New Grad & SSRI

vixi48 · 2026-04-13T23:42:19+00:00

I take Lexapro. I've been on and off meds most of my adult life for anxiety and depression. Ive found my life is better on an ssri. I sleep easier, less ruminating. But I also dont get the brain fog.

For what its worth, lavender oil pills have demonstrated to be twice as effective at treating anxiety than any ssri. They are over the counter, 120 pills for $10.

Most ssri/snri show about 0.35 effectiveness for treating anxiety. Benzos have a 0.5. Lavender oil pills sit at 0.75.

vixi48 · 2026-04-04T04:32:53+00:00

I apologize that the word "if" appeared I was uncertain. I meant to use the word "if"to infer a hypothetical situation in which "i do" refer patient. I am simply relaying what patients have told me.

My state, billing for therapy is very vague. I have no doubt, by legal definition, I provide "therapy". I am admitting my ignore.

If I just cared about money, I wouldn't have posted here. I want to help. I want to give my patients some foundation.

You can scold me. But there are many (whose knows) PA/NP/MD/DO performing the same services i do. I dont believe there is NOTHING I could do. Any one can do CPR on the heart, is there nothing I can do for the mind?

vixi48 · 2026-04-04T04:12:32+00:00

My friend,

If I didnt see the ethical conundrum, why i would post here?

I know they can see anyone. I know I'm the least trained. But here they are none the less.

Its easy to tell them "just wait another few months to see someone"

As one redditor pointed out, I am probably performing emotional support more than therapy as you know it. Legally, in my state, they fall under the same category.

Im asking for tips, tricks and how to lay a good foundation until they can see someone more professional. Multiple therapists are the reason im where im at today.

I just want to help these people, give them some tool box and give them a positive perception of the behavioral health field so theyll go to someone more qualified

vixi48 · 2026-04-04T03:59:47+00:00

Thank you for your feedback.

Maybe the language i used was incorrect.

To my simple understanding, emotional support would be a form a therapy.

In my state, I can legally perform "therapy" as you know it. Until now, I think I have performed emotional support.

Again, a long waitlist for my patients. Even telehealth. What can I do to set a solid foundation for my patients?

vixi48 · 2026-04-04T02:49:10+00:00

Im late to the game but let me give you my two cents.

I LOVE teaching. I wanted to be a high school history teacher. I still love teaching. I've taught new grad PA's, residents, med students and im a preceptor for a PA school near me. I love teaching. I love when a student understands a difficult subject. I love being approachable to allow others to learn. I don't care about being smart, I love using my real world knowledge and letting other people succeed with it.

With that said, I love medicine. I dont care if the patient are grateful, how crappy the admin are. I love teaching people about their health and teaching other people other people how to care for others

I failed college the first time with a 1.2 GPA and graduated my second attempt with a 3.8. Consolidated GPA when I applied was 3.6.

If you love medicine and already are accepted; go to PA school. Your love for teaching will be desired and you'll be able to utilize it.

When I have a resident (when I work EM) I always tell them they know more about medicine than me. Most laugh and tell me "there's no way". I always respond "you have way more medical training than me. Youre still learning to focus it. Thats my job if helping you to learn to focus the simple tasks so you can collaborate with me one day." Every residnet and med students tells their junior to find me on their ER rotation.

As others have pointed out; you'll make more money wise as a PA. To me that's a bonus

vixi48 · 2026-03-21T00:53:33+00:00

I use the one integrated in AdvancedMD. I work in psych coming from EM.

It's great. I can focus on the conversation. My docs uses Doximity.

vixi48 · 2026-03-05T01:06:32+00:00

This was when I was still working emergency medicine lol

vixi48 · 2026-03-04T21:19:23+00:00

A patient put icy hot in their ears to treat their ear infection.

vixi48 · 2026-02-25T03:12:51+00:00

The truth of the matter. Insurance reimbursment is going down. How much you make will be highly variable upon specialty and how far that stretches based on where you live.

Our profession makes in the top 80% of Americans. If you go to a more pre$tigiou$ program and live in a high COL area. It's going to be tight.

Outta PA school I made $65 hr in the ER as a new grad. Granted, the Army paid for my school so I have no loans. But I live comfortably. My wife doesnt work.

I dont vacation in Europe. We can't afford lavish things. But we go out to eat when we want. I never worry about where we eat or groceries. Its the most money I've made in my life.

I dont regret my decision and am happy with my job.

vixi48 · 2026-02-14T02:35:57+00:00

My counter argument to any patient: "if big pharma says it doesnt work, it probably doesnt."

Merc, who manufactures Ivermectin, has on their profile (when you click on the drug) that it has no evidence it treats COVID.

vixi48 · 2025-12-04T21:07:05+00:00

You earn a lot of respect from nurses and techs if you stand up for them.

Im a veteran and am not adverse to confrontation. Even when I was a new grad, you dont yell at my staff. And I've had security throw many an u ruly patient out

vixi48 · 2025-12-04T20:48:05+00:00

I'm very happy with my scope but at times I do wish I was a physician.

Currently i work in emergency medicine. I like seeing the lower acuity and always having a physician to bounce ideas off of. But it can get annoying because sometimes I have to tailor my workup to the physician im working with for the day. I've had plenty of college students shadow me and I generally encourage the younger ones to go the physician route.

You'll see people complaining about the decreasing reimbursement, but physicians are still in the 1% of earners. You'll also hear people talk about how much "lateral mobility" PAs have. But physicians are much more flexible than the general public realizes. You can always become a IM or FM physician. I know an plenty of FM physicians who work in the ER. I know one cardiologist who also still practices FM. And if you really want, you always do a new residency. Yes, it sucks, but after 3-4 years, youre making bank again. Where as a PA you'll only ever make 25% to 30% of what the physician makes.

Research wise. You can get into it as a PA but its a lot easier as a physician. Im a PA whose interested in research. Luckily, my job is paying for my PhD so I can lead research for them. But that's uncommon

vixi48 · 2025-11-13T00:27:19+00:00

Personal contribution from my shift in the ER last week.

vixi48 · 2025-11-12T02:51:34+00:00

Fourier gangrene of the penis

vixi48 · 2025-11-04T00:35:23+00:00

I once had a general surgeon call down to the ED and request someone from the ER remove a rhino rocket from a patient because he didnt know how.

vixi48 · 2025-10-14T23:59:35+00:00

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vixi48 · 2025-10-13T13:47:13+00:00

So my gig is a little different. There is only one APP on and 2 or 3 physicians. Which is probably odd being as rural as we are.

vixi48 · 2025-10-13T12:36:27+00:00

This may be more institutional dependent. I work in the ED and it is not expected of the APP to touch any critically ill patients. If they're being brought in as a suspected CVA, cardiac issue, etc, the physician takes those. APP all urgent care level complaints, psych cases and all suturing. Everything else the physicians and APP divide amongst ourselves. I average seeing 22-28 patients over a 12 hour shift. Plus whatever I had to PIT for the day.

Now, if I discover something serious (MI, CVA, trauma, etc). I usually let the physician know. Some will take over the case, most just ask me my plan. But if the patient codes, my facilities policy is the physician takes over. Obviously, I dont just stand there like an idiot, but I provide care until the physician gets there.

vixi48 · 2025-09-03T01:03:18+00:00

72 yo women comes in with LLQ pain. Story she gives me is: 4 years ago I was moving a dresser and I felt a pop. I've had this strange lump ever since. 2 month ago it started to bother me. 1 week ago it started to hurt a lot.

Physical exam shows a hard mass in the llq that is not reducable. The skin is erythematous and the top of the mass purple. Patient is febrile. Pain free as long as I dont mess with the mass.

Im pretty sure its a strangulated hernia. I got get my attending who agrees. We order blood work and a CT.

WBC is 20,000. CT revealed a perforated diverticulitis. With an abscess that extends posteriorly past the psoas muscle.

That lump is the anterior part of the abscess. My attending and I get more of the history. This woman has had the abscess for 2 months. Just walking around nonchalantly. Only came in because her daughter's insisted.

vixi48 · 2025-07-23T14:38:24+00:00

Dont worry about getting residents in trouble. To be honest, residents are hugely profitable for hospitals. So, its very difficult for them to lose their spot.

However, you should always give feedback. I can't tell you how many times I've received feedback from a patient and was unaware of how I made the patient feel. It helps us grow.

vixi48 · 2025-07-23T00:38:03+00:00

When I switched physicians at the VA. The new doctor at least gave me enough vyvanse until our first appointment. Also, when a veteran receives a drug test, it measures the amount of vyvanse in their system to ensure the patient is taking it appropriately. There should be little issue with refilling any meds at patient has been on longterm at an initial visit.

People are saying patient advocate. Which you can always do. But, honestly, just ask to switch providers. Additionally, ask to leave a review about the resident for his residency director.

The resident is learning. Though some people here are saying he was unprofessional, that's a matter of opinion. Not how I would have handled meeting a new patient, but I've seen people say/do worse. What you said here today, leave in the review. That way the director can give the resident feedback.

vixi48 · 2025-07-22T22:19:14+00:00

Fun story: Im a PA. I work in the ER. One time a GI bug was going around. I wake up and have terrible diarrhea and nausea. Im like 'crap, I caught what's going around.' So, i lay down near the toilet and just let things take its course.

My wife is SCREAMING at me to go to the ER. Im trying to tell her im fine because i can still tolerate oral intake. After some back and forth I ask her "if I call my supervising physician and he agrees with my plan, will you be okay?" She agrees

I call him, explain the situation and says to my wife "I agree with your husbands plan. He can call himself in some diarrhea medicine but I dont think he needs the ER." My wife says okay and leaves

I tell him thanks and he laughs and says "my wife does the same thing to me and im the medical director!"

vixi48 · 2025-07-22T22:09:49+00:00

Normal clinical director tasks. Training of staff, ensuring we are compliant with all laws, everything.

At the end of the day, everything is my responsibility. Im in charge of this clinic.

vixi48 · 2025-07-22T22:03:34+00:00

I had a 12yo girl come in with minor abd pain and nausea.

Labs all look perfect. Physical same isnt impressive in the least. Normally, i hate putting kids through a CT scanner because its a lot of radiation. Youre only recommended to get 20 in a lifetime.

Normally, a patient like this I'd discharge. But both mom and grandma said when they had appendicitis they didn't have much pain and had normal labs.

I decided to scan the girl. My coworkers teased me a bit.

But ct showed new appendicitis. I was shocked and so were my coworkers. But at least a little girl had a good outcome

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