How many hours should a PA resident work?

[rev ronin]

what about the pa who works solo coverage at a rural facility with distant backup by phone? there are places where PAs give tpa for stroke, TNK for stemi, and manage every single pt who presents without a doc on site.

in real time they are it. it's not ok to say " I don't need to know how to manage a difficult airway (or deliver a shoulder dystocia or do a paracentesis, etc), the doc will do it" in this setting.

 

Actually, I posed a similar question to one of my faculty members who worked at a remote Alaskan site--would he ever do an emergent appendectomy by himself if he couldn't get the patient flown to Anchorage due to the weather? His answer was that that was never within scope of practice for a PA to do. Airways clearly are within an EM PA scope, and I would expect that your other examples would be, too. But an emergency thoracotomy and direct cardiac massage are almost certainly not within PA scope.

 

So there will always be theoretical situations where a PA will not be as good as a doc, and it's entirely possible that patients might die when a higher level of care could have saved them. But in rural solo coverage situations the PA doesn't have to be as good as a doc, just sufficiently better than the "nothing" that was there before to justify stopping for stabilization (assuming transport to a higher level of care is even possible).

 

I think it's really cool that some PAs are trusted enough to be allowed to push TPA by their SPs. I don't think that Undergrad+candy stripper+PA program+12-18 month PA residency is going to get PAs to that point, whether the residency is 40, 80, or 168 hours per week.

[EMEDPA]

I think it's really cool that some PAs are trusted enough to be allowed to push TPA by their SPs. I don't think that Undergrad+candy stripper+PA program+12-18 month PA residency is going to get PAs to that point, whether the residency is 40, 80, or 168 hours per week.

The folks I know who do this mainly fit this profile:

prior paramedics

trauma rotations in school

every credential you can imagine(acls/atls/pals/also/fccs/difficult airway/etc)

10 + years of em pa experience with graduated increases in scope of practice and autonomy

I know one who did a residency.

high level autonomous positions outside of their normal emplyment( military, dmat, disaster teams, overseas missions, etc).

 

definitely not for the candy stripper crowd...

[EMEDPA]

Actually, I posed a similar question to one of my faculty members who worked at a remote Alaskan site--would he ever do an emergent appendectomy by himself if he couldn't get the patient flown to Anchorage due to the weather? His answer was that that was never within scope of practice for a PA to do..

navy corpsman with much less experience than a pa have done this(appys)...would I try it if there was no other option and the pt was going to die if no one opened them up? probably. you don't work in a setting like that without a little cowboy in you....

[bgdog]

Are you 21yo??? What one has to do with the other? There are good mentors and bed mentors. There are people who teach you and people who use you and hours don't matter. What hospital you are in and who is in charge of your training means way more than the hours you spend there.

 

heh heh, ok, sure kid, whatever you say.

 

BTW who is your bed mentor??

[EMEDPA]

BTW who is your bed mentor??

I guess that's one way to rack up hours and get a good LOR....:)

[bgdog]

Except that people who know what they're doing and have a choice... get a good night's sleep.

 

Absolutely, completely agree Rev, sleep deprivation does not induce a productive learning or working environment by any means, and that is not my point not do I advocate that in any way.

 

Getting enough sleep was not my issue.

 

the pa resident should be able to work at least 40hrs/ week. beyond that i can't see the benefit of working more hours.

 

My reply is directed at this^^^^

 

Apparently HE has the notion that working more than 8 hours a day during an Emergency Medicine Residency offers ZERO BENEFIT.

 

My opinion differs, obviously.

 

My point is this. A residency is designed to expose one to lots of pathology and focus the experience to a high degree, which is the crux of the biscuit.

 

An eight hour day ain't gonna cut it.

 

Hopefully, the resident likes Emergency Medicine enough that the work is intrinsic, meaning that just the act of doing it brings great pleasure. He doesn't have to be told to stay, he stays because it's friken cool stuff and he gets to do it.

[EMEDPA]

and because a real em pa job is likely more than a 40 hr week....my typical week is 45-65 hrs....last week 65 hrs, this week 67 hrs

[rev ronin]

So we're not as far apart as we might have initially seemed. I did way more on the rotations that allowed it than I was required to. I was the only PA student in my gen surg rotation who pulled overnight call, and I did it twice.... but I did it when I knew I could then catch up on sleep on the weekend and not be dragging along and behind the sleep curve. PA residents should absolutely have the opportunity to be involved in as much as they can stand, but they should know their own limits and do what they can within them. I object to a heightened expectation that places clock hours above quality, rested learning and is inflexible downwards.

[EMEDPA]

PA residents should absolutely have the opportunity to be involved in as much as they can stand, but they should know their own limits and do what they can within them. I object to a heightened expectation that places clock hours above quality, rested learning and is inflexible downwards.

PAs as human beings have the same limits as med students/residents. if a med student can do a 100+ hr week so can a pa student....and I did for 5 weeks in a row. if I had done just 40 hrs/week on that rotation I would have done no procedures and only been to the o.r. a few times instead of having an awesome trauma experience. I would do it again. a residency for a pa or an md is an immersion experience, not a hobby or something undertaken casually.

my dad did an md internship in the 60s and worked 36 hrs on/12hrs off for a year. he had one day off the year I was born and it was the day I was born. his residency director didn't give him the next day off. was it fun for him? no. did he learn A LOT about his specialty? you bet. it was a busy city hospital type residency, one of those places where they say the problem with overnight call every other day is that you miss half the cool cases.

if he could do it I could do it too and would actually welcome the chance to experience that type of learning environment..I applied for the only em pa residency in the country( LA county/USC) the year I graduated and unfortunately that was the year they lost their funding and closed....I got a call I thought would be them telling me what day to come for the interview and it ended up being a call to tell me there would be no class the next year...totally bummed I missed out.