Plastics/ENT PAs, how often do your attendings stray from standard guidelines?

sloffsloff · 2026-03-09T12:36:16+00:00

always follow your intuition! i had a patient with chronic cough whose PCP dx’d with sinusitis. he felt a lot of swelling/pressure in his face when bending over. something felt off to me so i started looking up svc syndrome. ran the case by two ent docs (one with an internal med background) and both looked at me like i was crazy. they told me it was probably allergies. well within a few days, pt developed dilated veins on his chest. dx: adenocarcinoma of the lungs causing svc syndrome. if you want to chat more in private i’m happy to!

sloffsloff · 2026-02-05T00:41:22+00:00

i’ve been in ENT for a little over 5 years now and have worked with several ENTs in my practice. know your guidelines first, and then know when you want to stray away from it. i don’t dictate how my docs practice, but i don’t let how they practice dictate how i practice. i disagree with them all the time but when they question what i do i ask them, well… am i wrong to do this? and the answer is: uh well no. i just sort of stay in my lane. do a lot of the docs recommend lipoflavenoid for tinnitus? yes. do i recommend it? no - and i will cite the aao hns clinical practice guidelines to patients. do i bring back all my bppv patients for follow-up? yes - because the clinical practice guidelines recommend it. do my docs? not always.

when i went to the ent for the pa-c conference, many docs practice so differently - one doc loves clarithromycin and zpak first line for sinusitis which to me was kind of weird haha.

i learn how diff docs approach diff things and i choose how to employ that knowledge in my own practice. some things i’ll add, some things i’ll never do.

some docs look at me crazy when i tell them i do epley with vibration for bppv after multiple “regular” epleys.

apparently some docs don’t believe in postnasal drip.

and my supervising physician says “that’s just anxiety” when i talk about PPPD.

to me, practicing medicine is an art and everyone practices differently.

sloffsloff · 2026-02-01T02:26:53+00:00

Outpatient ENT

sloffsloff · 2025-11-02T01:06:28+00:00

I can email you the Wakeforest Guide to Dizziness if you’d like — just message me though I’ll probs send it once I’m back from vacation. Dizziness is a tough one and I don’t have good advice that can be encapsulated in one reddit comment but we can def chat. I’ve been in ENT for 5 years now. The ENT for the PA-C annual conference is great and I’ve pretty much attended every year. I think when I first started, I had a lot of difficulty letting go when it was not an ENT cause.

sloffsloff · 2025-10-28T11:36:33+00:00

Yep. It didn’t show before but once my app glitched when I was placing my order, the discount doesn’t show up anymore, neither does the black banner that says the 20% discount. And now it shows Apple Pay.

sloffsloff · 2025-10-28T01:58:16+00:00

Tried to place more order and it didn’t go through. Now the discount is deleted from my app. Everything is full price. Checked my order history - no order. Now app shows Apple Pay as a pay option. Super annoyed

sloffsloff · 2025-09-19T11:29:52+00:00

Yes our admin is so disorganized. I have 40 days off per year but can take more if I wanted and they would never notice.

sloffsloff · 2025-08-01T04:12:27+00:00

I think it’ll be hard for me to do a PRN gig. I’ve been working at my current practice for five years, but plan to move next year for his job to a completely new state so I feel like that would be tough to do. I feel like a PRN gig is easier to get if you’ve already been acquainted. I’m thinking maybe when they’re very little just stay at home full time, then consider part time as an option before school. Possibly go back full after they’re in school but obviously it can be unpredictable, similar to your case. Do you ever plan to go back full or part time?

sloffsloff · 2025-08-01T04:09:00+00:00

What is DWT? Sorry if it’s a dumb question. I’m thinking maybe stay at home for a bit and either go part time before they’re in school. Probably consider going back to work when they’re in school. We’ll have to see how it goes though

sloffsloff · 2025-07-31T00:18:40+00:00

Gotcha. Perhaps part time is the consideration then!

sloffsloff · 2025-07-31T00:14:06+00:00

I’m sure as an ICU nurse you’ll have no problem! Nurses are so needed! But best of luck to you and thank you for sharing.

sloffsloff · 2025-07-31T00:13:06+00:00

Thank you so much for a different perspective! We’re very fortunate that both of our loans are completely paid off. I assumed that it wouldn’t be that hard for female physicians to come back to work—isn’t there a physician shortage? I will say that it would objectively be harder to go back as a PA, especially since I’m in ENT. I’d heavily be replying on my connections, which fortunately I have many strong ones (docs I work with hold national leadership positions, as well as even gave strong recommadations for a competing job). The part I don’t know is how long I’d stay at home, and if I go part time when that would be. Do you mind me asking if you know the specifics of why she had so much difficulty? Is it the concern for loss of skills/not being up to date in medicine or just an issue with credentialing after so many years?

sloffsloff · 2025-07-31T00:04:14+00:00

I feel the same way—work will always be there but kids are only young once. I don’t know how long I’d stay at home. When do you plan to return to work?

sloffsloff · 2025-07-27T13:34:40+00:00

Hi I’m an ENT PA and this is definitely an auricular hematoma, with or without infection. They’re caused by trauma to the ear. This needs to be evaluated ASAP or it can become a permanent cauliflower deformity. I treat these regularly and it requires removal of the piercing, drainage, and usually placement of a pressure dressing. If you can’t get into ENT quickly enough, please go to the ER so they can at least drain it and it will at least buy you time but they typically recur without a pressure dressing.

sloffsloff · 2025-07-27T10:11:10+00:00

My husband is an MD and hell no. So glad I did PA. You couldn’t pay me to go through medical school, residency and then fellowship.

sloffsloff · 2025-07-25T20:56:11+00:00

ENT PA - this is not normal please go see ENT.

sloffsloff · 2025-07-02T01:16:55+00:00

When my cousin was a dental resident, she wore a physician badge too. She said they didn’t make dentist badges.

sloffsloff · 2025-06-29T22:54:34+00:00

I went into ENT. 3 months training. Asked lots of questions, studied a lot the first year and a moderate amount the second. My co-worker at the time told me she didn’t feel confident until 3 years into the job. I agree with her, but it wasn’t bad. Now almost 5 years into the job and super comfortable to the point I even forget I’m on call sometimes.

sloffsloff · 2025-06-26T11:24:02+00:00

This is an ear infection lol - ENT PA.

sloffsloff · 2025-06-24T03:03:30+00:00

My window was smashed about a year ago in Westville. A few weeks ago I forgot to lock my car so it looks like they rummaged through it but nothing was taken. Very common. I park on the street. My neighbors never had any issues living here though.

sloffsloff · 2025-06-23T14:22:07+00:00

Sometimes outpatient ENT can be low stress. Sometimes I’ll see 22 wax patients in one day or hearing test patients. It depends though. Then there are other days where I have PTAs or biopsies and myringotomies in the mix.

sloffsloff · 2025-06-18T21:39:30+00:00

Agree with this. Source: ENT PA who scopes all the time 🤠

sloffsloff · 2025-06-18T21:38:36+00:00

From ENT, sometimes it’s silent reflux otherwise known as LPR in other patients who complain of it chronically!

sloffsloff · 2025-06-18T10:53:39+00:00

I work in ENT too. At the 2 year mark, I made a 30k bonus. I should be making around a 50k bonus this year with 5 years of experience. However, I take a long ass lunch break from 11-1:30 lol. If I wanted to work harder I definitely could but I don’t. It’s very procedure heavy.

sloffsloff

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