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Average amount of support and teaching on first job


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I am trying to get some idea of how much teaching and support PAs are getting on their first job. I realize there are outliers - those who run every pt by attendings and those who practice complete autonomy starting on day one. But hoping some can chime in with general insight. How often do you discuss PTs with another provider, and did you receive much teaching per se or just answers as far as what to order? All responses are much appreciated.

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9 months in and I'm still chiefing 75% of my patients. I'm in a subspecialty at an academic medical center and have lots of educational opportunities. This is one of the things that I was specifically looking for with a first job. I'm at the point now where I don't feel that I need to chief most patients, but it depends which doc I'm working with and I really don't mind since there's always teaching involved. I was told when taking this position that I would be training for at least a year. 

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These questions never happen in a vacuum.

Were you promised something or led to believe that you would be getting teaching and support?

Are you getting less teaching, less support and more being told what to do?

Or are you getting too much attention, everything you do being overseen to the smallest detail?

 

I think the answers you will get will be all over the place with no clear standard. Much will be facility dependent, group and practice dependent or physician dependent. 

There will be PA positions where one can practice at the very top of their license, others you follow protocol or a locally determined standard....and never get past that.

 

My first job 16 years ago, I was hired to see fast track patients in a large community hospital ED, we saw about 15k at that time. All part of a plan to free up the ED docs to see critical patients.  My first patient was a female in her late 60s whom had had a TIA. Not your usual fast track patient. It was obvious that I was there to pick up the next chart. A steep learning curve ensued. I remember always being acutely uncomfortable and not sure of what I was doing. After a few months, the director had a conversation with me that was difficult to interpret but I think to a certain extent I was on double secret probation.

 

So I hunkered down and really started paying attention to what I had to do. I realized that the people I worked with really did not want me coming to them all the time to ask for answers, they were busy enough. They needed someone that could perform just like they did with a majority of cases that presented. So I did a lot of work on my off days and anticipated what I had to do for patients I saw and why. I didnt realize it at the time but essentially what I was doing was developing what medical educators called illness scripts. Basically a story or narrative of a disease process and how it presents and the particulars to diagnosing and treatment. It is a bit more complicated than that but you can google that and read up on it.

 

I started off with developing these based upon presenting symptoms and that got me pretty far along. Then I started filling in gaps. There was also a lot of other technical things that I had to get up to speed on such as EKG interpretation, xray interpretation and documenting. Fortunately b/c of prior experience there were other skills such as suturing and splinting that I had a certain level of comfort with. It was not easy. You will hear similar things from other recent grads especially if they start practice a field of medicine that is broad such as EM, primary care, peds and general surgery. There are many places that the majority of this knowledge and experience you will only be able to obtain on your own. The polite term is self directed learning. 

 

But once you get on this path, you will develop insight and a level of comfort that will increase with more experience and time. Time is important. I have worked with board certified EM physicians who have confided that even with med school and residency they did not feel comfortable for several years out of residency.

 

Good luck.

G Brothers PA-C

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Thanks all for the replies. I am fortunate that I have attendings to go ask questions or I can insist they see my pt if I am really uncomfortable. It is mostly at my discretion when to ask them unless I am admitting someone then it is mandatory I check with them. I have been trying to be more conservative but they are busy so I don't want to come with every nuance. So I am trying to get some idea how often people are running things by their attendings (as a new grad) vs dealing with issues on their own.

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New grad here- have been working a grand total of two weeks. Large, urban, academic medical center in the ED with a committment to teaching (i.e. this is something the institution is known for). I present every patient to an attending as does all of the PAs and residents. Depending on where you are with your knowledge there is more hand holding and order suggestions. We rotate through all the areas of the ED eventually (we learn to take care of level 1-2s last) but see a variety of patient presentations every day. I really wanted my first job to be at a place where I would see a variety of complaints but would people around who were used to teaching and willing to teach. That said every attending is different but so far I have am more comfortable with having a safety net and lots of people to learn from. This is the job I interviewed for- I had other opportunities with more autonomy but I feel like I can get that at any point in my career. I should add that while I do present every patient to an attending I am often running info by consultants, pharmacy, PT, case management, residents, who ever can answer the questions. We regularly page patients PCP's and specialists in the ED and send FYI emails to let them know the patient was seen. Sometimes the info you really need isn't from your attending. I had a pts PCP come down to see them in the ED because they were confused and based on our brief phone conversation she couldnt determine if the pt was at baseline or worse. Turns out pt was at baseline so we cancelled our work-up and sent them back to the nursing home with reasurrance and saved the tax payers a 15k + workup for no reason.

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New grad here- have been working a grand total of two weeks. Large, urban, academic medical center in the ED with a committment to teaching (i.e. this is something the institution is known for). I present every patient to an attending as does all of the PAs and residents. Depending on where you are with your knowledge there is more hand holding and order suggestions. We rotate through all the areas of the ED eventually (we learn to take care of level 1-2s last) but see a variety of patient presentations every day. I really wanted my first job to be at a place where I would see a variety of complaints but would people around who were used to teaching and willing to teach. That said every attending is different but so far I have am more comfortable with having a safety net and lots of people to learn from. This is the job I interviewed for- I had other opportunities with more autonomy but I feel like I can get that at any point in my career. I should add that while I do present every patient to an attending I am often running info by consultants, pharmacy, PT, case management, residents, who ever can answer the questions. We regularly page patients PCP's and specialists in the ED and send FYI emails to let them know the patient was seen. Sometimes the info you really need isn't from your attending. I had a pts PCP come down to see them in the ED because they were confused and based on our brief phone conversation she couldnt determine if the pt was at baseline or worse. Turns out pt was at baseline so we cancelled our work-up and sent them back to the nursing home with reasurrance and saved the tax payers a 15k + workup for no reason.

This is exactly the setup you want with a new job...provided there is room to become more autonomous as you progress.  No one expects anyone to fly solo after the first year, but you should be well on your way to feeling comfortable with beginning management of patients without talking to someone else first. 

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I presented every pt for a day or 2 at my first job then only the ones I wanted to and the admits. I worked at a facility with an md fp residency so there were always senior residents around and many pas with 10+ years of experience to bounce stuff off of. I learned more from the other PAs at my first job than the docs on the service. they were always available, but it was just easier to ask the guy sitting next to me( a pa) than go down the hall to see a doc.

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I had very little. I started in spine surgery. Plenty of teaching and patience were promised but when you get down to the reality of day-to-day practice, most docs have neither the time nor the inclination to coach you every day. They dont need another student. They need someone who can move patients competently, most of the time. That's the truth of on-the-job "training".

 

ED's are hard because much of what you see is (or potentially is) high acuity. The stakes are high and the patients don't stop coming in.

 

Depending on your specialty, I would do your best to look something up yourself before approaching an attending. Bring a copy of Current with you to work or have apps handy on your phone. If it's really acute or you are stumped then ask. Also don't be afraid to ask nurses and other staff about protocol or logistical questions. They tend to be more available.

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