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  1. Hello All! My Name is Jordan, and I am a current PA Fellow(resident) in the Emergency Department at Albany Medical Center. I decided to create this on-going discussion as I found one of these useful when I was considering applying for residencies/fellowships. From here on out I'll refer to the program as a fellowship because it is annoying to type /residency. In case you didn't know, they are the same thing as far as PA's go, its basically just whatever your institution wants to call it. I'm sure we will spend many hours at the conference some year deciding between the two. I digress Currently I am about a month and a half into the program and it has been a blast. We (the other fellow and I) pretty much jumped right in to the action of the Albany Med ED right off the bat. We had a short orientation and shadowing experience and were walked through a few patient care scenarios our first few days, as we waited for our first rotation to start...Ultrasound. Ultrasound was two weeks and it was amazing the amount of skill that could be acquired during that short time. I accumulated nearly 200 scans during that period. Ultrasound will be one of the most useful tools for me as I plan to go rural when I finish my year here in Albany. The instructor for the course was Dr. Beth Cadigan, an attending in the ED/ Ultrasound guru. She was great to learn from and patient with each individuals learning curve (us fellows and 1st year ED residents), she stated several times that it took her awhile to acquire US skill, which was probably related to her being the worst kid on the street at video games! We spent 2 weeks in the ED ultrasounding willing participants, several hours in the simulation lab receiving training, and individual time with online US lectures. We are currently on our Radiology rotation, mostly spending time in a radiology suite looking at chest films. As for rotations, next we will enter Ophthalmology, and subsequently Pediatrics (ED), and then in no particular order, SICU, EMS, Trauma, Toxicology, electives, interspersed between all of these are ED shifts. I believe total AMC ED shift time will be around 7-8 months. I'll finish today with a comment about the faculty in the AMC ED. They have been AWESOME! The attendings, PAs, and residents have been great to work with and willing to take time to teach. Any questions, just ask. Be back soon!
  2. Hey all, As there seems to be a lot of growing interest in EM PA residencies across the country, I just thought I'd start this to (hopefully) offer answers to any burning questions you guys have about EM residency in general or at Iowa in particular. Ask away! I'll edit this initial post to include all Q&A to make it easier on the reader. Who I am: Year-1 EM PA resident at the University of Iowa Hospitals and Clinics (UIHC); Graduated from South University - Tampa C/O 2015; formerly trained as EMT, paramedic. ***Obligatory disclaimer: I do not represent UIHC, nor the EM PA residency program there, nor any other part of the institution of the University of Iowa in any other capacity than as a resident learner and medical provider in the Emergency Treatment Center. All answers are based on my current knowledge, personal opinion, and/or cited references.*** Why did you choose this particular program? There's lots to love about the residency experience here: PAs are on equal footing with medical residents, the "your patient, your procedure" policy, high availability of attending faculty during your shifts, the well-organized administration, variety of electives (and option to create your own)... there's much more. However, far and away the thing that impressed me the most was the amazing faculty. It was apparent from my interview day onward... Easygoing, personable, humble, reasonable people; only ever as serious as they need to be; will often go out of their way to drop some knowledge on you. They inspire respect not out of fear or intimidation, but by their scope of knowledge and willingness to teach. Large egos are not in fashion here. Everyone is known by their first name or nickname. Since I've started, I realized this mentality has trickled down to the R2s and R3s as well; everyone is willing to help out. Other than that, moving to a small Midwest town has always been on my bucket list for some reason. Iowa City is a great little town too; full of great culture for its size, but small enough that I walk/bike to work every day. I probably couldn't have picked a better time either, with Hawkeyes having had a blowout season and the Iowa Caususes soon, I feel like I'm getting the quintessential Midwest experience. Do you feel you get enough slit lamps, chest tubes, intubations, ect. without having several off service rotations? I know procedures is the big question; personally I feel like I'm off to an adequate start after 3 blocks in the ED, and just now starting to get confidence in picking up patients that need these procedures. Also keep in mind this is (mostly rural) Iowa, and you're not going to see GSWs or similar trauma every night like you would in Baltimore or Philadelphia, although a good amount of MVCs. That said, each resident's mileage will vary; if you're procedure-hungry, you could probably expect to increase your numbers up to about 30% over mine (total guesstimate). So here's some numbers, keeping in mind this is a new PA grad, with 12 weeks in the ED so far, where I was the Primary on the procedure: 4 LPs, 4 paracenteses, 1 chest tube, 1 US-guided central line (fem), 0 intubations, 4 dental blocks, countless peripheral nerve blocks... and i haven't logged slit lamps but i'd say probably 5-6; I could have been doing many more slitlamps if I wanted. There's a dedicated ophtho room with slit-lamp setup here, and if you want to pick up all the ophtho patients for a night I don't think anyone would fight you for it. One thing definitely worth mentioning that often gets overlooked, we have 2 or 3 portable ultrasounds for bedside studies available 24/7, with linear, curvilinear, and cardiac probes attached. If you ever want to play around with ultrasound it's there. We use it all the time for peripheral IVs on tough sticks, checking for abscess/pockets, FAST exams... even some fancy nerve blocks. As cool as it is to poke prod and cut a patient, sometimes I feel that as a PA, the highest-yield learning during this residency won't be the procedures but my proficiency with ultrasound. But again, your mileage may vary. How is housing near the hospital? Housing nearby to the hospital is great, from what I hear. I actually live on the other side of the river in downtown Iowa City (which wouldn't be my first choice for a family) but there are many available houses for rent in the University Heights area that I think would work well for a family (and it's closer to the hospital too). Are they pretty bias about picking Iowa grass or would a person with FM/military medicine experience be given a good shot? I think any great candidate is given a good shot. That being said, Iowa has a fantastic PA program, and most of the residency applicants are graduates from there, so if you look at the numbers it may appear that they're heavily favored. However, I didn't graduate from there and I got in, and I didn't have to beg. Two of the three initial acceptance offers given for the latest class were to out-of-state candidates, one of those being a military-trained PA. So I would say everything considered, there's not a perceptible selection bias. What's your biggest dislike of the program? Honestly, I can't think of anything I dislike that would be particular to this program; I feel that any dislikes would be common to most if not all programs. I really tried to come up with something and I've started writing several different things here but erased them, because they didn't seem like they were real problems. Mostly just annoyances, ones likely to be encountered anywhere, and largely an issue that is outside the program's or ED's control. But if you want to know the ups and downs of something in particular I can try to help. Do you think that NOT being from an EM background hinders someone's chances? Hinders vs a candidate that has an EM background? I have to say yes; at a minimum, an EM background shows a proven interest and ability to handle the particular stresses that come with EM. I wouldn't let that stop me from applying though; I would just go wild on my EM rotations in PA school and do as much as possible there, and make sure to mention it during the interview. What's the hour work week look like - Any time for picking up additional shifts for supplemental income? During your ED blocks (which are the vast majority) you have about 45 hours (5 shifts x 9 hours) of scheduled work hours. However, amount of shifts can vary from week to week. Shift times also vary, from morning to day to overnight. Scheduling for the most part always puts your next shift equal or later in the day than your last, which is helpful. Also, it's rare to always have all documentation done before your shift ends. I'd say I work at least 1 additional hour per shift, often several hours if it's been a rough day. I finish my documentation before shift ends maybe 10% of the time. I will say I'm not the fastest documenter, but in general I would probably my numbers are a safe estimate. UIHC doesn't allow PA residents to pick up ad-hoc shifts as regularly employed PAs, at least last time I checked. I believe working at an outside facility is possible with permission, but don't quote me on that. How's the whole interview process, structure, day like? Similar to PA school. Morning presentations by faculty and administration, a tour of the ED, the resident's lounge and offices. Four or five 10-minute interviews by current faculty, then lunch. I will say one big difference between PA school and residency interviews is it's much more of a two-way interview, with them selling the program to you and you selling yourself as a candidate. I imagine PA school is so competitive that those adcoms don't see the need to do that. Did you apply w/o PANCE scores (or contingent on completing it correct?) Correct. I applied without having taken the PANCE, and even got my offer before I had my scores back. I'm not sure if having scores in-hand (or exceptional scores) is a factor in the selection process, but I'm anecdotal proof that they aren't required. But of course my acceptance was ultimately dependent on passing. (Continued below....)
  3. Hello, I recently made a post yesterday and got some great feedback. You can read more about my background and thoughts there. Feel free to give more insight. I am reading all comments and using it sort of as a guidance in making a serious life decision. You can check it here: However for the professional PA's who are currently working, my main question for you today is: Are you satisfied as being a PA? What are some things that Physicians do that you can't in your specialties? Give me concrete examples! A lot of people say autonomy, wide scope of practice, vertical mobility, etc. But what exactly are those day-to-day job differences or limitations that you have noticed in your specialty as a PA? Or do you feel like you have full autonomy? I am interested in either Internal Medicine (Hospitalist) or Emergency Medicine. But if it's pretty much 90% of the same job as Physicians, then I am not sure if 7 years of medical school is worth it for me. I know people usually recommend PA to MD mostly if you want to go into either surgery or a specialization of some sort. Can't wait to read your thoughts! Hopefully your comments and answers will give me and others in similar situations a strong resolution.
  4. UNM EMPA RESIDENCY: The University of New Mexico School of Medicine, Department of Emergency Medicine is excited to announce that we are accepting applicants now for our 2020-2021 class. Applications will close Jan 15th, 2020. Our class will start the last week of June, 2018 for an 18-month program for 2 residents. This year we have expanded our eligibility to applicants graduating an ARC-PA accredited program prior to May 31st, 2020. We strive to equip physician assistants with the clinical experiences and didactic teaching that will enable them to practice high-quality, evidence based emergency medicine. Our graduates will have comfort and competence in the care of critically ill patients, the broad scope of emergent presentations, and the skills necessary to be leaders in their profession. Cirriculum (# of 4 week blocks) Dedicated Orientation Block (1) Adult ED, including dedicated longitudinal block in ED Resus Unit (8) Community ED (1) Peds ED (2) Medical ICU (1) Surgical ICU (1) Combined US/Anesthesia (1) Cardiology (1) Orthopedics (1) Toxicology (1/2) OB/GYN (1/2) Electives (2) Salary/Benefits: $57,000 yearly salary Access to health, vision, dental, disability insurance with employer matching Contribution to retirement Paid Vacation Paid travel and registration SEMPA 360 conference SEMPA membership $500 per year CME allowance ATLS, FCCS, and dedicated airway course in orientation Setting: New Mexico's only level 1 trauma center, academic hospital and children's hospital Tertiary referral center for large rural state, with high acuity patients Easy access to outdoor activities, climbing, biking, skiing, as well as wonderful food and culture Nationally recognized faculty in EMS, Critical Care, Wilderness Medicine, Simulation and many other areas Applications Open: October 1st, 2019 Applications Close: January 15th, 2020 Website: http://emed.unm.edu/education/prospective-applicants/physician-assistant-residency-in-emergency-medicine.html E-mail: cpkalan@salud.unm.edu
  5. The EMPA Fellowship at ARMC is currently accepting applications for its next class, which is set to begin in Nov of 2018. This Fellowship is housed at Arrowhead Regional Medical Center which is San Bernardino Counties Trauma and Burn Center located in the city of Colton, CA. The program includes clinical and didactic education that is designed to provide PAs who are new-grads or new to emergency medicine an efficient and supportive training experience that will enable top-of-scope practice in any emergency department. In addition to over 40 hours of online EM education, Fellows will attend 4-5 hours of weekly lecture that is specifically designed to build upon primary PA education. Fellows are also strongly encouraged and paid to participate in weekly EM physician resident lecture. Rotations include: Ortho Surgery (Trauma, SICU, Burn) Pediatrics Ob/Gyn Ultrasound Anesthesia Diabetic Youth Camp EMS The program now offers two options: 1. 14-month Traditional track ($55,000) Over 60 EMPAs have graduated from the Traditional track and report being very well prepared to practice in a wide variety of ED settings. 2. 20-month Doctorate of Medical Science track ($75,000 w/tuition paid) This is a new offering that builds on the Traditional track through a partnership with Lynchburg College in Virginia. The EMPA Fellowship is lengthened to enable time to complete the DMSc coursework, and the tuition is paid by the Fellowship. There are a select number of positions available for this option, and they will be filled competitively. There are currently 12 Fellows enrolled in the DMSc track. All Fellows are eligible for a full benefits package including Health, Vision, Dental, 401k. All lectures are CME certified providing more than 200 hours of CME. SEMPA and CAPA memberships are provided. EMPAFellowship.com Deadline for application is June 15, 2018 Please visit the website and select Apply Now to be contacted by our program recruiter and to learn more about the complete application process.
  6. Hey folks, I've been working in emergency medicine for about 1 year in a setting with a good mixture of high acuity and fastrack patients at a teaching institution. I've also worked during this time per diem at a low volume urgent care. While this has been an outstanding first job in terms of resume building and learning, it of course has the downside of wild hours, nights, weekends, holidays, etc. at a rather noncompetitive hourly rate/salary. I don't hate the job, but I also don't see myself doing emergency medicine forever. Or at least...not at this salary. For those who started in emergency medicine, what are your thoughts on transitioning to an urgent care job? I have heard some describe a miserable existence of patient volumes upwards of 60 patients a day, but I am guessing this is very dependent on the institution. Are there other specialties that make for a natural transition from emergency medicine? Am keeping all my options open at this point. Thanks!
  7. Just wondering if there has been any update of PAs practicing in Canada, specifically emergency medicine. Any clue on the scope of practice and salary?
  8. Hey PA Forum, I am Pre-PA, please don't kick me out, as I wanted to know from PAs what they think about the field, and where my feelings in the application process stand. I went through my undergrad with not much of a direction, graduating with a BS in Biochemistry but a 2.86 GPA. I worked for 2 years as a "scientist" but I was really just running samples through a machine (medical device) and it did not allow any sort of interesting work. I worked as part of the lab at the Boston Marathon, analyzing runner blood samples in the device, and it was the first time I was exposed to the medical field. This allowed me to appreciate their work, and also, for the first time, feel I could make a difference with my efforts. I capitalized on this excitement, and looked into nursing and PA, and decided PA. I got an EMT certification, and gave CPR to a patient in a trauma room at the nearby hospital as part of the certification. I was so excited, and then I got a job as a CNA in a teaching hospital on a heart failure floor. Everything was coming along. I was also taking pre-reqs this whole time, I completed A&P I,II, Genetics, Biochemistry, all either A or B+. As I worked at the hospital, I mainly bathed patients, and provided care in daily living, working under nurses. But the attitude of the nurses really got to me. Some would bully the technicians in a way, it was never intentional but I could not stand them. All the technicians and nurses were gossipy women and I, more of an introverted male, just felt nothing in common with them, and everything I did was judged. Nurses, and techs and female patients would occasionally hit on me, and it just felt uncomfortable. It became so frustrating for me that these shifts became almost me vs them, in my head. But I kept pushing on, I kept searching for jobs in the ER, because that seemed so exciting to me. I shadowed a resident in the ER, and loved every minute of it. I really enjoyed it because it was exciting; very different than anything I had seen; the machinery of the body was in a life threatening situation, and it was very rewarding to fix it. I also really loved all things space, and always was researching things about space. However I wasn't able to get a position in the ER, and I just felt like the oddball out all the time; and the feminine and social aspect of medicine was driving me nuts. I felt like everywhere in healthcare was this; and had this veneer or being the savior for patients, I just felt I was beating up the wrong tree for my own goals. I shadowed 5 PAs, and enjoyed the ER experience the most. I decided I wanted to try something in engineering due to my love of space. So after 9 months of being a tech, I moved to Houston, with my sister (couldn't go home, father is an alcoholic and made life at home toxic). I decided to try everything I enjoyed to figure out if this field was for me. I started taking engineering classes, a geology class, and started to learn programming, and am volunteering in a lab where I help a professor research bacteria on the Space Station. I have been stressed out, figuring out if this career is for me. I went to healthcare career fair, and interviewed for an ER Tech job, to try it out again, and am hoping it is less daunting on me. I also am thinking about pursuing biomedical engineering, as it may combine my interests, but I am nervous, because it seems a bit antisocial. I was wondering if I could get some advice about my situation, and if I have it all wrong about actually being a PA. Thanks!
  9. Thumper was a respondent on the Becker site and "Optimal" in this setting refers to optimal exceeded workloads which many of us have. Not unlike Thumper, I agree that this is an issue that has ramifications such as this study but affects many more caregivers such as the different techs, nursing assistants, PAs and NPs in the hospital setting and emergency room clinicians as well as surgical staff, including the surgeons themselves. The nurses are the first to suffer as a large group as they are understaffed and instead of a 6:1 ratio of nurse to patient, a night shift nurse can have a 16:1. Did the patients magically change their admitting diagnosis or are these the same patients with the same problem and the addition of poor sleep in their surroundings compounded with post-operative pain. They are under-treated, seen ,perhaps twice a shift,even if they are hitting the call button. From a NA standpoint,patients are not turned, properly fed or soiled beds or diapers are not changed adding to skin and soft tissue breakdown and decubitus ulcers. The nurse needs to be "The Flash" to dispense medications and these type of errors can be deadly. Yes, personnel costs money but the litigation's and need for additional time in the hospital at its own expense is far more. My mother-in-law was a DON at three hospitals and found this happening in all three and was frustrated by administrations refusal to hire more people. Surgical personnel are more scarce because so few are trained in this discipline and it is not unusual for a surgical nurse, surgical technologist, surgical PA or NP and the surgeon themselves to work more than 80 hours to a hundred hours per week. Let me prove this as a malpractice attorney and I would have a field day of serving the institution and the caregivers who legally are working while intoxicated due to lack of sleep. Do we really care? If these providers started a pact and documented these atrocities ,hospitals would be put out of business. As a PA who cares, I would join the pact because our patients are failing because of lack of revenue to pay employees but fat paychecks for administrators.
  10. Hello folks, I'm currently a PA-S graduating in a few months. I'm posting in the general discussion since I wanted to get opinions from PA-C's, particularly w/ urgent care experience. I've applied for a number of EM jobs, and am in the process of applying to urgent care positions as well. I've decided work life balance is very important to me, and Urgent Care seems to fit the bill from what I've seen. My question is, do you guys think Urgent Care is an appropriate field for a new graduate? I will have had 2 rotations in EM by that point, and will not be solo at any of the UC locations. However, I've heard some members stating it is a poor choice, since you have more "autonomy" and need to have a good sense of what is high acuity and what isn't (which comes from experience). Given that it fits the lifestyle I want, should I still consider it? Thanks!
  11. Hi, So here's the story. I am beginning my first rotation and it is in the ED (no previous ED or UC experience). My preceptors are all very nice and willing to help, but I can't help but feeling like I am neither measuring up nor reflecting my program well. I wanted to get some feedback to gauge if this is a normal experience, as there are no other PA students at my site to compare notes with. I received an hour training on the EHR and beginning the second day was expected to see a few patients on my own and present them to my preceptor with assessment and plan. This wouldn't be a problem except that I am very slow in addition to having forgotten a lot of the medicine (I have a 3.8+ GPA from didactic year, but once I took the test most of the info seemed to blur into general confusion). I have no idea what to do with the mass of lab results from the current and previous ED encounters, nor sure that I've ruled out even 50% of the serious conditions. I am also very slow at charting (for reference, my program allowed multiple days to finish one entire SOAP or H&P note). I am also very poor at multi-tasking, which is an awful quality for the ED. I know I am trying and that I am reasonably intelligent, but this makes me think I should have stuck with some desk job rather than managing healthcare. For all of these reasons I can tell that I am a drain on the preceptors who are already busy. I get that I am here to learn from the preceptors, but can't help but feel that this is not how things should be. I do ask for feedback, but the preceptors are SO nice that I can't tell what they truly think. I'd appreciate any advice, what's normal, whats not, etc.
  12. Good Afternoon PA Family, I am an EMT on my path to physician assistant school and I am looking for someone to shadow in the greater San Diego County area. The specialty of the PA is NOT of the utmost importance, but if I had a preference it would be in ER, Pediatrics, or any primary care. However, I would be grateful for the opportunity to shadow a PA in any specialty. I am very curious, have great interpersonal communication skills, professional, and most of all have a passion for PA medicine. Thank you for taking the time to read my post. If you have any questions, please do not hesitate to contact me on here. Sincerely, Andrew
  13. Hey guys, I’m a second year PA student graduating in December (PANCE in January). I’ve always planned on doing an EM residency and now is the time I finally get to apply. I picked about 6 residencies to apply to. I was wondering if anyone knows how many applicants the programs are getting now that they are gaining popularity. I did well in PA school (pending last two rotations) and worked as a tech in the ED prior to PA school. A lot of the programs are only accepting 2 residents per cycle and it has me a little concerned. Thanks for the responses in advance
  14. I started my practice in an ED at a level one trauma center and was informally trained in bedside ultrasound on the job. Over my 3.5 years with the group, PAs were brought into the same rigorous training standards as the EM residents with the goal of securing credentialing for all PAs. I ultimately completed the requisite exams and was technically credentialed at that point. I left that position shortly after and began working with another area organization in EM. Bedside ultrasound is culturally used less as the average practitioner with my current group has less experience, however many of the staff are ultrasound trained. I'm running into issues with ultrasound documentation in that we are allowed to perform the exam, bill and document only if we have a credentialed physician looking over our shoulder while we perform the exam. We have been asked not to document the ultrasound in our note for both billing and medicolegal reasons (understandably). When this issue for APPs (both PAs and NPs in my new practice) came up, our group was told that it is system-wide policy that APPs can't do or can't be credentialed to do bedside ultrasound. I'm wondering what resources are available to help PAs/APPs develop a credentialing process for bedside ultrasounds within their organization. I see there is a Society of PAs in Clinical Ultrasound, however not many resources regarding this professional practice issue. Can anyone help point me in a direction or offer up their professional experience?
  15. Given the incredibly small number of respondents, the AAPA salary data is almost worthless. Meanwhile, reading the responses to many of these posts often makes it seem that almost any offer is too low! Does anyone here practice in the southeast (Virginia, North Carolina, South Carolina, Georgia, Tennessee)? I think Florida is a separate animal and it's still hard to know if comparisons between states translates well. However, given a more or less standard benefits package as a full-time employee (health, CME, PTO, 3% escalating to 10% retirement 401K), what do you think is a fair hourly salary range for a new grad in EM? What about for an experienced person, e.g. with 3+ years of experience?
  16. Question that I've been struggling with...when do you pull the trigger on firing a noncompliant patient? We terminate after 3 no shows, if they are threatening, if there is a lawsuit (haven't seen that happen but obviously policy). I know many also terminate for failure to comply with recommendations. Almost all patients are noncompliant in some way, whether it's not making dietary changes, taking meds as prescribed, etc, and we don't terminate them. What about extreme cases? What is the breaking point? I work in neurology and we have a patient with epilepsy secondary to craniotomy for aneurysm many years ago. She has been in status epilepticus many times. She continues to have seizures but refuses further testing (EEG or neuroimaging), labs, or even adjustments in medication. She does seem to be compliant with the medicine she takes, but obviously the dose is not adequate and she won't increase it, so basically a moot point. She continues to be admitted for breakthrough seizures, refuses EEG, and leaves AMA. She refuses to see my SP due to personality conflicts I guess, so I'm her main neurology provider, which is fine. I'm getting more and more nervous however about possible legal ramifications if she goes into status and doesn't wake up. I know I have tried everything I can and I document at length that we discussed the various risks associated with her not complying with our recommendations, that she is aware of the risks and continues to refuse, etc. I am getting very anxious about the eventual disaster that will happen with her and me being the main person treating her epilepsy. I feel like my documentation is thorough enough that if a lawsuit would happen, it wouldn't go anywhere. Obviously I don't want it to even get to that point however. We have other neurologists here so I wouldn't be abandoning her per se, I just feel very guilty about giving up on her. As I type this I'm seeing exactly how bad her situation is and I think I know my answer. I know there are practices that terminate for less, even if patients don't get vaccinations. I would however like to get other people's opinions and see what other PA's breaking points are for when they just don't feel they're getting anywhere with a patient or if a patient blatantly ignores their medical advice. Thanks! Edit for additional details I forgot, which don't help her case at all, has had hemiparesis, thought to possibly be Todd's paralysis, but has been recommended to start daily aspirin which she also refuses.....
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