Are all ERs this horrible to work in?

[quietmedic]

Wow, that's quite an experience to the OP....

[mindsasone]

 I found that the best teachers were the other PA's & NP's.  ED docs were good, but only had time to answer brief questions, not give explanations.  The other PA's & NP's had a bit of time to give those explanations or to show you tips for more complicated procedures.  It still took me 1.5 years to get efficient at moving the level 4-5's, and another 1-1.5 to get efficient at moving the level 2-3's.  Still working on that - I still get bogged down \

 

Wow.  A year and a half...that's amazing, considering that this hospital pretty much gave me (and any new PA) a few months to master all of the above, with as little help as possible, or out the door you go...Hope I find a better place some day, I really would like to work ER.  I certainly learned a ton, which allowed me to move on to where I am now, but the place I was at really burned me, big time, and left a very bitter taste in my mouth. But trying to stay hopeful for the future...

[jwells78]

Tough one.

 

 

 

ED Personnel ARE known to eat their young. When I started out, I kept my head down, mouth shut, and learned as much as I could. Took 3-4 years to get a good stride on the mainside ED, and equal amount of time to get Attendings to TRUST ME.

 

And thats part of this: trust. Maybe what you took as them being too hard on you was them pushing you too be better. Our ED chewed up several new people.

 

With all due respect- If you really want to get back into it-- swallow the pride, take the lumps, and prove yourself.

 

That or find a nice cush rural ED gig with a cool Attending that wears hawaiian shirts.

[EMEDPA]

 

 

 

 

 

That or find a nice cush rural ED gig with a cool Attending that wears hawaiian shirts.

so what are you saying here? :) I have found rural practice more challenging with higher acuity and more personal responsibility, although the volume is MUCH lower allowing one to focus on a few pts at a time instead of many. In 15 years at my last job, for example I never cardioverted. have done it 3 times in the last few months at one of my rural gigs in addition to 18 intubations recently vs the handful over the last decade at the job I just left.

[jwells78]

EMED- exactly.

Rural gig provides opportunity for: growth, autonomy, procedures, ect- w/o the competition w/ residents, or dealing w/Attendings overwhelmed by the ever-increasing inner city census and other metro red tape.

 

OP said they wanted to get back into it, but wanted to avoid those obstacles.

 

Hawaiian shirt came to mind because any Doc Ive been around who wore one was totally chill and a pleasure to work with! ;D

 

Hawaiian shirt FTW!

[sk732]

 

And thats part of this: trust.

 

Trust, much like respect, is a two way street - I have an attending I work with that doesn't even trust themselves, is afraid of their reflection, much less taking risks - no wonder they don't trust me...and I don't trust them to have my back or anyone else's.  If something goes wrong, first thing they do is pull a chart to look for possible blame, hopefully someone else.  Hard to work with people like that. 

 

SK

[EMEDPA]

rural EM practice is not generally a good fit for a newer grad. even if it is double coverage, if you get 2 codes or bad traumas at once, one of them is yours. you have to be ready for that. I was 5 years out before doing any solo coverage, and that was at a lower acuity urban facility. I was 9 years out before starting double coverage rural. I was 17 years out before doing high acuity, solo rural. and this follows a prior career as a paramedic in L.A. and Philadelphia.

[Reality Check 2]

I trained in a Level I ER in Texas, Regional Burn Center, 1000 bed hospital.

 

Our detriment all those years ago was actually NOT having many clinic/office based rotations available.

 

Like EMED, I did extra rotations - trauma surgery was a given since we were a trauma hospital. You got general surg thrown in to boot.

 

I did an extra ER rotation and 2 ortho rotations with emphasis on ER to OR - lots of open fractures and general badness.

 

I came out of school fairly prepared to work in ER but actually got to work in a suburban ER where my patients weren't always actively trying to die and were drunk a whole lot less. My history taking had to change from "how many dudes?" to "so, you were hanging Christmas lights and fell off the ladder?"

 

Our ER didn't have a real Fast Track. I saw whatever. I ran codes in 1998 and on. Put in chest tubes, intubated, T-ed up for OR or ICU. Also did the more subtle - PID, UTI, drugs and whatever, nursing home altered LOC - whatever came through the door. Put MIs on the helicopter since we didn't have a cath lab.

 

I would not have felt qualified without my training at a huge teaching hospital. If you couldn't learn there - you were hiding in a closet somewhere. I was also a happy trauma sponge who thrived on the trauma team - learned everything I could get my hands on.

 

Fast forward to today - living in Washington. The hospital 100 feet across the street has the WORST ER with arrogant, crabby staff. They seem to perpetuate an attitude that "you shouldn't be in the ER and I am going to prove it - damn whatever is actually wrong". They don't seem to want to work. I would hate to put a student there.

 

So, to the OP. I sense a bad attitude in the ER staff and it is usually top down negativism or hubris. 

 

I would say - you need to find a better environment where you can honestly find a mentor and build your skills toolbox.

[mindsasone]

I would say - you need to find a better environment where you can honestly find a mentor and build your skills toolbox.

 

I guess so....hoping one day!

[kargiver]

Unless you have prior experience in EM, completely focused your rotations on EM while in PA school, read 2-3 hours a night for the first year, know how to fake it until you make it, then few new grad PAs belong in an Academic ER where they are expected to pull the weight somewhere between a PGY-3 and an attending.  At this point in PA development, unless you have the above, anyone considering EM (not urgent care) should be considering a 12-18 month EM residency program.  And even many of these folks we are seeing coming out of residencies are still lacking in many areas but its much easier to fill in the gaps.  PA school is not designed to teach you how to spin 6-10 plates at a time, know what is sick vs. not sick by looking at someone, or teaches the golden rule of EM - rule out that which kills.  Smaller suburban ERs where you are allowed to learn but the volume is high enough to see acuity and build your skill set is a decent choice - that doesn't relieve you of the reading you need to do, podcasts, papers, and everything else that it takes to practice EM to the standard of care.  Because if you don't, when you are sitting in the courtroom and you are asked my you didn't do a spinal tap on someone (even though you already started antibiotics and the jury wants to blame someone), it is you who will blamed, not your attending.

 

G

[Annika]

late to the party, but what I can say is it is NOT always like that. I worked EM initially, loved it, but I went home scared to death every night. I am not the most "go get 'em" person out there, so was always 2nd guessing myself. I then went to a rural ED- and it was Me, Myself and I with 2 ancillary staff. And I got a lot better- because I HAD to. 

 

I am now back in the ED, which I love. I have only been there a few weeks, but the group of PA's, and I think the doc's too are so welcoming, and friendly. I am in ED heaven right now. I do believe this will be my forever job. I have not gotten any real feedback yet, so maybe they think I am an idiot ;) ! Relearning Epic, as well as getting back to the ED mentality (I was in Pulm/CC for the in between years) is going to take a bit. I forget sometimes what to do. But EMRA books, as well as my well loved copy of Tintinallis have been great.

 

Don't stay someplace bad- doesn't matter if it's you, or the place, or a person. Just. Don't. Stay. The one thing we know in our jobs is life is VERY short, and we have one one shot at it. Get it as good as you can the first time- there is no mulligan in life. 

[quietmedic]

On 4/14/2017 at 3:58 AM, kargiver said:

Unless you have prior experience in EM, completely focused your rotations on EM while in PA school, read 2-3 hours a night for the first year, know how to fake it until you make it, then few new grad PAs belong in an Academic ER where they are expected to pull the weight somewhere between a PGY-3 and an attending.  At this point in PA development, unless you have the above, anyone considering EM (not urgent care) should be considering a 12-18 month EM residency program.  And even many of these folks we are seeing coming out of residencies are still lacking in many areas but its much easier to fill in the gaps.  PA school is not designed to teach you how to spin 6-10 plates at a time, know what is sick vs. not sick by looking at someone, or teaches the golden rule of EM - rule out that which kills.  Smaller suburban ERs where you are allowed to learn but the volume is high enough to see acuity and build your skill set is a decent choice - that doesn't relieve you of the reading you need to do, podcasts, papers, and everything else that it takes to practice EM to the standard of care.  Because if you don't, when you are sitting in the courtroom and you are asked my you didn't do a spinal tap on someone (even though you already started antibiotics and the jury wants to blame someone), it is you who will blamed, not your attending.

 

G

Very well put...I'd add that EM residencies are few and far between, and VERY VERY hard to get into, especially if you are not a new grad (they tend to prefer fresh meat)...so probably best chance is to find a nice ED crown at a not-so-buy, not-teaching hospital outside of "the city"...