Proballr32 Posted October 19, 2014 Share Posted October 19, 2014 Hello everyone, I'm curious to get some perspective here about the transition from Ortho to ER. First a little background....I have been practicing in Ortho for almost 4 years. My first year was in a traditional Ortho surgery practice, but the last 3 have been in non-surgical ortho. I typically see 20-25 patients per day and my days consists of mostly joint injections/trigger point injections. Due to my background in sports medicine and career in baseball before becoming a PA, Ortho was natural for me. However, during PA school I fell in love with ER. Coming out of school I had a couple Ortho and ER offers, but ultimately picked Ortho due to my previous comfort with it. I've always kicked myself for not taking the ER gig, and have since attempted to find another position but all have required previous experience until now. So now I have been offered another ER position in the location I would really like to live, however I'm finding myself questioning my capabilities. I was very confident during my ER rotations in school and was able to participate in the care of very sick patients and I wasn't phased. However, over the course of the last 4 years in Ortho, I have seemingly forgotten how to manage many simple basic conditions. This has been evident to me as I have shadowed a couple times at the prospective ER and find myself not having a clue about what should be a simple case. Even simple procedures like an I&D and suturing are foreign to me at this point, as I have not had to do any procedures other than injections. My concern is that I will get into the position and then underperform due to having to look up the workup/treatment for most things I see. And I know the doc won't want me coming to them to present every patient I see. The ER position would be a mixture of some fast track shifts along with main ER shifts. Physician coverage is 24 hours, but obviously none located in fast track. It's a pretty busy rural facility and was told that I should expect to see about 30 patients in a 10 hour shift. Any suggestions? Thanks in advance! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 19, 2014 Moderator Share Posted October 19, 2014 consider doing one of the several EM PA bootcamps out there. definitely attend a major em conference like sempa, acep or essentials of em and go to every lecture with a topic you don't feel comfortable with. find another pa to mentor you along the way. good luck. many of us going from em to ortho surg would have to do something similar. recognizing you aren't up to speed yet is an important first step in getting there. Link to comment Share on other sites More sharing options...
gbrothers98 Posted October 19, 2014 Share Posted October 19, 2014 This is good advice above. You can also get the streaming version of the EM bootcamp at: http://ccme.coursehost.net/course/embootcamp I also turn those starting in EM to these 2 texts to review: Minor Emergencies: Expert Consult - Online and Print, 3e An Introduction to Clinical Emergency Medicine It sounds like you were an outpt proceduralist with a limited focus due to being in an ortho practice. It is likely that when you start practicing in the ED, you will remember some of the things you were comfortable with in time, sort of like riding a bike. On the other hand you are going to be held responsible for producing real volume from what you describe. You may get to that point with some support and time. How likely is it that your new employer will provide this for you or are they throwing you right in to swim or sink? If just thrown in, then I think you need to get ready to pull your big boy pants on and deal. You could attempt to involve your new employer in a realistic conversation about the fact that you likely wont be able to see 30 patients in 10 hours realistically and will need some support and guidance at the start. I think that this is a struggle that many new PAs are facing, they can only get a position in specialties, lose that general medicine ability and then need to start climbing that mountain again when they have a nonspecialty position become available. Good luck, I think this will be a good move for you but it will be a challenge. G Brothers PA-C Link to comment Share on other sites More sharing options...
Proballr32 Posted October 19, 2014 Author Share Posted October 19, 2014 I appreciate the suggestions. I was actually thinking about the bootcamp series, so I'm glad to see you both recommend it. I would have about 2 months before I would start shifts, so I figure that should be enough time to get back up to speed on some things. Gbrothers, you are definitely right about getting into a specialty and forgetting general medicine. As an orthopedic proceduralist, I have had no need to really think about the "medicine" side of things. I think that placing my medicine thinking cap back on is what will be most challenging, but I'm hopeful it will be like riding bike. The medical director in the ER seems great and likes to teach. He is telling me that despite 4 years of practice as a PA, he will treat me like a new grad since I have no ER experience, which I appreciate. However, that being said, I do realize that around 30 patients per shift will need to be seen so the realist in me wonders about that aspect. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted October 20, 2014 Share Posted October 20, 2014 Do you have a good internal sensor for knowing who is "sick" versus "not sick"? If not....then I think you should reconsider. If so, then jump in. Good luck, and let us know how it goes! Link to comment Share on other sites More sharing options...
gbrothers98 Posted October 20, 2014 Share Posted October 20, 2014 Things I carry in the ED: EMRA abx guide, WikEM, AgileMD with PV cards, MDcalc, 10 second EM on iphone Airway card from Airway site Tarascon Pharmacopia I use almost all every shift. GB PA-C PS a nice lil handbook is EMRA Basics of EM, both phone and print editions, a nice succinct entry into EM Link to comment Share on other sites More sharing options...
SocialMedicine Posted October 20, 2014 Share Posted October 20, 2014 i would imagine fast track has a great deal of ortho cases so that will be good for you. Although did you practice orthopaedics or just deliver joint injections ? I was a bit confused. A lot of resp infections, GI sx, headache as well that some of the boot camp/conferences probably do not delve into because they are the standard/least sexy topics. It sounds like you may need a month of working 1 on 1 with a PA or MD to get going. Are they providing you with that ? Maybe you can work the first month in the main ED every shift and present cases. Make sure they understand your skill level. The last thing you want is to be leaving a job because it was overwhelming. but in my experience the fact that you are thinking about this stuff shows you will be in a good position. Link to comment Share on other sites More sharing options...
sscheinfe Posted October 20, 2014 Share Posted October 20, 2014 TAKE THE JOB!!!! EM is the HARDEST field by far to break into as a PA, far harder than any surgical specalty. I've been trying unsucessfully for 4 years. If you have an offer, for god's sake take it! But I'm a bit biased. Link to comment Share on other sites More sharing options...
BruceBanner Posted October 20, 2014 Share Posted October 20, 2014 TAKE THE JOB!!!! EM is the HARDEST field by far to break into as a PA, far harder than any surgical specalty. I've been trying unsucessfully for 4 years. If you have an offer, for god's sake take it! But I'm a bit biased. ^I think Derm actually takes the cake but EM is a close second. OP, I'd take the job as long as your SP has expressed CLEAR understanding of your greenhorn status and is willing to be patient while you learn. I bet in a month or two you'll be feeling a lot better; hopefully they wont dump someone really sick on you for a while. Link to comment Share on other sites More sharing options...
AMS_ER Posted October 23, 2014 Share Posted October 23, 2014 I started out in EM as a new grad because I couldn't find an ortho job that was the right fit. After a year ended up in Dallas, Tx "living the dream"... 6-7 day work weeks, call three weeks out of the month, hospital rounds daily at 1-4 facilities. Shame on me. After 6 months of looking for another ortho job and still not finding the right fit. I decided private practice maybe wasn't the right fit for me after I got a little disheartened on my last ortho interview at a sports med practice that went like this: "how are you when it comes to asking for help?" "Oh I have no problems asking for help, as long as someone is listening." "Hahaha, we want you to ask for help, your just a PA, it's not like you practice medicine." Needless to say, I went back to my old ER. I have the autonomy I love (and need in the ER), still get to take care of fracture and joint dislocations, and get to work 3 days a week. And I've found a new love for critical care. The transition is uncomfortable at first. But like others before me have stated know your limits and how to tell "sick" from "not sick". And I'd definitely get some type of review beforehand. I would also recommend talking to your supervising physician about who you should go to with questions. Just from experience, figuring out who is a viable resource and good teacher is difficult to figure out when you're new. But you'll love it! I couldn't imagine going back, even though I still love ortho. The docs I work with know they better not put a joint back in without me ;) Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.