EMPAs outside of urgent care settings

[thomasrconnor1]

Hi all,

 

I am currently a 19 year old second year (sophomore) pre-PA student in upstate NY and also work as an ER tech in our regional medical center. I absolutely love working in the ED and would really like to work as an EMPA once I finish PA school but have concerns about simply being put on urgent care or "non-critical" patients, if you will. I know that at my hospital, our NPs/PAs in the Emergency Department are only permitted to work in our Fast Track area and are delegated to tasks like suturing minor lacs, etc. Although I greatly respect the work that PAs in urgent care do, I have a strong interest in patients with higher acuity such as traumas, etc. Is it very common for PAs to only work on non critical patients? How do I position myself to be able to work with the most critical patients? Sorry if there is any confusion as this is my first post! Thank you in advance for all of your help!!

[SoCalPA]

You might want to consider doing a residency. There are several in New York and I've heard that Albany Regional Medical Center has a good EM residency. You can read about it on the forum here.

[gbrothers98]

2 pathways to working with critical patients in the ED.

1. Become a physician and attend an EM residency.

2. Go to PA school. Attend a PA EM residency/fellowship after graduation. Realize that you will never take care of critically ill patients in a big medical center cause that is where physicians congregate. Make your peace with working at community hospitals in outlying, more rural communities. Acquire a hefty CME budget to enable you to regularly attend workshops to keep up to date with critical care skills. Realize there is a high pucker factor caring for someone actively trying to die.

 

Several insights from a PA who has worked solo in a small ED and taken care of critical patients:

1. The ED is exciting.....until it is not. There is high burnout in ED staff across the board due to a variety of factors. It is a challenge to make the ED a long term career and not everyone can do it solely based upon desire.

2. Shift work, nights, holidays, weekends take you away from all the regular people in your life. Be aware that you will be the odd man out, missing some of your life you wish you did not.

3. While in your ED you are witnessing PAs working below their license, for some this is where they want to be. At other sites and facilities, due to the population aging, conditions that used to be seen on the main side are getting pushed to the fast track. In some places fast track does not mean low acuity, it means you arent having AMI, stroke, multi trauma, sepsis or other severe life/limb threatening issue. So a PA in that setting still gets to see plenty of abd & chest pain, acute resp complaints, etc.

4. While I applaud a 19 year old with a definite plan, you are also 19. I think there is a lot of opportunity available to PAs in this country. These range from practicing clinical medicine to academics, entrepreneurship, healthcare administration and other related fields. Take a look at the landscape because if your timeline works out to be a PA, you will have a 35+ year career. 

 

Good luck.

G Brothers PA-C

[Febrifuge]

I personally happen to love Urgent Care, and find it more intellectually interesting than traumas and codes. I too did the ER Tech thing -- in an inner-city academic center, even -- and honestly don't miss it that much.

 

Even so, when you say

I know that at my hospital, our NPs/PAs in the Emergency Department are only permitted to work in our Fast Track area and are delegated to tasks like suturing minor lacs, etc.

...what you're saying is, your ER doesn't really employ PA's to the best of their abilities and potential. That says more about your hospital than it does about the PA profession, honestly.

[db_pavnp]

I fear it says a lot about a lot of hospitals...

[GreatChecko]

EM PAs work the full spectrum across the country. In many facilities, the PAs only do fast track and there are many PAs who are happy staying there. In others, they see everything. Some places are still working to figure out the right balance and are willing to let PAs take greater roles, if the PAs want to. 

[HJK]

EM PAs work the full spectrum across the country. In many facilities, the PAs only do fast track and there are many PAs who are happy staying there. In others, they see everything. Some places are still working to figure out the right balance and are willing to let PAs take greater roles, if the PAs want to.

So true. I work 50/50 between urgent care and main ED because I wanted to. Some only dose urgent care while some only does main side. My previous job did not allow PAs in the main side at all.

[lightbearer06]

When I first graduated, I had three job offers. One was in a large academic center that really pushed teaching PAs. Another was in a community hospital and relegated the PAs to fast track. I asked the ED administrator "Well, what if I want to learn to do advanced procedures?"

 

"Well, that would require changing hospital bylaws...blah, blah blah." 

 

The interview was over at that point. I took less money to work in the large academic center where I was, to some extent, looked on like a resident, and now I feel comfortable handling most things that come through the door. 

 

I am now working a rural ED with single physician coverage. We are right next to a nursing home so I mandatorily see 1-3 complicated, polypharmacy 80+ YO patient per shift.

 

You can do what you want, but I think that you need to look at your first few years out as a residency, whether you actually go into a a residency or not. Find the job with the largest scope of practice and physicians willing to train you.