unrealistic expectation of adding FT Ortho to PRN EM??

[mahnken]

Hi guys!!  I am a new grad and I have always wanted to do EM and fortunately, I was lucky enough to get a position with a group for PRN shifts to cover 3 hospitals.  I start May 1st, needless to say, I'm very antsy and broke.  I have no idea if I am going to have enough shifts to choose from to survive and I suppose I won't know until I start looking at schedules.  In the meantime, I have been looking at locums positions.  I interviewed with an ortho practice that needs someone FT immediately and they are no longer accepting locums (I didn't know this until I was sitting in the interview).  I really loved their group and I could see myself there, but I have no exp in ortho and I'm not entirely sure yet if its for me.  

 

I was offered the ortho position today and its tempting to take it and pick up EM shifts as much as I can.  However, 8-5 M-F with call 1 weekend/mo does not leave a lot of time.  Also, the diff in pay is quite substantial.  I would want to take as many EM shifts as possible if they're avail, but again, I don't know if there are going to be 10 shifts/mo avail or 2- and if the latter is the case I will be upset I didn't take the ortho position.

 

Anybody have exp working PRN and mixing in another FT job??

[EMEDPA]

call the guy who does scheduling for the em group and explain your situation. ask if he can consistently give you 10 shifts/mo.

if not, you probably need to take the ortho gig and do em when you can.

I have 1 full time em job and 2 part time em jobs. one part time job gives me 2-3 shifts/mo and the other gives me 0-4 shifts/mo. I could not pay my bills just on the per diem job income.

[GetMeOuttaThisMess]

With being a new grad you really don't have any experience to speak of in any setting yet (not intended to be tacky). Bird in the hand.... Try ortho if no ED guarantee and learn good ortho skills because you'd need them in the ED or UC. If ED is what you want start picking up 1-2 shifts/mo. for several months then ask about making a FT switch after a year. Think of ortho as an informal residency. You don't want to leave too early if you can avoid it. Remember that they're investing in you also (ortho group).

[mahnken]

Thanks for the replies. E- I actually asked them before how many shifts on avg were avail and they kept telling me they can't guarantee me any and that it changes each month.

 

Getmeouttathismess- lol, you are so right I have no experience as a PA at all. I was referring more to "exposure" as I have never had an ortho rotation or even seen an ortho related surgery, but I have been an EMT for 3 years, and worked in the ED. ;-)

 

Consensus sounds like taking the ortho job is a smart move and slowly get feet wet in EM as most likely won't be offered that many shifts PRN seeing hospitals are fully staffed. That was the whole point of the offer from the director anyway - get me in the door bc he thought I fit well into his group, but too green for the FT position. I still have guilt with both though, bc I don't want to leave the ortho practice too early and I also don't want to ever turn down shifts at the parent hospital when needed

[GetMeOuttaThisMess]

You're coming in with the exact background that I had when I accepted my first position (spine). Didn't do Ortho in school (ED and Plastics instead). PA's weren't in ED's back then but I had been an EMT beforehand. Best of luck.

[UpRegulated]

NP student here, so feel free to correct my ignorance, but I am genuinely curious.  There is one thread here talking about how long one was in their first job, and this thread with a new PA grad potentially splitting time between ortho and EM.  I suppose I should reply to the "first job" thread separately from this one, but how can one bounce from one to the other and have any clue as to what you are doing?  Are you not retraining all over again?  From spine to EM?  Hand surgery to FP?  I understand the "generalist" approach to PA training, but...

 

And advising a new PA grad to split time in EM and ortho?  Is not learning one specialty enough for a new grad?  Is picking up only 1-2 shifts a month in the ED really a good way to learn EM for a new grad?

 

Maybe I'm missing something here. 

[GetMeOuttaThisMess]

I think you answered your own question with the "generalist" response.  PA's are not trained in core programs toward any specific niche, but instead are given a basis for being able to provide primary care.  While I wasn't a spine specialist thirty years ago when I got out I still had enough core knowledge and training to be able to take a hx. and perform a problem oriented physical.  I've never done Gyn, aside from ED gyn exams, but I could walk into an exam room today and feel comfortable with taking an appropriate problem-oriented history and performing an appropriate physical exam.  One has to keep in mind that just because one has a job in emergency medicine doesn't mean that they're cracking chests, inserting SC lines in trauma patients and so forth.  A lot of EM IS primary care.

[PACdan]

And advising a new PA grad to split time in EM and ortho? Is not learning one specialty enough for a new grad? Is picking up only 1-2 shifts a month in the ED really a good way to learn EM for a new grad?

 

Maybe I'm missing something here.

The OP spent three years as an EMT and worked in the ED before attending PA school. She has experience in this environment/area of medicine. This is the case for most PAs and PA students; having experience in various health fields. Ortho is where she is not familiar. Yet we are trained as generalists and jack of all trades. PA school lays down the foundation for on the job training where our competencies are increased via practice.

 

 

 

 

Sent from the Satellite of Love using Tapatalk

 

 

[mahnken]

Upregulated- you bring up a good point and it's something I thought about as well. I want to be great in my specialty of EM but it's going to be hard to dedicate as much time to educating myself via my books and podcasts etc if I'm also needing to learn ortho.

[Mainer]

I think it's important to note the differences in training b/t NP's and PA's. 

 

PA's will all have 1000+ hours of clinical training in primary care (peds, IM, FM) alone.

 

In addition, the medical model believes that in order to be a competent primary care provider, you must also complete considerable formal clinical training in general surgery, EM, psych, women's health/OB, ect. for an additional 1000+ hours.  In PA school I had to take 9 different shelf exams after each of the respective clinical rotation. 

As an example, general surgery is where you see acute abdomens, hernias, breast CA, ect.  Doing the extra training in these aforementioned specialty areas allows you to see things you must know to practice primary care medicine, but might not see in 1000 hours of family practice/im/Peds experience. 

 

Typical NP programs have between 600-1000 hours of clinical training total.  In my 6 week EM rotation, we had an FNP rotate through.  Her entire rotation was 5 days.  She did not take shelf exams.  She was also working 30 hours a week as an RN while completing her clinical training as an NP.  Her program start to finish was 2 years. That simply wouldn't fly in PA school.  Studying medicine is your full-time job around the clock job.

 

Now to answer the question.  The generalist approach allows you to effectively move from specialty to specialty.  Outside of primary care/EM, it often takes many years to become competent in specialty practice as a PA.  Working full-time as an ORTHO pa is reasonable while working some ER shifts as a PA.  Granted, you might be seeing mostly urgent care as a part-time ER PA, but you may also become a more competent ORTHO PA with ER exposure.  You'll also be exposed to the more critical cases. 

 

The same is true for physician training.  Medical school is structured similarly to PA school.   Everybody receives a generalist education and then you specialize. 

Specializing without a generalist education is self limiting. 

 

I know NP's tend to focus in a certain area.  That is how PA/MD and NP's differ. 

[cbrsmurf]

jfc, another thread that has somehow degraded into a pa vs np thread

[Mainer]

Or better yet

 

Another example of PAs "tossing in the towel"

 

An unwillingness to fight.

 

The fact is

Our training is longer, harder, better.

 

That should be revered, highlighted, and we should CONSTANTLY remind everybody, whether they are decision makers or not.

 

I'm sure many have noticed, Dr NPs aren't afraid to fight.  They're making us look like second tier providers, but the data clearly suggests we are SIGNIFICANTLY better trained and better prepared to take on the growing demands of healthcare. 

 

At some point, the profession has to desensitize and play hardball.

 

Just MY OPINION!

[cbrsmurf]

yea, preach to the choir!  that's super-effective!