PA = resident?

[ladyinred1]

I went on an interview today for an EM position at a level 1 trauma teaching hospital that has a residency program for mds and a pa program. During the interview, I was told that they like to consider pas as equal to the residents and I as a new grad would be considered a first year resident. In addition, the er is divided into three levels of acuity with fast track the least and critical care the highest. Because they have a residency program, only two pas are able to be working with critical care patients one day a week when residents have grand rounds. I was told the reason for this was that the residents need the training doing advanced procedures. I asked what procedures I would be expected to perform and was told the usual suturing, splinting, I&D, etc. thinking back on it, it doesn't seem like I would be equal if I have little exposure to higher acuity patients.

 

I understand that I am a new grad and there is going to be a large learning curve and that no position in any field will give me great autonomy in the beginning but I was a little disheartened by this, especially considering that they have a pa program. I guess my question is, is this standard in an er? How do pas feel about being considered equal to residents?

[HJK]

Well, i do understand your concerns but would be a good place to start. Spending a couple of years learning the basics while being able to watch residents and attendings..

 

Of course, if you are treated like resident then might as well go into a residency would make more sense though..

[SoCalPA]

^^seems like a residency might make more sense. Unless of course $$ is a concern.

[EMEDPA]

residents, even interns, get more respect that even senior PAs at most places....

[SoCalPA]

^disheartening

[Gordon, PA-C]

If they are treating you as a first year resident then I would run far away from that job because it's a joke.  PAs should be treated MINIMUM like a 3rd-4th year EM resident.  

 

First year residents don't do any procedures solo whereas 3rd/4th years are allowed much latitude to do things without the attending being in the room.  

 

In many places, first year residents are supervised by upper level 3/4 year residents.  

[delco714]

You're looking for an er position in a level one academic er...did you really expect differently? Emed could and does go on for hours about respect and autonomy in er pas...and landing those jobs ..

[Acebecker]

If they are treating you as a first year resident then I would run far away from that job because it's a joke.  PAs should be treated MINIMUM like a 3rd-4th year EM resident.  

 

First year residents don't do any procedures solo whereas 3rd/4th years are allowed much latitude to do things without the attending being in the room.  

 

In many places, first year residents are supervised by upper level 3/4 year residents.  

 

Wholeheartedly disagree with that.  He's a new grad.  New grads treated like interns - makes sense to me.  Heck, I think even EMEDPA had that same experience.  That is, until the PA is second year out of school. Then treating him like a 2nd year resident makes sense.  See what I mean? 

 

Now, take a seasoned PA and put them into that ER setting and yes, they should be treated like a 3rd or 4th year resident.  In some cases should be treated like an attending. 

[EMEDPA]

Wholeheartedly disagree with that.  He's a new grad.  New grads treated like interns - makes sense to me.  Heck, I think even EMEDPA had that same experience.  That is, until the PA is second year out of school. Then treating him like a 2nd year resident makes sense.  See what I mean? 

 

Now, take a seasoned PA and put them into that ER setting and yes, they should be treated like a 3rd or 4th year resident.  In some cases should be treated like an attending. 

yup, that was my experience as well at a place with a residency. my 3rd yr there I had md interns rotating with me and I wrote their evals.

[cinntsp]

How do people make it out of school without knowing what the job environment is like out there?

 

OP: do a residency and work somewhere other than a large academic center if you want more autonomy.

[SocialMedicine]

This is not an MD better than PA issue often. It is a money issue. It is hard to train and credential a PA in a procedure. Think about it ... the didactics  the observed procedures .... for some EDs or CCU it is a challenge to make this happen. especially if they have faculty over committed to teaching a residency program and residents fighting for procedures. This is where a PA residency becomes valuable. I would consider it. Makes sense. I like it is a PA and patient. 

[Marinejiujitsu]

Which city is this? Sounds familar. Lol

[SocialMedicine]

Why would a brand new PA be treated as anything more than an intern ? IMO the new PA should be an intern level provider for at least 1-2 years. Maybe year 8 they can rise to the level of fellow/attending status.

[Marinejiujitsu]

BTW I would not want total autonomy in the emergency right out of school. Overall, we need to be micromanaged at least the first year. The average doctor out of residency loses an average of 7 patients their 1st year due to their clinical decision making at least per a pmd doc that I studies under.

[Marinejiujitsu]

BTW I would not want total autonomy in the emergency right out of school. Overall, we need to be micromanaged at least the first year. The average doctor out of residency loses an average of 7 patients their 1st year due to their clinical decision making at least per a pmd doc that I studies under.

Sorry, missing a comma. :huh:

[ladyinred1]

You're looking for an er position in a level one academic er...did you really expect differently? Emed could and does go on for hours about respect and autonomy in er pas...and landing those jobs ..

An academic center with its own well known pa program. I would think they would put more effort into training pas that they hire.

 

How do people make it out of school without knowing what the job environment is like out there?

 

OP: do a residency and work somewhere other than a large academic center if you want more autonomy.

I went to school 4 hours away from where I am living now. Additionally, my program had its own pa EM residency program. And we did not have a class on 'this is how jobs work in the real world'.

 

Maybe I wasn't clear enough. The interviewer said they consider pas as equal to residents and did not make any mention about experience level. In the hospital where I did my program, pas were respected and well trained. My issue is not my level of autonomy my first year working. I have no desire to work in an er with full autonomy in the first 12 months, if not longer. I am looking down the line and how this could impact my growth as a provider. And no, I do not want to do a residency for various reasons.

[greenmood]

Sounds like this place does not use PAs with higher acuity patients, and thus have no incentive to train PAs on higher acuity patients.

 

If you are looking for that kind of training, seems like you will need to find another location.

 

Your question was, "is this standard?" In large academic centers, possibly. The equality with residents is an entirely different question, in my opinion, and I think you took something from that the interviewer did not intend. Being given the same autonomy is not the same as being given the same training. You may have a resident's autonomy, but it will only be with the patients you're asked to care for.

[LT_Oneal_PAC]

BTW I would not want total autonomy in the emergency right out of school. Overall, we need to be micromanaged at least the first year. The average doctor out of residency loses an average of 7 patients their 1st year due to their clinical decision making at least per a pmd doc that I studies under.

There are studies to suggest that more years of experience equals worse outcomes. Not trying to make a point, just you reminded me of a study I saw once

 

http://annals.org/mobile/article.aspx?articleid=718215

[Marinejiujitsu]

There are studies to suggest that more years of experience equals worse outcomes. Not trying to make a point, just you reminded me of a study I saw once

 

http://annals.org/mobile/article.aspx?articleid=718215

I better retire then lol

[Soulfari]

This sounds like something I would be interested in when I attempt to get my foot in the EMPA door. Are they paying you as much as a resident, or are they paying you within limit of the national average? Sounds like a good opportunity to learn, and at worst a great line for your resume (Large academic center, Level 1 Trauma, etc). 

[gbrothers98]

I went on an interview today for an EM position at a level 1 trauma teaching hospital that has a residency program for mds and a pa program. During the interview, I was told that they like to consider pas as equal to the residents and I as a new grad would be considered a first year resident. In addition, the er is divided into three levels of acuity with fast track the least and critical care the highest. Because they have a residency program, only two pas are able to be working with critical care patients one day a week when residents have grand rounds. I was told the reason for this was that the residents need the training doing advanced procedures. I asked what procedures I would be expected to perform and was told the usual suturing, splinting, I&D, etc. thinking back on it, it doesn't seem like I would be equal if I have little exposure to higher acuity patients.

 

I understand that I am a new grad and there is going to be a large learning curve and that no position in any field will give me great autonomy in the beginning but I was a little disheartened by this, especially considering that they have a pa program. I guess my question is, is this standard in an er? How do pas feel about being considered equal to residents?

Not surprising at a teaching hospital.

The focus in an academic ED with a residency program will always be on the residents and their education.

Instead of focusing on a perceived potential lack of exposure to procedures, focus on several other things.

1. Is this a good job?

2. Does there seem to be a supportive environment?

3. Can you see yourself becoming a long term member of this team?

4. Is this the only potential deal breaker?

My unsolicited advice is this. Take the job if offered. Nothing, nothing is ever perfect. This will be a great experience for the short term. For the long term, it will be up to you navigating the obstacles you perceive. I worked in a community hospital ED right out of school. Great experience and learned a ton but it was not an academic environment. One of the ED attendings had graduated from a residency where much of his procedural knowledge came from the PA staff that provide a consistent core of staffing to the ED. Residents come and go. Someone needs to stick around and keep the lights on. PAs can do that in any ED.

An added advantage to working at this place. You will meet and likely befriend quite a few people whom you can network with later in your career. If you work at a place like this for 3 years, you will meet 3 classes of EM residents plus the attendings and other PAs you will work with. What gets you opportunities in the future is knowing the guy who knows the guy (or girl). Dont pass this up or discount it.

Good luck.

G Brothers PA-C