Two PAs with the same job title and completely different days.

This one is a blast from the past. Ngan and Josh put together a full presentation on life as an infectious disease PA for one of our virtual shadowing sessions during ID Week, and it ran about an hour and a half. I split it into two episodes so you're not stuck listening all at once. This is part one.

Ngan is one of our mock interview coaches at The PA Platform. She graduated from FIU at the end of 2017, started out in ENT, and moved into inpatient ID at a VA hospital in Orlando. She also has an MPH with an infection control track and worked as an epidemiologist at two health departments before PA school, including a CDC-funded hepatitis C project and the tail end of Ebola.

Josh is in Dallas and has been doing HIV and ID care since 2017, mostly outpatient. His day looks nothing like Ngan's, and that is the entire point of this episode.

There's a really useful piece in here about hours, too. Ngan's epidemiology work counted as healthcare experience, not patient care experience, so she worked as an MA in an HIV clinic to get her PCE. That distinction trips up a lot of applicants.

What we cover:

• What infectious disease PAs actually treat, from HIV to TB to travel medicine
• Ngan's inpatient day: consults, rounding with the attending, chasing down cultures
• Josh's outpatient day: HIV primary care, telemedicine, and the insurance side nobody warns you about
• How each of them landed in ID, and why one rotation changed Josh's whole plan
• HCE versus PCE and why the difference matters on your application
• Why being nice to people pays off later, since one of Ngan's old contacts is now her attending

Heads up that this was recorded during the pandemic, and Ngan has since moved to a different specialty. Part two picks up right where this leaves off.

Resources:

Mock Interviews with our coaches: https://www.thepaplatform.com/services/mock-interview

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

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

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

Mentioned in this episode:

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Today's episode is a blast from the past and a part one of hearing about the day in the life of two different infectious disease PAs.

The first one is Non, who's also a PA platform coach, and Josh.

And you're going to hear so much great info from them.

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.

Hey guys, thanks for tuning in.

I am excited to introduce the speakers on today's episodes to you.

I think they both have been on the podcast before though, so I'll try to link those in the description.

Non is one of our amazing Pre PA coaches who does mock interviews at the PA platform.

She comes highly requested all the time.

So if you are planning on doing a mock interview, make sure that you schedule Non or any of our other awesome coaches and you can use the code Future PA to get a discount on that too.

So in today's episode, I'm Savannah, by the way, Pre PA coach during pa, who knows what else.

But thanks for listening to the Pre PA Club podcast.

This was done, let me think, last October, I believe, where we were doing some virtual shadowing and did a Day in the Life series with Nan and Josh and they put together this amazing presentation about their jobs as infectious disease pas.

Nan, actually, since this recording now works in a different specialty, but this is really great information in just how PAs can have the same title but do different things and have different jobs.

So I really want you to pay attention to the differences that they discuss.

And this ended up being a very long session.

It was about an hour and a half and so I've split it into two episodes because that would just be a very long time to listen.

So this is part one.

Next week we will have part two where it will pick up where we left off and jump right back into their conversation.

So stay tuned.

Make sure you're subscribed so you don't miss out on that part too.

And make sure you follow these guys on Instagram.

I'll have their handles in the description so that you can find them and if you have any burning questions, send them their way.

Sure.

Hi guys.

For those that don't know me, I am Non.

I am actually a PA platform mock interview coach.

So, you know, love working with Savannah.

Love working with you guys and helping out the PPA community.

I am still an early career.

I started out in ENT and recently transitioned to infectious disease thanks to this pandemic so I'm excited to talk to you a little bit more about my journey.

Hi, everyone.

I'm Josh.

Hopefully you can hear me well through this.

I mostly do outpatient ID.

I'll talk more about it.

And I'm glad you all have set some time to hang out with us.

All right, y', all, they're really fancy and put together a presentation for you.

If you have any questions along the way, put them in the chat, and we'll be keeping track of those, but I'll let you guys jump in.

All right.

Okay.

True life.

I'm an idpa.

We don't have any music.

I guess we're working on it.

Unfortunately, this probably outdated, you know, so please don't call us the elderly.

I hope people get the reference.

So this week is actually.

Actually started yesterday, Idaho.

It's usually a week set aside in October, and it's usually an annual joint meeting for a bunch of ID companies or ID organizations that you could see that we've listed there.

It's pretty much just a big networking and a big event conference for ID people to get together and share the latest data, share maybe the latest things.

I mean, this year, obviously, it's mostly centered around COVID 19, but last year was centered on a lot of new HIV medications and other exciting developments in antibiotics.

But it's fitting, and thanks to Savannah for inviting us this week, because it is ID week.

All right, so our lovely meme.

You know, I always love these PA names, so kind of what social media thinks we do, you know, as we show up in our hazmat suit, rolling around, you know, seeing COVID patients or something.

My mom probably thinks that I'm a nurse handling, you know, medications.

I like to think that as a PA that I'm really there really saving lives, you know, treating people from these nasty infections.

What the general society probably thinks of us.

You know, we're probably hiding out in a lab, licking the plates and playing with bugs all day or something.

Sadly, sometimes our attendings may think that we're their own personal assistants.

No, but what we really do work behind a desk.

Josh actually gets to do telemedicine, so I'm sure this is how he feels sometimes.

Or maybe most days.

Yes.

Wearing a headset and sitting closely with my colleagues, talking to patients by phone.

And giving them thumbs up as well.

Yeah.

All right, so, like, I Said my name is Nan, I am currently relocated to Orlando.

I currently work serving veterans at the VA hospital.

And I think this had a lot of impact on kind of why I landed my job.

You know, I received my master's in public health specifically with a track and infection control.

Part of my rotation or my capstone project was actually rotating for several months with the infection preventionists at the hospitals.

And so that was mainly with schoolwork.

But in terms of healthcare hours, clinical hours, I worked at the local health department, actually two health departments as an epidemiologist.

Originally I was hired to help with the CDC funded grant looking at young adults that were exposed to Hepatitis C. And then later, once I graduated with my mph, waiting for a PA school to start, I worked at another smaller local health department, kind of more as a general epidemiologist doing outbreaks, whether it's with varicella or chickenpox, measles.

There was a big outbreak.

At one point, I would say probably to date on paper, the coolest thing that I ever got to was catching the tail end of Ebola.

And so naturally I think it's very fitting, right, to have done crazy Ebola with another crazy pandemic.

Probably the worst one, I hope it is the worst one in our lifetime that I had to go back into the ID world to help with COVID But like I said, once I realized that I wanted to become a pa, had to get those actual hands on patient care hours.

My experience as an epidemiologist was mainly behind the scenes doing a lot of health education.

So those are considered more health, you know, the HCE versus the patient care, PCE hours.

So I had the opportunity at the health department too.

We actually had an HIV clinic and so I worked as an MA there for about a year.

And one of the fellows in training, Idaho fellows in training at that time, is now actually one of my attendings.

And so I think it's so important and it's just a good life lesson to just always be nice to people network, because you never know know when an opportunity may present itself.

And so currently compared to Josh, I am an inpatient id, so mainly I work, you know, on the hospital side.

When I first started back in July here in Florida, there was a second wave.

That means especially right after 4th of July, you know, people did not want to social distance.

So we saw another peak.

Granted is my hospital is much smaller.

I think in total we're like maybe, oh, I don't even know this number.

It's a really small hospital.

But at one point we were probably, I want to say, in the numbers of teens for Covid, which is literally nothing.

Like Josh is probably laughing on the inside coming from like a private community hospital.

But for our numbers, those were pretty busy.

And so my first month as an idpa, I was solely dealing with COVID patients.

No, I was not in the room.

I wouldn't even consider myself a frontline worker.

My role in terms of COVID was really just to evaluate the patient and serve as a consultant, look into the patient's history, their labs and everything, and see if they even meet qualifications to receive some of those experimental antivirals.

One of them you probably have heard already, remdesivir, and then even the convalescent plasma.

And so that was kind of my experience predominately the first month.

Now I do a little bit of everything, which we'll go into a little later.

But I'm more what you would consider a general ID pa.

So that's a little bit about me.

I'll hand it over to Josh.

Alrighty.

Okay.

Thanks, Don.

So yes, I'm in Dallas, Texas.

I moved out here for my first PA job.

And so I do have a mix of inpatient.

Before it was mostly like two weeks on inpatient, two weeks off to meaning like two weeks outpatient.

But now majority of my time is in clinic setting doing HIV care and ID care.

And so what that entails mostly on the HIV side is doing a lot of HIV primary care, which also includes not just managing someone's HIV regimen, but also managing their other comorbidities, whether that's hypertension, diabetes, cancer, what have you.

And also doing immunizations and other screenings and other things.

I do outpatient as well as also follow up on antibiotics.

So say someone saw someone like non on the inpatient side, started them on treatment for something.

We'd follow them outpatient to make sure everything was going okay from a lab standpoint, from their line and antibiotics as well, and kind of jumped around.

But before PA school, I was mostly doing research, mostly cancer related research.

Nothing really ID related or even HIV related.

And it really wasn't until I was in PA school that I had two hiv.

I Had one HIV and one ID rotation.

That really opened my eyes to this world and fell in love.

And I've been, like I said, doing HIV care and ID since I graduated.

Listed some things I'm currently working on and interested in certainly improving patient adherence.

We do have research studies looking at the function of smartphone apps and helping with adherence to medications and also looking at how COVID 19 progresses and has affected the HIV population.

And then other interests include precepting PA students.

So I do actually have a PA student with me right now and she's doing her primary care preceptorship and so she learns the hiv, but also is sort of having a long term rotation on just really the, a lot of the primary care stuff that a lot of PAs will go into once they graduate.

I guess we can move on to round two.

Ding, ding, ding.

Oh, yes.

Okay, so what is id?

And you know, this is, you know, we wanted to talk about more in detail of what this subspecialty is.

It's technically subspecialty of internal medicine.

So essentially adult medicine, majority of our patients are there is specific pediatric id, which of course is for the pediatric population.

But so given it's a subspecialty of internal medicine, we will look at and evaluate infections of any and every organ system.

So that can be infections of the skin, infections of the brain, heart, lungs, abdomen, bones, anything, eyes, whatever.

If, if it's complicated, they're gonna con the other hospitalists and primary care doctors will consult an ID specialist to, to take a look at it and give their 2 cents or recommendations.

Idaho also includes microbiology.

So all that stuff you learn in microbiology about gram staining and all those other kinds of stains, and then plates and agar plates and cultures and spectrometers, spectroscopy stuff, we don't usually, we don't work with them, but we do interpret results from those things and we take those results to give antibiotic recommendations.

Also involved in vaccines as far as not just administering it, but also in sort of a way of infection prevention.

Of course, like I said, I work in hiv, so we manage HIV and any complications related to aids.

Sexual health is a big part of infectious disease.

Given sexually transmitted infections, we also take care of those.

And Nan has a lot of experience in public health and that's also a major part, as we see during this pandemic, of how infectious disease specialists and infectious disease providers play a big role in public health education or educating the public, as well as the research involved with looking at epidemiology as far as incidences and prevalence of certain diseases and infections and trying to see if there's a pattern going on and trying to use that information to maybe educate the public or prevent further worsening of outbreaks.

Tropical medicine and travel medicine is also a big part of it.

Say we have to deal with infections related to malaria or Zika or some other what maybe not native to the United States.

We also deal with those, maybe someone that traveled recently, as I mentioned, infection control and prevention.

And so that's more so in regards to maybe in the hospital setting, say for example, someone has Covid or suspected tuberculosis or even in the clinic setting suspected C. Diff or whatever infection prevention is involved with giving the best recommendations possible in protecting the staff and protecting the patient from cross contamination and further worsening infection or new infections in these settings.

Transplant medicine is also a big part.

I also group that with managing infections in the immunocompromised patients.

That's also something that infectious disease specialists look into.

Say for example, someone's getting a transplant and they're put on long term steroids or long term antibiotics, immunosuppressants, then they're at risk for infections and they may consult an ID specialist to help manage that.

Bioterrorism is also another part.

Not very common, thankfully for many infectious these people, but also something for us to be aware of.

Especially if, I don't know if any remembers during the anthrax outbreak that happens, I think It's a like 20 years ago now.

But definitely something that was scary and something that again they got infectious disease specialists involved in one, trying to figure out what was causing all these people to get sick, but then two, helping to mitigate the issue.

Yes, and I just want to add a comment to that.

So of course with my experience working at the health department, anytime you have a large event like say years ago when I was living in Tampa and President Obama came any of these major events.

Normally the health department works very closely with hospitals and there are certain surveillance that's kind of what the health department or at least working in epidemiology, what you're always doing is trying to survey, capture maybe certain symptoms like fever, diarrhea, vomiting.

And then you know, whoever is in charge of that particular type of disease per se, they're in charge of those tracks.

Because sometimes even if you think about it like say you go with common ideas, you know, you go to a family picn and everyone gets food poisoning from eating the potato salad.

Well, that similar food outbreak can be done.

And then sometimes you have to Question if it's a larger number than the typical, like, you know, setting that might be considered a bioterrorism attack.

So I just kind of wanted to throw that fun bit in terms of, you know, we work especially in id, we work very closely in public health.

And so you don't always get to hear about public health, you know, but truly those are the individuals that are working every day to help keep you and your family safe.

So just wanted to throw that in there.

So think a public health official, if you know one.

Yeah, definitely, yes.

And again, this is just more of the wide spectrum.

We don't dabble in all of these things at once.

But ID is a very big specialty within itself.

All right, all right, so now this is technically round two.

Ding, ding.

So what was my reason for choosing id?

Well, clearly, I think my background working in public health, as I've been saying, ties in greatly to yid.

I think what is so unique about ID that maybe I didn't really consider earlier on is compared to other specialties, you know, you're not just there to treat the patients.

You know, we're really utilized as a consultant.

So, for example, of course in the hospital, the primary care team, the hospitalists, you know, they're taking care of the patients.

They now, this individual is now affected with bacteremia or sepsis, you know, blood infection.

So now they get ID involved.

And so, you know, having that kind of unique relationship, I think it's great.

There are other community efforts.

So say someone is overseeing a assisted living facility.

Right.

We heard earlier on with this pandemic.

So many nursing homes had these Covid outbreaks.

And so the, those individuals, you know, at that point they would consult with the ID physicians or practice to get input.

So it's not just a one on one with your patient.

And kind of what Josh said earlier, we really do work in a way, maybe indirectly, and trying to help protect our communities as well.

I think another thing that makes ID so unique is just really the incredible progress.

You know, I can't think of another specialty where we're moving that quickly in medicine.

So if you think about, think about it like, you know, when the HIV epidemic or pandemic began, it was, you know, in the 80s and people were just dying left and right.

And now I think I just recently have a patient in their 80s still living with HIV.

So, you know, just these medications that we're coming out with, you know, are helping them with smallpox, eradicating smallpox with vaccines.

So that's another, another public health ID effort.

With hepatitis C, the same thing when I was working on that project just a few years ago.

And I think that was back in.

Oh, gosh, maybe it was a while ago, but back then I recall sitting there at my desk calling up patients, telling them, hey, are you aware that you tested positive or you came or were exposed to hepatitis C?

And then to which oftentimes they would ask me, well, is there a cure?

Is there any treatment?

And at that time there was no treatment.

And hepatitis C treatment is all new within recent years.

So it's really exciting to see that we are heading way coming up with better medications to treat all these infections.

So I would say, really, those are my reasons why I chose id.

Yes.

Thank you.

Just.

Yes.

Yes.

Okay.

So for me, like I said, I didn't really get really interested in ID and HIV care until my rotation.

And I mentioned the patient population because one, given that, yes, during this pandemic, people that were infected with HIV were very stigmatized in a very vulnerable population and many times underserved populations as well too, or just didn't have the same access to care.

And so that appealed to me.

And thankfully, I do get to work in a county or safety net hospital where we see someone regardless of their ability to pay or whether they have documented or not, not.

And so thanks to government funding, we're able to see them and get them into care.

And again, you know, a big part of HIV care is trying to end that stigma.

It's become a chronic disease now for many patients.

And like Nan said, we have people in their 70s and 80s with HIV who've had it since the 90s and were on horrible drugs back then, or trial drugs which had all those side effects that scared people, of course.

But we're living in an era now where medications are successfully getting people healthy within a month to two months and only on like one pill once a day.

A majority of people.

And with that, that's sort of where the leads into research opportunities.

Medications are always advancing and there's always drug trials happening even before this pandemic.

And I'd say in regards to antibiotics and in regards to HIV medications, we've seen more advancements in the past 20 years of drug classes and drug types, more advancements than probably most other specialties.

Not to tout us that, but like, compared to cardiology, a lot of medications they have since the 90s, they're still kind of using, well, medications we had in the 90s we stopped using, thankfully, except maybe one of them.

And so that's just because A lot of research doesn't want to settle on what's there.

And we're always trying to make things better.

And of course during now there's a lot of research opportunities with investigational drugs.

But and also because we don't know as people with HIV are living longer, we're seeing different things in regards to cancer or in regards to long term care.

And so there's research involved in there and trying to improve their health as they get older, living with hiv.

And then of course, a big part of my outpatient is involved in primary care.

And so like in most primary care settings, you see these patients over, you know, I mean, as maybe you see them at once or twice a year or three to four times a year and over years and you really build a relationship with them.

And I have many patients where I saw them maybe a day after they were diagnosed with HIV and coming to grips with that, or maybe they were diagnosed in the hospital and they had a very severe weakened immune system.

And I've seen them go from, you know, fearing this virus or just fearing, you know, for themselves to now they are living and they're on their medications.

Some of them even have families now or they have a significant other that or a partner that they're wanting to start a family with.

And so you get to see that progression and build that relationship.

From an outpatient primary care standpoint, that appealed to me and why I'm still doing it today.

And then I guess like Nan said, with hepatitis C, we can cure it.

So that's always cool when you can say you cured someone of something without.

Having to cut their, you know, organs out or something.

Right, right, exactly.

And most treatments just 8 to 12 weeks.

So wonderful.

All right,.

All right.

So what does my daily routine look like?

So I stayed up all night probably because I had a little bit insomnia, but I create a little TikTok video to show you.

But in case you missed that minute, recap.

Essentially, with my job, I'm lucky.

There are no weekends, no call.

As long as I'm a practicing pa, I hope that is the case.

I work Monday through Friday, get into the office around 8:00', clock, and I'm usually out by 4:30, which was a nice change.

When I previously worked in ENT, my hours were also similar, 8 to 5, but a lot of times I was staying up till close to 10 o' clock charting or doing something ridiculous.

So nope, I come home at 4:30, no notes.

This is it.

Which is a huge blessing.

Like I said earlier, my Role is general ID consult.

We'll go into a little bit more of what I commonly see, but typically in the mornings, once I get to work, I log on to our EMR and just kind of take a glimpse and see if there's any new consults that came in overnight.

Normally, if not, the teams will start contacting us, you know, by 10 o' clock to notify us of the patients.

So from there I kind of gather my own list.

Unfortunately, my EMR system sucks and it's very archaic and I kind of have to do this manually, but I kind of gather my patients, I look at, you know, their labs, read other specialty notes, kind of get an idea of what happened within those last 24 hours.

Of course, with ID work essentially bug chasers.

So I'm looking, you know, to see what cultures are growing, if the patient had surgery, you know, what did the pathology report, the surgical path report, you know, did it grow, anything there?

What did it look like?

Because that is something that I also didn't realize that in id, you know, you are the ones to make all these recommendations.

You have to know first of all, what dosage, what antibiotic, and then kind of be the one to guide how long these individuals are on treatments for.

You know, sometimes a simple, like, say, blood infection, that can be two weeks for foot infections, you know, these individuals.

Individuals can be on these antibiotics for like six weeks, sometimes a full eight weeks, and sometimes requiring a PICC line, you know, an IV access line.

So, you know, so typically once again takes about two hours.

And I don't know if I'm new and I'm slow or it's just because our EMR is just so archaic.

But I really struggle and it takes me a while to have to individually click through each item.

And so I finished gathering my stuff either by 9 o' clock or so, and then I make it onto the floor.

I round on my patients first and then around 10 o', clock, 11 o', clock, I'll meet with my team and that generally consists of my attending and possibly a resident, most often an internal medicine resident.

In my current setting, any new consult is required to attending physician kind of sign off on that or cosign.

And so typically we'll kind of round on the patients together, make any changes to our treatment plan.

And by then rounding can take sometimes up to two hours.

They'll take me until like lunchtime.

At that point, I'm back at my desk.

I'll finish up my notes from the morning, sometimes call.

I mean, Josh, I don't know if you ever bug your labs, maybe not, but obviously we have a lab in the hospital and so call can I press them and be like, hey, it's taken a while.

Can you give me any insight on what's either the gram stain or what's somewhat growing?

You know also sometimes call patients for follow ups but then just kind of wait, see, you know, there may be another peak where we'll get another new consult that afternoon.

And so most of my afternoon is spent doing what I call administrative time, just sitting there ordering, you know, different imaging or really.

Specialists.

And then what I really do enjoy Thursday meet together as a group.

Currently I am the only PA in my practice.

There are five other attendings and we'll have a new one joining us in a few weeks.

And so that our huddle, we will discuss any interesting cases for the week.

And so I think with ID and it may just not be feasible with other specialties, but particularly in ID it's one of those specialties that really requires multiple set of eyes because there are no clear cut answers.

Yes, we have guidelines but a lot of times you have to kind of work with others to try to find out the best recommended practices.

And so this is something that I do look forward every Thursday to.

I.

Guess currently or I'm sorry for next week.

I know we're going to talk about TB in the eye, so I have some reading to do at some point this week on Thursday.

But in a nutshell that's kind of so essentially go in, figure out who I have to see, see them and just kind of wait until we have new patients to see.

Cool.

So mine we'll look at more from my outpatient standpoint, I'll start from the top AM conference or grand round.

So it depends on certain days of the week.

Usually Wednesday mornings we'll have like a conference, it's usually a lecture or something so someone will present in some HIV topic.

If I'm in the HIV clinic, for example, we just had one looking at hepatitis B and hepatitis A in the HIV population.

So some of it's basic science, some of it is just sort of maybe discussing new evidence or new guidelines that might be out.

And that's we usually would meet in a lecture hall, but now it's all virtual.

The same thing with grand rounds as well too.

Ground rounds is usually a time also set for an hour and a morning, usually Thursday morning.

And that's usually the ID grand round.

So it's usually a time for the ID fellow physicians in training to present an interesting case they saw.

And then we as sort of the group will maybe give our differential or discuss kind of what we think the, you know, the different the diagnosis could be based on the labs and the presentation that they gave us.

And then maybe if it's something like was that last week was Cryptosporidis sporadiasis, which is just a diarrhea infective agent, sort of like the background on it and sort of what it can do in certain populations.

So it's definitely these are more teaching time.

And then usually it would go into sort of my normal patient flow.

I'll have anywhere from maybe like 12 to 14 patients in when I'm in the HIV clinic or in the ID clinic.

And so that's with the.

The reason I listed as a patient centered medical home is that in many HIV clinics, not just the one I am at, but in outpatient clinics they will see a variety of patients.

And like I said, we do the primary care but that includes new patient intakes that I've listed there follow up.

So patients who've obviously been in care for a while and you're just doing, you know, just checkup stuff like you would at your normal primary doctor and then maybe someone was in the hospital recently and you managing the antibiotics on the outpatient setting or like I said they were diagnosed in the hospital and you're following them outpatient.

We also run an urgent care so one app or advanced practice provider will, which includes a PA or an NP will sort of run the urgent care clinic for that day.

And so it's more of just a walk in clinic for specific to our patients with hiv.

Again this is sort of part of the funding.

Thanks to that we try to make it sort of a one stop shop for our patients.

And then now thanks to Covid, we've been doing a lot of telehealth as well too.

And so it's just a mixture of things.

And that telehealth for us is usually by phone or through this video app.

And then administrative tasks that I might do are things like for prescription refills, responding to certain patient messages on the EMR or say for example a insurance company is not going to cover a certain medication or they're giving an alternative that is inferior or something.

Maybe they're always offering alternative that they say they don't want to cover.

And so they might request a peer to peer which is just a provider talking you as the provider calling the insurance company, speaking to provider on that end, trying to do things like that, that doesn't happen too often, thankfully, but where you're trying to get imaging done.

And so it's more of those administrative tasks, you know, keeping the things that you do to keep patient flow going, but not.

It's more of indirect patient care, not directly sitting in front of the patient and, you know, prescribing a medication.

It's all the behind the scenes stuff that you may have to do.

And so, yeah, that's typically outpatient and that's kind of, I listed kind of scattered like that because it just kind of varies by the day.

But essentially it's usually if there is lecture in the morning, then it would be followed up by whatever kind of patients sort of are scheduled for you that day.

All right, so typical cases, you know, really, like I said, I spent the whole first month in Covid.

That is still there.

Just because I'm not seeing COVID patients doesn't mean they don't exist.

Typically, with our current setup right now, since our numbers are still pretty high, we have one provider seeing only COVID patients.

And the only reason why is it gets technical.

You know, some of these medications, because they're under investigational, like, you know, research based on a national level, they are kind of mandated and control when you can give it.

So you have to be in touch, get a patient started or order the medications by a certain time.

And so it's best to not kind of mix that with a patient who might have neutropenic fevers and can literally crash on you at any second.

So, you know, kind of dealing with two urgencies.

So it's best to have one individual on Covid and then, you know, one just doing general id.

I will say the bulk of my Service, it's probably 80% bone infections, a lot of, you know, foot infections, joint infections.

And this is something that I've really been pondering for some time.

I'm really curious to know what other PAs in the community are seeing.

I feel because of the pandemic, so many primary care offices were closed or in a way, unfortunately, refusing care to urgency patients because they were scared.

And so as a result, there's been some neglected care.

You know, I see a lot, lot of patients with comorbidities, they're obese, they're diabetics with hypertensions, high cholesterol, high, you know, hypertension, everything.

So I feel, because their blood sugars weren't very well managed, and who's to say maybe they weren't great in the first place pre Covid, but certainly with COVID it's been really hard to have that discussion with patients saying, hey, yes, we know this toe got infected, yes, we know we have to amputate the this toe.

But now you're back a month later, it's not healing, we have to cut more off.

So that is a very tough discussion to have.

Of course, I'm not the one doing the surgery, but as part of the team, I'm still managing these antibiotics long term.

So I would say, unfortunately, that is the bulk of my service right now.

Poorest vc, you know, everyone likes to talk about poop.

So C Diff it's there in the hospitals, of course, blood infections, bacteremia, sepsis.

We see, because we do treat older patients, we do see a lot of endocarditis, of course, urine pneumonia.

And especially now with flu season upon us, will be interesting to see how that will pan out.

But I would say overall this is probably the bulk.

Maybe UTIs, complicated UTIs, right.

We don't see treat the bread and butter, but because the hospitalists, and this is something I want to make clear as well, right, we're not consulted on every infection.

We're not seeing every single patient on the floor.

But the ones that get a little bit more complicated working in id, we in a way kind of have a special key where we have the power to okay for certain medications to be given.

And so the hospital team may not be able to prescribe them, but if they have ID on board or at least to review, then we can say, okay, yes, this patient can have this type of antibiotic.

And so I would say pretty much, I would say the bulk of what I see on a day to day basis.

With a sprinkle of interesting cases here and there.

But.

Go ahead, Josh.

So in the HIV clinic, all my patients that I see there all have hiv, but given that it is a primary care clinic, we are managing other things as well say that they do have or they are in a stage of AIDS and maybe they have an opportunistic infection and they have to be on long term antibiotics for it.

We will manage that.

Outpatient, of course.

Can't forget sexually transmitted infections especially.

We've seen a rise of it during this pandemic as people were not sheltering in their own place, but other people's places.

And so things like gonorrhea, chlamydia, syphilis, mycoplasma, genitalium, lymphogranuloma, venerium, fun things like that definitely are sprouting up on the rise.

We're Treating those and then PREP is also a very hot topic and a very important topic, not just in an ID clinic, but the goal is to hopefully have that, that primary care providers doing this as well who don't see patients with HIV.

And so PrEP in short, stands for pre Exposure Prophylaxis.

And it is something that someone who does not have HIV can take to prevent them from getting hiv.

It's a one pill, once a day.

It actually is a combo of two HIV medications that will work just like HIV meds, but it's more of preventing that HIV medication, or if someone was to potentially get infected by hiv, it would prevent that HIV virus from latching on or sort of replicating within the genome of that person.

So definitely something that we offer and provide to, say, the partners of someone who has hiv.

So there's an HIV positive, HIV negative partner and they want to be the negative partner, wants to be protected.

PREP is available and we do offer and manage that, that outpatient antibiotics.

So like Nan had mentioned, if someone's getting treated for bacteremia or some osteomyelitis and they're on that antibiotic for six weeks, well, in the outpatient setting, we have to make sure that their liver and kidneys are doing fine, depending on what those medications are, if they have a PICC line in which most do, we have to make sure that that's okay.

And if it needs to be changed, we will take care of that or have a nurse take care of that.

Tuberculosis is something else that we still see here down in the south, actually, even other parts of the United States as well too.

But people who get infected with tuberculosis have to take treatment for a good nine to 12 months or if they're getting latent tuberculosis treatment, which just means a sort of a sleeping TB infection that's about, usually six to nine months.

But again, those are like four antibiotics and those need to be managed outpatient and then even COVID 19 in some respects, I do have some patients that we get enrolled in some outpatient trials, but also testing as far as from a clinic setting, because like I said, our HIV patients aren't protected either.

And so they have been getting infected with this new virus.

So it's been sort of our duty to get them tested and to educate if necessary and this and that.

And so, yeah, that's kind of fit.

So it's a lot of, I guess, like Nan would say, sometimes what we'd consider bread and butter of primary care with UTI and similar infections.

We do see those in the outpatient setting and take care of them for our patients with hiv.