NP Week 2016: This Emergency NP's Indirect Journey to Medicine

In the spirit of NP Week, we hear how Gabriel Westheimer transitioned from ski patrol to the trauma center

Nov 17, 2016 - Guest Author


Gabriel Westheimer is a FNP who is Emergency Medicine fellowship trained. He has been working at the Zuckerberg San Francisco General Hospital and Trauma Center for the past three years. Prior to SFGH he worked at several community departments in the East Bay and Sacramento. He is passionate about NP education and interested in making his clinical students think critically and build a foundation for their careers. His goal for SFGH is to reach a point where NPs are working to the fullest extent of their practice.

Outside of work he and his wife enjoy cooking and making cocktails for friends (#BarMonheimer). They love international travel and are active resort and backcountry skiers.

You can follow him on Instagram at @gwestheimer and Twitter @NPintheED.


Choose two words that best describes your work style:

Mellow. Focused.

What is your device of choice?

Apple iPhone 7 – our hospital gets terrible reception so keeping it on WiFi and on airplane mode makes the battery last all day with extra to spare.

Favorite apps & software?

MDCalc, EMRAABx, Sanford Guide, AgileMD, UpToDate.

How does Doximity help you in your work as a clinician?

I use the news page on a regular basis to stay up to date on current articles pertaining to my practice and refer patients who are out of my county system for follow up visits to specialists.

What’s your secret to staying productive?

Always learning. I tell my students the second you feel that you understand everything and don’t need to keep learning, then don’t come to work.

Describe your journey to medicine.

Anything but direct. It started with my love for skiing and wanting to be a professional ski patroller. After getting my undergrad degree in theater, I took a one month wilderness EMT program through the Wilderness Medicine Institute. Jump forward a few years and I was Ski Patrolling in Utah with a wonderful crew at Deer Valley Ski Resort. Knowing that I would be moving to the Bay Area and that I wanted to go back to school, I applied to Samuel Merritt University and began their fast-track NP program. After graduating, I was fortunate to be the first Emergency Medicine Fellow for Emergency Medicine Physicians (EMP) in their Sacramento, CA Hospital. For the past three years I have been at my city’s level one trauma center:
the Zuckerberg San Francisco General Hospital and Trauma Center.

What do you wish you knew when you were a student?

That it will all work out.

Who is your mentor?

I have had lots of mentorship from Dr. Tris Rieland and Dr. Greg Rosellini, who led my one-man fellowship and helped set a foundation of excellence in emergency medicine. Now, I am fortunate to work at San Francisco General surrounded by some excellent mentors. Seeing how Dr. Michelle Lin has grown Academic Life in Emergency Medicine (ALiEM) and how Dr. Paul Jun has helped shape HIPPO Education has been inspiring.

As an Emergency Nurse Practitioner, you must be busy. How do you find work/life balance?

One of the best things of emergency medicine is being able to sculpt your work life balance. It is true that the odd hours and the random shift schedule can impede some things including important family time and regular sleep patterns. Once you get beyond that, you are able to take advantage of the flexibility and have some serious space from work.

For me it is a combination of downtime with my wife, eating good food, mixing cocktails, and hanging out with our two greyhounds. Active travel is also an important part of my work life balance. I was able to spend six weeks on the road with my wife and friends, traveling and driving throughout Africa while leading our own safaris. I'll soon be departing on a three-week Japanese backcountry skiing adventure come the new year. Exercise is a big part of our down time and training for our next adventure.

Do you have a favorite song?

Not at this time

What’s the best advice you’ve ever received?

If there is something else you can do, don’t be an actor.

What would your colleagues be most surprised to learn about you?

Most people don't know that I am completely blind in my right eye from Coats disease.

The 5 Most Interesting NP Salary Facts

Nov 16, 2016 - Doximity Blog


To celebrate of Nurse Practitioner Week, we launched Career Navigator, the first interactive salary map for nurse practitioners by specialty and county.

We built Career Navigator using Doximity's nurse practitioner network, which includes 25% of all US nurse practitioners. With the data you provided us, we were able to analyze and find the following 5 facts on nurse practitioner salaries you may not know about:

1. Gender discrepancies exist across specialties

While 87% of nurse practitioners are female, men make 11% more than women on average. The specialty with the largest pay gap is Geriatrics, where men make about 13% more than women. The smallest pay gap exists in Acute Care, where men make 2% more than women.

2. Salary varies by specialty

The highest paid specialty overall is Psychiatric-Mental Health, with Neonatal coming in as a close second. The lowest paid specialities are Women's Health and Pediatric.

3. State salaries vary for nurse practitioners

We found the average compensation for nurse practitioners is highest in California by a significant margin. Coming in second and third place are Nevada and Oregon.

4. Independent practice states show higher salaries, but not by much

Our findings showed that nurse practitioners in the 21 states with the option of independent practicing made 4% more than their counterparts in states without independent practice options.

5. Pay for nurse practitioners is similar in rural and urban areas

We found that nurse practitioners in both rural and urban areas had relatively similar salaries, with nurse practitioners in rural areas making 1.4% more than those in urban areas. Previously, we have found that physicians in rural areas see an average of $1,500 more in salary each year compared to those in urban areas. However, we also found that PAs in urban areas make approximately 5% more than PAs in rural areas.

See what the average salary is for your specialty in your county in Career Navigator.

NP Week 2016: How this Pediatric NP Found her Niche Abroad

Kicking off National NP Week with a special "How I Work" - all the way from Malawi

Nov 14, 2016 - Guest Author


Ashley Ramirez is a Pediatric Nurse Practitioner (PNP) with a background as a Neonatal & Pediatric Intensive Care Nurse for the past decade. Recently, she worked as a Fetal Medicine PNP at UCSF Benioff Children’s Hospital in Oakland, California. As of July 2016, Ashley joined the Peace Corps as a Pediatric Nurse Educator and is currently working and living in Malawi, Africa. You can find Ashley on Twitter @AshJRamirez, or on her blog, Life As a Pediatric Nurse.


Choose one word that best describes your work style:

Focused. Working in the Intensive Care and Critical Care setting my whole career, my pace is usually one speed: Ready. Set. Go! Over the years I have noticed there is always work to be done. Sometimes it can overwhelm you as the projects tend to pile on. It ends up being extremely daunting. However, I noticed I work best when I can identify tangible goals and projects, breaking them into little chunks to focus on. I prioritize them and slowly execute them in small doses. Creating little internal deadlines for each project. There are always endless projects to be done, but having a good sense of prioritization is key. You can then focus on setting goals and timelines to help make it possible.

As I am learning the Malawi language (Chichewa), we say “Pang’ono a Pang’ono,” meaning bit by bit.

What is your device of choice?

In clinical and travel: iPhone, but my MacBook Air is a close second

Favorite apps & software?

iPhone:

UpToDate
Doximity
Medscape
WHO e-Pocketbook
NPR news
BBC news
Camera +

Macbook air:
Microsoft and Google drive: sharing docs and storing files for education, powerpoints, lectures and modules

How does Doximity help you in your work as a clinician?

Healthcare and technology is at an interesting time. Although technology is making a positive impact, unfortunately there’s a lot of barriers in the system, which in turn impedes optimal delivery of care to high risk patients. Communication within mixed healthcare systems is a blaring obstacle. In turn, we continue to work in silo, duplicating a lot of the workload. Because of this, it translates to marginal gaps in care that is provided. Doximity was a great portal to really connect with providers in the community and optimize the coordination of care. More specifically to this high risk population accessing different healthcare systems.

When I was in the states, I used it daily. In California, I was a coordinator for a Fetal Medicine Program as a Nurse Practitioner. Most of my work involved coordinating care with nearly a dozen pediatric specialists and their respected colleagues to develop individualized plan of care for high risk pregnancies. Doximity was instrumental in connecting with the specialist to coordinate and optimize care in an urgent fashion.

What’s your secret to staying productive?

Taking time to unplug. I have that motto of “Work Hard, Play Hard." I feel like there is a time for everything. As stated above, I am very goal oriented and work great with deadlines. But once achieving those little deadlines I also think it’s healthy to unplug and treat yourself. I truly believe on the weekends people need to turn off your phones and be unplugged with life. Hiking and running is my key to being disconnected and staying balanced. I love getting lost in the wilderness or near water. Lake Malawi has been a new replacement for my Tahoe or Marin headlands fix.

What do you wish you knew when you were a student?

Knowing you are your greatest critic. To have more confidence and be more gentle on myself -- we are truly our worst critics. I’m always so hypercritical, often inflicting fear that initially limited myself in taking risks. Once you realize you don’t have to be a genius to achieve big things, life truly is an adventure of taking risks. The goal is to aim for progress, not perfection. Once you are able to change your perspective, it slowly falls into place. As long as you have a great work ethic and solid plan, you can achieve anything you put your mind to.

Who is your mentor?

I have several mentors. The ones most pivotal in my life include a select group of my Advanced Life Support (ALS) colleagues at Alta Bates Medical Center and my Nurse Manager, Joan Werner. Joan was the initial game changer in my career projection. She pushed me to achieve more and taught me about planning and goal setting. She was the most supportive, nurturing mentors I could’ve asked for. She embodies everything a Nurse should be.

In addition to her inspiration and autonomy she allowed our ALS group to have, I was able to grow into a mold from my stellar colleagues. Some of the accomplishments my colleagues have accomplished has raised the bar within our practice in resuscitation and stabilization in the Delivery Room. It was inspiring to live and breathe how small, simple changes can make a huge impact. Work became a constant PDSA cycle: Plan, Do, Study and Act, which has now been ingrained on my work ethic.

As an NP who is currently working abroad, what advice do you have for other clinicians interested in working in another country?

There are plenty of opportunities, especially in Pediatrics, and it’s not all about helping patients directly. Think about global health on a more sustainable level. It’s wise to invest your time in a strategic initiative that is long term with goals. The book “Dead Aid” is a must read to gain a new perspective.

Think of global health as a continuum; working collaboratively with in-country support on the higher level. Helping solve issues together rather than put a band aid on identifiable problems. We as health care professionals always have good intentions “to do good,” but sometimes we lack a feasible plan with tangible outcomes.
My work in Global Health has definitely changed my outlook on medicine and it just changes you, in general, on a different level. I think working in global health has drastically expanded my skill set and importance of the systematic approach in the delivery of healthcare. It has helped me step back and see the big picture -- not to jump into projects to be a savior and for personal gain, but actually evaluate what the greater good is. I am still learning this.

Working in Global Health is a constant reminder of why I do what I do. There are barriers and obstacles in all of our line of work, no matter where we are in the world. Struggles will always be there. At the end of the day, being able to shape a new generation and help improve care through education and training has been a big shift for me. To possibly have an impact on improving care that is provided to little humans who are faced with lack of access and lack of resources. It’s about problem solving and learning together to help improve care, no matter where they are born in this world. It’s all just a humbling experience. I may not see the change, but I hope somewhere down the line I can help motivate a Malawian to help save lives one breath at a time, one baby at a time and thus a trickle effect. It definitely is not easy but I think it’s worth it.

What’s the first thing you do when you wake up?

Usually blast my playlist of choice via Spotify. Music is my mood lifter. Also, if I can squeeze in three-four morning runs or yoga session then it’s a great week -- or perhaps stressful. Nonetheless, that’s how I filter through it all.

What’s the last thing you do before you go to sleep?

I know it’s horrible, but check my messages and emails. However, during periods when work and life are pretty crazy, I listen to a guided mediation playlist.

How do you decompress?

Exercise! Hiking. Trips to the lake. Running. Basically anything that gets your body moving, distracts the mind, being grounded by the outdoors and feeling unplugged from work.

I can’t live without...

iPhone. I’m constantly listening to music, taking pictures or using google maps.

What are you currently reading?

"Shantaram" by Gregory David Roberts, and always have “When Breath Becomes Air” by Paul Kalanithi on hand.

Do you have a favorite song?

Eek. I can’t just say one. Currently, the albums Rihanna - Anti, Beyonce - Lemonade, Petit Biscuit - Petit Biscuit and other random songs by Major Lazer, Mura Masa and Kygo are always playing on loop.

What’s the best advice you’ve ever received?

Such good questions.. Perseverance. Passion and Patience. Honestly, I can’t say there is one magic advice that was that powerful in one single moment. Rather, I think facing challenging moments sprinkled with small, kind words of encouragements; focusing on the three P’s listed above are essential. Over time, finding a positive, consistent way of coping with tough times eventually leads to a silver lining. Life isn’t about one single moment, one single piece of advice nor one single path. Life is a string of failures that eventually lead to success. Just remember to have a little fun during the process.


NP Week 2016: How this Tech-Savvy NP is Breaking the Mold

Continuing our NP Week series, we profile FNP Helen Lu, who's reinventing what it means to be an NP in our digital world

Nov 14, 2016 - Guest Author


Helen Lu is a Family Nurse Practitioner primarily working in Clinical Informatics. She has a background in family practice and is an Epic-certified Physician Builder and a clinical EMR trainer. Her day primarily consists of training providers, building clinical content on Epic, identifying and troubleshooting workflow issues, and providing support to her clinics, while her clinical duties are in in-home assessments. She is currently based out of Sacramento, CA.


Choose one word that best describes your work style:

Comprehensive. I strive to be efficient, helpful, pleasant, and empathetic on a daily basis.

What is your device of choice?

Microsoft Surface Pro.

Favorite apps & software?

For work: WebEx, Epocrates, HCC helper, UpToDate, ASCCP Mobile, Figure 1
For Social Media: Facebook, Instagram, LinkedIn, Pinterest, Doximity, for articles and connecting with colleagues from work

How does Doximity help you in your work as a clinician?

New clinical guidelines, interesting articles to read on the go, social networking with specialists and classmates.

What’s your secret to staying productive?

Spotify and headphones! I try to focus on one task at a time with my undivided attention (although very difficult), this helps me complete tasks the correct way the first time.

Describe your journey to medicine.

When I was 2 years old, my mother was diagnosed with Lupus, an unpredictable chronic autoimmune disease that attacks the body. The disease, coupled with the extensive medications taken, caused her to have complications such as osteoporosis, muscle pain, and kidney problems. She woke up in the morning not having the choice to say “I’m going to do this, this, and this today,” rather, “What will my body allow me to do today?” She was frequently tired, nauseous, irritable, and prone to infections. I was always sure to be circumspect around my mother when I was ill, mostly in fear of giving her a cold she might not be able to fight off. This was one way my mother’s illness taught me to be independent; I had to take on the responsibility of taking care of myself, as well as the rest of my family. Although witnessing my mother’s illness was always a stressful matter, it sparked my interest in medicine and blessed me with the opportunity to grow. It taught me the importance of being compassionate, with the ability to understand that not everyone is capable of taking care of themselves.

What do you wish you knew when you were a student?

I wish I would've known at a younger age that an open heart and an open mind will allow you to go anywhere. Status will get you nowhere.

Who is your mentor?

I am lucky to have had mentors at different stages of my life. My Mom, who led me to believe in myself. My brother, who told me "The World is Yours, take it" at a very young age. My family, who has always been the catalyst I needed. My preceptors, professors, and colleagues who always knew the correct answers and always provided the right guidance. My patients, who teach me something every single day.

As an NP who is very tech-savvy, what is your advice for others looking to become more involved in digital health/technology?

Networking, continuing to learn, and a keen interest in digital health/technology.

Do you have a favorite song?

Rachel Platten - Fight Song

What are you currently reading?

"Think Like a Freak" by Steven Levitt and Stephen Dubner

What’s the best advice you’ve ever received?

I try to live by this every day.
“You cannot give to anybody in this world what you do not have. And therefore you must concentrate on getting. You must become the most beautiful, sensitive, wondrous, magical, unique, fantastic person in the world to be able to say that I have all of these things so that I can give them away and share them with you. If I don’t have wisdom I can only teach you my ignorance, If I don’t have joy I can only teach you despair, If I don’t have freedom I can only put you in cages. But everything that I have, I can give them away. And so, I dedicate myself to becoming the best ‘me’ the world has ever known.”
-Leo Buscaglia

What would your colleagues be most surprised to learn about you?

I love to karaoke! Though I'm not very good at it.

How this Johns Hopkins Orthopaedist & Military Colonel Battles Burnout

In celebration of Veteran's Day, we wanted to highlight 30-year military veteran, Colonel James Ficke, MD

Nov 11, 2016 - Guest Author


Colonel James Ficke, M.D., is Robert O. Robinson Professor of Orthopaedic Surgery at the Johns Hopkins School of Medicine and director of the Department of Orthopaedic Surgery. He is also orthopaedist-in-chief of The Johns Hopkins Hospital. During his deployment as deputy commander of clinical services at the 228th Combat Support Hospital in Mosul, Iraq, from 2004 to 2005, he was the senior orthopedic surgeon, treating more than 600 U.S. soldiers and Iraqi patients for war injuries. He is nationally renowned as an expert on the treatment of complex foot and ankle patients, lower extremity trauma patients and amputees. This is how he works.


How has the military shaped your active orthopaedic practice?

To start with, I wouldn’t be an orthopaedic surgeon if it weren’t for the military.

The military created my orthopaedic practice. I joined the Army at West Point and studied engineering then went on to Uniformed Services University for Medical School. Originally, I thought I wanted to do wilderness medicine but was exposed to an Air Force orthopaedic surgeon for a 2 week required rotation, and he was so excited about his practice that I was inspired. His name was “Doug Harryman.” He was a mentor for a short period but had a tremendous impact on me.

Ultimately, I served in the military for 30 years because I came into a position of leadership near the 9/11 events. I was at San Antonio, a level 1 trauma center, where we received many of the casualties from Iraq and Afghanistan and it inspired me to stay on Active Duty. Orthopaedic surgery through the military, research, and service of others has inspired my career in foot and ankle and trauma, which were both areas that were needed in the military.

This is a picture in the olive garden of the Benham Monestary in Nineveh Iraq where we had a Medic Baptized. The caretaker served us olives from the trees behind us.

What is the last book you read for fun?

You’re going to get a kick out of this. I must confess, the last book was A Passion for Leadership, by former Secretary of Defense, Robert Gates. I enjoy reading about other people’s successes. It’s a first hand account of leadership by a highly successful individual and icon for us as leaders in academics and organizations. The book depicts his many trials and tribulations and was a remarkable story about how one person came to a position of leadership - especially with such a humble upbringing.

Where is your favorite place you have visited with the military?

Sigh… that’s a little harder question. I have a hard time with favorites and I’m not avoiding your question. Every day in life there is something incredible.

One of the most exciting places was when I served for 1 year in nothern Iraq. We had a Christian soldier baptized in Benham Monastery built in 400AD – this area had one of the largest libraries outside of Rome at the time.

An Iraqi priest was able to baptize him. This was a man practicing his Catholic faith in 2005 in Iraq in peace. I think the most exciting thing about it was that we were at a place defending the freedom of mostly individuals with Islamic faith but freedom of religion was still permitted.

It was one of the highlights of my life because it signified what we did in the military: Preserve freedom of religion/expression for many of those who may not traditionally have it.

What is the first thing you do when you wake up?

Well, like most people, I guess, I shave – shower – grab a cup of coffee – kiss my wife goodbye and head to work.

After taking care of the ‘mechanics of the morning,’ I arrive ½ hour early at work before anyone is there to plan my day, collect my thoughts, and think about the opportunities in front of me for that day.

What’s your favorite type of exercise?

Running. I try to run 3-4 times per week. It gives me time away from distractions and it’s a known fact that people who incorporate an exercise habit into daily practice are happier. They have better health overall. These days in medicine and specifically for Doximity viewers, the notion of burnout is significant. A recent paper showed that up to 45% of physicians are suffering from burnout. I score very low on the burnout ratings, and I have lots of energy and enthusiasm and attribute much of that to getting outside with my regular exercise. Certainly not everyday, but regularly, and that’s valuable.

How has Doximity influenced your career and practice?

Our Department (Johns Hopkins Orthopaedic Surgery) is partnering with Doximity with the “physician referral network,” which is a pilot right now. I’m not a big social networker, but I know many of my colleagues use that feature to keep up with other professionals. It’s a growing way to have a referral network. And clearly the articles are very valuable.

What’s the most important lesson you learned as an Eagle Scout?

Well, you’ve done some checking. I still have the rank of Eagle Scout on my CV. It’s deeply ingrained in my core values including the Twelve Points of Scout Law: Trustworthy, Loyal, Helpful, Friendly, Courteous, Kind, Obedient, Cheerful, Thrifty, Brave, Clean, and Reverent (And yes, he did name them all).

Who has influenced you the most?

Well… I mentor people and I think it’s a skill you have to practice. Sir Ernest Shackleton was a tremendous leader. He influenced my life in the way he led his endurance expedition and brought all of his people home. He kept the unruly members close and taught them accountability.

I study biographies. I think any biography you read can really influence your life and how you practice.

One of Dr. Ficke’s former residents whom he mentors, Chad Krueger, and one of his own mentors, Mike Yaszemski