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Could you present each of the fast track patients you're worried about to the attending? Standard presentation: age, gender, relevant hx /mechanism of injury , s/s, and exam findings. Then "I'm worried about A, B, C and am doing X, Y, Z to evaluate for that. Is there anything else I should do? Would you like to see the patient with me?" That way you can chart that you discussed the patient with the attending, including charting what you said to them. Hopefully, even if they don't want to transfer the patient to the main ED, they'll help guide your workup.

I've seen versions of this posting on several locums agency's web sites and email. It's poorly written - not uncommon for these sites. Often these postings are "cut and paste" of some template they have. What you see may not reflect what the job actually is. Notice that this one mentions NP's, but then includes language about physicians. I've even talked to some recruiters who didn't really know about they job they were recruiting for. So, don't read to much into this ad.

When I've had students I tell them that I'll quiz them often. I also tell them the motivation is that the act of recalling information tends to cement it into memory. I also tell them that the goal is to show progress over the course of their rotation. Embarasment is to be avoided.

"Act" doesn't necessarily mean managing the situation yourself. It can and often does mean sending the patient to the appropriate resources. So, if you are doing a home visit and encounter something that needs further attention, you just start that process, whether it needs non-emergent OP f/u or emergent transfer to an ED.

Amen to that. My PA school would not accept my cell biology course as filling their "biochemistry" requirements. The admin person who looked at the name of the course really couldn't penetrate the actual course syllabi.

Two thoughts: How well you do as a new PA will depend significantly on how you and the hospitalist work together. Only you can assess how that relationship is likely to go. It will probably take 2-3 years at least for you to get up your learning curve. The lack of CME $ and retirement is a big issue. Don't know which staffing company, but in EM having a 401K match and some CME $ is standard. Lack of PTO is common - you're expected to handle vacations by schedule adjustments.

Before you prescribe Narcan, remember it requires a (near) sober person to administer it to the patient. It's only when they are altered with respiratory depression that they need Narcan. It's only worthwhile to prescribe Narcan, which is pretty expensive, especially in some of the easy to administer packaging, if the patient is likely to have someone sober around when they're using. Make sure they are likely to be found by family, responsible friends, etc. before you go ahead and prescribe.

Another interesting question is the variation between folks who went to PA school straight from undergrad vs. folks that were in the workforce for awhile.

@Marine - thank you. I work 144-168 hours/month @ my FT job for $85/hour and 0-20/month for $75/hr at my PT job. But, I live in SW Ohio where cost of living, especially housing, is much lower. My 9.75 acres, very nice house, pond, and barn cost about $600K. I'll probably make about $165K this year.

After 5 years UC experience consider the travel/locums route.

$230K/yr: wow. What's the cost of living? If you don't mind, how many hours/month and what hourly rate?

In EM, recruiters consider 5 years of EM experience in most cases to be considered an attractive experienced candidate. In a few cases, 3 years of EM experience is considered enough. I've not talked to them about residency trained EM PA's just because I have the years of experience but did not do a residency.

It's both facility and state dependent. In Ohio, by state law I can't do procedural sedation. In Indiana, by state law I can, but the doc has to be in the ED (I do EM). However, the Indiana hospital chain I work in does not permit it. However, as a paramedic in Ohio I can RSI, just not as a PA.

The two standard texts for EM are Tintinalli's and Rosen's. I strongly recommend Trott - Wounds and Lacerations, Emergency Care and Closure and Habif - Skin Disease. Get a free subscription to Medscape and the free Epocrates on your phone. Join SEMPA - go to the conference. The EM bootcamp is very good, but I'd wait until you've been working for a year or so. Having patient encounters in the back of your head will make the lessons sink in much better. Expect at least a 3 year learning curve to become fully proficient.

I'm an EM nocturnist, so an RVU based compensation model would be harmful for me. Volumes are typically lowest overnight, often between about 03:00-06:00. Yet, a provider has to be there. Nocturnist docs I've worked with have had the same concerns. So, it depends on your area of medicine and hours of work.