EMPAhopeful Posted April 23, 2009 Share Posted April 23, 2009 Are there any critical care PA's on this board? How popular is critical care for physician assistants? I know a lot of NP's go into critical care (i work with 3 nurses that are in ACNP school), but was wondering what PA's thought of critical care. What is the scope of practice like? Do you have more freedom, especially since there isn't always a physician in the SICU/MICU/etc? If you're a PA intensivist, do you visit the ER to admit ICU patients/do procedures? My hospital does have PA's, but I rarely see them! I've seen PA's twice at my hospital: once in the ER as she was admitting a patient, and a second time in some sort of ICU or intermediate CU (can't remember). So basically, what is it like being a critical care PA? Link to comment Share on other sites More sharing options...
andersenpa Posted April 23, 2009 Share Posted April 23, 2009 Like any PA job, lots of variability. I've worked several different CCM jobs, working as part of an intesivist team, covering SICU/step down units with no intensivist/surgeon present, to my current job in CTS where the PAs are the primary ICU providers. You'll have more autonomy if it is a non teaching/non resident service. Night shifts also have more autonomy with the skeleton crew on. Some CCM PAs do ED admits; I've mostly worked SICU and those are mostly direct admit from the OR. If you work in a MICU you will possibly do ED admits/evals/etc...... Variety of procedures- lines, taps, chest tubes, other drains, LPs most common. CCM is my favorite part of my current job b/c we have significant autonomy, are first responders, etc. There's a steep learning curve as a new grad since most of these topics are not covered in the didactic phase, usually introduced in clinical rotations. There are several surgical residencies which will give a good base for critical care. The SCCM Fundamental Critical Care Support course is also very good for an overview/intro. Link to comment Share on other sites More sharing options...
IcuPAC Posted June 28, 2009 Share Posted June 28, 2009 I work in Critical Care in a smaller regional hospital that is a referral center for the area. Mostly we do medical ICU patients, but we are consulted for cardiac, neuro, and trauma cases. I work 12 hr day shifts, seven days on, seven days off (though usually the Sunday I'm scheduled to work is only a few hours). I am a new grad, and I must say the learning curve is incredibly steep. I work very closely with the intensivists at this point. That being said, I follow a set of patients (usually around 30% of our total census) and manage their care. This includes procedures, exams, ordering and interpreting test, and requesting consults. I have my own informal midday rounds with the doc where I can get their advice on patient care issues. Often my patients are ones that are nearing being ready to transfer to the medical floor, so I coordinate their transfer and call the hospitalist. I don't go to the ED because at my hospital we never do. As far as procedures, I routinely put in central lines and arterial lines. I occasionally intubate with the MD present. If you are in PA school and you want to do Critical Care, then I recommend doing medical ICU and nephrology as electives. Certainly surgical ICU would be nice too, but at least from what I've seen PAs don't go to the OR a lot on trauma cases -- they follow them in the unit. I wish I had done a nephrology rotation (with lots of inpatient exposure) because understanding acid-base, electrolyte disturbances, fluid management, and renal failure is so central to working in critical care. Hopefully, of course, your PA rotations also include inpatient and ED, which are helpful too. PA school does not really give you the didactic training to go into critical care. For Critical Care the book you must own is Paul Marino's "The ICU Book". Read it.... memorize it. Also go the Society of Critical Care Medicine's website and find out how you can take their "Fundamental Critical Care Support" two day course. Best wishes jstuben Link to comment Share on other sites More sharing options...
EMPAhopeful Posted July 12, 2009 Author Share Posted July 12, 2009 Thanks for the help! I'm really interested in critical care. I still have a few more pre-reqs to go, and I'm looking to be a tech in a CT-ICU preferably, but any ICU would be great to get experience. I'm an ER tech right now, and I always love going up to the ICU with patients and seeing how the ICU "works". Thanks again. Link to comment Share on other sites More sharing options...
CCM-PA Posted July 19, 2009 Share Posted July 19, 2009 Can we have a subforum "Critical Care" under specialties? Thanks. Link to comment Share on other sites More sharing options...
Febrifuge Posted July 19, 2009 Share Posted July 19, 2009 I got to sit in on the FCCS course while on my Surgery rotation; highly recommended. There's a Level One in central Michigan where PAs run the SICU (among other areas) and are trauma gods. With my new hospitalist job, at a community Level One with no IM residency, it's MD intensivists-only in the MICU and SICU, which strikes me as a potential wasted opportunity, but their house, their rules. Longer-term I think the trauma/ surg/ critical care area is a ripe one for PAs, especially as others have said in places without residency programs. As one doc described us to a patient, "they're better than residents; PAs don't have to leave after a few years." Link to comment Share on other sites More sharing options...
Cowboy Posted August 13, 2009 Share Posted August 13, 2009 I work in CCM in a 450+ bed hospital. We have 24/7/365 coverage with a PA and MD. We cover ICU, CCU & SICU for a total of 42 beds. We (PAs) have a fair degree of autonomy in the units. We are usually the first called by the nurses for patient problems ranging from abnormal lab values to pre-code patients. We preform 99% of all the invasive procedures (CVC, A-Lines, Chest Tubes, Swan, Lumbar Punctures, Intubations etc.). We make evening rounds with and without the MD. We have PA students from several schools which I mentor, monitor and lecture. They work with both the MDs and the PAs. In our area most of the ICUs have PAs working, including the "teaching" hospitals that have residents and fellows. I've worked in a level one trauma center and that was a great experience as well. No residents only Trauma fellows. Very much automony there as well. PAs would mostly handle the basic traumas and on the major ones are first assist. Also followed the post op care until discharge. If you're interested in CCM there are opportunities and more are on the horizon. I know of another local hospital that doesn't have CCM PAs but are seeking to hire. Just need to come up with the $$$. In terms of shifts we work 24 or 12. I usually do a 24 / 12 one week and 24 / 24 the following week. Nice to be able to get all the hours requried in 4 days (7 shifts) over two weeks! We usually have a good week to 1.5 weeks off each month. Link to comment Share on other sites More sharing options...
crieman Posted August 13, 2009 Share Posted August 13, 2009 I graduate in 2 weeks and the job I accepted is in pulmonary/critical care at a 600 bed hospital. At first they will have me doing the pulmonary patients on the floor as well as any patients that come out of the ICU. After I feel more comfortable they will incorporate me into the ICU where I will be doing procedures, intubations, chest tubes, central lines, etc. I was a paramedic before going to school so this job is a dream come true. I would also like to see a critical care section in the specialties section. Link to comment Share on other sites More sharing options...
Guest beccahead Posted August 19, 2009 Share Posted August 19, 2009 Ditto the request for a critical care subsection under specialties. I graduate this month and have accepted a job in Critical Care - the pioneer PA in a sea of NPs and I'm thrilled (although terrified!) to have the opportunity... Link to comment Share on other sites More sharing options...
crieman Posted October 24, 2009 Share Posted October 24, 2009 I wish I had done a nephrology rotation (with lots of inpatient exposure) because understanding acid-base, electrolyte disturbances, fluid management, and renal failure is so central to working in critical care. Hopefully, of course, your PA rotations also include inpatient and ED, which are helpful too. PA school does not really give you the didactic training to go into critical care. jstuben After doing this for nearly a month now, I have to say that this could not be more accurate. I really wish I could've done a nephrology rotation. Link to comment Share on other sites More sharing options...
crieman Posted December 3, 2009 Share Posted December 3, 2009 And again, please add a critical care section under specialties. Link to comment Share on other sites More sharing options...
EMPAhopeful Posted December 4, 2009 Author Share Posted December 4, 2009 generally, is there a difference in level of autonomy of the PA in MICU, SICU, CCU, CTICU/CVICU, etc.? I guess this is hospital dependent as well. Link to comment Share on other sites More sharing options...
VentJock Posted December 7, 2009 Share Posted December 7, 2009 generally, is there a difference in level of autonomy of the PA in MICU, SICU, CCU, CTICU/CVICU, etc.? I guess this is hospital dependent as well. dont forget NICU and PICU and peds-CVICU Link to comment Share on other sites More sharing options...
nightrt Posted December 7, 2009 Share Posted December 7, 2009 dont forget NICU and PICU and peds-CVICU I second that! Link to comment Share on other sites More sharing options...
VentJock Posted December 16, 2009 Share Posted December 16, 2009 generally, is there a difference in level of autonomy of the PA in MICU, SICU, CCU, CTICU/CVICU, etc.? I guess this is hospital dependent as well. even within the same hospital it varies. Where I work now we have tons of NNPs (no PAs) in our NICU, meanwhile our PICU has no PNPs (or PAs). Link to comment Share on other sites More sharing options...
Can28 Posted March 17, 2012 Share Posted March 17, 2012 I am very interested in CCM and would also like a section under specialties. Thanks Link to comment Share on other sites More sharing options...
Can28 Posted March 17, 2012 Share Posted March 17, 2012 I am very interested in CCM and would also like a section under specialties. Thanks Link to comment Share on other sites More sharing options...
MikeyBoy Posted March 20, 2012 Share Posted March 20, 2012 Haven't been on in awhile, but it's good to be back. I agree with the above- Let's start a CCM section please! Heading to the FCCS conference here in Baltimore on Thursday- really looking forward to it- I'll let you all know how it goes! Link to comment Share on other sites More sharing options...
polarbebe Posted April 3, 2012 Share Posted April 3, 2012 Haven't been on in awhile, but it's good to be back. I agree with the above- Let's start a CCM section please! Heading to the FCCS conference here in Baltimore on Thursday- really looking forward to it- I'll let you all know how it goes! How was the FCCS conference in Boston? I just recently started in the MICU as a relatively new PA. I am considering taking the course (btw how much is the live instructor course - the website pricing tiers lists $750 and the online course is $2,250) ... the reason why I ask is my hospital does not provide CME reimbursement, thus this would be out of my pocket. :sweat: Also weighing possibly taking this course versus NPI Hospitalist Procedure course. Thanks. Link to comment Share on other sites More sharing options...
MikeyBoy Posted April 6, 2012 Share Posted April 6, 2012 Cost $550, covered by my job. Overall, I would give the conference 7/10. On some subjects, like shock, electrolyte management, immediate resuscitation, ACS, bipap, etc-the live course didn't really offer much beyond what I have already learned in practice. These were things you have to read about/see/ and treat to really master- obviously no conference can cover a subject as in depth as ACS/arrhythmia in a 45 minute session. We had a small group, so the skill sessions were nice with only a few students per instructor- I'm fairly weak on mechanical ventilation and the 3 in depth sessions on it really helped. The text is a great overview and template of critical care and how to approach it without having the overwhelmed feeling. It seems some FCCS courses differ by location, but in general they all have to use the same power points and templates. Mine was held at a large trauma center, and included a refresher on the approach to trauma. I would ask your coworkers in the MICU and see if they found the course rewarding for your particular practice. Good luck! Link to comment Share on other sites More sharing options...
DJ Bunnell MSHS PA-C Posted April 13, 2012 Share Posted April 13, 2012 APACVS has a critical care conference every summer. It is not focused on cardiac surgery. This year the conference is June 25-29th ni Long Island, NY It includes lectures and hand-on skills course at a bioskills lab. You can receive the APACVS Critical Care Skills Certificate of Completion and the SCCM FCCS Course http://www.apacvs.org brochure http://www.apacvs.org/documents/PDF/AttendeeBrochure040912.pdf online registration http://www.techenterprises.net/apacvs/registration.taf?conf_id=40&_function=form Link to comment Share on other sites More sharing options...
polarbebe Posted May 8, 2012 Share Posted May 8, 2012 APACVS has a critical care conference every summer. It is not focused on cardiac surgery.This year the conference is June 25-29th ni Long Island, NY It includes lectures and hand-on skills course at a bioskills lab. You can receive the APACVS Critical Care Skills Certificate of Completion and the SCCM FCCS Course http://www.apacvs.org brochure http://www.apacvs.org/documents/PDF/AttendeeBrochure040912.pdf online registration http://www.techenterprises.net/apacvs/registration.taf?conf_id=40&_function=form Thanks looks like a great class, wish I saw this earlier, already registered for the FCCS 6/4-6/5. The sono and vent look interesting. Link to comment Share on other sites More sharing options...
Guest carolanimal Posted September 25, 2012 Share Posted September 25, 2012 I work in Critical Care in a smaller regional hospital that is a referral center for the area. Mostly we do medical ICU patients, but we are consulted for cardiac, neuro, and trauma cases. I work 12 hr day shifts, seven days on, seven days off (though usually the Sunday I'm scheduled to work is only a few hours). I am a new grad, and I must say the learning curve is incredibly steep. I work very closely with the intensivists at this point. That being said, I follow a set of patients (usually around 30% of our total census) and manage their care. This includes procedures, exams, ordering and interpreting test, and requesting consults. I have my own informal midday rounds with the doc where I can get their advice on patient care issues. Often my patients are ones that are nearing being ready to transfer to the medical floor, so I coordinate their transfer and call the hospitalist. I don't go to the ED because at my hospital we never do. As far as procedures, I routinely put in central lines and arterial lines. I occasionally intubate with the MD present. If you are in PA school and you want to do Critical Care, then I recommend doing medical ICU and nephrology as electives. Certainly surgical ICU would be nice too, but at least from what I've seen PAs don't go to the OR a lot on trauma cases -- they follow them in the unit. I wish I had done a nephrology rotation (with lots of inpatient exposure) because understanding acid-base, electrolyte disturbances, fluid management, and renal failure is so central to working in critical care. Hopefully, of course, your PA rotations also include inpatient and ED, which are helpful too. PA school does not really give you the didactic training to go into critical care. For Critical Care the book you must own is Paul Marino's "The ICU Book". Read it.... memorize it. Also go the Society of Critical Care Medicine's website and find out how you can take their "Fundamental Critical Care Support" two day course. Best wishes jstuben Thank you so much for this post! Ive sat in on the FCCS class at the hospital I work at. It was so interesting! Sometimes it's incredibly remarkable/intimidating to know that there's so much yet to know! Link to comment Share on other sites More sharing options...
jmkesler Posted February 14, 2013 Share Posted February 14, 2013 Would you mind telling me where this hospital is? or the area of the US this is in. Thanks. Link to comment Share on other sites More sharing options...
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