What does a hospitalist PA do?

[wsu-pa]

Hi, I'm a pre-PA student and I'm trying to get an idea of the different specialties PA's operate in and find one that may peak my interest. Though PA school is still a ways away and choosing a specialty to begin with is even further, I want to begin at least learning the most popular specialties and what they do. One specialty I've seen a little bit of info about is hospitalist medicine. Technically speaking, I've seen it referred to as inpatient care. Now don't jump all over me saying I don't know what I'm talking about and that I should reconsider my career choice, because I don't know what I'm talking about haha, that's why I'm here :)

 

But from what I've read about inpatient care as a PA specialty is that you deal with patients admitted to the hospital and examine them, order tests, diagnose, perform some of the more routine procedures that physicians need not be present for, treat patients (providing it is a relatively simple illness requiring a relatively simple treatment), write prescriptions (again, provided they aren't real risky prescriptions. In which case the supervising physician should be consulted), and some more. Is there any truth to this? Is this typical of what an inpatient care PA would do on a daily basis? If not, can someone give me a description of what they do do? What does a normal day look like?

 

If there is a specialty that's closer to that description? That job description sounds like what I am interested in so I don't know if maybe there is some other specialty that is closer to that description. I've heard of specialties like primary care and general practitioner, both of which sound like pretty broad specialties that would deal with patients suffering various illnesses. Maybe I'm thinking of one of those, or one of those would be a better match to the description above and be of more interest to me.

Thanks!

[Lemon Bars]

I work in a hospital, though I'm just a lowly patient care tech. I work on the telemetry floor and also in the ER. I think there are eight hospitalists where I work, including two PAs and one FNP. The rest are MDs. They come down to the ER to consult with the doctors about whether a patient should be admitted to the hospital. After a patient is admitted, I believe the hospitalists spend most of their time managing patients' medication levels and checking in on patients who aren't doing so well. I don't know for sure, but my impression is that hospitalist and hospitalist PA work would be fairly complicated, involving very sick patients who are on many different medications.

 

 

At certain times of the night, there is only one ER doctor and one hospitalist. If you end up on duty as the only hospitalist (PA hospitalist) you may have to make decisions regarding complicated issues. If you want something simpler urgent care is probably a better bet (although you may still get the occasional indigestion that turns out to be a heart attack). That's all I can tell you as I work night shift and I don't interact with hospitalists much. I just see them swing through the ER to consult with the other docs regarding admissions.

[wsu-pa]

Thank you for the info! It actually sounds similar to what I want to do. I've heard that hospitalist/inpatient care PA's diagnose patients who are admitted to the hospital and are in a relatively stable state. I would like to be working with patients like that and even treat patients who have relatively simple illnesses and don't require complex medications. Do you know if the hospitalists where you work do any diagnoses?

[chiefPA]

Patients with uncomplicated problems are usually not admitted. I would say that PA hospitalists are generally managing some pretty complicated medical problems.

I suggest you do some shadowing to be sure you want to be a PA

[Just Steve]

The words you chose to describe PA included descriptions that you are under the impression that PAs only deal with simple or uncomplicated patients...

 

A good place to begin your PA education is to wrap your mind around the fact that your patients can and will be very complicated and to approach them with the notion that a PA doesn't take care of critical patients is a fast way to kill one of them.

 

That being said... An example of the fun times... PA is solo hospitalist coverage in a community hospital in northwest Washington state. 12 hr shift, covering inpatient census of approx 60-70 patients plus 4-8 ICU patients. Pt on medical floor took a fall earlier in the day, initial assessment after fall was benign, now, at 10 pm at night, is pale, cool, diaphoretic, and mentally altered. While you are working on that the ETOH detox guy turns aggressive and becomes a hazard to the nursing staff...gotta figure out why. Evening lab work on third patient comes back with a critical potassium level and has an irregular heart beat. Meanwhile a ventilated patient in the ICU keeps dropping their oxygen sats and is requiring higher and higher PEEP settings, fever is spiking. ER pages you for two admits. One admit is a slam dunk "sure no problem" admit, the other is a ER dump that they want to pawn off to medicine but the patient doesn't meet admission criteria. You, the PA, get to tell the MD "sorry, that bird don't fly" aka: no admission for that patient. ER MD doesn't like that answer and gives a bit of push back. You compromise and ask them for a better work up from them to get some basic labs/imaging and they give you the song and dance of being too busy. You want to help them out but you also know if you agree to admitting a patient who doesn't meet certain criteria, you'll be in the hot seat in the morning, not the ER doc, with your supervising physician and hospital administration. While you are tap dancing with the ER, your pale clammy patient labs come back with a HgB of 6.5 and a negative stool guaic. Just where is that blood going? Why again did they fall? No one on night shift knows why, they thought it was a simple trip/slip...day shift didn't document that well, those slackers.

 

And that is before half the shift is over.

 

A hospitalist can be a multi dimensional, dynamic, complicated, stressful, action packed job. I think it is akin to being the ER for inpatients. You are managing sick patients who are trying to get more sick. Not as busy as an ER but every bit, probably even more, cerebral, of any PA job.

[nebaker]

I'd definitely take chiefPA's advice. No offense, but it sounds as if you're not really clear on what exactly a PA does. Do you have any experience working in healthcare or shadowing?

[kb1988]

The words you chose to describe PA included descriptions that you are under the impression that PAs only deal with simple or uncomplicated patients...

 

A good place to begin your PA education is to wrap your mind around the fact that your patients can and will be very complicated and to approach them with the notion that a PA doesn't take care of critical patients is a fast way to kill one of them.

 

That being said... An example of the fun times... PA is solo hospitalist coverage in a community hospital in northwest Washington state. 12 hr shift, covering inpatient census of approx 60-70 patients plus 4-8 ICU patients. Pt on medical floor took a fall earlier in the day, initial assessment after fall was benign, now, at 10 pm at night, is pale, cool, diaphoretic, and mentally altered. While you are working on that the ETOH detox guy turns aggressive and becomes a hazard to the nursing staff...gotta figure out why. Evening lab work on third patient comes back with a critical potassium level and has an irregular heart beat. Meanwhile a ventilated patient in the ICU keeps dropping their oxygen sats and is requiring higher and higher PEEP settings, fever is spiking. ER pages you for two admits. One admit is a slam dunk "sure no problem" admit, the other is a ER dump that they want to pawn off to medicine but the patient doesn't meet admission criteria. You, the PA, get to tell the MD "sorry, that bird don't fly" aka: no admission for that patient. ER MD doesn't like that answer and gives a bit of push back. You compromise and ask them for a better work up from them to get some basic labs/imaging and they give you the song and dance of being too busy. You want to help them out but you also know if you agree to admitting a patient who doesn't meet certain criteria, you'll be in the hot seat in the morning, not the ER doc, with your supervising physician and hospital administration. While you are tap dancing with the ER, your pale clammy patient labs come back with a HgB of 6.5 and a negative stool guaic. Just where is that blood going? Why again did they fall? No one on night shift knows why, they thought it was a simple trip/slip...day shift didn't document that well, those slackers.

 

And that is before half the shift is over.

 

A hospitalist can be a multi dimensional, dynamic, complicated, stressful, action packed job. I think it is akin to being the ER for inpatients. You are managing sick patients who are trying to get more sick. Not as busy as an ER but every bit, probably even more, cerebral, of any PA job.

 

Wow, great description! I'm interested in the hospitalist side as well, and that was very informative.

[wsu-pa]

The words you chose to describe PA included descriptions that you are under the impression that PAs only deal with simple or uncomplicated patients...

 

A good place to begin your PA education is to wrap your mind around the fact that your patients can and will be very complicated and to approach them with the notion that a PA doesn't take care of critical patients is a fast way to kill one of them.

 

That being said... An example of the fun times... PA is solo hospitalist coverage in a community hospital in northwest Washington state. 12 hr shift, covering inpatient census of approx 60-70 patients plus 4-8 ICU patients. Pt on medical floor took a fall earlier in the day, initial assessment after fall was benign, now, at 10 pm at night, is pale, cool, diaphoretic, and mentally altered. While you are working on that the ETOH detox guy turns aggressive and becomes a hazard to the nursing staff...gotta figure out why. Evening lab work on third patient comes back with a critical potassium level and has an irregular heart beat. Meanwhile a ventilated patient in the ICU keeps dropping their oxygen sats and is requiring higher and higher PEEP settings, fever is spiking. ER pages you for two admits. One admit is a slam dunk "sure no problem" admit, the other is a ER dump that they want to pawn off to medicine but the patient doesn't meet admission criteria. You, the PA, get to tell the MD "sorry, that bird don't fly" aka: no admission for that patient. ER MD doesn't like that answer and gives a bit of push back. You compromise and ask them for a better work up from them to get some basic labs/imaging and they give you the song and dance of being too busy. You want to help them out but you also know if you agree to admitting a patient who doesn't meet certain criteria, you'll be in the hot seat in the morning, not the ER doc, with your supervising physician and hospital administration. While you are tap dancing with the ER, your pale clammy patient labs come back with a HgB of 6.5 and a negative stool guaic. Just where is that blood going? Why again did they fall? No one on night shift knows why, they thought it was a simple trip/slip...day shift didn't document that well, those slackers.

 

And that is before half the shift is over.

 

A hospitalist can be a multi dimensional, dynamic, complicated, stressful, action packed job. I think it is akin to being the ER for inpatients. You are managing sick patients who are trying to get more sick. Not as busy as an ER but every bit, probably even more, cerebral, of any PA job.

 

That sounds like quite a job! First off, I noticed you said "hospitalist coverage PA in northwest washington community hospital" I'm from western washington haha weird. Anyways, as I stated earlier, I really wasn't sure what a Hospitalist does I was only able to find a small amount of info about it but from what I found it sounded like what I was kind of looking for at this point. I understand you're reasoning behind wanting to clear up what exactly a hospitalist PA does at the beginning of your response. But I wanna thank you for not trying to crush my dreams completely haha. I've been on other sites who immediately tell you you have no clue what you're talking about (as if I came to a PA forum to teach people with my vast medical knowledge and experience as a PA). I don't know why but it seems like most people on here seem to find joy in telling others that they don't know what they're talking about and that they should reconsider PA school. Why wouldn't they want to encourage people to pursue their passion rather than climb on their high horse and tell people they don't have what it takes to be a PA.

 

Anyways, allow me to clarify a little bit about my reasoning behind why I was under the impression PA's worked largely with the relatively simpler patient population. I admit I may have kind of sort of maybe made a bit of an assumption by thinking that PA's don't have quite the training that an MD does so they weren't qualified to supervise critical patients like those in an ICU. Thank you for clearing that up. Is it safe to say that PA's have very nearly the same training as MD's? I know many PA schools are part of medical schools and thus many PA's are taught right along side MD's. This also helps create a bond because PA's work in a very tight knit relationship with their supervising physicians. I had originally thought that if I came into a PA forum thinking PA's are the equivalent to MD's I would get eaten alive by people telling me to go to med school instead. I do have a fair amount of healthcare shadowing. A very close family friend is a PA at my local hospital and I spent many hours job shadowing, following him and some of his fellow PA colleagues around, and just generally bouncing ideas off of them about PA school and the profession. I recently took an interest in hospitalist PA specialty and haven't seen said friend since I moved to college a few months ago.

 

But the info you've given is extremely helpful. It hasn't deterred me one bit, only inspired me to do better if I'm going to have more responsibilities. Thank you and any more info is greatly appreciated.

 

Questions: question for clarification; so do hospitalist PA's have their own caseload? You said they often deal with admitting patients, are they then responsible for diagnosing and treating those patients? If so, where does the SP come in? Is the SP like someone to consult if the PA is having trouble with a patient diagnosis, treatment, etc?

[wsu-pa]

Patients with uncomplicated problems are usually not admitted. I would say that PA hospitalists are generally managing some pretty complicated medical problems.

I suggest you do some shadowing to be sure you want to be a PA

 

I appreciate your recommendation and I've actually done quite a bit of shadowing of PA's as well as a bit of general volunteer work in hospitals so I've kind of been around the environment. But like I said in my OP, I had a hard time finding any substantial info on the hospitalist area of PA work. If you read my post in response to "Just Steve" you'll see why I was under the impression PA's worked with relatively simpler cases most of the time. I realize someone with a common cold probably won't be taken to the ICU. But that's why I say relative. There must cases that are simpler than others or some that don't have a patient in critical condition.

 

I can't help but notice from your tone that you almost find some sort of joy in telling me to reconsider. But you haven't deterred me one bit, just motivated me more to do better especially if I'm going to have more responsibilities and held to a higher expectation. But thank you for the motivation anyways :)

[wsu-pa]

I'd definitely take chiefPA's advice. No offense, but it sounds as if you're not really clear on what exactly a PA does. Do you have any experience working in healthcare or shadowing?

 

I do have quite a few hours around a PA's however it's been a few months since I last got to really talk to the PA I usually shadow and have since taken an interest in the hospitalist specialty of the PA career. The PA I shadowed worked in family practice and generally did things like meet with patients, give shots, and gave consults to patients about diagnoses/treatments. I'm still pretty young so I haven't accumulated many hours of HCE as defined by PA schools but I have ideas for getting HCE and experience in the medical field during and after college. I'd be a bit young if I tried to apply to PA school right out of college anyways (21) and I think that would hinder my chances of admission unless I had perfect grades, tons of great HCE, and an awesome personal statement; as well as nailing the potential interview. Don't get me wrong, I have good grades now, I always have, and I don't intend to change that anytime soon. But I think such a young applicant would need like a 4.0 or very very close, as well as lots of perfect HCE.

 

Like I said, PA school is still pretty far away for me so I'm not pressed for time or anything. I'm more focusing on creating a good foundation during undergrad so I can get into PA school when I do apply. I'm just trying to start seriously considering all the different specialties I can go into and see which one or two (or more!) I'm really interested in checking out in greater detail.

[EMEDPA]

my er pa group staffs a 24 hr obs unit in addition to covering the er. we conduct and interpret treadmills, work up TIA's, handle "stable" obs pts as well as not so stable pts who end up failing obs and going to the ICU/Cath Lab/OR, etc.

a lot of this has to do with the crappy workups done prior to admission by folks other than us.

examples:

note #1: "stable pt, replete dig and potassium, d/c in a.m."

actual pt: s/p 12 open heart surgeries for single ventricle, passes out and becomes bradycardic whenever she sits up in bed. dig loaded. no better. transfered to cardiothoracic service on transcutaneous pacer for implantation of permanent pacer.

note #2 : "92 yr old with mechanical fall. needs P.T. to teach her how to use walker than d/c in a.m.

actual pt: confused 92 yr old, previously totally with it, living alone, driving, etc, now septic and hyperkalemic. ICU admit

note #3 : stable chest pain needs r/o by enzymes then d/c in a.m.

actual pt: s/p recent cabg with ongoing chest pain. persistent tachycardia. enzymes neg. d-dimer neg., c.t. for PE anyway: + large b/l PEs

etc, etc.

one of my former jobs had PA hospitalists running the trauma ICU at night, doing all procedures, etc. first time md attendings saw pt was in a.m.

PAs can and do see critically ill pts in the ER/ICU/Medical floors on a regular basis. some of this is based on prior experience, some on school rotations, and some on the job training. not every pa is cut out to see pts with high acuity but those who want it can find it.

I worked a solo er shift last night. last pt was a febrile, confused 95 yr old full code on dialysis. no potential for pathology there, right? right at shift change so one of my partners got to work that one up.

[EMEDPA]

wsu- why aren't you considering medschool? at 21 with good grades it's a no brainer(assuming you're not actually a troll on the forums here-you wouldn't be the first).

[EMEDPA]

perform some of the more routine procedures that physicians need not be present for, treat patients (providing it is a relatively simple illness requiring a relatively simple treatment), write prescriptions (again, provided they aren't real risky prescriptions. In which case the supervising physician should be consulted), and some more. Is there any truth to this? Is this typical of what an inpatient care PA would do on a daily basis?

so far off base. are you really not a troll?

PAs perform lots of non-routine procedures. some do bronchoscopy, paracentesis, u/s and ct guided procedures, PAs at Duke do diagnostic cardiac caths, etc

PAs in washington (your state) have sch 2 dea scripting rights, the same as docs. we write for "risky prescriptions" all the time.

PAs in washington by the way are "sponsored" not supervised once they pass their boards and they have a law in wa saying a pa can sign anything our sponsoring physicians can(death certificates, etc).

[gnaar]

Hey guys, in defense of wsu-pa, I think we can lay off them a bit. It sounds like they are in high school or early university and just trying to get info, like any of us when we were exploring our options in education and future careers. No need to get defensive about stuff. I remember wondering wtf a hospitalist was when I was in university volunteering in the ED, Google shore didn't help, and it took me doing an inpatient internal med PA student rotation to really get it. Let's be encouraging to young people exploring medicine.

 

In response to your post, wsu-pa, I really liked working in inpatient medicine as a PA student. It used to be that family practice docs would see their patients if they needed to be hospitalized, but in this era of living longer and better treatments there are often more hospitalizations than FP docs can handle, so hospitalists were originally created to cover patients that were hospitalized for FP docs. Every hospital is different in the scope of practice that they will train their PAs and the job description of a PA hospitalist, but in my experience PAs do admit their own patients from the ED, begin the workup, follow and reassess the patient until discharge, and arrange follow-up after discharge. Some hospitals have PAs do all kinds of procedures and some have that responsibilty fall on critical care providers or interventional radiologists. Some smaller hospitals will have their hospitalists cover all kinds of patients, from the "bread and butter" of medicine (COPD exacerbation, DKA, etc) to surgical patients (just had a surgery and things aren't going well or potentially have an illness that needs surgical intervention like appendicitis) to cancer patients to cardiology patients to covering the ICU or doing rapid responses. Some hospitals have their hospitalists cover mostly "bread and butter" medicine patients. Typically the PA will present their patients and care plan to the attending physician and perhaps the rest of the hospitalist team in order to bounce ideas off of each other and make sure everyone is in agreement and on the same page.

 

What appeals to me about this area of practice (at least in my experience) is that the environment is constantly challenging you to learn more and you are often seeing new things, it is usually very academic and you have the opportunity to learn alongside residents and attendings, you have the chance to see your patients throughout the day and get labs back more quickly than outpatient, and you really need to understand the physiology of what's going on with your patients rather than just following protocols.

 

Best of luck in your endeavors! If and when you decide to go to PA school, you will have plenty of time to figure this stuff out and what piques your interest the most.

[krissten27]

Just Steve- that sounds AWESOME. Do programs have intake medicine rotations? The one I'm attending doesn't- could I do it as an elective?

[greenmood]

Just Steve- that sounds AWESOME. Do programs have intake medicine rotations? The one I'm attending doesn't- could I do it as an elective?

What do you mean by "intake medicine?" Typo? The rotation may not be labeled hospitalist; just look for an inpatient internal medicine rotation at a hospital that employs PAs in its model.

 

What Steve described was essentially my hospitalist rotation, but less glam-sounding. Medicine Hospitalist PAs where I work are paired with a physician on the service and split the cases evenly between them. All patients are discussed on rounds. As a hospitalist in the dept of surgery I am on the floor and in the unit caring for post-ops while the MDs are in the OR. Sometimes that means discharging overnight obs patients from the previous day, and sometimes it swings wildly in the opposite direction and I spend the day trying to get a handle on bleeding and sepsis and anastomotic leaks, dealing with cranky consultants and busy RNs, haranguing IR to squeeze my patient in for a procedure, etc.

 

There is something new and different every day and I am constantly learning. It's very fast-paced and my brain is always engaged. That's what I liked about hospital medicine even as a student, and I feel fortunate that I found a job in a field I love.

 

 

Sent from my iPad using Tapatalk

[krissten27]

sorry that was a typo- i meant inpatient :)  but that really sounds great, I am definitely going to look into that for my elective rotation

[Topquinn]

The words you chose to describe PA included descriptions that you are under the impression that PAs only deal with simple or uncomplicated patients...

 

A good place to begin your PA education is to wrap your mind around the fact that your patients can and will be very complicated and to approach them with the notion that a PA doesn't take care of critical patients is a fast way to kill one of them.

 

That being said... An example of the fun times... PA is solo hospitalist coverage in a community hospital in northwest Washington state. 12 hr shift, covering inpatient census of approx 60-70 patients plus 4-8 ICU patients. Pt on medical floor took a fall earlier in the day, initial assessment after fall was benign, now, at 10 pm at night, is pale, cool, diaphoretic, and mentally altered. While you are working on that the ETOH detox guy turns aggressive and becomes a hazard to the nursing staff...gotta figure out why. Evening lab work on third patient comes back with a critical potassium level and has an irregular heart beat. Meanwhile a ventilated patient in the ICU keeps dropping their oxygen sats and is requiring higher and higher PEEP settings, fever is spiking. ER pages you for two admits. One admit is a slam dunk "sure no problem" admit, the other is a ER dump that they want to pawn off to medicine but the patient doesn't meet admission criteria. You, the PA, get to tell the MD "sorry, that bird don't fly" aka: no admission for that patient. ER MD doesn't like that answer and gives a bit of push back. You compromise and ask them for a better work up from them to get some basic labs/imaging and they give you the song and dance of being too busy. You want to help them out but you also know if you agree to admitting a patient who doesn't meet certain criteria, you'll be in the hot seat in the morning, not the ER doc, with your supervising physician and hospital administration. While you are tap dancing with the ER, your pale clammy patient labs come back with a HgB of 6.5 and a negative stool guaic. Just where is that blood going? Why again did they fall? No one on night shift knows why, they thought it was a simple trip/slip...day shift didn't document that well, those slackers.

 

And that is before half the shift is over.

 

A hospitalist can be a multi dimensional, dynamic, complicated, stressful, action packed job. I think it is akin to being the ER for inpatients. You are managing sick patients who are trying to get more sick. Not as busy as an ER but every bit, probably even more, cerebral, of any PA job.

 

Just Steve -

  First year PA student here.  Thanks for the great synopsis!  PA work is versatile, dynamic, challenging and rewarding-- thanks to you and others for effectively getting the word out about what we (for me, future tense) do!