EMEDPA

the key to staying sane in EM is high acuity and low volume. I agree that high volume, mixed acuity is a formula for burnout aka moral injury.....I just can't see 30 in 12 hrs anymore. I am so done with that....a busy shift now is 20 in 24.

you have this. just spend an hr looking at peds vaccination schedules and stuff you don't do every day and take it basically cold. you have 5 chances to pass it and you are a damn fine PA. I have taken it this way 3 times with less studying and higher scores each time. last time I spent maybe 30 min reviewing primary care stuff in the parking lot before the test. PS Tell Mary D I said Hi.

do it all the time. we staff a doc or a PA interchangeably. I took a sign out on a trauma I ended up admitting just this morning from one of the docs in the group.

I work for TH at one of my part time jobs. I would be fired in a heartbeat for this.

my answer is still the same. Love medicine, but should have gone to med school. full time rural now, but driving way too much for the privilege.

I consult specialists and the hospitalist for transfers and admits. I present pts at sign out in the morning to whoever(doc or PA) is relieving me. If I don't know the answer to something I try to call the appropriate specialist for direction. There is always more to learn and no one knows everything.

yup, we had a derm guy for a while....

yup. wanna see a doc? there may be one here in 24 hours or there might be another PA. oh, and that doc is a new grad FP doc...

At my 2 solo jobs I see everyone and do everything unassisted. At my double coverage job I generally let the doc know if I am about to intubate/cardiovert, etc, but we alternate charts regardless of acuity so they don't care. the hospital encourages them to run bad traumas, codes, strokes, stemis, etc , but it generally doesn't happen because they have their own pts to deal with and I have mine and whoever is up for the next pt just takes the medic report and dives in.

4/hr is a formula for burnout. did that for years. I am done w that.

love my little ER....nothing for hours then an svt and an acute resp failure presenting 5 min apart. both went well.

really varies a lot by region. you may find it is hard to beat 80/hr. there are places in the NE where you can get > 100/hr 1099, but they are not all that common in the grand scheme of things. I am in basically the same boat as you with 23 years as an EMPA. I left a w2 job paying 80/hr with full benefits for a 1099 paying 85/hr with a much better schedule and work/life balance.

https://www.tesu.edu/academics/online-degrees accredited online BS degree. will accept all transfer credits from prior work. some folks do as few as 2-3 courses if you have a prior health care credential or A.S.

almost done with a 24 right now. have seen 7 patients including a dissecting AAA, a recurrent syncope, and a septic patient with diverticulitis. high acuity, low volume. love it. at my last job I would manage an entire hallway(10 rooms) and be expected to help out in fast track if they got busy or be a procedure guy on traumas if that team got busy. I am done with that.

I try to do most of my documentation in real time. I don't chart from home ever. when I worked with an RVU bonus structure I pretended it didn't exist. you can't depend on it, so don't. Once I have 4 open charts(the most you can have on epic), I don't start a new patient unless they are dying or all the charts are up to date. That being said, I will stay late for disasters at shift change(codes, etc) or if the night provider will be totally overwhelmed. I either work solo coverage or dual coverage, never more than 2 providers, so if I am leaving and it is just the night guy and there are 15 pts I generally won't leave. they generally make this up to me by kicking me out early another night. My primary job is solo coverage and a busy day is 15 pts in 24 hrs. my part time job is double coverage and I typically see 65 pts in the 3 days in a row I work once/month. I don't ever want to be busier than that again. I did 15 years of the 25-50 pts/12 hrs thing. never again.