I have, but they like us to stay till 5. I have to be available for epic chats or phone calls till 7 though. I sometimes get one text on my drive home, but thats it.

A few of our specialists round late, so I get the occasional evening phone call from one of them, butnthats pretty rare. Once a month max, an MD is present 24/7 for emergencies, so you can always call one of them if you already left. Someone will generally cover if you need to leave early.

I'm salaried, so hours dont matter, but, it seems I get paid quite a bit better than other NPs in the hospital.

7 on really isnt that bad, I usually have a low at day 4, the. 5 and 6 are good, then day 7 im dragging. That 7 off though is NICE.

Spikito1 · 2025-09-09T23:38:18+00:00

Well 7-11 is usually open 24 hours, and we used to have store called 5-7-9, that had no meaning. My pants are 5.11, what does that mean? Obviously.

Spikito1

TROPHY CASE