EM New Grad offer

[acozadd]

Awesome! What state? Glad to see those with REAL prior HCE be rewarded. I've seen way too many low ball offers accepted because a new grad only had experience as a "scribe" and didn't know any better. Not bashing scribes, but prior medics and nurses run circles around them as new grads.

FWIW, in ortho I would take a new grad scribe who scribed in ortho vs. a medic/RN who was in any field other than ortho. If the scribe was conscious during their time as a scribe, they would already know PE, basic XR interpretation, and protocols for various injuries and surgeries in ortho. The medic/RN would know to splint it and let ortho deal with it...

 

Your broad generalities about any one group running circles around another is a nice opinion, and will probably receive praise from some of the old school board members, but from my experience I can tell you it isn't fact.

[EMEDPA]

FWIW, in ortho I would take a new grad scribe who scribed in ortho vs. a medic/RN who was in any field other than ortho. If the scribe was conscious during their time as a scribe, they would already know PE, basic XR interpretation, and protocols for various injuries and surgeries in ortho. The medic/RN would know to splint it and let ortho deal with it...

 

 

I think you wildly overestimate what many scribes know. I don't know any who can read an xray , do an exam, or do anything other than type "f/u ortho 2 weeks" on a d/c order. they have never checked for dopler pulses or cap. refill,, checked range of motion, or even touched a pt for the most part. sure, they get to see other people work and talk about it. that's called shadowing.....An ER nurse would know A LOT more about ortho than a scribe.

at some places the scribes don't even follow the provider into the room, they transcribe what the provider says when they come back to the nurses station.

[EMEDPA]

FWIW my group just interviewed a handful of new grads for a bunch of open positions. we ran them all through the same scenarios, asked them the same questions, etc. The decisions were made by a panel of docs and PAs.

hired: NP who was an er nurse, PA who was an er tech, PA who was a navy corpsman, PA who was an emt and did an empa residency

not hired: PA who did research, PA who was a scribe, PA who was a medical receptionist.

[acozadd]

I think you wildly overestimate what many scribes know. I don't know any who can read an xray , do an exam, or do anything other than type "f/u ortho 2 weeks" on a d/c order. they have never checked for dopler pulses or cap. refill,, checked range of motion, or even touched a pt for the most part. sure, they get to see other people work and talk about it. that's called shadowing.....An ER nurse would know A LOT more about ortho than a scribe.

at some places the scribes don't even follow the provider into the room, they transcribe what the provider says when they come back to the nurses station.

We use scribes in our practice. There is quite a bit of variability between them, but the seasoned ones do the full documentation of history, physical, and discussion without any prompting by the doc/PA. A quick glance and a nod of approval is all that is required. Most of the time the discussion is already done prior to entering the room on routine fracture follow up and post-ops because they know the basic protocols...

 

I have talked to many ER nurses, primary care docs/PAs, etc. about ortho patients and I can assure you that based on these conversations, there is very little understanding of ortho taking place. I recently had an ER nurse walk a patient from the ER triage to a walk-in ortho clinic down the hall and say "I think the patient tore a tendon (knee pain), you should see him." I asked which tendon and I got a blank look. I asked what exam they had performed and got an equally blank look. I could go on with examples if you wish...  

 

As I've always preached, prior field-specific experience is what matters. A medic or ER RN would have a leg up in ER (as your examples would indicate), would not in many subspecialties. A prior athletic trainer might have a leg up in ortho, but not in ob-gyn.

 

The ED that I rotated through had a general policy of not hiring new grads and even developed a residency program to circumvent that. I have no prior ER experience, but the lead PA told me that if I hadn't already accepted a job in ortho they would have extended me an offer. I was rotating through with students that had prior ED experience and were looking to get into ED as well... Not bragging, just saying that your broad generalities do not apply to all and are offensive. :)

[EMEDPA]

not intending to be offensive. sounds like you had a great scribe experience. many do not and serve as a mobile transcriptionist for 6 months before pa school and may never even enter a pts room. I grant you there are medics, rns, rts, etc who are not the world's best candidates either, but at least there is some basic threshold if you are a medic or a nurse. you passed a program and passed a test. to be a scribe you need a bs degree and the ability to type. I advocate scribe experience for those going to medschool as it provides a great extended shadowing experience, but overall I prefer a typical traditional applicant with good grades to a scribe with the same good grades. we will never agree on this and that's ok.

you mention "the seasoned scribe". I don't see many of those as the job seems to be a revolving door for folks trying to get into med school. our place has them( I don't use them as we have to pay for them ourselves), and aside from the chief scribe, they change every 6 months.

when you serve on adcoms you pick who you prefer and I will do the same. glad you are enjoying your ortho job.

[JohnnyM2]

FWIW, in ortho I would take a new grad scribe who scribed in ortho vs. a medic/RN who was in any field other than ortho. If the scribe was conscious during their time as a scribe, they would already know PE, basic XR interpretation, and protocols for various injuries and surgeries in ortho. The medic/RN would know to splint it and let ortho deal with it...

 

Your broad generalities about any one group running circles around another is a nice opinion, and will probably receive praise from some of the old school board members, but from my experience I can tell you it isn't fact.

Good input. It would seem to me that knowing how to negotiate a contract has much more to do with prior contract experience than prior HCE. I can't see why a new PA with prior ED tech, EMT-b, or nursing experience (which some, here, refer to as REAL HCE) would be especially adept at contract negotiations whereas a prior scribe would not. As previously stated, making the most of your prior HCE, whatever that may be, is one aspect of contract negotiation. It is also important to know the local market for PAs and NPs. All the important parameters have been discussed on this forum ad infinitum, including pay, vacation, insurance, health care benefits, cme money and paid time off and so on. A smart PA will read all of these threads, research their local market understand their own strengths and weaknesses and negotiate accordingly.

 

It is important to understand that, for a given job, some things may not be negotiable, no matter how much the employer wants you. If the employer doesn't offer vision and dental to anyone, you are unlikely to be so valuable that they agree to initiate these policies just for you. If they have three experienced PAs making $40-$45/hr, it is unlikely you will be able to negotiate $50/hr. Part of contract negotiations is to know when to walk away because there isn't a good match.

 

With regard to highly inexperienced new graduates taking low ball offers, so what? I don't know why someone who can't suture would even accept an EM job. This forum is rife with examples of new PAs who accept jobs beyond their skill level, a sure recipe for failure. Some of these new and very inexperienced grads are best off taking a job that offers close supervision and limited responsibility until they come up to speed, even though that job may offer limited pay and benefits. Nothing wrong with that. I have read enough posts on this forum to realize that there are PAs out there who, unfortunately, graduate with limited skill sets. That may be partly due to the focus of the program they attended, the quality of the rotations, or their own failure to use both their didactic education and their rotations to learn as many skills as possible. How many times have I read that you what you get out of your rotations is directly correlated with what you put into them. Unfortunately, the PANCE, can't test for skills which are essential to many PA jobs. Too bad there aren't more high quality residencies available.

 

I can appreciate that some of the old guard who post here feel that schools are now accepting too many candidates without "suitable" HCE. So be it. But here is where I differ with you. As you have gained experience you have often come to resent the lack of equitable pay, autonomy and respect you have earned through years of practice. Why then do you denigrate the new grads who entered PA school without first spending 10 years as a paramedic? After some years of experience they will be where you are today and it won't matter if they started life as EMTs or scribes. They will be full fledged PA-Cs trying to deal with the same issues that frustrate you today.

 

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[JohnnyM2]

you mention "the seasoned scribe". I don't see many of those as the job seems to be a revolving door for folks trying to get into med school. our place has them( I don't use them as we have to pay for them ourselves), and aside from the chief scribe, they change every 6 months.

My daughter was a scribe for two full years. During that time, after reading many posts on this forum, I asked her if it wouldn't be better to be an ER Tech, or an ekg tech for a time. She said the ekg techs, attach leads, chat with the patients and run a strip which they hand over to the attending. She also felt that she was learning a lot more as a scribe than she would as an ER tech. Keep in mind that, in her program, she was a hospital employee, worked very closely with the docs and, though she did not touch patients, she did interact with them and did a lot more than "type." She was involved in transmitting orders for meds and lab tests and notifying her physician when reports were available. The physicians took the time to explain to her what they were doing and why. She learned a lot about the diagnosis and treatment of conditions that commonly presented in the ED and became thoroughly versed in medical terminology.

 

Some years back I ran the security committee in our gated community. I was expected to show up every time the front gate admitted an ambulance. I could say that with each call there were two ambulance EMTs and, separately, a local fire department, EMT. The fire dept guy didn't do much but provide muscle. One ambulance EMT was in charge. The other, presumably an EMT-b, was just a gofer. Not sure the experience of the two presumed EMT-bs was worth more than what my daughter was learning in the ED. Also, the vast majority of the calls were pointless, non emergencies that could have been handled by an MA: (Got history and vitals and then patient decided they felt better.) I got tired of getting up at 3 am for that b.s. so I quit.

 

I don't want to denigrate EMT-bs, but to say they had to at least pass a test and get certified is risible. Where we live, the local community college offers a Summer EMT program that allows you to take the certification test. Nevertheless, I would never say EMT-b isn't "real" HCE, but this constant harangue that only EMT constitutes REAL HCE gets tiring.

 

 

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[EMEDPA]

t this constant harangue that only EMT constitutes REAL HCE gets tiring.

 

 

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no one said that. RN, LPN, resp therapist, cardiac exercise physiologist, ortho tech, surg tech, critical care tech, ,medical asst., clinical nutritionist, physical therapy assistant, etc are all acceptable and valid entry points to the profession.

[acozadd]

But overall I prefer a typical traditional applicant with good grades to a scribe with the same good grades. we will never agree on this and that's ok.

 

That has never been my point. My point has always been that, given how specialized medicine today, a bucket statement of needing to have xyz background to succeed, or one group running circles around another just isn't true. I have always said that field specific experience is useful.

 

Our perspectives likely vary because we are on two different ends of the continuum. I had 5 years of "low-level" experience prior to PA school and now work in a specialty where I do not use 99% of what I learned in school, and 99% of what I know has come after graduation. From my experience, I have seen that even physician-level training in other fields doesn't provide a good ortho foundation... so to say that a respiratory therapist or RN will have a leg up on anyone else is nonsense. You had many years of EMT experience and now work in ED. You had field-specific experience and don't practice in a subspecialty. Prior experience in the listed fields will be much more useful in your world. Back in the day when PAs entered primary care fields in much greater numbers, prior experience as you listed was certainly helpful. Both medicine and the PA profession have changed since that time.

[gbrothers98]

Prior HCE is a double edge sword. I will give you my personal example.

 

I spent near 4 yrs in the Air Force as a medic in the ED mostly, 6 months on the med/surg floor then all ED.

I had more than one interviewer tell me I was a near shoo in for PA school based upon this in part.

I landed in an ED job just prior to graduation, just plain fell in my lap with absolutely no work on my end. Right place, right time.

The place wanted a new grad, had just had bad time with PA with much ED experience.

They liked me b/c even though I was a new grad, I had all that prior HCE in the ED.

They told me I was there to see fast track patients.

First day there it was obvious that I was to pick up next chart, my first patient was having a TIA.

 

Several weeks later the ED director pulled me aside and had a heart to heart with me. Said some of the docs were having a hard time with me due to my lack of experience with more complicated cases. They had higher expectations based upon prior HCE.

He had a more realistic grasp of what my timeline should be and acknowledged that the learning curve is/was steep.

He reworked the schedule so that I spent more time with the ED docs that were OK with my slower pace and offered advice/direction/mentoring.

 

I in turn doubled down on my own investment off hours, essentially guzzling down all the Emed I could find.

His patience and my persistence paid off but it took at least another 6 months to really get up to speed that was satisfactory.

 

As for negotiating anything, at that stage of my life I was happy to have a job. Newly divorced, fit all my possessions in the back of the truck, less than a grand to my name, I needed work. My godfather gave me $500 for security deposit on an apartment and buy some food. My start figure was $25 / hr (this was 1998, dont feel bad, I make triple that now). I had no idea what benefits I had nor what I should get. No one had talked to us about anything in the working world, salaries, benefits, charting, coding, licensing, credentialing, DEA, nothing. All the school of hard knocks. I was satisfied that I was making more money than I had ever in my life, especially compared to the poverty level wages I made on active duty as junior enlisted.

 

What became especially clear to me after several years of practicing in the ED as a PA was that coming in, I had great experience for preparation and was a good medic. That did not necessarily translate into being a great ED PA right out of the box. Some may be able to do that but I think it is far and few. The rest is just hard work. I tell new grads that the hardest they will work is the first few years out of school, it makes PA school look easy.

 

I also try to educate them as much as possible about the job market and what they have to be aware of. We work tremendously hard to learn medicine. We dont have a lot of energy left to learn about wages and benefits, we just assume it will be fair. Very frustrating when we realize we have to negotiate and no one taught us how to do that nor investigate the worthiness of an employment offer.

 

Good luck

G Brothers PA-C