NP soon to supervise PAs. Just a matter of time.

[David the Nome]

"subpar cpr".

what's up with that?

I know not everyone wants to work in em or solo primary care but wouldn't it be nice if everyone was able to?

pa's who require major handholding at their first job make docs want to hire np's the next time around.

Makes sense

[deborah212]

sure they may catch up someday( 5 yrs maybe) but how many folks did they adversely effect in those 5 yrs that a better pa wouldn't have?

the first person you see your first day out of school is entitled to good care too.there are folks I work with who are > 10 yrs out of school who still don't have some basic em procedural skills that every paramedic has. sure, not everyone wants to work solo in a rural dept but it's not even an option for someone who can't intubate, start lines, run a code with some degree of competence, etc

I don't mean to be antagonistic; only expressing another point of view for others reading this thread. I think it's unrealistic to expect every PA to to be able to intubate, start lines, and run a code with some degree of competence just as it would be unrealistic to expect every PA to be able to work in Ob-GYN or neurology competently unless they had already been working in the specialty. I have great respect for paramedics. One of my good friends in PA school was one, and I certainly learned a tremendous amount from him. I agree that paramedics have more than a leg-up on being an efficient emergency medicine PA at the start. It would be interesting to see any statistics on the percentage of those who follow that route. Where I diverge in from your opinion is that they have a 5 year advantage in other fields like primary care and the internal medicine sub-specialties that are not high-acuity procedure based. There's medicine outside of emergency medicine/rural medicine.

 

I do believe I provided high quality care to the first, tenth, and two hundredth patients thus far in my career. What differed between the first patient and those of last week was the amount of of reliance on outside resources (uptodate, fellow PAs, and attendings) I required to provide this care. This could be what you are referring to as "handholding." I think this is a good thing, especially if that's what expected on hiring. I/we aren't islands. If I move on to nephrology or cardiology, I have no doubt that I will need more mentoring than what I currently receive as a hospitalist PA. Medicine is so vast, and I wouldn't feel comfortable practicing with minimal guidance.

 

With all this said, my experience as a PA is only a fraction of yours. I just wonder though if what you feel applies to all specialties (Contrarian seems to agree) or is the most relevant to EM.

[EMEDPA]

my feeling based on 24 years working in medicine with hundreds of pa's is that those with prior experience(any experience, not just medic) are better able to hit the ground running in any field than those who come in without experience. you can't learn the culture of medicine in just 1 short yr on rotations. there are lots of clueless new grad pa's out there who don't know how to interact with people and other medical professionals. I for one don't believe you should be able to go straight from high school into a 5 yr bs/ms pa program without experiencing some life first and particularly a bit of the culture that is medicine.

many folks on here will disagree with me and I respect your right to do so, will not censor it, but will continue to disagree based on my personal journey thus far.

[rcdavis]

IMHO it applies across the board.. The greater the pre- education experience, the more comfortable you are in the medical role. And that comfort helps you in "clearing your thoughts" - being able to calm the jitters, as it were, - and more clearly hear what the patient is actually saying.

You are able to spend more time listening and seeing the patient by dealing less with the " newbie" stream of consciousness and self observation than you would have to deal with as someone with less experience.

 

This, and the added years of both direct and vicarious experience, set you up in a situation wherein your "data banks" are a little more full than they would have been without that experience.

 

Studies show that, after about 5 years, the performance and capacities of both groups level out ( which is how most of the masters programs got away with lowering the amount of pre education HCE-- they were able to show that at the 5 yr mark there was no discernible performance difference between high and low levels of HCE PAs)

 

I am and have been a huge proponent of significant HCE, but as a high fire senior PA I have to concede that the last two hires I made were low level HCE, and these ladies have been absolutely stellar.

 

The only prejudice I will not lose is that, if given a choice between any ex mil MEDIC, or CORPSMAN and any non-military new grad, the military personnel will always be hired preferentially.

 

My attendings are now at the point where they beg me to find ex-navy corpsman or army 91ds to fill the rare opening that we have. My only problem has been finding these guys... They get hired quick. For most of the experienced hiring teams, being ex military medical.. Especially if you are an ex military PA.. is the equivalent of a degree from harvard.

 

Fwiw,

 

davis