"Duties" of PAs in the ER?

[FuturePA/MD/DO]

Hi, so I'm new to the forum and I am really interested in becoming a PA. I know that Trauma PAs and ER PAs are different but I am interested in the "duties" of the ER PA. Is it true that the ER PA will see the more minor cases while the Physician will run the code or stabilize the trauma pt? I have many doctors and nurses in my family and they all give me different answers. I understand that the duties vary but in general what are the primary duties? Personal examples are good too!

Basically, I don't want to become an ER PA if it means I will be treating the lacerations and stuff, I would rather be assisting in the code or helping stabilize the trauma pt. before handing them off to the trauma team or the OR. Would it be more worth it to go to med school if ER is what i really want to do? (I have done lot's of shadowing etc. and ER feels like the place for me :)) How does an ER PA contrast with a Trauma PA?

Thank you in advance!!

Daniel

[EMEDPA]

GO TO MEDSCHOOL IF YOU ARE ABLE! you will; never have to say "what if".

that being said, there are as many pa scopes of practice as there are jobs.

some places pa's do fast track only, others they work double coverage with docs, others they work solo.

I am working a solo night shift right now at my primary job. no doc in sight. I only see my sponsoring physician on the rare occassions when he relieves me in the morning. we staff pa's 24/7 with a doc on day shift only. I have run 3 codes here in the last week. after almost 25 years working in em I really prefer to work alone or double coverage with a single chart rack alternating charts with a doc( I do this at my rural part time job).

trauma pa's only do trauma( and sometimes also general surgery and/or critical care in the icu).

er pa's do everything, especially at places with no trauma team and no residents. when I work my rural job the trauma team is me and the doc. if we have multiple critical trauma pts he gets a few and I get a few. sweet deal.

[HopefulPA]

You can't get better advice than that of EMEDPA.

[MWalsh831]

I work in a level 2 trauma hospital outside of Boston. We usually have about 4-5 docs and 6-7 PA's. A lot of the codes and more critical cases will be run by the Doctors, however there are a couple PA's who have more experience and are comfortable running codes and the doctors will let them. Doctors are always nearby so if something goes downhill and they have a question they aren't out of reach. EMEDPA gave great advice, "what if's" suck.

Try doing some shadowing at different hospitals to see how they each utilize their PA's, or ask the PA if they moonlight somewhere else. Some of the PA's that work at the hospital that I am at moonlight other places that only allow them to work in fast track settings.

[dm123]

GO TO MEDSCHOOL IF YOU ARE ABLE! you will; never have to say "what if".

 

Great advice if it fits you, especially the if you are able part.

 

My class was composed of mostly over the hill types as far as the option of medical school was concerned. In fact, thinking back, of a class of 29, I don't remember anyone who wasn't at least in their very late 20's. There was only one who didn't have at least a Bachelor's degree, one Master's and a PhD in bio-chem that gave up a University teaching position to attend PA school. I would put the average age at 34+- on the day our class began. A diverse group, made up of Nurses, Med techs, Radiology techs, Paramedics, a Vietnam era medic and the like. Some married with kids and an understanding spouse. All were making a career change, at least that I remember. People don't generally do this to go to med school unless they come from affluents and money. I know personally, I paid my own way through PA school with savings, loans (grants were not available) and living off peanut butter and Rice Chrispies, and a ten speed bike.

 

I don't think becoming a PA is any lesser of a career than being a physician, it is just different. Which ever field you go into, after a period of time the sugar gets licked off your lollipop and it tends to become the same old-same old. This is why you get that paycheck at the end of the month. It it was all fun and games, people would do it for free.

 

Becoming a physician involves fate, family background, cultural background and of course capability and money. I attended the University of Florida. At the time we were told if we had what it takes to get through their PA program, we had what it takes to get through their Medical School program. Talking about smarts here.

 

I would think, even among physicians, that there is a bit of "what if" I had become a specialist instead of a Family Practice doc, or a surgeon instead of a specialist, or a neurosurgeon instead of a general surgeon. Maybe during the "match" when graduating medical school, the young doc had a large group wanting to be surgeons and he/she had to "settle" for Family Practice whereas in another year he/she could have placed. Kind of like the NBA or NFL draft.

 

Life may not deal you a pair of Aces but with the right attitude you can still win with a pair of twos. Doctor or refuse collector (garbage man), do the best with what you got. It takes a bit of luck, maybe a whole lot of luck as well.

[ventana]

I would rather be assisting in the code or helping stabilize the trauma pt. before handing them off to the trauma team or the OR. Would it be more worth it to go to med school if ER is what i really want to do? (I have done lot's of shadowing etc. and ER feels like the place for me :)) How does an ER PA contrast with a Trauma PA?

Thank you in advance!!

Daniel

 

 

 

As a doc you are not assisting - it is your Ars on the line - you are the head coach and everyone is under you (I know we all work in a team format but in reality this is sort of true - the buck stops with the Doc)

 

If you like being the best 2nd in command PA is great - I personally like being able to leave work at work, and enjoy being a PA - however, if I had gotten into med school I am sure I would have enjoyed a MD as well. If you are still young - and smart enought to get into med school - go for it - if you are older or more into enjoying live instead of selling it down the river go to PA school

 

But don't think PA's only assist - just today (in primary care) I saw patients and developed working Ddx including pneumonitis, right heart failure, uncontrolled DM, obeasity, general decline, wrist (navicular) fracture, 2 cases of low back pain, one asthma, one work note needed, a half dozen or so URI's, a possible adrenal insufficiency, ?ACL versus strain, and about 10 other patients (busy day) - - - - How many times did I ask the doc what to do? NONE - every case was mine, I decided all work up and testing---PM cortisol/acth, Exercise stress test, Hematology consult for thrombocytopenia, xrays, ordering PT, interperting CXR for likely isolated right heart failure, readingEKG to r/o acute changes..... by no means is this an ASSISTANT possition

 

There are also PA's that single staff remote ER's and for every purpose they are the doc (course not getting paid like a doc) That run the entire show

 

 

think about it

 

ponder it

 

shadow doc's and PA's

 

see if you have the ability to get into Med school - hate to say it but med school admission does not favor the typcial white male applicant

 

and if you decide on PA - and want to be a doc someday you still can - and hopefully will be more bridge programs in the future.

[Emerson]

I would suggest considering Med School only if it fits into the overall goals you have set for yourself and that it supports your lifestyle. As a PA, I am very happy not having to deal with all the administrative, staffing, regulations, malpractice, etc that comes along with being a partner in a group. Certainly the financial aspects are a motivator, but ultimately I am happy to have chosen my path as a PA in the ED. Ultimately, what you do in the ED depends on the group or hospital system you're working within. My group doesn't consider PA's to be semi-pro's!! In fact, I think the PA's in my group are held to a higher standard than my attending counterparts. My group covers (3) ED's one of which is a Level 1 trauma center where I get to participate in many cases. Generally, we don't have a fast track and I am working up everything from ankle pains to a STEMI. Procedures I get to perform include: Lumbar Punctures, Chest Tubes, Intubations, Abscess Drainage, Suturing, etc.

 

In the end, you'll get different answers because it all boils down to the group or hospital system you work within. You're going to be faced with so many different aspects of healthcare that you may find yourself not liking ED at all, but rather developing a passion for another field based on your rotational experience. Rather than pigeon hole your decision based on what an ER PA vs MD/DO does, I would look at the overall PA vs MD/DO concept and compare that to the goals you have set for yourself in your life. Good luck!

[EMEDPA]

I think the PA's in my group are held to a higher standard than my attending counterparts.

that's not a good thing....

md makes mistake..."well it was a confusing clinical picture and an atypical presentation"

pa makes same mistake......"they should have known better, an md would never miss that....."

 

I have heard this many times...in fact awhile ago I presented a case to one of my attendings and said "I think this pt has xyz"(and documented this in my note). attending said "no they don't, send them home"(also documented).

well, they had xyz. independent doc didn't review all my documentation and said" a physician would never have missed this"( and wrote that opinion in his review). I referred them to my note. end of story. no apology of course. I don't work there anymore. I quit because of this lack of pa support from the docs and the administration in general. several of us quit at the same time and now they are staffed mostly with new grad "independent np's".

[PAruby]

As mentioned above, it depends on where you practice. Where I'm at, I would certainly not become an ED PA... I am currently a paramedic with a fairly broad scope to include suturing, insertion of whatever kind of tube you want to place wherever you want to place it, running codes, intubations, conscious sedations, and the works. As an ER PA in my community, I can do almost done of that and might as well stick to an urgent care, while if I were to specialize in peds, cardiac, neuro, derm, etc. I'd have a whole lot more flexibility and autonomy (depending on my physician partner of course).... just my two sense being in that setting for several years. I don't know much about Trauma PAs, but if you're into skills and such that might be a better option for you!

[Emerson]

that's not a good thing....

md makes mistake..."well it was a confusing clinical picture and an atypical presentation"

pa makes same mistake......"they should have known better, an md would never miss that....."

 

E -

 

PAs in my group staff patients with our attendings and they must agree with our final medical decision making prior to discharge/admit - which, eliminates "an md would never miss that". Most often, I work up the patients and then will talk to my attending "Patient in Bed 21 classic GB story. US reveals 2 mm non-obstructive stone, labs unremarkable, etc". Attending will stop by the patients room, do their own exam and either agree with my MDM or add to the work up. I like this concept for many reasons: 1) 6 months into my career I certainly learn a lot staffing my patients this way 2) I practice in a very wealthy area where patients are extremely knowledgable and want an MD involved in their care. However, If I have a case that qualifies for fast-track criteria and I can dispo those patients on my own.

[EMEDPA]

in many settings pa's do not have to staff cases at all or in a rural setting there may be no one to staff cases with as you work alone. in these situations a pa doing exactly the same thing a doc would do may get judged more harshly just because they were a pa, even if the case is not straightforward.

docs are more willing to accept mistakes from other docs than from pa's, even the same mistakes....

[dm123]

that's not a good thing....

md makes mistake..."well it was a confusing clinical picture and an atypical presentation"

pa makes same mistake......"they should have known better, an md would never miss that....."

 

I have heard this many times...in fact awhile ago I presented a case to one of my attendings and said "I think this pt has xyz"(and documented this in my note). attending said "no they don't, send them home"(also documented).

well, they had xyz. independent doc didn't review all my documentation and said" a physician would never have missed this"( and wrote that opinion in his review). I referred them to my note. end of story. no apology of course. I don't work there anymore. I quit because of this lack of pa support from the docs and the administration in general. several of us quit at the same time and now they are staffed mostly with new grad "independent np's".

 

Great Post!!

 

This is kind of like the relationship between a Sargent Major and a Second Lieutenant, they lose the end game. Your supervisors lost competent help to save face. If they do it enough times, they will end up with the short end all alone.

[brookspa]

yuo are ablolutely correct. We are held to a higher std. Maybe thats why so many ct studies and "extra labs are done, proving our case" no doubt other mds hold us to a standard above that, which they would hold a fellow MD/DO. that felt clumsy. I work that solo country ED, critical access hosp. I talk to rec. physicians at larger hospitals and they are hesitant about working with no back up, in any specialty available. just what you are used to.