Dr. Rhoton's Anatomy 2D and 3D

Medtronic and Dr. Rhoton put together an amazing YouTube series on "Rhoton Anatomy" in both 2D and 3D versions. I highly recommend checking them out. An incredible amount of effort and detail went into these!

 2D: https://www.youtube.com/playlist?list=PL6307C9E54B56AD87

3D: https://www.youtube.com/playlist?list=PL202A5006EB93D42D

Dr. Rhoton Biography

Dr. Albert L. Rhoton, Jr. attended Washington University School of Medicine, graduating with the highest academic standing in the class of 1959. He completed his neurosurgical training at Washington University and joined the staff of the Mayo Clinic in Rochester, Minnesota in 1965. He became Professor and Chairman of the Department of Neurological Surgery at the University of Florida in 1972.

Dr. Rhoton has served as President of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the Society of Neurological Surgeons, the North American Skull Base Society, the International Interdisciplinary Congress on Craniofacial and Skull Base Surgery, the Florida Neurosurgical Society, and the International Society for Neurosurgical Technology and Instrument Invention. He served as the Honored Guest of the Congress of Neurological Surgeons and was awarded the Cushing Medal of the American Association of Neurological Surgeons in 1998, the highest honor given by the two largest neurosurgical societies in the United States. He has been awarded the Medal of Honor of the World Federation of Neurosurgical Societies, and has served as the Honored Guest or been elected to Honorary Membership in neurosurgical societies in Africa, Asia, Australia, Europe, and North and South America.

He has published over 400 scientific papers. He has received the Golden Neuron Award of the World Academy of Neurological Surgeons and was selected as the 2011 “Neurosurgeon of the Year” by the journal World Neurosurgery. He completed the Millennium and Anniversary Issues of Neurosurgery and a book entitled “Cranial Anatomy and Surgical Approaches,” which has been translated into several languages. He has received an Alumni Achievement Award from Washington University School of Medicine and both a Distinguished Faculty Award and a Lifetime Achievement Award from the University of Florida.

Friends, colleagues, and former residents contributed nearly $2 million to the University of Florida Foundation to create the Rhoton Chairman’s Endowed Professorship at the University of Florida, a gift that has grown to more than $6 million. This is in addition to 11 endowed chairs that Dr. Rhoton has raised for neurosurgery over the years. He and his wife, Joyce, have four children, all pursuing medical careers.

Source: http://www.stmeded.medtronic.com/anatomy-courses/rhoton-biography/index.htm

SMS Texting is Not HIPAA Compliant

Just wanted to share a great article on texting and HIPAA Compliance: Five Ways to Ensure Secure Text Messaging in Your Medical Practice

PAProgramSearch.com: Great Pre-PA Resource

I recently received an email from Ken Johnson, the developer of PAprogramsearch.com. Ken and his significant other went to the same process that many of us did when searching for PA programs and also encountered the same frustrations. It is difficult to find out which schools have which requirements. I ended up with a spreadsheet of the schools that I was going to apply to, their prerequisites, and checkboxes for the things that I had completed. Since there's no standardization of PA programs and their prerequisites at this time is difficult for students to keep track of.... in comes PAprogramsearch.com.

This website allows you to check off particular classes that you have taken as well as shadowing hours, etc. And then produces a list of schools with the "match percentage". The site is very easy to use it appears to be up to date. I always recommend going to be official program website to double check the prerequisites (as they can change at any time) but this is a great place to start.

Financial disclosure: 
I have no monetary or other connections to this website or the developers . Just sharing a resource. 

Home page

Check off the classes that you have completed and add your GPA/Experience in hours at the top.

A list of "matches" is generated.

Surgical Training for Neurosurgical PAs

Laminectomy

Last week I had the privilege of attending a surgical training in San Francisco, California. The event was created by the Association of Neurosurgical Physician Assistants (ANSPA) in conjunction with Ethicon. I must say it was a fantastic experience. I was able to spend a half a day in a live porcine wet lab. The lab was for PAs only so it enabled me to spend more time with the surgical instruments and take the lead on certain aspects of the surgeries that we performed - both opportunities that I don't necessarily get on a day to day basis. It was successful in building my confidence.

We performed a craniotomy and tumor removal as well as a laminectomy with a focus on hemostasis. This is an unusual experience and I learned a great deal from both the PAs that attended and the Ethicon reps regarding hemostasis products. I had the least amount of surgical experience of all the PAs that were there (9 months), however all of the PAs were friendly and helpful and I learned quite a few new techniques. It was also inspirational to see what other PAs around the nation were doing as part of their daily grind. It ranged from PAs that spent the majority of their time in the OR as co-surgeons to those that split their time 50-50 between OR and floor work.

I was able to meet and spend some time with Josh, a neurosurgical PA for over 10 years, who is the current president of ANSPA. The AAPA recently completed a video on him and his contributions to his neurosurgical practice. The surgeons that he works with on a daily basis speak very highly of his surgical and patient skill sets. Mike Nido, PA-C and Dean Barone, PA-C were also instrumental in making this event happen.

All in all, hats off to ANSPA for working hard to make this happen for PAs. They hope to create more of these learning opportunities for neurosurgical PAs in the near future. If you are not a member, I highly encourage you to do so if you're interested in neurosurgery as a physician assistant.





*Disclosure: I am in no way financial tied to Ethicon. Just attended the event.

What if PAs Couldn't Suture Anymore?

This a repost from a call sent out by the AAPA based on a resolution brought to the AMA's House of Delegates. Read it and take part in your future scope of practice as a PA.

Join AAPA in responding to negative AMA resolution

While workforce experts are predicting a shortage of providers with the implementation of the Affordable Care Act, the American Medical Association Board of Trustess is proposing a resolution for its House of Delegates that could severely restrict PAs' ability to provide care to patients. PAs should be very concerned about the resolution, which will be considered by the AMA HOD when it convenes on Saturday, June 15. The recommendations are very restrictive and display a misunderstanding of the way PAs and doctors provide care as part of a team. Among other restrictions, the resolution expands the definition of surgery to include repair and removal of human tissue and, although parts of the resolution are somewhat unclear, states that surgery as defined in the resolution is to be performed ONLY BY PHYSICIANS. If adopted as presented, the resolution will call into question procedures like suturing, punch biopsies and vein harvesting, which PAs perform on a daily basis across many medical specialties. The resolution also proposes that only physicians should perform invasive procedures that utilize radiologic imaging. You can read Report 16 of the AMA Board of Trustees in full here.

AAPA is spreading the word about the negative impact this resolution would have on patient care and PA practice, but we need your help. Please review the list of AMA delegates in your state or specialty, and if you have a connection, please let that physician know the true damage that this resolution could create. Also, talk with and encourage physicians in your practice to speak with other physician leaders about the resolution. AAPA's suggestion is that the resolution should be defeated, or modified to specifically state that it does not apply to PAs practicing within the parameters of state law.

For more information on the AMA resolution please contact Ann Davis, PA-C, MS, Senior Director of Constituent Organization Outreach and Advocacy, at ann@aapa.org.

The PA Mentoring Project

While I was at the national AAPA conference in May in Washington DC, I learned about a new mentoring project that was recently launched. It is called the National Physician Assistant Mentoring Project. Their tagline is "PAs helping PAs". It was started by Robert Smith, PA–C and Habia Collier, PA–C.

The idea is to have more seasoned PAs be mentors for younger/new to the field PAs and PA students. These two physician assistants were very passionate about this program when they came to speak to the AOR.

This mentoring project is in its infancy, however it needs more PAs that are willing to be mentors in order for it to grow.  Check out their website at: www.PAmentoring.org


Hats off to these two for getting such a great idea up and running!

Pic Source: www.euphoricbirth.com

Free AAPA app

The AAPA has developed an app! They officially launched it at conference and I wanted to give you a little overview. Cost: FREE

Easily accessible links to JAAPA, PA Professional, the PA microsite, and Joblink!

Keep up with the social media buzz and the trending #hashtags.

Keep up with the latest news in the AAPA profession.

PA MAN - I Love Conference!

This, in a nutshell, is why I love conference. PAs know how to have fun. Hope to see everyone there in Boston next year! Check out the video...

PA MAN (Challenge Bowl 2013)
Click for video

Blog for Women in Surgery

I recently came across this blog... seems to just be starting up, but has lots of promise. I've added it to my favorites list.

Women in Surgery

NHSC Loan Repayment Webinar

Looking to utilize the NHSC to take care of some of your student loans? NHSC just put out a webinar explaining all of the rules/regulations associated with partaking in the Loan Repayment program.

Loan Repayment Webinar

Would You Treat People Differently If You Knew What They Were Thinking?

The Cleveland Clinic put together a pretty amazing video on "Empathy" - it addresses all of the different people, their thoughts, and issues -- Would you treat people differently if you knew what they were thinking?

This video can be viewed at: http://www.youtube.com/watch?feature=player_embedded&v=cDDWvj_q-o8

New PA Student Site

Check out the new microsite dedicated to PA Students! I was part of the team that worked hard to put this together and the AAPA was an integral part of giving us the funding to get this up and running. It is a "one stop shop" that was created BY PA students FOR PA students!

Check it out. Write a blog entry for the site. Submit a new scholarship that you found that is relevant. The continued success of the site is dependent on YOU the PA student to help keep it alive with content!

See the About Us section to know where to send your content!

www.PAStudentEssentials.com

Do You Use Social Media?

Do you use social media personally or professionally? If the answer is yes to either, you should check out this recent JAAPA article on social media. As we all know, anything that goes up on the internet has an infinite lifespan. Think about protecting your personal life and career...

Managing Your Digital Footprint

http://www.socialable.co.uk/

Billing and Coding. Who Cares?

Reimbursement? Who cares? In short, YOU should.

Scenario 1:

It is time for your annual review and you've been working hard all year. You've stayed late to see extra patients and come in occasionally on your days off to cover the shifts of sick co-workers. You decide that you are going to ask for a raise based on the extra efforts that you've put in, but when you do the office manager states that everyone has been working hard so that alone does not justify a raise. Where do you go next? Your next step should be to present objective data. You should be prepared with not only the number of hours that you have put in this year, but also with your revenue (which you get from your billing records!) If you are able to show that you have increased your billings by a significant percentage, you're more likely to get something extra than if you just say you've been "working extra hard". Know what you are being reimbursed - check your billings bi-weekly or monthly to stay on top of it.

Scenario 2: 

You are working for a small family medicine practice with a couple physicians. You are the only PA. The family practice employs a billing and coding specialist to bill for all visits and procedures completed at the practice. You don't know much about billing and coding so you leave it up to the "specialist" to take care of all that. After all, you care about is seeing patients, right? This year, Medicare decides to audit the practice that you work for and they find several fraudulent mistakes in your billing. You have apparently been upcoding* several office procedures and double billing for some office visits. You are now facing criminal charges for defrauding the federal government and are facing jail time and a $300,000 fine. You try explaining that you never actually did any of the billing yourself, but in the eyes of the law, you are still at fault. Know what codes are appropriate. This is a two-way street. Don't overbill, but don't under bill either. Under-billing can be misconstrued as favoritism toward certain patents or it can just hurt the bottom line of your business. Its a Goldilocks and the three bears thing... not too much, not too little... but just right.






Both of these scenaios are real and they show the importance of understanding reimbursement/billing/coding. You've worked really hard to become a PA, don't lose it all because you didn't want to be bothered with the paperwork of billing. 















*upcoding = adding additional codes so that you are paid more money than you should get

Pic: http://www.tormont.com/en/Products-in-English/English-Products/GOLDILOCKS-AND-THE-THREE-BEARS/102518-118-1042.aspx

6 Salary Negotiation Strategies

This entry is a repost from the PRSA Job Center. I thought it was relevant and worth a repost- It makes a lot of the same points that I stated in another one of my entries earlier (Negotiations 101).

Six Salary Negotiation Strategies

Navigating the salary negotiation process can be tricky. You don’t want to overplay your hand, but you can’t afford to sell yourself short either. Many job seekers shy away from negotiating out of fear they’ll blow the deal.

But here’s a little secret: Most employers expect to engage in some back-and-forth discussion at the bargaining table. In fact, more than one-third of executives interviewed by Robert Half said they’re more willing to negotiate salary with top applicants than they were one year ago. Only five percent of hiring managers are less willing to negotiate.

Consider the following six tips for negotiating with finesse:

1.   Understand your market value. Savvy salary negotiating doesn’t involve throwing out a ridiculously high figure and hoping the employer says yes. The best negotiators are well-informed.

Do your homework and support your request with concrete numbers from reputable sources. Review current compensation standards for PR professionals in your area and at your experience level by consulting publications such as The Creative Group’s 2013 Salary Guide. The Occupational Outlook Handbook from the U.S. Department of Labor’s Bureau of Labor Statistics is another valuable resource.

2.   Look at the whole picture. Remember to consider all aspects of the deal, not just pay. An attractive healthcare benefits package, bonus opportunities, a retirement savings plan and perks such as tuition reimbursement or relocation assistance can make up for a lower base salary.

Also, don’t overlook the intangibles when doing your cost/benefit analysis. For instance, flexible scheduling, remote work options and a shorter commute can improve your work/life balance.

3.   Research the firm. Before you start plotting your negotiation strategy, get an idea of how much wiggle room there is. Learn about the organization’s financial standing by reviewing its website and searching for relevant news stories in business and trade publications. If it’s a public company, look at the most recent earnings statements and annual reports.

Ask members of your professional network what they know about the organization, too. If you discover the firm or agency recently announced layoffs or a salary freeze, you’ll probably want to recalibrate your expectations.

4.   Keep it friendly. Always manage negotiation discussions tactfully. You can make a strong case without issuing ultimatums or threatening to walk away if your demands aren’t met. Remember: You’re negotiating with someone who could be your future  boss, not haggling with a used car salesperson you’ll never see again.

Be poised and pleasant, not adversarial. And be a straight shooter. Candidates sometimes falsely claim to have a more lucrative job offer from another company only to have the misguided bluff called and end up with nothing.

5.   Ask to revisit the issue. If the company can’t quite meet your desired salary, ask if the hiring manager would be willing to re-evaluate your compensation in six months. The firm could be in better financial standing by that time, and your manager will have had an opportunity to see the value you provide firsthand. It never hurts to ask, and now’s the time to do so.

6.   Get it in writing.  If your salary negotiation is successful, make sure to get a contract detailing all aspects of the agreement. This includes compensation and any special arrangements (such as a signing bonus, extra personal days or early salary review) you’ve settled upon.

                                                               
Finally, if you decide to turn down an offer, do it with class. Go out of your way to be gracious and appreciative. It’s best to give the employer the courtesy of a phone call rather than a quick “thanks, but no thanks” email.

The bottom line is that you want to do everything possible to leave the door open to future contact. Just because you weren’t able to come to an agreement for this particular position doesn’t mean there won’t be a more desirable or suitable opportunity at the company down the line.
                                                           
The Creative Group is a specialized staffing service placing interactive, design, marketing, advertising and public relations professionals with a variety of firms. More information, including online job-hunting services, candidate portfolios and TCG’s award-winning career magazine, can be found at creativegroup.com.

Free Book for Your Surgical Rotation

Scribd is a great resource for free textbooks (and not just the cheap ones). You can buy a subscription to have total access (Premium) or you can upload non-copyrighted materials and get a Premium membership for free.

I found this surgical book written for students on their surgical rotations. It is pretty awesome and comprehensive. A snippet from the table of contents is below.

Surgical Techniques: Textbook for Medical Students

Interested in Global Health?

This video/ppt by Kaiser.edu is Global Health 101 in less than 15 minutes. If you are interested in working as a PA in the global market this is a perfect introduction to help you get a better idea of what's going on outside of the United States.

2011 PA Salaries

Advance for NPs and PAs in a site/magazine that puts out salary data each year for NPs and PAs based on surveys. It is a good way to gain general knowledge about salaries in your area, but keep in mind the numbers are based on a voluntary survey.

These salaries can seem inflated or even below average because it is largely dependent on how many people answer the survey. If one plastic surgery PA answered the survey and stated that s/he made $200K, it would look like plastics PAs were some of the best paid - when in reality, this is not true. Also, if 10 family practice PAs answered and most of them were around $85K, but 2 only make $70K that would drop the average even though those 2 might be anomalies.

Take home: Look at the data. Consider it. Don't consider it the end all be all. The best way to get an idea of salaries in your location and specialty is to ask people that work in the field. I don't recommend walking up to a PA and asking them what they make. You won't make many friends that way. But you can ask them what they think the salary range would be for a new grad working in their department with your skill set.


Source: http://nurse-practitioners-and-physician-assistants.advanceweb.com/Web-Extras/Online-Extras/The-2012-National-Salary-Survey-of-NPs-PAs.aspx

Secrets of the Social Media Trade

I have received quite a few emails over the past few weeks asking me how I keep up with all of my social media outlets. I'm on Twitter, Facebook, Linked In, and obviously ...blogging. The secret is Hootsuite. Hootsuite is one of many free social media dashboards available today. I haven't tried any of the other ones so I'd be interested to hear if you have.

Why is Hootsuite the secret to my success? Because it allows me update ALL of my social media outlets at the same time. I can input a message once and send it to all outlets with one click. In addition, Hootsuite allows me to schedule messages to go out at any time in the future. This enables me to sit down once or twice a week and set up the majority of my postings for the week. This is an enormous time saver.

If you are looking for a way to save time, but keep all of your social media outlets up-to-date or if you are just starting up your social media endeavors- check out Hootsuite or another dashboard. 

Post-Grad Advice

It has been 3 months since I graduated from PA school. I still haven't started work and I'm not in the minority of my class. I write this entry as a "heads up" for soon-to-be grads. Our class was told that it could take 4-6 weeks to start working after graduation, even if you were already offered a job! I think that time frame is a good minimum to think about. You should plan for about 2-3 months without an income just to be safe. If you start working prior... great! but if not, you will have a bit of a cushion for things like rent, bills, loan payments, and your licenses.  Getting all of your national/state stuff for credentialing will cost you around $1500. Even if your institution says they will pay, it is typically in the form of reimbursement - that means you need to have the money upfront.

Tips to Start Working Sooner

• Fill out as much as you can on your state license application and state controlled substance application right after graduation. You won't be able to do everything, but having it ready to go so that as soon as you get your NCCPA ID you can finish it up.
• Request official transcripts from your previous institutions. You will need them for your state license and often this is the step that holds up the process. Some school can take 5-7 days to mail out official transcripts.
• If possible, hand deliver the documents to the offices instead of putting them in the mail. If it isn't possible, think about expedited delivery.
• You will need your supervising physician to sign paperwork. Depending on your relationship with that individual and their schedule, think about scheduling an appointment soon after graduation because they can fill out their sections completely prior to you getting your PANCE results.

With all of this being said, even if you do everything ahead of time - you still might not start work for 2-3 months because some of the process is out of your control.

• Some hospital credentialing boards only meet once a month, so even if all of your stuff is in if you've missed that month's meeting then you will likely have to wait til the following month.
• Your hiring department may not be able to on-board you right way, especially if they hired several new grads. They may stagger your start date with other new grads for training purposes.
• Stuff gets lost in the mail. It happens.

Take home: Be organized and get as much of the application process done ahead of time as possible. Plan for 2-3 months without an income and be sure that you have $1400-1500 "extra" money to pay for your licensing.