switching my sleep over in preparation for nights is super annoying. everything is closed so it’s not like a can run errands. i end up mass cooking or cleaning my whole house or watching entire tv series. like, that seems productive and shit but it’s really not. i’d like to read but that makes me too tired. i also end up over eating. so, in general, what i’m saying is that night shift kind of sucks. the only benefit at work is fewer people and no rounding.
There is nothing quite as satisfying as leaving the hospital after three 12 h shifts and seeing the helicopter come in that *I* do not have to deal with.
Am I just uneducated/dumb to think that you can’t call a cancer “limited stage” if there are already mets, pathological fx, and multiple sites of lymphadenopathy upon diagnosis? Is this just a thing where it’s limited to a certain number of organ systems? Like, am I just dumb? It seems like fake news.
You know HOW these rich fools don’t pay taxes? They don’t pay themselves a salary. They don’t even pay less taxes by withdrawing capital gains. They fucking walk into a BANK and say “hey, loan me $100 million dollars because you know I’m good for it.” They use their company or yacht or whatever the fuck as collateral and the bank is like “sure, you’re rich, we’ll get the loan money back for sure.” Because they will. And so, your average rich person can do this tax free. Why? Because loans are NOT taxed. Sure, the borrower may pay a little interest but nothing that comes close to what they SHOULD pay if they were taxed.
If that doesn’t enrage you, then I don’t know what will.
Came back from “vacation” the other day. Not that visiting relatives is truly a vacation but there you are. I was regrettably flying American Airlines and my flight got delayed like 10 times, then canceled. I ended up getting rebooked at not stuck at the airport but it was still annoying.
Yesterday I did LITERALLY nothing besides watch Princess Weiyoung and nap. I regret nothing. Though, I did vow to actually not be a pile today and have thus far managed to accomplish some things.
I don’t go back to work until Friday so I suppose I’ll get out on the bike more. It’s finally cooled down here so doing a 30 mile ride might be in the agenda.
I managed to survive my first night shifts. I was VERY thankful that I had some back up last night. I knew before going in that there would be two new transplants so I was nervous about managing them alone. I hadn’t actually gotten a fresh transplant yet and I had been warned that our liver transplant team is…not the greatest. Many of their patients tend to bleed out. Luckily, they did everything right last night because my fresh liver did fabulous! Didn’t have to give any kind of blood products! My fresh kidney/pancreas transplant also did well. They didn’t make urine for the first few hours but picked up after midnight.
The amazing thing about my transplants was that they received organs from my patient who was declared brain dead a few days ago. That guy ended up giving a liver, kidney, pancreas, and heart to people in my hospital. Just extraordinary how one person’s death can give life to so many.
After my shifts, I was pretty useless yesterday. Mr PopPen was also a little tired and useless after his business trip so we just loafed and watched Harry Potter. He ordered pizza while I was napping! Best way to wake up is someone shoving a plate of pizza in your face. :-D He’s truly the best.
Today, I actually slept decently until probably 1800 and then forced myself to get out on the bike. I’m rather behind - I’ve set a goal to ride 1,000 miles by the end of summer (9/22) and I figured I have to ride about 50 miles a week to do it. I’ve got probably 780-800 miles to go lol. I figure if I make 500-800 miles, that’s good too. At least this has motivated me to get off my butt and do something.
The bad part about being outside all the time like this is that I have had AWFUL allergies. The worst, really. I’ve got my zyrtec, bendaryl, and flonase but this year I also required an ocular antihistamine :-(. And we have rather dry heat and a drought at present so my nasal mucosa is very dry and I keep getting nose bleeds. *sigh* I can’t win I guess.
Tonight, I’m off and go back to work tomorrow evening. I’ve been pretty productive with house chores and meal prepped for work this week.
Annnnd that’s a long update that no one asked for! :-D I plan to do some critical care concept posts and hopefully revive the PA-C of tumblr spotlight series but that also means that I need to go digging for different specialists.
First night shift went well! I got good sleep before hand and we were steadily busy. Was a little nervous going into it as I’ve never worked nights as a provider before. My first few nights shifts I have another PA-C with me more as a resource but I’m expected to do everything myself. I managed ok last night, though no huge catastrophes happened. I haven’t slept so well today as it is hot as hell and I’m ludicrously stubborn and refuse to turn on my AC until July. But I digress.
I did have a bitch of a CVC to put in, though. Relatively young and healthy patient who I thought “ah this will be a quick line”. Nope! Couldn’t get a RIJ to save my life. The vessels were so collapsable in spite of being well resuscitated. LIJ was a success, though!
I’m on again tonight and tomorrow. I hope we are a little less busy so I can practice my cardiac POCUS skills on my intubated patients. I likewise need to do some view of AEDs and status management. The neuro critical care part of my job has by far been the steepest learning curve. I still have a sense of imposter syndrome though it is more manageable than when I first began practice.
Hi! ADHD ex-grad student here. I got some feedback from a mentor-role person (not my direct mentor, but offered to talk to me about my future) about primary care work. They were saying how primary care has unfortunately evolved over the years to mean more about insurance, 15-min visits, and overscheduling a provider. They recommended primary care at a student health services sort of role so that it's still primary care with possibly less limits bc of insurance and also you can educate young adults, etc. Do you have any other recommendations about what kind of primary care role may be something worth exploring rather than only the outpatient-clinic-at-a-hospital route? (City gal here who is not looking to do private practice)
Honestly, the whole setup of outpatient medicine these days is kind of the worst. It’s a BIG part of why I’m leaving my current job. I love taking care of patients, but it’s not set up to let us do it well. We are essentially punished for spending time with our patients. I hate it. So here’s some other options to explore in primary care.
Option 1: Direct Primary care. The DPC (sometimes called “concierge medicine, though I think that’s not exactly the right description) model is probably the best system I’ve seen to give doctors what we want out of our careers. They still get paid well, it’s ultimately cheaper for the patient, and they get ample time with their patients. The downside to it in my mind is that it doesn’t help patients who can’t afford the monthly fee to be a "member” of the practice.
Note - there are many ways to do DPC - some operate on a strict cash for each office visit or lab system, whereas others charge a base monthly fee that includes unlimited office visits. Some employers have actually found that it was cheaper to “insure” their employees by paying their membership fees to practices like this, so it’s a growing field for sure.
Option 2: Academic Medicine. You end up seeing less patients, but the ones you do see tend to be the underserved, which is a draw for folks like me who are social-justice oriented. It pays less, but generally affords more time for educating yourself and your patients with less worries over insurance hassles.
Option 3 would be to be a company doctor for a large employer. These jobs are harder to come by, but your patients would all have the same insurance so there would be less hassle there. I can’t guarantee that the push to see higher volumes wouldn’t be there though.
Option 4: the VA. Traditionally working in VA clinics has been considered a cushy job for primary care docs because, again, there’s no insurance hassles to deal with, and because they typically see low patient volumes. It’s probably not ideal if you want to work full-spectrum family medicine, but if you prefer taking care of adults it would be a good option.
Option 5: Prison medicine. It pays extremely well but it’s not great. There’s no insurance hassle. Instead, there’s the hassle of dealing with sick people with limited resources. You can’t send people out for CTs or MRIs or stress tests when you want to. There’s usually pretty high volume to be seen as well.
Option 6: Nursing Home care. It’s longitudinal primary care, but you sort of control your volume. You take however many patients you want and you spend as much time as you want with them. There are requirements about seeing patients monthly and about trial weans off certain medications every so often, but the rules aren’t super hard to follow. Nursing home patients also are almost exclusively covered by Medicare or Medicare/Medicaid, so once again the insurance hassles are minimized because you don’t have to deal with 25 different companies.
Option 7: House Call doc. This is a revival of old timey medicine. It probably pays less, but the overhead is minimal. You’d see patients in their homes, nursing homes, assisted living facilities, etc and likely charge flat fees rather than going through insurance.
Reblogging for any followers interested in being a PCP.
A lot of the aforementioned hassles are reasons why I did not end up in primary care. The shear clinic volume at most places is insane and you are definitely punished for spending more time with patients. I even saw this in a specialty clinic setting in burn. The fact that many places base a portion of pay (and worth) as a provider on RVUs is ludicrous.
I had a colleague who worked in prison medicine for several years. She really enjoyed it because she said she could actually focus on medicine and the patient rather than insurance. She also had many opportunities to do procedures so that’s also a bonus.
I was asked recently to lecture about burns to my alma mater and it was just a trip.
First off, I have low key PTSD going back in the building because, let’s be honest, PA school sucks everything from you. It’s hard not to be there and think “well, shit, I spent 2.5 years of my life trapped in this damn building” and then shudder dramatically. I also had a less than great experience with the program director so seeing them again was…ew.
But! It was nice to see my old professors and share my knowledge with up and coming PAs! I really wanted to cut the fluff and give them what they needed to know and I feel like I accomplished that. Plus, nobody looked like they wanted to die and I did get a chuckle or two for my classically horrible puns.
It also occurred to me that it has been 7 years since I have formally taught in a classroom. Those of you who have been here a while know that I was a K-12 teacher in a past life. Doing a formal lecture was a nice reminder that I never let that skill set go to waste and that I did enjoy teaching.
Co-founder and organizer of #PAblr on tumblr. Currently working in critical care. Formerly in burn medicine
Crafter. Rabbit lover.
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This is a medical blog which details MY journey to becoming a PA-C, as well as a platform to connect with other people interested in the profession. Though, there are *some* pics of bunnies. Or science puns. You get it. ;-)
**I do NOT give medical advice** I do write educational content for other providers and students. HOWEVER, I am more than happy to answer GENERAL health related questions or questions about my job/specialty/etc. Just don't ask me if you should see your provider for that mole on your back or something- if you are asking, you should go.
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