Davo Posted April 20, 2011 Share Posted April 20, 2011 Im a student and hope Im allowed to post a thread here-if not please disregard. Im starting clinicals late this summer. We are required to take internal medicine 1/2, ortho, etc but we get an elective as well. With very little warning (under 24 hours) my school has asked me to pick an elective rotation as well-Ive requested hospitalist as my first choice. I think I enjoy medical patients :=-0: On top of that we were told that its a challenging choice. Ive been reading up on it tonight but though primary sources were a better idea. What clinicals did you find best prepared you for the role of hospitalist? Any advice to someone who may be taking a hospitalist clinical rotation? How about online resources? Thanks in advance. Davo Link to comment Share on other sites More sharing options...
deborah212 Posted April 21, 2011 Share Posted April 21, 2011 The best thing you can do to prepare yourself to become a good hospitalist PA is the same to becoming any good PA... 1) Read, read, read. Buy Pocket Medicine http://www.amazon.com/gp/product/1608319059/ref=pd_lpo_k2_dp_sr_1?pf_rd_p=486539851&pf_rd_s=lpo-top-stripe-1&pf_rd_t=201&pf_rd_i=0781744474&pf_rd_m=ATVPDKIKX0DER&pf_rd_r=0M8XNCE1EADB0WEQ2WAX before you start rotations, and as you encounter diseases and diagnoses as a PA student, look them up. Pocket Medicine is great in that it cites the most relevant literature to back the recommended treatments. Read uptodate/emedicine (both online) when you get home. It's never bad form as a student to not know an answer. What is bad form is not to look it up if you don't know. 2) Be proactive. Ask questions. Write down pearls as you go. 3) Don't be above doing scut work. Help out the nurses, PAs, residents, etc. Be humble. 4) Stay open. You never know what rotation might pique your interest. While hospitalist medicine might look good now, you may find that working in the OR is where you truly enjoy yourself. I knew my first job was likely going to be that of PA Hospitalist so I also chose electives that I thought would be beneficial: cardiology, rheumatology, and internal medicine sub-I where I worked 1:1 with an attending. When I interviewed for the job as the same institution where I did my schooling and the sub-I, I asked the director how working as a hospitalist PA would be different than my sub-I... He replied that it would be a lot harder. He was certainly right. While my electives were helpful in that I was exposed to some of the diagnoses I later saw, nothing can change the fact that EVERYTHING changes once it is your name on the presciption pad. Work hard, study hard, and enjoy yourself. You'll be fine! Link to comment Share on other sites More sharing options...
Annika Posted April 22, 2011 Share Posted April 22, 2011 Also a student thinking in that direction....the book the above poster recommends is fantastic! There are a few that I have (love reading) but this one seems to be the "it" book. Must say, however, that I need stronger glasses to read it! LOL Guess that's being old! Deborah- if you ever care to elaborate on your job, I know I'd love to hear it. Its one area that really appeals to me.... Link to comment Share on other sites More sharing options...
deborah212 Posted April 22, 2011 Share Posted April 22, 2011 Deborah- if you ever care to elaborate on your job, I know I'd love to hear it. Its one area that really appeals to me.... Hospitalist medicine, I believe, will be among the fasting growing fields for PAs, especially given the new ACGME restrictions limiting resident work-hours. There are many positives for the patient have a PA-attending hospitalist team: continuity of care, familiarity with the most current hospital medicine treatments for respective admitted diagnoses, and physical presence in the hospital for response to acute events. The PA experience in the field varies quite a bit I would expect depending on the setting (academic vs community, dedicated hospitalist attending vs private, large service vs small). I have worked as a hospitalist at 2 institutions; both were large academic tertiary referral centers. At the first hospital, I worked a M-F “40” hour work-week. Here, each PA would be assigned a panel of patients (average of 8) and work with several attendings who were either dedicated hospitalist or private physicians. We covered both the floor and medical step-down units with PAs and attendings rounding separately. If I was the first to see a patient, I would usually page the attending to run my plan if 1) I had any questions or felt a consult needed to be called 2) if the patient was ready for discharge or 3) the patient was sick. The positives of this model were that PAs were granted a tremendous amount of autonomy. Because the service was large, there was a nice comradery among the PAs. The negatives were the work redundancy given the separate rounding and that same autonomy. It was stressful to go as a new grad to a separate rounding set-up. However, I learned a great deal this way. At the second hospital, I worked a staggered schedule of 12 hour shifts. Rounding was done together with PA/attending. Census was typically lower on this service at 6-8 patients. I’m amazed when I see advertisements for hospitalist PAs covering 15-20 patients. I think the difference here is the academic/tertiary hospital vs community/small. While I might be able to round on 10-15 diverticulitis, PNAs, and COPD exacerbations… I would fall apart if that also included arranging IVIG for hemolytic anemia, a bone marrow biopsy for suspected MDS, or managing a peri-ICU patient on BiPAP while doing admissions. As far as in hospital emergencies, I’ve never had to start CPR on a patient. I’ve had one patient who got intubated on the floor, many who were started on BiPAP, many AF RVR, much hypotension/hypertension, and recently quite a few stroke codes (stroke team activation). Being hospitalist means you will deal with death, either with a patient dying unexpectedly on the floor/ICU or expectedly in comfort care scenarios. My thoughts on hospitalist medicine: it’s a fantastic first job because of the broad medicine exposure. At no point could I ever claim that “I’d seen it all.” I do think there is a moderate amount of burn-out because hospitalist medicine is grueling physically, intellectually, and emotionally. Personally, I don’t see it as a forever career for me, but I’m glad for my experience thus far. Link to comment Share on other sites More sharing options...
Davo Posted April 22, 2011 Author Share Posted April 22, 2011 Deborah thanks so much for your recommendation and window into your day to day. I just placed an order for Pocket medicine. Concerning the work hours of residents, is there any such legislation/policy concerning PA work hours? I know it can vary greatly but in general how have you found the physicians? Are they generally open and accepting of PA hospitalists? Link to comment Share on other sites More sharing options...
Contrarian Posted April 22, 2011 Share Posted April 22, 2011 Pocket Medicine is good (on my bedside table) Other VERY good but little known choices are the "Saint-Francis Guides." Also... I'm confused, isn't a inpatient medicine rotation still one of the REQUIRED rotations (Surg, Inpatient, EM) that ALL accredited programs must have for ALL their students versus a "elective"..??? Contrarian Link to comment Share on other sites More sharing options...
deborah212 Posted April 22, 2011 Share Posted April 22, 2011 I'm confused, isn't a inpatient medicine rotation still one of the REQUIRED rotations (Surg, Inpatient, EM) that ALL accredited programs must have for their ALL their students versus a "elective"..???All programs due require inpatient internal medicine. I did 2 months on a typical resident team with q4 call. When I did my elective on the PA hospitalist service, it was an advanced internal medicine rotation. I was functioning as a quasi-PA with no residents or PA intermediaries. The purpose of the rotation was to simulate how I would function as a hospitalist. All my scipts and orders, though, still needed to be cosigned by the attending, and I only carried 2-4 patients per day. I'm not sure what Davo's elective entails, but perhaps it's something similar. Concerning the work hours of residents, is there any such legislation/policy concerning PA work hours?No work hour restrictions. You sign a contract that should specify the amount of hours. Otherwise, I stay until I sign out or later if a sick patient needs transfer. I know it can vary greatly but in general how have you found the physicians? Are they generally open and accepting of PA hospitalists? It depends. I feel pressure to work harder because I'm a PA and am surrounded by top rated residents and physicians. Generally, we are treated well and once attendings start working with us, they love it. The residents on consults that I have the most issues with are usually the ones that give everyone flack. Link to comment Share on other sites More sharing options...
Davo Posted April 25, 2011 Author Share Posted April 25, 2011 All programs due require inpatient internal medicine. I did 2 months on a typical resident team with q4 call. When I did my elective on the PA hospitalist service, it was an advanced internal medicine rotation. I was functioning as a quasi-PA with no residents or PA intermediaries. The purpose of the rotation was to simulate how I would function as a hospitalist. All my scipts and orders, though, still needed to be cosigned by the attending, and I only carried 2-4 patients per day. I'm not sure what Davo's elective entails, but perhaps it's something similar. No work hour restrictions. You sign a contract that should specify the amount of hours. Otherwise, I stay until I sign out or later if a sick patient needs transfer. It depends. I feel pressure to work harder because I'm a PA and am surrounded by top rated residents and physicians. Generally, we are treated well and once attendings start working with us, they love it. The residents on consults that I have the most issues with are usually the ones that give everyone flack. Good to know, and you are right about the hospitalist elective rotation. BTW I should be getting pocket medicine in a few, and am looking forward to it. Link to comment Share on other sites More sharing options...
GoodRx Posted May 15, 2011 Share Posted May 15, 2011 My program does not require inpatient internal medicine, which is unfortunate because I am very interested in hospital medicine. I am graduating in December and am almost half way through my rotations. Would it be worthwhile for me to attend the Hospitalist Boot Camp? I would assume students could go. I would need to get my program to give me the time off and I can afford it so would it be a good idea? Thanks! Link to comment Share on other sites More sharing options...
Contrarian Posted May 15, 2011 Share Posted May 15, 2011 My program does not require inpatient internal medicine... Really...??? I was under the impression that for a program to be accredited... it HAD to have this Inpatient rotation for its students, along with Primary Care-(FP/IM/Peds/OB/Gyn), Surgery, and EM rotations. If this is not a requirement for accreditation... then the notion that ALL accredited programs teach to the graduate level, are equal, and teach the same things regardless of degree issued is patently false. Interesting... Contrarian Link to comment Share on other sites More sharing options...
deborah212 Posted May 15, 2011 Share Posted May 15, 2011 I was also surprised. I looked it up in the ARC-PA standards for accreditation, and apparently a program does NOT need inpatient internal medicine.... any inpatient rotation suffices. B3.03 Supervised clinical practice experiences must provide sufficient patient exposure to allow each student to meet program-defined requirements with patients seeking:a)medical care across the life span to include, infants, children, adolescents, adults, and the elderly, b)women’s health (to include prenatal and gynecologic care), c)care for conditions requiring surgical management, including pre- operative, intra-operative, post-operative care and d)care for behavioral and mental health conditions. B3.04 Supervised clinical practice experiences must occur in the following settings: a)outpatient, b)emergency department, c)inpatient and d)operating room. GoodRx, what have your "inpatient" rotations included? In this case, I really would try to do an "elective" in inpatient internal medicine (either on a resident team, hospitalist service, or in the ICU). I haven't been to the hospitalist boot camp, but several of my colleagues went last year and found to be amazingly applicable to hospitalist practice. It is lecture based. As a PA student, if you have the choice between going the hospitalist boot camp and getting a rotation in inpatient medicine, I'd choose the rotation. Link to comment Share on other sites More sharing options...
Contrarian Posted May 15, 2011 Share Posted May 15, 2011 So theoretically, a PA student could complete their entire program with 3 clinical rotations: 1- 12 month "death by power-point" session... 1- 10 month Family Practice Rotation (medical care across the life span to include, infants, children, adolescents, adults, and the elderly women’s health to include prenatal and gynecologic care) 1- 1 month Psych Rotation (care for behavioral and mental health conditions) 1- 1 month OB rotation with a doc that does C-Sections (care for conditions requiring surgical management, including pre- operative, intra-operative, post-operative care) WOW....!!!! I could see this working with the OLD PA student demographic, but looking at this from the perspective of our current MD/DO detractors... There was a time when pretty much EVERY PA student generally ran rings around 99% of the MD/DO students they interacted with because they arrived in the program with decades of previous experience and were genuinely comfortable functioning in the health care environment. They were mostly in their late 20s... early 30s (often 40s and 50s) and the young-ins in the MD/DO programs could do nothing but respect them for the experience they brought to the table. The way they seem to see it NOW is a comparison of a in-experienced 23yr old MD/DO student who knew nothing about health care 2 yrs ago with a in-experienced 23yr old PA school graduate who knew nothing about health care 2 yrs ago ... and have rightfully come to the conclusion that they are galaxies apart in medical knowledge... and also seem to see their generational peers/cohort who become PAs as taking a shortcut into the practice of medicine... but wanting the same perks, respect, and renumeration as those who followed the traditional MD/DO path into the practice of medicine. When you couple the above with the removal of the previous "SIGNIFICANT" paid direct health experience requirement ... I now sort of understand (but don't "completely" agree with) why they laugh at us over on SDN when we go on bragging about clinical hrs and insisting that we should be given some sort of standing in a MD/DO program...??? But I'll simply stop "flogging this horse" since it stopped breathing about 8-10 yrs ago... :heheh: Just a few thoughts... Contrarian Link to comment Share on other sites More sharing options...
deborah212 Posted May 15, 2011 Share Posted May 15, 2011 So theoretically, a PA student could complete their entire program with 3 clinical rotations:1- 12 month "death by power-point" session... 1- 10 month Family Practice Rotation (medical care across the life span to include, infants, children, adolescents, adults, and the elderly women’s health to include prenatal and gynecologic care) 1- 1 month Psych Rotation (care for behavioral and mental health conditions) 1- 1 month OB rotation with a doc that does C-Sections (care for conditions requiring surgical management, including pre- operative, intra-operative, post-operative care) Plus a 1 month rotation in the ED. I don't know of any program that does it this way, but it's still scary that it's possible. Link to comment Share on other sites More sharing options...
Contrarian Posted May 15, 2011 Share Posted May 15, 2011 Plus a 1 month rotation in the ED. Since it REALLY only seems to be about the $$$$ and NOT about whats best for the profession or the students... I'd bet that a free standing Urgent Care or Fast track would suffice...??? :saddd: Link to comment Share on other sites More sharing options...
GoodRx Posted May 15, 2011 Share Posted May 15, 2011 Since I'm in the program at the moment, I don't feel like I'm at liberty to say much about it. It may be surgery is considered inpatient, I don't know. I really just wanted to know if the boot camp was a good idea for a student or not so I could build a better foundation. The topics look very interesting and useful. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 15, 2011 Moderator Share Posted May 15, 2011 Really...??? I was under the impression that for a program to be accredited... it HAD to have this Inpatient rotation for its students, along with Primary Care-(FP/IM/Peds/OB/Gyn), Surgery, and EM rotations. Contrarian there are programs now that do not have peds or ob rotations too....I belive the material has to be "covered" but some programs believe you can do that with extra FP rotations...not a good idea IMNSHO....gotta have the ob L+D and surgical c-section experience Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 15, 2011 Moderator Share Posted May 15, 2011 So theoretically, a PA student could complete their entire program with 3 clinical rotations: 1- 12 month "death by power-point" session... 1- 10 month Family Practice Rotation (medical care across the life span to include, infants, children, adolescents, adults, and the elderly women’s health to include prenatal and gynecologic care) 1- 1 month Psych Rotation (care for behavioral and mental health conditions) 1- 1 month OB rotation with a doc that does C-Sections (care for conditions requiring surgical management, including pre- operative, intra-operative, post-operative care) WOW....!!!! I could see this working with the OLD PA student demographic, but looking at this from the perspective of our current MD/DO detractors... There was a time when pretty much EVERY PA student generally ran rings around 99% of the MD/DO students they interacted with because they arrived in the program with decades of previous experience and were genuinely comfortable functioning in the health care environment. They were mostly in their late 20s... early 30s (often 40s and 50s) and the young-ins in the MD/DO programs could do nothing but respect them for the experience they brought to the table. The way they seem to see it NOW is a comparison of a in-experienced 23yr old MD/DO student who knew nothing about health care 2 yrs ago with a in-experienced 23yr old PA school graduate who knew nothing about health care 2 yrs ago ... and have rightfully come to the conclusion that they are galaxies apart in medical knowledge... and also seem to see their generational peers/cohort who become PAs as taking a shortcut into the practice of medicine... but wanting the same perks, respect, and renumeration as those who followed the traditional MD/DO path into the practice of medicine. When you couple the above with the removal of the previous "SIGNIFICANT" paid direct health experience requirement ... I now sort of understand (but don't "completely" agree with) why they laugh at us over on SDN when we go on bragging about clinical hrs and insisting that we should be given some sort of standing in a MD/DO program...??? But I'll simply stop "flogging this horse" since it stopped breathing about 8-10 yrs ago... :heheh: Just a few thoughts... Contrarian you know I'm with you on this...check out the current "little hce and pa school" thread for current attitudes about hce....pathetic....it's because of this that pa programs are getting longer and longer...usc now at 3 yrs to add more clinical time, etc we are heading for the avg pa program being 3 yrs and then after that, the mandatory residency.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 15, 2011 Moderator Share Posted May 15, 2011 Since it REALLY only seems to be about the $$$$ and NOT about whats best for the profession or the students... I'd bet that a free standing Urgent Care or Fast track would suffice...??? :saddd: yup, I've seen it.... of course then they add in rotations that really don't add much to pa school.....cosmetic derm elective rotation for example..... Link to comment Share on other sites More sharing options...
deborah212 Posted May 15, 2011 Share Posted May 15, 2011 Since I'm in the program at the moment, I don't feel like I'm at liberty to say much about it. It may be surgery is considered inpatient, I don't know. I really just wanted to know if the boot camp was a good idea for a student or not so I could build a better foundation. The topics look very interesting and useful. If you can't get a rotation, I would do the Hospitalist Boot Camp. As I said before, I've heard good reviews from 3 different colleagues. Maybe I'll see you there. :) Link to comment Share on other sites More sharing options...
Contrarian Posted May 15, 2011 Share Posted May 15, 2011 If you can't get a rotation, I would do the Hospitalist Boot Camp. I agree... but just don't be suprised if sitting in a chair listening to lectures and staring a powerpoints covering Internal Medicine topics isn't that "fruitful"... and a lot cheaper to do at your PA program. I'd really INSIST on doing the actual rotation taking care of real patients.... My $0.2 Contrarian Link to comment Share on other sites More sharing options...
Davo Posted May 16, 2011 Author Share Posted May 16, 2011 If you can't get a rotation, I would do the Hospitalist Boot Camp. As I said before, I've heard good reviews from 3 different colleagues. Maybe I'll see you there. :) Just wanted to say thanks for the book recommendation. Pocket Medicine has proven helpful several times over my rheumatology module. One of my biggest frustrations in school has been the lack of clear, succinct data when its most needed. Having to flip through indexes or powerpoints or the web to get info impedes the learning process, imo, and this book does not have that problem. Link to comment Share on other sites More sharing options...
greenmood Posted May 16, 2012 Share Posted May 16, 2012 Going back to the original Q... je comprends that one must be a good overall PA to do well in a hospitalist position. But I would love to know if there were any speciality rotations that you felt were good experience going into the field. I have a hospitalist rotation and my advisor suggested cardiology or infectious disease a a corollary. Will def pick up Pocket Medicine. :) Link to comment Share on other sites More sharing options...
Doc Savage Posted May 16, 2012 Share Posted May 16, 2012 Since I'm in the program at the moment, I don't feel like I'm at liberty to say much about it. It may be surgery is considered inpatient, I don't know. I really just wanted to know if the boot camp was a good idea for a student or not so I could build a better foundation. The topics look very interesting and useful. All students have to have an "Inpatient" Medical rotation. It does not have to be in internal medicine. A few of our students have used Ortho or CV surgery as their "inpatient" rotations. Back to address the OP's original query. I worked for 4 years in the Hospital with Hospitalist and intensivist's as a Nurse before PA school, then I got to do my rotation at that same hospital. I thought I was pretty prepared for my internal medicine inpatient hospital rotation. I knew it was not going to be "easy" but the level that I was expected to perform at and the things I had to do handed me my butt on a platter after the first week. I also was a two tour combat medic vet... so I know what its like to get my butt handed to me quite well. I did excellent on the rotation but I was so fried out by the end of it... the last day I yelled at a patient. An IV druggie who went AMA, IV pole and all,to smoke and then come back. I told her her endocarditis will likely kill her if she does not get antibiotics. She started yelling at me about how we were imprisoning her, and I lost it. This is after I spent several nerve grating hours trying to deal with this histrionic person and get her to stay so she wont DIE! So nothing could have prepared me... not even 4 years in a similar environment in a different role. They offered me a job but im not so sure about it. Just be a great student and great person and be involved 100%. They said other students were playing angry birds during rounds and going on cruises and there to vacation rather than learn. I was there in the pits everyday and was early and stayed late and was totally committed. THATS what you have to be. Link to comment Share on other sites More sharing options...
VictoriaO Posted May 17, 2012 Share Posted May 17, 2012 I'm a new-grad in a hospitalist position, so I'll kick down my 2 cents on this... It's a tough, fun, grueling job, rednoms has the right of it, you get some genuinely sick patients that are not invested in their health (some of CFers, type-1 diabetics, etc) and sometimes your job is negotiation tactics. Before PA school I was sort-of a trained-on-the-job LPN, so I admined all sorts of meds, insulin, did wound care, basically any of the nursing orders (under RN delegation) for a group of very similar patients (most formerly homeless) to the ward frequent fliers (CHF, DM II, HIV, Hep C, ESRD, most with superimposed addiction and psychiatric illness, some with fascinating rare diseases like CREST syndrome, Elhner's-Danlos, Eisenmenger syndrome, Huntingtons, Milroy's disease, etc). Much of the time I was cajoling the schizophrenic Parkinsonian patient that he needed to go the ED since his blood pressure was still 240/130 after 2 doses of captopril, convincing the toxic-appearing urosepsis-smelling guy that he needed to go get IV antibiotics and his vitals of B/P 90/60, HR 130, temp 103 did not mean he could take a tylenol and we call his doc in the morning, or telling the patient that the cup of blood next to his bed was not tomato juice (quit lying) and he needs to go in because he's probably having a GI bleed. So coming into PA school knowing what your COPD/CHFer look like when they start to decompensate, being comfortable knowing most of the internal medicine-type drugs, their doses, and what type of patient gets them, as well as being able to handle an angry drug seeker or calm a paranoid schizophrenic was great preparation for being a hospitalist PA. It might just be centric to my hospital, but we get a lot of classic "difficult' patients which were my bread-and-butter prior to PA school. At a community hospital you might get more of the classic diverticulitis, COPD exacerbation, CAP, vs my facility, where they must have some rare disease that you might need to look up, significant non-compliance with outpatient meds who come in demanding IV narcotics and nicotine patches. Never boring though! As far as rotations go, doing an elective with a hospitalist PA would be a great idea. Our daily job can be quite different from the more formal internal medicine rotations you will get as a student with teaching rounds, long case presentations etc, low-census caps, etc. What I would suggest as an elective would be medicine ICU. You will have patients crump on you as a hospitalist, it happens sometimes when you least expect it. I've been coming into the role of the "damage control" person on my team, when our admission pager is howling non-stop I'll go to the RRTs on our patients, go look at the tele strips, start calcium gluconate, insulin drip, BiPap, etc while my docs go admit. So doing an ICU elective will make you a bit more comfortable in these situations to know who's about to be "buying some plastic" as they say and who can be managed still on the floor with a fixable problem. Otherwise as far as electives go, I would say nephrology would be exceedingly helpful. Our service does a lot of consultations for surgery and psych teams (why is my patient so hyponatremic? why is their GFR tanking?) is a big one, so feeling comfortable with those types of issues and how to do your work-up is very helpful. A good book for this is "Fluids and Electrolytes made ridiculously simple", it has a lot of great problems and cases to solve. Cardiology is always good, I'm glad I didn't do it actually because we co-manage any of our cards patients with, well, Cardiology, and we round with them sometimes, reading their detailed note is great learning. ID is always good, but if Sanford is already your best friend (like mine) then you might be ahead of the game. Really any of your core internal med electives could be helpful, heme/onc, pulmonology, etc Good luck, and keep us posted in the hospitalist PA forum where you end up! Link to comment Share on other sites More sharing options...
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