Role of PAs on Trauma Team

[Nonlegit]

I've PM'ed people in this forum looking in the past for examples of these dream jobs, so I know how this feels. I will say this, most bases have been covered here. Level 1's will often have a ton of residents, ED and Trauma are usually two different services, and PA's (and NPs, since they exist in this role as well) often end up with as much surgery scut as trauma response.

 

The only major thing of note is that a hospital close to my own (also a Level 1) that is well known for trauma care (and is an absolute traumarama) employs a big group of NPs that supposedly are legendary. Our residents do a trauma rotation there, as do residents and students from other services from all over, with the exception of a surgery program in the hospital itself! So its my understanding that these NPs are studs, as there isn't a ton of competition for trauma workups. Not sure why they don't hire any PAs...but this has been my nut to crack for the last couple of years, which I will hopefully have fully fleshed out (and networked) by the time I get into school.

 

I do believe that the NPs are hired to cover the TSICU as floats with trauma response being assigned to individuals. Interesting stuff.

[Snakeeater12]

I don't ever see job advertisements for Trauma PAs. Lots of jobs for Trauma Physicians but not PAs. If one attends a residency/fellowship is it unheard of for the trauma jobs to sorta find them? How did those of you working in Trauma find your jobs?

http://www.indeed.com/m/viewjob?jk=ffa24396226bcd0b&advn=8285678679456567&from=serp&dest=http%3A%2F%2Fwww.indeed.com%2Fjob%2Fphysician-assistant-pa-trauma-surgical-relocation-vancouver-wa-ffa24396226bcd0b&desth=648b7016113937d3d3ef9aebe94bec98&pub=6275122494696506

 

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[SoCalPA]

Thank you. As soon as I said I didn't see any, I began seeing them everywhere I looked. Very good to know that they are out there.

[TheDude]

Tulsa, Oklahoma has a facility that uses PA's on the Trauma Services and has been for awhile.  I interviewed there and was offered a position but was unable to take it.  They utilized the PA's in some pretty cool ways in my opinion. 

 

The shifts were 12 hours on (2 PA's during days shift, 1 at night, along with the same for Physicians), 4-6 days in a span, followed by a week off.  They responded to all ED Trauma alerts, did all bedside procedures including chest tubes, intubations, central lines, etc... and if I remember correctly, they did bedside trachs with the attending watching.  There was little OR time as they were mostly busy in the ICU, but there were times for when they were needed in the OR. 

 

It's slowly trickling down to the area I live in, but our trauma center is academic and the PA's are coined "floor whores" per one I know there, and he doesn't like it much...I think its because its an academic center and the lack of respect/skills set/you name it.  But the ones I met in the other facility loved it.  Pay was good, hours were not bad, and the time off was the biggest selling point.    

[SoCalPA]

Is it really possible to work 4-6 12 hour shifts in a row? Is there much down time in trauma? I mean like how many trauma alerts in a 12 hr span? Just an approximation.

[EMEDPA]

Is it really possible to work 4-6 12 hour shifts in a row? Is there much down time in trauma? I mean like how many trauma alerts in a 12 hr span? Just an approximation.

the 4-6 in a row are not 60 hrs but 5 days with a 12 hr shift each day.

when I did my trauma surg rotation we did alternating 12 and 24 hr days for 5 weeks. > 600 hrs for 1 rotation. and it was my first. and yes, there can be a lot of down time between traumas, but you still need to cover the floor. and if you go to the OR you often spend 3-5 hrs there at a time. we lived there in a bunk room right next to the trauma bay and had meal passes for the cafeteria.

[SoCalPA]

Wow that's crazy. Sounds a bit like summer camp with the bunking. lol. I guess having the whole next week off can make it not so bad.

[EMEDPA]

Wow that's crazy. Sounds a bit like summer camp with the bunking. lol. I guess having the whole next week off can make it not so bad.

the local trauma PAs do 7 on, 7 off. 12 hr shifts.

on my rotation I had 1 day off in 5 weeks because we had a single day with no traumas in which we d/c everyone on the floor and did not have trauma clinic next day.

[jwmoneymaker]

The autonomy and scope of practice varies widely throughout the country for both Level 1 Trauma Centers and lower level centers. As a PA student I rotated within a Level 1 in South FL and that service operates very similar to the Level 1 I'm currently employed at as a PA-C in regards to the limited amount of "action" (procedures, new consults, admissions, trauma alerts, OR time, etc.). Rarely the opportunity presents itself to partake in procedures, but not very often. Most, if not all Level 1 centers are large academic institutions where the priorities of the attending’s and faculty are geared towards preparation of future Trauma Surgeons, i.e. Surgical Residents. That being said, the mid-levels spend most of their time taking part in daily rounds, ensuring medication regimens / labs are being addressed, and working eagerly towards discharging the pt's. We also take part in seeing the recently discharged patients at our outpatient trauma clinic on a once a week basis. The schedule is decent at 4 days per week, 10 hour shifts, no nights, rotating weekends between the mid-level team. Personally, I would rather work a variety of rotating shifts if it meant having the opportunity to be more engaged in the "action" trauma process.

 

Prior to taking this PA position, I worked at a few Urgent Cares as a sole provider seeing 20 - 40 patients in a 12 hr shift. Autonomy wise that was fantastic as I did a lot of laceration repairs, I&D's, FB removals, splinting, and occasional dislocation reductions. The pt population was broad and I learned a great deal in that environment.

 

I have an extensive EM background from the USAF and as a civilian flight paramedic. Within those two positions I was able to do much more hands on procedures including crics, intubations, line placements, needle thoracostomy, tube thoracostomy, escharotomy, faciotomy, wound closures, blood administration, IO placements, suprapubic thoracentesis, pericardiocentesis, vent management, cardiac monitor management, hemorrhage control etc.

 

Ultimately, I consider lower level trauma centers more inviting places for mid-levels based upon the aforementioned. Since the PA career field is already approx. half a century old, I doubt the trend of implementing mid-levels in a more invasive trauma role is going to change anytime soon, at least in the civilan setting(s).   

 

Flight Paramedics / Combat Medics / Critical Care Paramedics have a huge scope of practice / protocols and routinely encounter a great deal of action. Although, the salary of a PA makes the lack of hands on procedures more tolerable. Hopefully, this gives some useful insight into your future decisions in regards to PA employment options. 

 

I'm currently planning on moonlighting at an ED in an attempt to satisfy my need for procedures, however minor / non-invasive they may be.

[EMEDPA]

I think non-academic level 2s are a great fit for trauma PAs. typically high volume, high acuity with no residents around at most places.

[SoCalPA]

Thanks JW that puts things into perspectives. I'm kinda coming to the the same conclusion as EMEDPA. Looks like PAs interested in Trauma might have quality opportunities at a Level 2 Trauma Center. Although most of the trauma/critical care residencies are at Level 1 centers. I guess that's a good thing as long as it's structured.

 

Any suggestion on a professional way to ask a trauma residency program "will I get enough exposure and access to procedures even though you have resident program in the same hospital"?

 

[GreatChecko]

Pretty much how you asked it...

 

Ask how the procedures and traumas are split between MD and PA residents and ask the residents the same thing. I asked pretty much the same questions anytime I was interviewing for a EM PA residency. BTW, most EM residencies also incorporate traumas and the related procedures into the curriculum. For example, Hopkins has their residents cover the trauma bay overnight when they are senior PAs (last few months). So YMMV.