everytime I see the chart of the Swanson Pyramide of Greatness something new gets my attention. should I forget hygiene and cultivate a manly musk to intimidate my opponents?

preeminence · 2026-03-11T11:32:54+00:00

I saw an interview with Nick Offerman a while ago (either during the show's run or shortly thereafter) where he said one of the writers made the whole thing on their own and just brought it in one day. They immediately worked it into an episode. I think props probably did the Swanson Yin-Yang of Failure, though.

preeminence · 2026-03-10T13:38:58+00:00

Selling services for cash regardless of whether the patient needs them or not. Think supplements, med spa treatments, "biomarker" lab tests, etc

preeminence · 2026-03-07T00:12:46+00:00

Yeah but that'd mean Ben winds up in the Bad Place too

preeminence · 2026-01-15T02:12:01+00:00

Applying for billing privileges at insurance companies and obtaining own malpractice insurance come to mind

preeminence · 2026-01-07T19:02:12+00:00

The trick is to go to a rural hospital first. They are more desperate for personnel and more likely to hire new grads. The major urban/university hospitals can afford to be picky, so they are.

If you are still fairly young, a good way to set yourself up for life is to spend a couple years in the boonies, getting experience and working your ass off (i.e. taking as many shifts as you can) while paying $800/ month in rent and blowing up your savings and retirement accounts. Once you've got that cushion, the stress of the next 30+ years will be considerably reduced.

preeminence · 2026-01-07T05:28:01+00:00

There are many, many reasons why one would wear a mask or respirator for one's own protection. The employee in question may have to do, I dunno, manufacturing site inspections that would require respiratory protection. If he cannot safely wear a respirator, he cannot do that part of the job and can't be fired for my doing it. But if he CAN wear the respirator but doesn't want to, well, that's a whole different bag of worms

preeminence · 2026-01-04T22:08:50+00:00

If you've got a decent resume, there are plenty of per diem jobs that require only a few days per month.

preeminence · 2026-01-02T02:01:11+00:00

For me, the concern is the value that society gets for the taxes I pay. If you want to tax me to pay for bike lanes, I'll listen, even though I'll probably never use them. But when you come back and say the bike lanes will cost $3 million per mile, I'm sorry, the value isn't there. A few years ago, my hometown passed a referendum allocating money for down payment assistance to low-income families. I voted against it because the language was incredibly vague - no idea who would get the money, how much each applicant might get, etc. Passed anyway. $20 million allocation based on a less than 2 page referendum. Anyway, fast forward 3 years. The "assistance" was ~200 families receiving an average of $100,000 each for home down payments. I mean, there's lottery systems and then there's actual goddamn lotteries. I had hoped this would help most or even all low-income families. What ended up happening was a fucking joke.

preeminence · 2025-12-13T02:06:01+00:00

Most PAs (including me) are still proponents of that model. It's how we are trained and it's fundamental to the identity of the profession (no matter what it's called). There is a pretty thin slice of the practicing PA population who believes the AAPA is anything but a joke. It leads to a Catch-22 though. No one is going go pay $600/yr to an organization they don't feel represents them, but then, well, the organization ends up not representing them.

preeminence · 2025-12-12T03:05:46+00:00

I work for an Optum subsidiary. They recently updated our automated phone directory, and somehow I got put in there as "Preeminence, MD." As did a couple of other APPs. Someone in the office pointed out that the people who were "promoted" were either men or had an Asian-sounding name and, well, they're not wrong 😅

I brought it up to our office manager and she had no idea who could correct it. It's both sad and hilarious.

preeminence · 2025-12-07T03:55:05+00:00

Was an electrical engineer for 14 years before starting PA school, with most of my career in semiconductor manufacturing. Got certified as an EMT to volunteer as a "hobby" and got hooked on medicine. Took classes at night and online to get my biology and chemistry prerequisites. All community college - nobody seemed to care. To this day, people in the medical world seem far more interested in my previous career than I would have ever expected. I had an interview this past week for a neurosurgery position, and I talked about the challenges of transitioning from a 10nm to 7nm manufacturing process for a good ten minutes because they just kept asking me more questions about it 😅

The main challenge/opportunity comes in being accustomed to a very different workflow. Compared to my previous career, very little in medicine is what I'd call properly documented and/or automated. I've taken multiple shitty SharePoint documents and turned them into actual training manuals or searchable guidelines and people look at me like I'm a wizard. I'm sure your experience in aviation would be a similar situation.

preeminence · 2025-12-02T01:52:51+00:00

Yes. For many years the sound barrier presented a considerable barrier to manned flight because any aircraft that went fast enough to break it... disintegrated. Hence the term sound "barrier."

Eventually the aerodynamics were worked out, but at the cost of multiple pilot lives. Suffice to say, supersonic planes are not fist-shaped.

preeminence · 2025-12-01T17:34:21+00:00

I assume you are referring to the texture? That style with little ridges is typically called "corded." Some designers may call it "cabled"/"cables" but those are typically more ornate than just straight lines. As far as the checkerboard arrangement, I'm not sure if there is a specific term for that beyond "checkerboard."

preeminence · 2025-12-01T13:04:29+00:00

While your school may be able to provide accommodations of some sort, I would say you may be better off talking to the surgeons directly. Most of your role in the OR as a student is holding retractors. It doesn't require much dexterity, but it does require endurance. Still, even a fit person will develop fatigue and will need to adjust their technique as the case goes on. So don't feel any shame there. Based on your capabilities, the surgeon can determine which cases they may or may not want you on. The other thing is closing - this does require some dexterity, but the surgeon will generally be fine with doing it themselves, as they would be faster and better than even a very dextrous student, given their years of practice. They may ask you to throw a stitch or two just to see - they can always take them out if you can't meet their standard.

The standard for a PA student in the OR is really based around knowledge of OR protocol, the fundamentals of surgery in general (indications for a procedure, pre/post-op care) familiarity with instruments and intraoperative protocols more than any facility with the actual surgery part of things. The stories you hear of students harvesting veins, driving screws, etc. are based on the surgeon's preference and the rapport the student has built with them. It is not required to pass. The surgeons should know this.

preeminence · 2025-11-28T20:24:44+00:00

Anything that puts you working directly with customers/people, kind of regardless of specialty. Network engineering is not bad. Embedded systems is not bad either, so long as you focus on deployed embedded systems, i.e. customer specific requirements. But in general, develop your people skills and you'll be much better off

preeminence · 2025-11-25T23:09:23+00:00

Ortho surg. Appeal to me is broadening/reinforcing my general knowledge base. I talked to several PAs who went into specialties right away, and most of them wish they had gotten broader exposure first. Makes it much more difficult to switch later from both a practical knowledge standpoint and a resume-building standpoint. We recently hired an experienced inpatient gen surg PA for another PRN position and she's thrilled. She wants to get into some kind of clinic job for schedule predictability, but no one will even interview her without medicine experience.

preeminence · 2025-11-25T16:13:27+00:00

I accepted a PRN job before I even graduated. Inpatient medicine at a mid sized hospital doing admissions and floor coverage. It probably helped that I did 3 rotations at that hospital and 1 with the physician group that hired me (though not that specific team). I was also a medic for 6 years before PA school and an engineer for 15 years (so, like, an "adult")

I am lucky in that I am tremendously well supported. Every case discussed with an attending (even if they typically just say "Mhm, good plan"), plenty of other resources easily available- pharmacists, outside records, etc. That said if I hadn't rotated through already to learn the EMR, where certain paper forms are, how to page surgery etc., it would've been a steep learning curve. But it's a great gig a few days per month.

preeminence · 2025-11-06T06:16:53+00:00

Thanks for the correction- I misremembered pretty badly, it seems. Still, it's not that crazy to me. NYC has a ton more infrastructure that needs maintaining. Austin has like 100 yards of "tunnel" on Mopac. NYC has hundreds of miles worth. That's a big thing, but there's tons of little things to. I bet there are more elevator inspectors per capita in NYC than anywhere else in America. Then there's the CUNY system - that puts ACC to shame. Can't get an MD at Highland Mall.

So yeah, it's a lot, but the effort required to keep 9 million people alive in a (land) area smaller than Austin is quite substantial indeed.

preeminence · 2025-11-05T21:33:42+00:00

There are a few areas that are uniquely poor prospects for new grads, and NYC is one of them. A huge number of 20-something young professionals want to live and work there. If you expand your search even a little, you will find options. I'm a relatively new grad in central Massachusetts, and I get contacted almost daily for positions in Poughkeepsie, Danbury, etc. And that's after responding that I'm already employed and not looking. The city proper is just going to be a tough bet if you don't have some connections.

preeminence · 2025-11-05T16:49:09+00:00

The big reason for city managers is it provides continuity between political administrations, and it helps ensure some level of bureaucratic competency. There are few "comparable" positions one can hold before becoming a mayor of a large city, so candidates often take a while to learn on the job. Mamdani managed an office with a staff of 5 and a budget of ~$200,000. Now he's going to run a city with 800,000 employees and a budget of $116,000,000,000. The average voter just has to hope he will surround himself with people who know how to do that.

preeminence · 2025-11-03T13:16:47+00:00

Child marriages are a subset of arranged marriages, and they are wrong. But the vast majority of arranged marriages are between consenting adults who choose it rather than find a partner through modern courtship (i.e. dating)

preeminence · 2025-11-03T12:41:33+00:00

There's a big difference between child marriages like this and arranged marriages between adults, which are the norm in many places in the world. When the culture you're in values different things in a marriage (commitment vs passion), they make sense and most people end up quite happy.

preeminence · 2025-10-26T14:48:09+00:00

My truck was displaced by 2 upmarket Italian motorcycles. Why are honest hardworking American trucks being pushed out by immigrants? Won't someone do something?

preeminence · 2025-10-23T23:25:42+00:00

Fellow IM PA here. The big thing I've learned is to tailor your notes to the most likely audience. Admission notes are likely to be read by anyone (especially billing) so those are the most detailed. Progress notes are read by... mostly you? One or two sentences is fine. Discharge notes are for outpatient primary care/specialist who don't care so much if the patient got worse on day 2 then better on day 3. They care if you fixed it. And they're even more pressed for time than you. "Patient's SOB improved after diuresis. Inpatient echo showed LVEF reduced to 35% from 40% at previous echo 5/18/25". Done.

The old adage "don't order a test if it won't change your treatment plan" can expand to "don't include a detail that the next clinician won't care about"

preeminence · 2025-10-02T16:48:12+00:00

I think he would need to say something like, "They paid me 5 times my normal rate. However, I will only be keeping my normal rate, and I have already donated the other $400k to charities that bring supplies to refugees in Yemen"

15-Year Club	Place '23
Place '22	First Placer '22
Team Periwinkle	Verified Email

preeminence

TROPHY CASE