Happy PA Week. Let's spend it in the ER at 3 a.m.

Brian Palm works nights in emergency medicine, and for PA Week I wanted to give you a look at a schedule most people never see. Part one of our conversation covers what nocturnal ER work is really like.

Nights are a different job than days. The volume shifts, the case mix shifts, and you have fewer people around to consult. Brian talks about the range of what comes through the door, how you make fast decisions with incomplete information, and how you stay sharp when your body thinks it should be asleep.

We also get into the tension every ER provider feels between moving patients through and giving each one the care they deserve.

What we cover:

• What a nocturnal ER shift actually looks like
• How night shift differs from working days
• The range of cases that come through overnight
• Making quick decisions under pressure
• Balancing throughput with thorough patient care
• How Brian ended up in emergency medicine

Resources:

Free Resume Download: https://www.thepaplatform.com/services/free-resume-download

Free Application Timeline: https://www.thepaplatform.com/services/free-application-timeline

PA Program Map: https://www.thepaplatform.com/pa-platform-map

Pre-PA Counseling: https://www.thepaplatform.com/services/pre-pa-counseling

Mentioned in this episode:

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Its PA Week.

What better way to celebrate than hearing from one of my favorite PAs, Brian Palm.

He's a nocturnal ERPA and we're going to be talking about his job today.

Welcome to the Pre PA Club Podcast.

If you want to learn how to become a physician assistant, you're in the right place.

I'm your host, Savannah Perry.

Let's get to it.

I want to thank mypa Resource and PA School Prep for sponsoring the Prepa Club Podcast.

So mypa Resource is a personal statement editing service that edits only PA school essays, only edited by PAs and most of us have admissions experience, so I am one of the editors.

Definitely check them out if you need help with your content, grammar, flow, making sure that you are on track for turning in your application.

And you can use the Code futurepa for a discount on any of their service options.

PA School Prep is an online course that focuses on the anatomy, physiology and med terms that you'll need for PA School to make sure you feel confident going into that first semester and that you are able to handle what PA school throws at you.

So check that [email protected] and also use the code futurepa for a discount there.

Hey guys, welcome to today's episode.

My name is Savannah Perry.

I am your host of the pre PA Club podcast.

If you are not aware, it is PA Week.

So every year from October 6th to 12th is officially the week where PAs are celebrated and recognized.

And so if you haven't been following along on social media, there's still plenty of time.

Make sure to follow HEPA Platform.

We've been doing giveaways every single day.

We have some that are still going through next week and we'll still be posting some through next Tuesday actually, so make sure you're following along there.

It's been really fun just seeing what everyone's posting, people talking about why they became PAs and what their job is like.

We had a great virtual shadowing event last night, which the replay will be posted for that shortly on our YouTube channel.

And today's episode is actually a throwback to a virtual.

I'm saying virtual shadowing.

I still have mixed feelings about that, so I'm calling it a Day in the Life event.

But this was our event with Brian Palm, who is the creator of my PA Resource and PA School Prep, which I talked about at the beginning.

But he is a great friend and he is a ERPA who only works nights.

So we talked on this event for about an hour and a half, so I'm not gonna Put all of that today.

I'm gonna do half of it, and then I'll post the second half later as another episode, just because I think that's a little too long.

But the entire video is up on YouTube.

If you'll go to YouTube.com thepa platform or just search for us there, you'll find that as well as when I did it a long time ago and talked about being a dermatology pa. We are planning another event for the end of October, and I have some more coming up in November and December, so stay tuned for those and make sure you're on our newsletter list so you don't miss out on any upcoming events.

But thank you so much for listening.

If you are enjoying the podcast, please like it, rate it, review it, and let me know what you want to hear more of.

But let's hear from Brian.

I got this floor mat, but my computer, Tripoli.

So it's not helpful or what?

Just because it's heavy, I guess.

Or because I'm.

Wait, why do you need a mat?

Well, just like, it's like a carpeted room and it's got, like, a computer mat on the floor.

Not a computer mat, but like.

What are those things called?

Floor mat, I guess, but it's like a plastic floor mat.

You know what I'm talking about?

Yeah, but why are you telling me about it?

Well, because I just have to, like, scoot because I'm in.

I'm in my.

Like, do you have, like, that spot on the couch that you just sit in all the time and then there's like, a divot.

Do you have that?

That's a Brian problem.

I have a nice couch.

I don't know.

No, I don't really.

Hi, everybody.

Hey, everybody.

Yeah, I don't know what he's talking about either.

That's fine.

You guys, like.

And I don't know if I just got the wrong thickness of, like.

It's not a floor mat.

It's like the plastic thing that goes under your computer chair to save your floors.

Right.

That's a different thing.

It's not.

It's called something else.

I don't know what it is, though.

I don't know.

I think if I was Google searching that I would call it a floor mat, but.

Well, anyway, computer format.

Y' all are from all over.

We got one from Toronto.

That was sweet.

All right, I'm excited.

I'm excited to talk about work on one of my days off.

Yeah.

And.

Wait, are you.

Just let me get scrubs.

I'm not Going to work tonight.

Thank you.

Like, I'm excited to talk about work after work.

No, just kidding.

But I'm excited to talk about work because I feel like all we talk about is pre PA stuff.

That's true.

We're not talking about that tonight.

Yes, Talking about.

It's going to be a nice change.

Yeah, exactly.

So great.

Let me make sure I got your Coke.

I'm ready.

How you make it through night shift, Is that the secret?

Yeah.

Well, yeah, I think so.

I've been doing this for, like, seven years, and I've had, like.

I drink like a monster every time I go in, but I've started to cut back.

Yeah, I know, it's terrible.

I started to cut back and I actually have been sleeping better, which is weird how that turns out.

If you don't drink, you know, what's the equivalent of, like four cups of coffee?

You end up sleeping more.

More better.

Huh?

English.

Yeah.

So.

But no, Vanilla Coke is just a special treat that I have on my days off mostly keeps me going.

You know, I had to take a picture.

No, gotta get one.

What I was gonna say.

Do you want to get one?

Drink my vanilla Coke.

You can take one of that.

Well, thanks for joining us, everyone.

If y' all have been to our pre BA conference or.

What else have we done?

A couple of our webinars.

I've done like, five or something, haven't we?

Yeah.

Yeah.

Y' all probably, you know, gotten tired of us.

Gotten tired of us.

You kind of already know who we are, but if you don't, we are welcome.

I am Savannah.

I am a dermatology PA in Georgia.

But we are not talking about me tonight.

If you want the replay link from when I talked about my job, we will make sure you have that.

But we are talking about Brian's job tonight, and he.

I'll let him do an introduction.

But before we jump into that, I'm gonna do some housekeeping.

So stuff.

And y' all, keep.

Keep.

The.

The questions, the comments, the questions coming.

We have a list of people.

Of questions that people have sent in on Instagram.

And so.

But like, keep.

Keep.

Go ahead and send your questions because we're adding those to a list right now and keeping track of them so that we can make sure we try to answer as much as possible so that you really get a feel for different things.

So anyway, but tonight we're talking about Brian and his job.

This, you know, can have a lot of names.

I'm calling it A Day in the Life Series Virtual Shadowing.

But I want to clarify that a little bit because, number one, not all programs are accepting these types of experiences.

So I would highly recommend that you check with programs before you include anything, any of these events on an application.

Because let's be honest, this is not anything like shadowing a PA in a real setting where you're seeing them interact with patients and nurses and doctors and all of those things.

It's so hard to, like, get shadowing experience now.

Like, it's.

I feel so bad for the.

The people that are looking to apply to school right now because, like, no hospitals are allowing shadows because it's such a big liability.

And that is just.

That's.

But at my facility, I'm trying to, like, figure out a way to do it, but it's just.

It's hard.

It's tough, and a lot of.

I mean, and it's just different, and I think that'll change.

Don't give up, y'.

All, like, keep looking for shadowing experience.

Yeah, there's still people that are getting hours, like, still getting into, like, shadow with people.

It's not to say that you can't find any.

It's just a lot more difficult now than it was, unfortunately.

Exactly.

So, I mean, just be on the lookout for hours.

Keep trying.

Same thing with healthcare experience, patient care experience.

Like, just keep looking.

It is out there.

It's just a little bit more difficult right now.

But when it comes to this event.

So we're not doing any certificates.

If you came and shouted me in real clinic, I would not give you a certificate.

It means nothing.

So.

So no certificates, nothing like that.

And we are not providing contact information for applications as well, because we have no way of verifying or guaranteeing that someone was here for a certain amount of time.

So for that reason, I don't feel like it is in good faith to validate that for anyone.

So it is up to you if you want to include this on your application and if the programs you're applying to are okay with that.

But ultimately, this is for informational purposes, a replay link will be sent out last.

Some schools are.

Some schools are, like, saying you can do virtual shadowing, but I think the schools that are doing that are a lot more lax on their requirements and stuff, too.

Right.

And, like, do maybe three hours, or they may not even be, like, requiring shadowing.

Right.

Just recommending it.

Yeah.

So extracurricular activity.

That's a good place to maybe put it.

But, yeah, that's.

That's kind of a good idea.

So.

But, yeah, I know if you watch the first one with me, there were a lot of.

A lot of technical difficulties with the replay link.

Like, number one, I don't know why the email.

The one in the email didn't work.

And then I was trying to get it uploaded to a certain, like, so where you could sign in and watch all of them at the same time.

That also didn't work because the file was too big.

I've said it before, I am not technologically savvy.

I like, Google my way through things and hope it works.

So I ended up just putting it on YouTube.

So if you missed the first one, it is on YouTube.

You can watch it there and then this one, I think.

I hope that a replay link will be available, but if not, we will get the video up somewhere, even if that is on YouTube.

So.

All right, I think that's it.

Let's do it.

Let's do it.

So give us, I think, before we, like, jump in and, I mean, you can take the reins if you want, or I'll kind of lead with questions, but.

Yeah, have a rundown of what.

What, like.

Yeah, well, I want to know, like, your.

Your work history.

Yeah.

Okay.

That's good.

Well, yeah, so, as Savannah said, my name is Brian Palm.

I am an emergency medicine PA And I work nights in the er.

I used to work at a trauma center down in metro Atlanta, but now I'm more like in a rural area, smaller hospital.

And so tonight, everybody, put on your Sparry hats, because we're going on a journey, and I'm going to teach you all about what it's like to be a pa.

So if you're interested in emergency medicine, maybe you are interested in things like sewing, right?

You like sewing and knitting and all that.

That's something you get to do in emergency medicine.

You get to play dress up, right?

You get to wear gloves and gowns and masks and goggles and safari hats when you want to.

Right?

Puzzles, if you like puzzles, you might enjoy emergency medicine.

Like, if you want to get to the bottom of why somebody who stubbed their toe is now saying that they can't see, that might be a reason why you go into emergency medicine.

If you like exploring, if you like exploring some of the deepest, darkest depths of the human body and finding treasure in that human body, that might be a reason why you pursue emergency medicine, all orifices included.

That's all.

I have other reasons why you might like emergency medicine.

All right, well, but anyway, no,.

The.

Job, in and of itself, it is very.

It is very diverse.

And like, there's, there's.

You see all kinds of different stuff in the er, right?

Like anything you could possibly imagine.

I've been doing this for seven years and I see something different every single day.

Somebody says something to me, different every single day that I've never heard before in my life.

Like, I said, I had a patient come in by ambulance who stubbed their toe like they broke it, and then saying, I can't see.

And I said, you can't see because you stubbed your toe.

And so I've got to make, as ridiculous as that sounds, as an emergency medicine provider, you've got to take all these complaints, these random complaints that people have.

Somebody comes in with a headache or chest pain or headache and chest pain and abdominal pain and cough and fever and all that stuff.

You've got to make sure that one of those complaints isn't something life threatening that's gonna kill them, right?

That they don't have a life threatening emergency and you rule it out and you send them to a specialist, like a cardiologist or a dermatologist, like Savannah's case.

And like, speaking of, like, you know, our jobs have a lot of overlap.

Like, there's like a Venn diagram, right, where, like, you know, my circle, I have like, you know, you know, different kinds of cases on all different specialties or subjects.

And yours is mostly on skin, but in the middle, like, we both don't get nauseated when we smell blood, pus, and burning hair, you know, so like, that's a common, you know, a common thing.

But, yeah, no, so it's.

It's different.

It's a.

It's.

It's different every day.

I love it.

I love emergency medicine.

I don't think I could do anything else just because of, you know, I've been doing it for a few years, but when I graduated school, most of my experience before I went to PA school came from being an ER tech in the same hospital that I worked at as a pa. And so before school, I worked as an ER tech.

And then after I graduated, I worked at that hospital as a pa, which was pretty cool.

And before I was an ER tech, I was an emt.

I worked on an ambulance, and then I had other various jobs in healthcare, but I liked emergency medicine just because of how different everything was.

Every patient is totally different.

You go from coding a patient in one room and then the next room, you've got to handle a kid with a runny nose.

So just the variability of the complaints that you get in the ER keeps things interesting.

It's not monotonous at all.

You never see the same thing twice or pretty much not the same thing twice.

Everybody's different.

Everybody's dealing with their own struggles, both physically and emotionally.

My job is to get to the bottom of it and figure out what.

What is the root cause of their symptoms.

And just like I said, to make sure that there's not there.

It's not something that's gonna kill them or is life threatening.

They need to be admitted to the hospital for.

So.

But yeah, it's fun.

I wish you guys.

I wish everybody could come shadow me, but now, like, like I said, it's terrible.

I love having students come shadow me, but not now.

Weird times which somebody did ask and I think we can go ahead and like, get this off the table or I don't know, whatever.

But how, like, what is your biggest Been your big.

What has been your biggest challenge so far during COVID or changes?

Yeah.

Your job or how it's been affected?

Because I feel like I don't.

And I think, like, sometimes it's hard.

Like a lot of pre PA students haven't been able to talk to PAs and you see a lot of PAs, like aren't.

Don't have jobs or losing their jobs.

Right.

So, yeah, like, how has it affected your job and then like your job, like going to work.

Yeah.

Well, so I'll start off with like my job at.

Well, I guess my job itself.

They're both kind of related, but like the.

My overall, like me, the hours that I work and like my shifts and all that, like since coronavirus started and so back in March, we all had to start taking call, like, just in case we got coronavirus surge.

Like, we had tents in front of the hospital, like ready to just take patients on.

You know, Georgia's a hot zone now and you know, was kind of in or parts of Georgia were back in March.

And so we were ready, you know, just in case things got like New York or New Jersey or anything like that, and a good thing that they weren't.

And so what started off as, hey, you guys might have more responsibility then turned into probably because we're a rural hospital and it's not people that are living on top of each other and going to the market every day, like in bigger cities, like New York City.

Right.

Like, I think a lot of people in New York have to go out every day to, you know, they don't have big grocery stores and stuff in New York City.

Like, they have grocery stores.

Of course but, like, you go typically to, like, get your things for the day or a couple days and then, you know, come home and you're not living on top of each other.

Whereas in neighborhood, you know, there's not a lot of people, like, socializing as much or at least, like, people can social distance a little bit easier.

So anyway, so what initially started off as, you know, we're ready to surge, you might have some extra responsibilities.

Then in, like, April and may, like, our ERs were actually pretty slow considering where we thought we were going to be.

And so there were.

None of us got our hours cut necessarily.

Like, we didn't lose shifts.

Whereas PAs in different specialties that worked in the hospital, like, I know some ortho PAs that stopped working because hospitals weren't allowing elective procedures, which is like shoulder and knee replacements and hip replacements and stuff.

Like, those PAs that were doing elective procedures were kind of out of work, you know, weren't going in, going into work.

So as far as that's concerned, like, I'm very fortunate that my hours weren't cut, but.

Oh, that's.

Well, that's right.

One of the day shift, they had a triage shift that they cut out.

And so some people might have had like one or two shifts for the month that were decreased.

But I worked nights, and so I didn't.

I wasn't affected by it as much.

There were some of my co workers that had to take one or two less shifts just because we weren't busy enough to.

To fill the position.

I guess our patient load decreased so much.

So that's that part.

Now we're busier than we were before.

Coronavirus.

Like, it's, you know, people just are going out and doing whatever the hell they want to do now without wearing masks.

And so, you know, let alone not wearing masks, but, you know, just like the normal stuff, right?

Like the chest pains, abdominal pains and vomiting and all that.

And now the kids are going back.

We see a lot more kids in the ER because parents that send their kids to school, like, are worried.

Well, now, you know, do they have coronavirus?

Want them tested and stuff?

So it's busier now, I feel like, than it was even before all this, all this mess.

So.

But regarding my job, when I'm just, like, rambling on, if you, like, want.

Me to stop, you're great.

This is exactly what I did.

You're good.

I'm just gonna keep talking and chat.

Like, if you.

I see, like, a bunch of questions popping up.

Like, if I glance over during My ADD rant like, I will, I'll answer as best I can.

Well, and that's what I kept doing.

I had to stop looking at chat and just look at my document.

So like you just go and.

But day to day, practice wise, you know, initially we were taking, you know, a ton of precautions, which still are obviously, but you know, every patient that came in, we were like wearing an N95, a gown and all this other stuff.

And then we would have to throw everything away after we saw the patient because like we didn't know what this, what the hell this thing was like back in March, right?

Like we saw videos from other sides of the world of people dying and like, you know, we didn't know.

And so we were just trying to do the best we could to take care of people and now we've kind of got a better handle on things six months later or so.

And you know, like I told one of my collaborating physicians this, you know, I don't think I'm going to see another patient without an N95 in my career now because you don't know who has this thing.

And like, I don't want to bring it home to my family and get, you know, my parents sick or grandparents sick or whatever.

And so I'm taking as many precautions with everybody as I possibly can.

And so if you come in for like an ankle sprain or a stubbed toe, I don't know why I remember that guy.

That was like four years ago at this point.

But anyway, I'm still wearing an N95 and I'm, you know, when I'm talking to you, I'm not as close to you as I likely was beforehand.

I'm more, you know, I'm kind of in the, not in the corner of the room, but less awkward than the corner of the room.

But I'm not, I'm definitely not as close as I used to be.

And, but I'm taking more precautions with everybody, like I said, just because, you know, you don't know.

You don't know who's got what.

Like we had.

So back in April, we had this lady come in for.

It was like a post op complication.

She had a hip replacement like a week ago and she was doing fine.

And then all of a sudden like, or over a course of like 24 hours or so, she started to act strange, right?

Like altered mental status, type complaint.

She had a fever when she came in and we were like, oh, it's a post op complication wound infection.

And so everybody's in there.

I had my 95 mask on because I'm like, forget it.

I'm not seeing anybody without an anti 5 mask on.

But everybody was in there as if it was like a hip post op complication.

And then we hook her up to the monitor and stuff and she starts coughing and her oxygen saturation goes down to 86%.

And we're like, hey, have you been coughing?

And she's like, yeah.

And I'm short of breath.

So like, you know, you probably had coronavirus.

I'm like, you just don't know.

You know, like people come into the ER for.

I had the other night, had a mom and bring her kid in and because her kid was.

Had a slight, what was it, a cough or a fever without any other symptoms.

And then she was like, well, I just want him checked.

But she checked in too.

She was like, I've got a lymph node that's large under my armpit that I want checked out.

And since we were here, I figured might as well just come in.

But she sat in the waiting room for like an hour before she told anybody.

Like, hey, I tested positive for coronavirus a couple days ago.

And it's like it, you know, you just, you just don't know who's got.

We're seeing that too.

I'll just comment, like on a private practice setting.

And I don't know if it's just because people feel like a medical place is safer, I don't know.

But like, we've had patients come in and we have a little screening thing and they'll say like, I just tested positive or my husband tested positive yesterday.

And it's like, yeah, yeah.

So, yeah, I mean, it's like.

And this is a very difficult time, like, regardless of what you think of coronavirus, right?

Like, you and I and other people, you know, younger than us, like, chat and stuff that are young and healthy and know with medical problems, like, by and large, we're all gonna be fine.

Like, if you get it, if all of us had coronavirus, most of us would obviously be fine.

My concern is that, like, I don't want to spread it to somebody that won't be fine, you know, and so I'm not, I'm not worried that I'm going to die of coronavirus.

Like, if I get it, I'm concerned that I spread it to somebody who then will or will get very sick, like, die or not.

Right?

Like, I don't want to spend two nights in a hospital.

Are you kidding me?

Like, I'm in and out of that place.

Like, forget.

I'm not staying any longer than I have to in that place, let alone me wanting to, like, you know, have.

Have somebody else stay in there, you know, if they didn't have to.

My hospital is great, but, like, I'm just saying, you know, like, you don't want to be in the hospital if you don't have to.

Yeah.

So it's hard.

Like, it, you know, I can't have the same or as much of a. I feel like the personal connection that I used to have with patients isn't as strong now because I can't see, like, my facial expressions and can't see me talking or like, even my eyes.

Right.

Because I've got goggles on everybody, too.

I wear goggles.

A N95 mask.

One of these that I brought.

I was gonna put that on with the safari hat, but I forgot.

And then a surgical mask, too, with everybody.

And then if somebody comes in that's highly suspicious for coronavirus, then I'll put on a gown and all that.

But.

Yeah, but it sucks.

Like, you can't.

You can't.

I feel like you can't have the same expression or connection with people.

And it's just very.

Like, I even noticed myself, like, you know, with patients that have, you know, cough or shortness of breath and stuff, like, I am more aware of, like, I'm not getting as close to this patient or, like, I'm not, you know, examining them as close as I typically would like with somebody else, you know, like, you know, standing back a little bit while I listen to them instead of, like, you know, getting in closer.

And I don't know, this whole thing, like, so I'm just ready for it to be over.

But, like, here comes flu season and, like, it's going to be the same thing.

It's just, you know, coronavirus sucks down with coronavirus.

Yeah.

Maybe flu won't be as bad because people are kind of wearing masks.

Kind of a pessimist.

So.

Yeah.

I don't know if you can tell.

I, like, have a pressure sore on my nose from my N95.

Yeah.

Yeah.

I get, like, little abrasions and stuff too.

Or like, off work.

Like, my face is, like, indented, mushed.

Yeah, yeah, yeah.

So we wear them just because I'm in people's faces all day long.

Yeah.

Like, you're getting in their face, so.

Right.

You are, like, in their face.

Yeah, yeah.

So I don't have that.

I don't have that luxury.

I'm not in people's faces all day.

But I saw some people asking, like, how long are my shifts?

Like in the year?

I say, can you just run us through like your schedule?

Like, yeah, like in a week or something.

I don't want to.

So, like, can I pull it up?

I'll show you my schedule.

I probably should have done this before.

Sorry, Chad.

So it's usually like two, three, four days on and then two, three or four days off.

I usually work like 14 or 15 shifts a month.

I can probably show you this.

I don't think there's anything.

So this is like my August schedule here.

And I work the green days, the blue days, I don't work.

But like.

So it's like 3 on, 3 off or 4 off, 2 on, 2 off, 2 on, 2 off,.

3 On, 2 off.

So I'm in the.

I'm in the middle of a nice stretch right there.

But like, so I saw somebody ask earlier, is there a way to do like seven on, seven off?

Like, it depends on the facility.

Right.

Like some places on my old job, I used to work like, what was it, 16 or 17 shifts and they were 8 hour shifts.

And so I work less shifts.

But I get like the same, if not more hours because I'm working 10 hour shifts instead of 8 hour shifts.

Some ERs work 12 hour shifts, you know, and like some ERs will have different shifts where you, you know, like if you work the afternoon shift, it's 1 to 9, and if you work the morning shift or the evening shift or whatever, it's five to five or something, you know, it's a 12 hour shift instead of.

At my facility, there's like, there's five different shifts and so there's a 7 to 5.

I'm gonna do my best here.

7 To 5, I think 9 to 5, 11 to 9 and then 4 to 2, 4p to 2a and then 9p to 7a, which is what I work.

And so they don't rotate me through because I just work nights.

And so my schedule stays the same even on my days off.

Like if I have like two or three or four days off, I don't flip my schedule around.

And so I'm up until the wee hours of the morning typically.

And I like nights because, you know, it wouldn't work for a lot of people, But I'm very fortunate and my wife is very supportive.

But you know, with working nights and not having a schedule where I work, you know, some morning, some afternoons, Some evenings, Some nights I'm home for dinner every night and I get to see my, you know, tell my kids good night every night.

Which is something that a lot of people don't get, right?

So if I worked a shift that was like 1p to 9p at my job, I would, if I worked that shift three days in a row, like, I wouldn't see my kids, like hardly at all, right?

Because if they were school age, I guess I wouldn't see them because I would be.

I guess if I worked until 9, I would still get up and see them in the morning.

But like, you know what I mean?

Like, if you work a later shift or a swing shift, you might not see your kids for a couple for like three days, which stinks.

But, you know, like I said, my wife is very supportive.

And that's important too is finding a partner that's like, understanding of your job and your responsibilities and hours and stuff.

And like, she knows, like, she doesn't want me being a zombie and like, you know, being tired all the time by like flipping my schedule back and forth, back and forth, depending on the day.

But that doesn't work for everybody.

And like, like I said, I mean, I know, I know that I am lucky to have that.

So that's important too, is just kind of realizing how good you got it.

And I've always done nights, like, since I started, I've been doing this, I'm going on seven years.

It'll be.

Well, I guess it's like six and a half years at this point.

But I started off, they wouldn't let me do nights initially just because there's less like, support on night.

So, like, you don't have consultants in the hospital, you don't have cardiologists in the hospital.

You don't have everybody in the hospital in the middle of the night.

You got to call everybody, Everybody's at home.

And so you've got to figure out, like, well, do I really need to call this person at 3am and like, wake them up?

You know?

Whereas during the day, if you had one other patient, you'd be like, hey, so and so is here.

Like, just so you know, what do you want us to do?

Whereas in the middle of the night, it's like, you know, if you're not.

I'm not trying to wake people up in the middle of the night if I don't have to.

Right?

You know, but yes, there's not a lot of support at night.

And so for new grads, like, when you get out of PA school, you might not be able to start nights initially.

And that's just because, again, there's not.

You don't have as much help.

Like, you know, the ER at night runs on, like, a third of what it does during the day as far as support staff goes.

So if that.

Maybe even like a quarter, I don't know.

But you're more kind of on your own, which is kind of cool in and of itself.

I find that I have.

And this will kind of vary from facility to facility, too, but I feel like I have more freedom and autonomy on nights than I would during the day.

Just because the suits are all at home, resting in their bed, comfortably in their comfy beds or whatever.

I get away with a lot more at night than I feel like I would during the day, which, like, is good for me because I think that I would, you know, I as, you know, like, I'm.

I'm more outgoing and stuff, and that just kind of works more at night than I think it would during the day, so.

Which is fine.

So I have no idea what the initial question was, but I think I answered it.

I think it was just, like, your schedule, but there are some, like, other questions, like, going off of that, which.

And I guess, like, for people to understand, and I may not even understand, but, like, one of my good PA friends just switched to doing nights in the er.

Jamie.

And, like, the benefits are usually.

And this may or may not be true, you can correct me, like, you typically get, like, a night differential.

Like, hey, less, maybe less shifts than if you did daytime.

Like, there, like, there are benefits that come with the sacrifice of doing nights.

Yeah.

Yeah.

So usually there is a night stipend at some places.

I know a pe, they got a job working nights and they're like, no, there's no stipend.

Like, this is the job, which sucks.

But again, it's just different everywhere.

But, yes, that's a benefit.

The pay is a benefit.

Up until today.

I actually got an email today.

We'll just say, like, before today, I could, like, I kind of make my schedule.

Like, I kind of suggest what I want my schedule to be, and they kind of work around it.

And because I'm the only night person at my facility.

And so when I'm on all of the day, shifters have to, like, rotate through the night shifts.

Whereas.

Because we had somebody leave recently.

Whereas before it was just me and her that did nights.

Like, when I was off, she was working and vice versa.

But now I kind of have a little bit more freedom and can have been able to, like, choose my schedule.

And so if I want, like, you know, a day off here and there, I don't have to go through, like, the management approval process, all that to get it off.

I just say, hey, this is what I want my schedule to be.

And they work around it.

But today I got an email saying I couldn't do that anymore.

Oh, no.

So I, you know, it's fine.

Hopefully that'll change again after a couple more conversations, but.

But again, that's different everywhere too.

Like, you know, if you work at a hospital where they just have a scheduler that, you know, lives across the country from you and doesn't know who you are, like, they aren't.

They don't care what your schedule, like, you have to go through and, like, get approved time off and.

And all that.

So, yeah, er, I just haven't a glance over.

So, like, do I work hourly or salary?

So, like, I do work.

I work hourly.

And my pay structure is, like, off of, like, RVUs.

It's like a productivity model almost.

My job before was almost entirely like rvus.

I got a base, like, hourly rate, and it's super confusing.

I didn't confuse it.

I didn't understand it when I first got the job either.

I didn't understand it until, like, three months in.

I was just like, I think this is fine.

I talked to people that work there, and they were like, yeah, it's a good deal.

But basically what it is is that they take.

So, like, if you get paid $1,000 a month, okay, I'm gonna try to throw them out.

But if you get paid $1,000 a month in your.

In hourly salary or whatever, right?

They take that based on how many shifts you work and, like, how many hours you work for the month or whatever.

Just say that's $1,000.

But during the month, the RVU model is based off of, like, the complaints that patients have and, like, the workups that you do and, like, how sick they are and if they get admitted and, like, their acuity and all this stuff, they get, like, designated a number, like an RVU number.

And that's based off of, like, a Medicare law.

I think that was in, like, whenever.

And so, like, I would, like.

If I saw.

Say this is not to scale at all, but if I saw 100 patients that all had the RVUs of 10, that would be a thousand, right?

So I would Even out for the month.

But if I saw 15 patients that had RVUs of 10 for that month, so I had $1,000 in my salad, this is like, nobody's gonna understand this.

This is.

Probably just Google that.

But.

But anyway, it's a productivity model and it works like, it works for me because, you know, I tend to be a hard worker and like, you know, they.

It encourages you to like, work faster, like through patients and be more productive to earn more money, which is nice.

But.

Yes, I am hourly, but it's based on productivity.

And it's like super confusing that you don't.

I tell you what, like, last time I looked at the salary report, it was like 10% of PAs worked on the RVU model.

If you find an ER job working in the RV model, take it, period.

Like, yeah, take that.

Rather than like a salary, like hourly rate or whatever, work on the productivity, because that's your salary will be more based on like, you and like, how you work and what you, you know, how you work harder and you get paid more, you know.

Well, and typically like, ER visits and procedures are billed higher than.

Yeah, well, like patient or normal stuff.

So.

Yeah, well.

And I think it's like another part of the RVU process is that there's like multipliers that are a factor as well.

And so, like, you're deemed your.

A lot of places you're given a multiplier and like the RVU multiplier times the amount of RVUs has to outweigh your salary for the month to get like a bonus, a productivity bonus at the end of the month.

So it's very confusing, but definitely, like, do RVUs.

So, yes, I'm hourly.

I'm also productivity based, but it's a good model.

Cool.

People really want to know, and I don't know how well, okay, they want to know, like, what a normal shift looks like.

So that can probably vary a ton.

But maybe tell us about like your last shift or something.

Yeah, God, that was like two days ago.

I don't know if I remember that.

So, yeah, so I get there at 9 o', clock, right.

I typically shower around 8.

I'm out of the shower by 8, 10, 8:15 or so.

I put on my scrubs by like 8:12.

I'm just kidding.

But I get to work around 9.

I get to work around nine.

I go in and usually like the hours from 8 to 9 or like 7 to 9 are some of the busiest of the entire day.

And so when I get there, things are typically on fire.

Like, there's a waiting room full of people.

There's patients waiting to be seen because everybody's after dinner, like, oh, you know what?

I think I'm dying.

I'm gonna go to the er.

That's typically, I guess, how it goes.

I've never had that thought before, but usually around that time, I guess people are, like, off work.

They don't want to go during work, and they're like, oh, I think I felt like I wanted to throw up for, like, 15 minutes.

I'm gonna go check into the ER and make sure.

Make sure that I'm not dying.

So that's my job.

No.

So I'll get there.

Let's see, the people that are working before I get there know that, like, I'm the suture guy and the procedure guy.

And so, like, a lot of patients that get bit by dogs or that have, you know, that, you know, a kid, a toddler that hits his head up against the corner of a door or, you know, things that need to be, like, repaired a surgical repair, they know that I'll do it because again, at my facility, it's different.

And it's different everywhere.

But I kind of work.

I tend to take more like lower acuity patients, like, just to get the process moving when I first get there.

And the lower acuity patients are things like ankle sprains and kids with the sniffles and just little things like possible broken bones, wrists, lacerations, animal bites, things like that.

So they leave those for me if they come in, if they know that I'm coming in here within the hour.

And so when I first get there, it's usually like, you know, ordering X rays, ruling out different things like fractures and foreign bodies and all that when I first get there.

But usually when I get there, I see like, five to eight patients in the first hour.

And, like, I just sign up for them all and, like, you know, go through.

And once I sign up for them and I go in and I do my initial exam and then do their workup, and then I get.

As far as those patients are concerned, I kind of get a break from running around the ER because I'm ordering tests and I'm waiting for those tests to come back.

Once I see go through all those patients, then by the time I go through all those patients, then the X rays are back and the blood work, if I ordered some, is back, then I go back through and I discharge people that I initially saw when I first got in, or I add things to the workup that, you know, based on like the lab findings or the X ray findings from when I first saw them.

But once that initial like bolus is through from patients that are walking through the door, then like around 11 or 12 o', clock, then people are coming from like by ambulance in the middle of the night, right?

It's like older people that are having chest pain or severe abdominal pain or drunk people, like I had five drunk people come in on Sunday night, which, like partying on a Sunday, like going out, you know.

But all those people come in by ambulance and like a lot more ambulances come in the middle of the night.

And a lot of the cases that come into the middle of the night are, are like, if you think about it, right, like nobody's got like sitting in bed at 3 o' clock and be like, you know.

Well, I shouldn't say nobody because plenty of people do like sitting in bed at 3:00 in the morning, like, oh, my ankle's been bothering me for four days.

Like maybe I need to go to the er.

Usually it's stuff like I was woken up like with this really bad chest pain or oh, I woke up with this really severe abdominal pain and vomiting and I can't go back to sleep type stuff.

Like the things that people take ambulances for in the middle of the night are usually things that they can't sleep with, you know what I mean?

Because if they are unable to sleep in the middle of the night, they're going to come to the ER and figure out, make sure that they're not dying.

And so that's what we do.

So we do a lot of like heart attack rule outs and we do a lot of like CT scans on abdomens to make sure it's not appendicitis or a perforated diverticulitis or gallbladder or things like that.

But the patients that come in the middle of the night are completely different than they do during the day.

Because if somebody came in in the middle of the day for an ankle sprain, you'd be like, oh yeah, this person's ankle hurt, they must have twisted it.

But if somebody comes in at 2:30 in the morning, you better believe if you come in at 2:30 in the morning with ankle pain, I'm like, what are you doing at 2:30 in the morning with your ankle?

Like, what, what made you wait?

Like come in the middle of the night type thing.

So, you know, we get a lot, not necessarily at this facility now because I'm not at a trauma center, but when I was At a trauma center in the middle of the night, it would be, like, traumatic car accidents, gunshots, stabbings, at, like, bars and clubs, you know, and still, like, still with the heart attacks and the strokes.

That's another thing, too, that we get in the middle of the night.

Is stroke rule out stuff or, like, surgical abdomen cases that come in the middle of the night.

So, like, that's also the type of stuff that came in when you work at a trauma center, but now we don't get trauma, and so I don't see a whole lot of that stuff.

Like, I used to.

Whereas every night it seemed like it was like, boom, boom, boom, boom, boom.

Like, you know, gunshot wound, stabbing, traumatic car accident, stuff like that.

Speaking of that, I'll talk about one of my.

Somebody asked, like, what was my favorite or, like, my most memorable case?

And so my wife was away for.

I think she was on vacation for a couple weeks when I was working at the trauma center, and I was working in the middle of the night.

And these two guys, they were like, hey, we got gunshot wounds rolling through the front door.

So I'm like, all right, well, here we go, right?

Drink up.

Get your monster in.

Yeah, so.

So these two gunshot wounds roll in in the middle of the night, and they're going to wheelchairs.

And I'm like, these guys look familiar.

Like, I've seen these guys somewhere.

I don't know if it's here or what, but.

So, like, I ran up to him as they're getting rolled to the trauma rooms, and I'm like, hey, like, you know what happened?

And.

And they were like, oh, we got.

You know, we got shot.

We were at a party.

Somebody stole our liquor.

So we chased them, you know, down the stairs and out into the parking lot, and they got into their car and shot at us, which is, like, so stupid.

Like, it's so stupid that people.

The reason why people get shot, right?

Like, stuff like that.

Like, you're running after a bottle of Kamchatka, like, vodka that costs, like, $12.99 at the liquor store that somebody's uncle bought them because you.

You know, you couldn't afford.

I mean, not that you can afford it.

You don't.

You're not old enough to drink alcohol.

But anyway, so they change.

Yeah.

Yeah.

I mean, like, college, right?

Like, anyway, so I was like, well, where are.

Like, where were you guys?

Oh, this really crappy apartment complex called xyz, and that's where I lived.

So, like, they were my neighbors.

Oh, no, thank God my wife wasn't home, but, like, there was a shootout in the parking lot of the apartment complex and, like, you moved.

Yeah, no, no.

Yeah, we didn't live.

We didn't live there anymore, but it was.

Well, no, we don't live there anymore, obviously, but we still live there then.

And it's like, what the heck?

But anyway, that's the craziest.

That's the craziest story that I remember because, like, just imagine.

I mean, that's like, crazy shit, right?

Like, people don't like shootouts like that.

I mean, you know, I just.

It's so wild.

Like, people just don't think about, like, in an apartment complex.

I mean, bullets could have been going everywhere, and you just don't know.

That's the kind of stuff.

Right.

Like, people that are, like, kind of recognized from the pool and, like, they came in with gunshot wounds and, like.

I mean, I think that's.

Yeah, you definitely get, like, way more interesting stuff than what I would see, probably.

Like.

Well, yeah, I see interesting stuff, but, like, the stories different.

Yeah.

Yeah.

Like, somebody asked if I'd ever do the er, and I liked it.

I didn't like broken bones, so.

Yeah.

I, like, can't deal with.

Mine was eyes.

When I was in school, I couldn't do eyes.

They're kind of creepy.

Yeah.

Now it's like, whatever.

Well, that's how it.

Like, so.

I mean, that's how I feel about blood and stuff.

Whatever.

But, like, so my.

I just was thinking, though, because I kind of forgot, but when I was on my ER rotation, it was right after the bad ice storm in Georgia.

Oh, God.

Yeah.

Like.

Like, kind of during it, but then, like, at, like, clearing.

So what we kept seeing a ton of was chainsaw injuries.

Like, I saw so many chainsaw injuries, which are surprisingly clean cuts.

Yeah.

To suture a ton.

Because these guys were coming in with their legs and arms.

Yeah.

That's.

That's the big.

The longest laceration that I've had to repair.

It was like, this long, and it went all the way down just about to the bone.

It took me hours.

Yeah, these weren't that bad, thankfully.

But, yeah, they were like, here's some suture stuff.

You know how to do it.

Yeah.

Little PA student.

And I was like, yeah, they just put you in a room.

Put you in a room for an hour or two and kept you busy.

Pretty much.

Yeah.

But I just remember seeing that.

And I.

And there was a guy who got a fish hook in his ear.

Oh, yeah, fish.

Like, we've got a lake around here.

And, like, it's fish.

Yeah, they get it, like, in their hands and fingers.

And it's.

They're so frustrating because, like, with fish hooks, when they get stuck in you, they've got that barb on the end, and so you can't just, like, pull them out.

And so you've got to push them through.

But the problem is that when they get lodged in the tip of your finger, there's not a whole lot of room to, like, angle them through.

And if you use really crappy, like, small hooks and they get stuck, like, sometimes they can break off.

And that's a whole other issue.

But those are.

Yeah, that's.

That's one of my least favorite procedures because sometimes you have to, like, really, like, yank them out.

And like, when you do that, then you, like, have a risk of hurting yourself, too.

One of the most satisfying things, though, is like, putting a, like, dislocated hip back in place.

Just the way, like, I saw that.

So when y', all, like, you stand.

On the table, you get on the.

Bed and you're like, you know, basically, like, trying to deadlift this person and, like, having to, like, pull.

And when it pops back into place, though, it's like, ah, yeah, awesome.

But that's like, people that, like, orthopedists, like, orthopedic pas, that's the kind of stuff they do every day.

They get to use, like, hammers on bone and all that stuff.

But, yeah, like, you know, another crazy, like, I'll tell you another crazy story.

I can keep going with these.

I'll do one more because it's kind of foul.

But so I was working.

This was before PA school, I was working as a tech in the hospital.

And like, like on a Wednesday in the fall, like 3 o' clock in the afternoon, like, you know, nobody's in the ER at that time.

Or at least that day there wasn't.

So this guy comes in and he's like 55, 60 ish or so.

And he comes.

He's like, sweating bullets.

And so I see him, like, walking in from the park.

I'm like, holy crap.

Like, what's.

This guy's having a heart attack.

Like, what's going on?

So he's like, you know, like, freaking out, like, walking through the doors.

I'm like, dude, like, what's going on?

How can I help you?

And he's, like, looking around, like, just, again, just sweating bullets, freaking out.

Like, he doesn't want to tell me what's.

What's wrong.

And so he's like, come over here.

And so he brings me over.

He's like, well, there's no easy way to tell you this, but I've got a giant dildo shoved in my ass.

Oh, the poor guy.

But, like, it was an emergency, right?

Like, he ended up, you know, you got to go to surgery for that stuff sometimes.

But, like, he ended up slipping, I guess.

I don't know if he was mopping or what, and, like, slipped in his kitchen and just ended up falling on it or what.

I don't know.

But, yeah, like, it's like, stuff like that.

Like, things that you would never, ever think of.

Like, you know, if you, like, read.

On the Internet that you're like, no way.

That's not true.

Like, it's true.

Listen.

Like, five hour energy bottles, Hot Wheels, cars, glass and plastic bottles.

I mean, you.

You name the orifice.

Literally, you name the orifice, and I have pulled something out of there for both males and females.

You name the orifice, and I pulled stuff out of there.

Wow.

Unbelievable.

Okay, there are some questions.

Very imaginative.

They've got a, you know, wide imagination and good on them, you know?

Yeah, yeah.

But wait, hold on.

We haven't even finished your shift yet.

Oh, yeah.

Like an hour in.

We're gonna be here all night, guys.

All right, so one hour.

No.

And so, you know, a lot of the main.

My main focus, like, I kind of pride myself working nights.

Like, I feel like it's my job, my responsibility to clear out the waiting room, right?

And, like, if there.

It doesn't matter if there's, like, three people in the waiting room or there's 20 people in the waiting room.

My job is to get that waiting room empty by the time day shift comes in the next day.

And so, like, I'm.

I'm pushing it, you know, early in my shift to try and clear that waiting room, because I know that if I clear that waiting room out, the sooner the sooner, the better, right?

Because if there's no patients to be seen, like, I can catch up on my CMEs or, like, read, you know, literature, you know, medical stuff or, you know, whatever, you know, like, if there's things that I need to do, I can do that if there's no patients to be seen.

So, like, I pride myself on the fact that, like, when the doc comes in in the morning, like, there's nobody in the wind or nobody to be seen.

Like, I feel like, you know, I did my job and it makes me look good, too, right?

Or, like, me and the doc I worked over and I'm not like, it's not only me, of course, but so anyway, so.

But like most of the night is, is spent that way though.

It's just like picking up patients as they come in, seeing the patient doing the examination, ordering the workup that you want to do, seeing how the labs and the imaging studies that you ordered and like the medications, if they work or not, how those work, if they work, great.

If they don't, then figuring out like, what other path to like, go down, right?

So like somebody that comes in for chest pain or whatever, say it's somebody like a 50 year old that comes in with right sided chest pain or.

Yeah, no, yeah, the camera's messing with me.

Right sided chest pain, right?

So you rule out, so like, you rule out, you know, all the heart stuff, but like, okay, so like, what else could cause right sided chest pain, right?

Like, you know, you ruled out pneumonia, you ruled out a heart attack, you ruled out a broken bone, you've ruled out, you know, angina.

What else, what else could it be?

And so you gotta think about, well, like, well, hey, your gallbladder's over here on the right side.

So like it could be the gallbladder that's causing right side chest pain.

And like a lot of the time it's that, it's things that it's important in the ER to keep a wide differential of.

Like, nothing is face value.

Like, even things like, I don't know, like I got, oh, I got bit by a bug on my leg the other day and now my leg is like big and swollen.

Like, I can't tell you how many patients I've had like that, that got bit by the bug.

And they're, you know, it's not a cellulitis, it's a dvt.

It just so happens that like, even though they got bit by a bug, they've got a big old DVT in their leg.

And so like, if I sent that, which is a blood clot in leg for those playing at home, but like, if I sent them home thinking that it was an ant bite, like, they could be dead, right?

Like, you know, we come back once the antibiotics aren't working and they would be okay.

But you know, it's important in the ER to keep, keep a wide differential, like I said, so even, like, yeah, I mean, it's crazy.

Like people just.

The things that can happen to the human body are just crazy, like without, like, like of no fault of our own, right?

Like just all of it.

It's like a car Right.

Like, you can do general maintenance on your car.

You can get your oil changed every 3,000 miles or whatever, but then one day your, you know, clutch is going to go out or something, or your.

Your radiator or whatever.

Like, and that's, like, with the human body, too.

Like, you can eat healthy, do everything you're supposed to do, and still, at 50 years old, you're still going to have a heart attack.

Like, you know, like, I don't know.

That's super morbid.

And, you know, but that's.

But that's reality, though, you know?

Yeah.

I mean, it's true.

Like, I don't know, like, chat.

Y' all can tell us if you've ever been a patient in the er, but, like, it's.

I mean, it's scary.

Like, I remember, I guess it was two years ago when, after I had my baby three weeks later, I was feeling very terrible.

Couldn't breathe, fever, all this stuff.

And I called my husband, who's a hospitalist, and he said, you need to go to the er.

And, like, I burst into tears because no one.

No one wants to go to the Eat.

Well, most people don't.

Like, normal people go to the er.

But, like, it's scary, like, because there's so much.

Like, if you're going to the.

Like, I think if you're a reasonable person, that's going to the ER for real, a real reason.

Like, it's because something's very.

Like, something's wrong.

Right?

Like you were saying, like, if someone in the middle of the night feels the need to go to the er,.

You got to take them seriously.

Right?

But, like, a lot of the time, and one of the crappy things about ER medicine is that, like, you know, a lot of the time, I don't know what's wrong.

You know, like, I see people that come in with abdominal pain in the middle of the night, and, you know, we do blood work, meds, CT scan, ultrasound.

Everything is normal.

Like, why are you having pain?

And it's like.

Like, one of the worst pieces of news that I have to deliver is like, I don't know what it is, but I know what it isn't.

I know you're not.

Your appendix isn't ruptured.

I know that you're not having a bowel obstruction.

I know you don't have a surgical emergency.

Same thing with chest pains, right?

Like, people that come with chest pain in the middle of the night.

Well, what was it?

I don't know what it was, but I know what it's not.

And like, unfortunately, there's not a chest pain test or an abdominal pain test.

Like, you can't.

There's not a blood test that we can run that'll say, oh, you're having this pain because you have costochondritis.

Like, there's nothing anything like that.

Unfortunately, there's no funding for tests that rule out conditions that are annoying.

Right?

So, like, you know, with people with pleurisy and costochondritis, all we can do is rule everything out.

Like, rule out coronary artery disease, heart attacks, you know, pneumonias, collapsed lung, all that stuff.

Pulmonary embolism.

We rule out all that stuff.

And that's where all the funding is.

Like, all the research has been done on.

On tests that will save lives, not necessarily on those that will eliminate frustration.

So.

Well, and that's.

I mean, so that I can relate to that in Durham.

Like, it's the same way.

Like, no one researches or comes out with new meds for things that don't hurt you.

And for me, like, people when, especially since they see it on their skin, they want to know why, like, why do I have this?

Why do I have eczema?

Why do I have rosacea?

And I don't have, like, I'm like, all day long, I don't have answers.

So we have, you know, 13 psoriasis medications and, like, nothing for eczema.

Like, one thing that's.

Yeah.

Keratosis pilaris.

Right?

Like the thing.

Like, keratosis Polaris.

Oh, yeah.

Kp, granuloma, annularity.

Rosier.

Like, all these things I see all day long that it's just like, you're not dying.

Right?

You make it go away.

And I'm like, no.

So, yeah, I know.

Yeah.

Mark asks, how do you balance productivity versus care?

And it's definitely a balance.

Right?

And so my, like, you can probably.

Incorporate this, but somebody else asked, like, why would you start with lower acuity patients?

Because that's usually what's waiting for me.

That's what my co workers tend to wait for me.

Like, unless we're just slammed and there's just sick people everywhere.

Like, they kind of.

Like I said, like, I.

When I first get there, I'm more of, like, I call myself, like, I practice in the step above urgent care when I first get there because, like, they're taking the sicker patients in the back and, like, this certain part of the ER and they know that, like, I'm going to do the procedures.

Right?

Like, so, like a laceration on someone's hand is a low acuity patient.

But that doesn't mean that it's not like time intensive.

Right.

So like the time that I spend with depending on the laceration is more than what I would spend, you know, depending like on an abdominal pain maybe, I don't know.

But because they're dealing with the sicker patients, like, I'm doing the more time intensive stuff, if that makes sense.

So the sick ones are already being taken care of.

Like they usually.

Yeah, like, I'll prioritize.

If there's sicker patients to be seen, I will see them.

But what I was saying was when I first get there, the people that are working know that like, I'm going to do the procedures or like I typically do.

Yeah, that I'm going to do the procedures when I get there.

Just because, like, that's how I, that's just how I work in this facility.

Like it was totally different at the other place that I worked at.

So.

But regarding the productivity versus care, like, my focus isn't on my paycheck when I'm at work.

Like, my focus is on taking care of people.

And so like I said, like, I pride myself on like, clearing out the waiting room and getting people taken care of and like, you know, ruling them out and, you know, taking away their pain and, you know, fixing what I can in the er.

But I don't think about, like, oh, I get to, I'll see this patient so I can, like, up my numbers.

Like, I don't give a shit.

Like, my lights are going to stay on because, like, I'm fine.

Like, the salary that you'll get as a PA regardless of what model that you, you know, get hired under is going to be fine.

Where, like, you don't have to like, count.

I'm not counting patients that I see or like, I don't have a quota that I have to meet on my RVUs.

I don't even know.

I don't keep track of, like, what my RVUs are based on the patients that I have because I don't even know what those numbers are.

But it's, But I understand what the concern is.

Like, well, are you just like seeing as many patients as you can and not spending the time with them?

And no, the goal is to get them seen, treated as quick and safely as possible.

And that's just emergency medicine.

Like, even in, you know, now, even in like family medicine, the, like, the focus and goal is like seeing, you know, 30 or 40 patients a day.

Like, how many patients do you see in clinic a day, would you say right now, medicine, like, I know you're not in family medicine.

Yeah, yeah.

No, my schedule is at about 25.

When I was like.

So I switched jobs last year and so my patient base.

But I was at about 35.

Yeah.

And I mean, I was slammed.

Like.

But like, these.

The offices are, like, pushing for seeing more patients quicker and stuff because that's like, revenue.

Right.

But like, me personally, my focus is on delivering care quality and effective care as quick as possible in the er.

So I'm on the.

As you, like, where, you know, I get.

Say that again.

I'm.

I'm on a similar model.

And like, to be honest, that was a concern for me starting because I was like, I don't want to be, you know, influenced by being on a productivity model.

But, like, honestly, like you said, like, I don't even think about it.

Like, it just.

I mean, it's not.

It doesn't cross my mind when I'm at work at all.

Yeah.

Like, if I'm in a negotiation, I'm going to talk about it being a commission, but I honestly get a bonus.

Like, oh, that's cool.

Like, yeah, I got rewarded for my hard work.

Cool.

Right.

But, yeah, like, look at a patient, I'm like, oh, I get an extra.

Yeah.

If I do this.

Like, no, that's weird.

Yeah.