Specialist PA: What for you is full scope of practice?

[polarbebe]

This general question is for specialist PAs who have the professional desire to practice at their full scope or "top of the license." Family practice PAs are generally practicing near or at the top of their scope of practice with usually great autonomy.

 

For your specialty (emergency medicine, CT surgery, etc.) what do you consider to be practicing at your full scope (what procedures, amount of autonomy, supervisory role, etc)?

 

How long did it take you or do you expect it to take to achieve it?

 

What classes, certifications, residency, training, previous healthcare experience did you receive that helped you achieve this?

[polarbebe]

I work in critical care and hope one day to be as knowledgeable and experienced as RCDavis

and also per diem in EM and hope one day to be as adept as EMed (which I doubt :).

 

Ideally in the MICU, hope one day to be a resource (as envisioned by the MICU director) to mentor senior residents and even critical care fellows, be proficient in all ICU procedures (CVLs, intubation, paras, thoras, a-lines), interventions and to use the ultrasound as expertly as the ICU fellow. I have heard that it takes about 10 years to know what you are truly doing in the ICU (from a senior PA who spent >20 yrs in a SICU). In EM, hope one day to have the experience, skills knowledge to work in a rural ED; time to that goal... potentially not achieveable working per diem/part time.

 

No significant precious HCE (minimal volunteer EMT experience). No residency. Pursued positions generally only with high acuity patients to maximize exposure and learning. Took FCCS... but that was almost like a review for me. Plan to take ATLS, ultrasound courses and airway courses in the future (I get no CME money).

[EMEDPA]

see any pt, do any procedure in the ED without a physician present.

27 years working in em as an er tech, medic, and PA. Just landed a job that allows this 1 year ago. Prior jobs were good. this one is perfect.

1. N.C.C.P.A. Board Certified with Surgical and Primary Care Honors

2. N.C.C.P.A. Certificate of Added Qualifications in Emergency Medicine, Inaugural exam 9/12/11

3. XXX and YYY State P.A. Medical Licenses

4. D.E.A. Certification, Schedule II-V

5. Advanced Cardiac Life Support (A.C.L.S.)

6. Advanced Trauma Life Support (A.T.L.S.)

7. Advanced Pediatric Life Support (A.P.L.S.)

8. Pediatric Advanced Life Support (P.A.L.S.)

9. Advanced Burn Life Support (A.B.L.S.)

10. Fundamental Critical Care Support (F.C.C.S.)

11. Advanced Life Support in Obstetrics (A.L.S.O.)

12. Basic Disaster Life Support (B.D.L.S.)

13. The Difficult Airway Course  

14. FAST Plus Emergency Ultrasound Course

15. Cardiopulmonary Resuscitation for Health Providers (C.P.R.)

[LT_Oneal_PAC]

see any pt, do any procedure in the ED without a physician present.

I would agree with this.

[EMEDPA]

I would agree with this.

or working dual coverage with a doc, but still seeing/doing everything. one of my per diem jobs is like this. we alternate charts from one rack regardless of acuity.

[LT_Oneal_PAC]

or working dual coverage with a doc, but still seeing/doing everything. one of my per diem jobs is like this. we alternate charts from one rack regardless of acuity.

I guess I read it as "see any pt and do any procedure without having a physician physically present, sign off before hand, or any other administrative BS and consult when I feel it necessary, not arbitrary and inflexible restrictions and guidelines"

[EMEDPA]

I guess I read it as "see any pt and do any procedure without having a physician physically present, sign off before hand, or any other administrative BS and consult when I feel it necessary, not arbitrary and inflexible restrictions and guidelines"

yup, that ^^^^^

[andersenpa]

Each place will have its own limits based on what procedures/technology offered, or the institutional privileging restrictions

 

Within 5 years (and with decent patient volumes) a PA should have mastered the core procedures for their discipline and see any patient. That should get you the exposure to at least get the ball rolling and stabilize any mess. This should be done without initial physician involvement. The next 2 yrs of your career will be seeing the real zebras, learning evolving procedures, and hopefully getting into leadership roles which foster a good environment for new upcoming PAs.

 

For certain specialties there is necessary doc involvement- eg if I have a postop bleeding cardiac patient I can stabilize them and do whatever bedside open chest activity needed, but they will then need to go to the OR w/ a BC surgeon so we can complete the job.

[EMEDPA]

Each place will have its own limits based on what procedures/technology offered, or the institutional privileging restrictions

 

Within 5 years (and with decent patient volumes) a PA should have mastered the core procedures for their discipline and see any patient. That should get you the exposure to at least get the ball rolling and stabilize any mess.

Agree, unfortunately the vast majority of PA jobs outside of primary care do not allow PAs the exposure to the full scope of their specialty due to arbitrary limits set on them by docs or hospital administration. Typical new em pa job for example in many metro areas is low acuity/fast track only. you won't get good at evaluating chest pain if you never see pts with chest pain.

[polarbebe]

Agree, unfortunately the vast majority of PA jobs outside of primary care do not allow PAs the exposure to the full scope of their specialty due to arbitrary limits set on them by docs or hospital administration. Typical new em pa job for example in many metro areas is low acuity/fast track only. you won't get good at evaluating chest pain if you never see pts with chest pain.

Working at a teaching hospital can also severely limit growth/learning potential.

 

Many medicine PAs in urban settings at teaching hospitals cover the less acute inpatients (particularly NYC) eg. cellulitis, non-complicated uncontrolled diabetes etc; they don't do procedures (paras, thoras, LP, etc) or even place IVs. The inpatients who are sicker are covered by house staff (who perform the procedures). Three PAs in my class who graduated close to five years ago now at a major hospital system work under this limited scope.

 

The medicine PAs at the oldest public hospital in the country and largest in NYC cover "a-lock" (in addition to the less acute inpatients)... "A-lock” are patients who remain inpatients due to social and dispo issues, they have no inpatient medical needs that can not be handled in a skilled facility. It should be noted that some of these PAs also are content being "assistants" and not practicing at the top of their license. The house staff at this hospital also cover the more acute and sicker inpatients.

[andersenpa]

Working at a teaching hospital can also severely limit growth/learning potential.

 

Many medicine PAs in urban settings at teaching hospitals cover the less acute inpatients (particularly NYC) eg. cellulitis, non-complicated uncontrolled diabetes etc; they don't do procedures (paras, thoras, LP, etc) or even place IVs. The inpatients who are sicker are covered by house staff (who perform the procedures). Three PAs in my class who graduated close to five years ago now at a major hospital system work under this limited scope.

 

The medicine PAs at the oldest public hospital in the country and largest in NYC cover "a-lock" (in addition to the less acute inpatients)... "A-lock” are patients who remain inpatients due to social and dispo issues, they have no inpatient medical needs that can not be handled in a skilled facility. It should be noted that some of these PAs also are content being "assistants" and not practicing at the top of their license. The house staff at this hospital also cover the more acute and sicker inpatients.

Reasons to do a residency if you want experience in a specialty/procedure heavy field.

[ventana]

about 1.5 years to get proficient  at interventional Radiology

 

never got admin to get behind me

 

left due to badge readings and total lack of Dx thought which I love..