Inpatient Medicine

[tigerpac]

I am a relatively new PA in the midwest who started working for an inpatient IM group a year ago. Since starting, I have felt somewhat dissatisfied with the use of the PA because it seems like we are being used as scribes. For example, we round on all of the inpatients initially. All of our notes have to be co-signed by the rounding physician who sees the patient, writes an exam and formulates an assessment/treatment plan in addition to ours. Any treatment plan you formulate can be changed by their addendum. I don't understand the benefit of paying us to just write notes. Is this the typical format of inpatient medicine, or is there room for more autonomy as an inpatient provider? Any thoughts? Thank you for your input.

[gbrothers98]

There are likely a few things that are driving this.

First, you admit you are a new grad. This is a safety feature particularly since you do state that entire plans are changed along with diagnosis. I would suggest you constructively view this as potential needed direction in your practice.

Second, billing. If the patient is on medicare, the group or hospital for now can only bill a percentage if the patient is seen solely by a PA but can bill 100% if the physician sees the patient. So this could also boil down to dollars.

3rd, if having a PA service is a new thing, the loss of physician control is difficult for some to handle. I have seen physicians micromanage the sh&t out of a patient encounter because that is what they are trained to do by themselves. They are not trained to rely upon the evaluation and assessment of others, especially someone with less experience and less training than they have.

The answer is yes, there are inpatient medicine positions that a PA can have much autonomy. But ask yourself, do you really need autonomy right now as a new PA? Or is it better to focus on the process and the medicine, gain the experience and benefit from the daily exposure to knowledgable clinicians?

Good luck.

G Brothers PA-C

[Guest Paula]

Do the rounding physicians give you any feedback on your assessments and plans?  Are they mentoring you?  Do you and the other PAs get any training on other skill building with procedures or exposure to ICU, cardiac care units, etc?  Do you show an interest in what the physician is doing and ask questions?  When they change your plans do you ask why and show curiosity?

 

I do not work hospital medicine.  I did a 4 week rotation during my clinical year.  I saw the PA have quite a bit of autonomy but she had been there for 5 years or more.  Each physician she worked with had a different style...some micromanaged and some completely trusted her assessments and plans.  They were rarely changed but from what I remember her notes were co-signed by the physicians and the physicians did see the pt. also.  I hung out with the physicians too when they rounded later and most were complimentary to the PA in front of the pts. and supported her treatment plans.  It really depends on your group (and the hospital policies, etc. ) how they use the PA force.  The PA I worked with in clinical did all the discharge summaries and teaching the patient certain things for home such as care for themselves with CHF or COPD or AFib, etc.   She was well liked and respected by the staff.

 

Keep learning all you can and ask questions, show yourself to be more than a scribe too.   After nearly 11 years of being a PA I find the learning never stops.  I'm with a new group of physicians and even tho I am experienced I know they have a lot of knowledge for me to glean from, plus I will have to earn their trust too.  I am in a FP/IM clinic position.