winterallsummer Posted January 29, 2014 Share Posted January 29, 2014 Besides family medicine, what fields do PAs practice independently in more than others? I know it will vary - some specialists may have much autonomy while other GPs have little, depending on where they work - but would like some general input. Thanks to all who contribute. Link to comment Share on other sites More sharing options...
UGoLong Posted January 29, 2014 Share Posted January 29, 2014 I'm on my own for most of the day in cardio. My doc wants me where he isn't, most of the time. Link to comment Share on other sites More sharing options...
johna877 Posted January 29, 2014 Share Posted January 29, 2014 To op... Is family med PA very autonomous? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 29, 2014 Moderator Share Posted January 29, 2014 rural family medicine and rural emergency medicine Link to comment Share on other sites More sharing options...
rcdavis Posted January 29, 2014 Share Posted January 29, 2014 Experienced PA---> EM anywhere Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 29, 2014 Moderator Share Posted January 29, 2014 Geriatric house calls - 100% on my own Link to comment Share on other sites More sharing options...
chatcat Posted January 29, 2014 Share Posted January 29, 2014 Occ Med...I'm the solo clinician. Link to comment Share on other sites More sharing options...
Acebecker Posted January 29, 2014 Share Posted January 29, 2014 I have a bunch of docs, a PA and an NP in the same building. But I only consult them if they know something the Pt isn't telling me. I get to choose when someone else takes a look at the Pt, not the other way around. It's pretty good autonomy. I work in UC within a hospital/family practice/internal medicine office. It's a bit of a weird setting. Link to comment Share on other sites More sharing options...
FSUnoles Posted January 29, 2014 Share Posted January 29, 2014 this is highly dependent on where you work and who you work for. As others have stated anything rural will give you the most opportunity. I heard on NPR there is a boom in North Dakota lol Link to comment Share on other sites More sharing options...
discogenic Posted January 29, 2014 Share Posted January 29, 2014 this is highly dependent on where you work and who you work for. As others have stated anything rural will give you the most opportunity. I heard on NPR there is a boom in North Dakota lol It's all about the frackin'! Link to comment Share on other sites More sharing options...
winterallsummer Posted January 30, 2014 Author Share Posted January 30, 2014 To op... Is family med PA very autonomous? Yes (I'm sure there are a few exceptions, but from my experience, it is highly autonomous once the PA is comfortable). Some practices give the PAs the healtheir patients and the older/chronic illness pts to the docs, but others do not discern between the two populations. Link to comment Share on other sites More sharing options...
Febrifuge Posted January 30, 2014 Share Posted January 30, 2014 Urgent Care. It has pros and cons, and maybe it isn't so exciting, but I have a light work schedule, evenings and weekends, and I am literally the only practitioner in the building, when I'm there. I meet with my SP twice a year face-to-face, and email whenever something weird has happened on a shift. I have essentially complete autonomy, and my department backs me up on any unpopular decisions. Great job for the PA who is a few years out of school, and has to juggle family responsibilities. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 30, 2014 Moderator Share Posted January 30, 2014 Urgent Care. It has pros and cons, and maybe it isn't so exciting, but I have a light work schedule, evenings and weekends, and I am literally the only practitioner in the building, when I'm there. I meet with my SP twice a year face-to-face, and email whenever something weird has happened on a shift. I have essentially complete autonomy, and my department backs me up on any unpopular decisions. Great job for the PA who is a few years out of school, and has to juggle family responsibilities. agree. the schedule is nice and the money is good. also allows a later transition to family practice or em if desired. Link to comment Share on other sites More sharing options...
johna877 Posted January 30, 2014 Share Posted January 30, 2014 Can you describe a "day in the life" of an urgent care PA? Such as job duties, patient population, weekly work hours, pay, etc. I appreciate your help guys! Link to comment Share on other sites More sharing options...
FfIghter23 Posted January 30, 2014 Share Posted January 30, 2014 Can you describe a "day in the life" of an urgent care PA? Such as job duties, patient population, weekly work hours, pay, etc. I appreciate your help guys! In Texas (Dallas,FW,Arlington area), mostly 12 hour shifts. 8am-8pm. Full time is 12-16 days a month. Great autonomy, but limited in the staff that you have working for you. In ER you will have experienced nurses. In Urgent Care, we get MA's with limited experience and abilities. The scope of practice is dependent on what you have on site. We have full x-ray. Great lab with capabilities to run CBC, CMP, BNP, D-Dimers, Cardiac enzymes, and other point of care testing with fairly accurate results in under 20 minutes. We see a bunch of lacerations, extremities-- as well as head. Fracture care with orthoglass. Obviously, about 50% of what you see will be URI, UTI, bronchitis, flu, impacted cerumen, and other basic stuff. About 10% is dermatology related and it keeps you on your toes. Pt population will be 3 month olds to 100 year olds. Low income and high income. I don't do narc refills, and I turn away the narc seekers. Every week or so there will be a good abscess to be drained. Its a good variety of medical problems for practitioners that ARE NOT right out of school. Fast-paced and you blink and the waiting room will be full while you are working up an abdominal pain and an 85 yr old with a productive cough x2 weeks. The pay will always be what you are worth. If you see at least 40 pts a day (in 12 hours), you better be making >$60-65/hr in my opinion. Good luck. Link to comment Share on other sites More sharing options...
Acebecker Posted January 31, 2014 Share Posted January 31, 2014 In Texas (Dallas,FW,Arlington area), mostly 12 hour shifts. 8am-8pm. Full time is 12-16 days a month. Great autonomy, but limited in the staff that you have working for you. In ER you will have experienced nurses. In Urgent Care, we get MA's with limited experience and abilities. The scope of practice is dependent on what you have on site. We have full x-ray. Great lab with capabilities to run CBC, CMP, BNP, D-Dimers, Cardiac enzymes, and other point of care testing with fairly accurate results in under 20 minutes. We see a bunch of lacerations, extremities-- as well as head. Fracture care with orthoglass. Obviously, about 50% of what you see will be URI, UTI, bronchitis, flu, impacted cerumen, and other basic stuff. About 10% is dermatology related and it keeps you on your toes. Pt population will be 3 month olds to 100 year olds. Low income and high income. I don't do narc refills, and I turn away the narc seekers. Every week or so there will be a good abscess to be drained. Its a good variety of medical problems for practitioners that ARE NOT right out of school. Fast-paced and you blink and the waiting room will be full while you are working up an abdominal pain and an 85 yr old with a productive cough x2 weeks. The pay will always be what you are worth. If you see at least 40 pts a day (in 12 hours), you better be making >$60-65/hr in my opinion. Good luck. What he said. UC can be a lot of fun, or a host of headaches. For example: this week I had a rash of abdominal pain patients (I think there were at least 10 out of the 80 pts I saw in my 3 day stretch). Only 1 was a true emergency (acute appendicitis) but weeding out the bad from the ok can be challenging (for me at least - I don't know how my colleagues feel about abdominal pain). The w/u can take a long time and the waiting room can overflow if you're not careful. The other large challenge that I have is that I am within a FP office and we are not open after hours. So we have to get everyone in the door and out before 1900 (sometimes even if they come in at 1850). If we were open 24 hrs and I had someone coming on who I could sign out my patients to, life would be easier. Link to comment Share on other sites More sharing options...
Febrifuge Posted February 1, 2014 Share Posted February 1, 2014 What he said. UC can be a lot of fun, or a host of headaches. For example: this week I had a rash of abdominal pain patients (I think there were at least 10 out of the 80 pts I saw in my 3 day stretch). Only 1 was a true emergency (acute appendicitis) but weeding out the bad from the ok can be challenging (for me at least - I don't know how my colleagues feel about abdominal pain). The w/u can take a long time and the waiting room can overflow if you're not careful. The other large challenge that I have is that I am within a FP office and we are not open after hours. So we have to get everyone in the door and out before 1900 (sometimes even if they come in at 1850). If we were open 24 hrs and I had someone coming on who I could sign out my patients to, life would be easier. Wow, I'm there some evenings and some weekends, and there is FP during the day (although in a different part of the building). I would love to be able to turn people away, but our hours are until 21:00, and I'm responsible for completely finishing a visit even if the patient walks in at 20:59. If it's a sore throat or a suspected UTI, great. If it's a laceration that needs repairing, at least nobody else is coming. If it's that annoying abdominal pain that's probably nothing but still needs a solid exam and detailed history, then shoot me now. Having someone to sign out to would be lovely, but we take pains to differentiate ourselves; we're not the day clinic, and we're also not an ER that closes at night. It is something of a saving grace that my group limits our urgent care labs to such an extent that I can't get a BMP, I can't get a blood gas, I can't get a CK or a troponin or a D-dimer, so if I feel like a patient's care would be more appropriate having such a test done, then I can refer them out to the ER. (Sorry, everyone. At least I have a sense of why they should go there, and actually believe they might benefit from it.) Imaging is similar; we have plain films, and that's it. They're digital, which is cool, so I can read them and then read the radiologist's reading as well, in short order. In a lot of ways, it calls to mind what practicing in a time warp might be like, where it's 1981 or something and several tools just aren't available. My SP simplifies it well: the UC is supposed to be for problems that aren't emergencies, but also can't wait for the next available appointment with a primary. And they should be problems that can be solved in one visit. That means if the patient wanders in having decided TODAY IS THE DAY and that headache for the last 6 months or that weird pain for the last 3 weeks needs to get worked up, all I have to do is determine whether I can diagnose and treat the issue, with what little I have available. If not, then the most useful thing I can do is refer them somewhere. Back to the PCP, or to a specialist, or to the ER if needed. And the thing that has turned out to be really fun for me is coming to understand that working with few resources makes me appreciate and respect them. It's just me, my education, my exam and history-taking skills, a few simple labs, and an LPN to help. I have come to value them all a lot more than I used to. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 1, 2014 Share Posted February 1, 2014 ^^^ I like the SP's attitude. My last position was somewhat similar except there was no onsite lab capability during the time of the visit except a UA, rapid strep/flu, and preg test. I would still like to do the same thing, only with a more realistic bureaucracy. Link to comment Share on other sites More sharing options...
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