Miscellaneous And Off Topic Subjects

[CGVT]

Wag the dog

[Dr. Strangelove]

It amazes me that no one can convince Trump that his diplomacy through Twitter is a bad idea. The Pentagon and State Dept. must pull their hair out over crap like this.

FDR used the radio and Hollywood ........

I don't think that for Trump, this is so much about formulating FP in public spaces. I think, like FDR, its garnering public support for who he is and what he is all about.

Not only did he get a slight bump in his historically low approval rankings after the Syria attack but Americans were overwhelmingly in favor of what he did - optics.

Well, to be more precise, Republicans are overwhelmingly in favor of what he did -- and were overwhelmingly opposed to Obama doing a virtually identical action.

[ame]https://twitter.com/KFILE/status/851794827419275264[/ame]

[Jeff Buchanan]

DSL, that's a different matter .....

My point is that the optics of the Syria attack, whether its mustering your base or swaying support from your political opponents, is Trump's objective in using Twitter.

I'd name both FDR and Ronald Reagan as practitioners of this approach just using different forms of media - the media of the day.

Trump isn't making FP as you assert via twitter and I doubt The Pentagon and State Dept. ...... pull their hair out over crap like this.

Maybe they roll their eyes a bit over Trump's use of Twitter like most bureaucrats will now and then over any president's public remarks but I'm pretty sure FP is being developed using the organs designed to inform formulation of it to a much greater degree than to what you (and others) imply.

[Da Geezer]

I heard this morning that a total of 430,000 persons were removed from their seats on all US airlines last year due to overbooking.

[crashcourse]

ok Jeff couple questions for you

I am a preceptor for 6-8 students a year from the Wichita state program. I too have noticed a drop off which I blame on the watered down acceptance of potential students--I am told by some of my students they get 1000 apps a school year--interview 100 and accept 45 so that's not the issue. But a lot of these coming through don't have any medical experience

being military trained I had to be medical for 5years before the military even looked at my application for PA school. trouble with my students is some of them are not only learning medical terminology and had how to talk to patents but some even couldn't speak English well enough--2 Vietnam students I remember in particular.

brings me to my second question you obviously are searching for the top dog if your looking at that many PA's and only choosing one. FYI you mentioned credentialing --last time I looked there were about 21 steps in the hiring process for a government provider position often taking a minimum of 6-8 months and many qualified candidates giving up before the process was through. the governements biggest problems is attracting specialists however--anyway what are those PA's that get through your process getting offered? I know it depends on the state (Michigan?) for the most part but you must have some ideas where salaries are headed these days. My guess is approaching 150K for no call 40 hour shift work for specialities/primary care is coming in the next few years

[entropy]

I heard this morning that a total of 430,000 persons were removed from their seats on all US airlines last year due to overbooking.

Removed or took deals to wait? Seems like a huge number to be forced off without any backlash. I'd suggest they are including $$$ or incentive deals in that numbet


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[Jeff Buchanan]

Crash .....

I'm particularly disturbed by the proliferation of PA and NP programs. The NP programs offering Doctoral degrees on line have always bothered me. But, whatever. As I said, there are not enough clinical preceptors to properly train today's mid-level providers. Hence, even though PAs may be able to pass the NCCPA Exam (and these are as hard as any MD board), their hands on clinical skills are lacking. MDs have long residencies. The shortest are 2-3y in Family practice. If I were more politically active in the PA profession and not about to completely retire, I'd argue for residency requirements before licencing at the state level.

Because I am familiar with the Emory University PA program from which I graduated, I recommended and we just interviewed our first PA with under two years experience. Never mind that I called one of her preceptors who I know and asked what he thought about her as she came through the program. He was very complimentary. Beyond this, I also know the application process at Emory is stunningly hard. You get through that (she was also a National Health Service Corps Scholar), I can assure you your background has been thoroughly checked and you are golden. Sadly, she accepted another offer ...... and this is what I mean, it's hard to find, recruit and then retain top PAs. There is a huge demand for the best and the rest, and there are a lot of them, are working in less than desirable medical practice settings.

To your second question, the SE US is not the place you are going to find the highest PA salaries. There are good jobs for PAs in Atlanta and likewise there are a lot more applicants than there are good jobs. This drives salaries down a bit. A starting PA with less than 2y experience is going to get offered in the $52/h range. At a 2000h work year, that's $104K.

If you want to sign PAs from the top programs - the ones that do have good clinical training (for our area that is Emory, Medical College of GA and a few others), benefits have to be up there. Profit sharing, CME reimbursement, production bonuses, paid vacation are big deals; so is health insurance - an area that we have issues with in our affiliation model (we are comparatively small and our health insurance plan is pretty weak). It is why one of our top candidates we recruited from Emory took a job with a big hospital (Dekalb Medical, OP services).

We value ER experience highly. An NP applying for a position with us needs to have a lot of ER experience either as a nurse (preferably THE charge nurse) or 2y of it as an NP. We get a ton of NP applicants - the majority of them have work experience in minute clinics and occupational health settings - nothing wrong with this - but these folks typically have problems formulating a differential diagnosis from a constellation of presenting symptoms in more complex cases because they think like nurses not like MDs. Their background training tends to be protocol driven; PA training more closely approximates an MD's model of it.

We've found mid-levels, both PAs and NPs, with ER backgrounds are very good thinkers medically and can handle the fastest pace you'll see in our clinic. For example, I'll see 25-35 patient's in a 10h shift. With our schedule blocked at 4 encounters/h, that's entirely doable ...... until someone is late (frequently are) or you get THAT patient. Backs up the flow; now you're staring at your schedule and there are two walk-ins and 4 other scheduled patient's checked in waiting to see you. It is no big deal for a mid-level who has worked in an ER to keep all these balls in the air and not screw something up (e.g., "oh, you have leg pain. It's in your calf, no worries and I'm in a hurry. Take some Motrin and call us in 5d."). Medical liability is a big deal. Like I said, we highly value providers who can handle stressful work-loads without incurring it.

We find someone like this, with a lot of experience looking to get out of the ER grind, and they're going to be offered ER level pay. In the ATL region, you're talking $60-70/h or $120-140K annually. Moreover, this kind of quality get's your error-less encounter throughput rate beyond the 2.5/h billable encounters that most practices deem as the margin between a break-even model and a profit model.

Hope this helps. The more I thought about this the more detail I thought was necessary to give you a good answer to the question about pay you asked. BTW, for comparison, ED docs right out of residency are pulling down $220k. If you survive your first year without killing someone and like ER practice, you'll make $250 on up. ER Medical Directors and their Associates will pull down $300K+

[Dr. Strangelove]

I heard this morning that a total of 430,000 persons were removed from their seats on all US airlines last year due to overbooking.

I believe the majority of those were voluntary. Pretty sure the number of involuntary removals is a lot smaller. Airlines are fined by the FAA every time an involuntary removal takes place, up to around $1300 from what I've read, so that'd be over $400M in fines. That's why they do the whole cash voucher thing to convince people to willingly give up their seats.

[CGVT]

It seems that the screw up was to allow the people to be seated rather than taking their seat from them prior to boarding.

When I used to travel a lot for the Coast Guard, I would stand by the desk in the terminal to be close when they asked for people to give up their seats so I could get the free flight voucher. I think that they aren't as generous as they were twenty years or so ago. More vouchers for a couple hundred bucks off rather than totally free flights.

[crashcourse]

Just checking Jeff thanks for the info
government PA jobs are the way to go
I see 40-50 a week in gen surgical practice--some ortho and gu
generally 40 hr workweek government holidays and 26 al and 13 sl days
no bonuses but I do pick up call money which is extra
Midwest lot of your experienced guys are drawing 120-140 and some of the new grads are picking up 100K
anyway just wondering
congrats on your retirement

[crashcourse]

and based on my posts you can see I would never make it by the first cut of your screening process. but now with grandkids roaming around eastern Kansas i'm stuck here. not bad place to be though--Kansas city being only 30 minutes away

[iam416]

You're far too close to Nebraska to be in a "not bad place to be."

[Dr. Strangelove]

The Alabama statehouse apparently gives the Illinois statehouse a run for its money in terms of public malfeasance.

[crashcourse]

that's why we go anywhere but north

[THE_WIZARD_]

I hope Talent and DSL fly United...