theswordfish Posted July 20, 2015 Share Posted July 20, 2015 If you were hiring for the ER, which skill set would you prefer? A PA with a background in a large and varied gen surg practice, or an orthosurg PA? I feel that the gen surg PA would have a better grasp of internal med, especially since they would have to do more complicated hospital rounding, as well as more procedural skills. The orthosurg PA would have a strong skills in radiology and sports medicine, both are also important in the ER. What do you think? Link to comment Share on other sites More sharing options...
cbrsmurf Posted July 20, 2015 Share Posted July 20, 2015 I don't work in any of those fields, so I am curious as well. I figure ED sees a lot of abdominal complaints (gen surg), but then again, there's a lot of musculoskeletal complaints as well. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 20, 2015 Moderator Share Posted July 20, 2015 You could make the case for either, really. To me it would come down to the individual- if one was adaptable and one wasn't, the decision is easy, no matter gen surg vs ortho. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 20, 2015 Moderator Share Posted July 20, 2015 all else being equal gen. surg> ortho. the ortho guy could do a few reductions, but would only know one abx (keflex) and very little real medicine. ortho=woodshop. :) Link to comment Share on other sites More sharing options...
winterallsummer Posted July 20, 2015 Share Posted July 20, 2015 Gen surg - deals with more emergencies, has wider differentials, etc. But I think it comes down to the individual in general. The main advantage in ortho would be in catching those hard-to-spot ortho cases and placing bone. Most ortho cases are XR'd then splinted and sent home for follow up, or handed over to ortho right away. Link to comment Share on other sites More sharing options...
RealityCheck Posted July 21, 2015 Share Posted July 21, 2015 Neither. Both are surgical and may know squat about otitis media, CHF, diabetic DKA or bee stings. It takes a lot of skills to do urgent care/ER but way more to do family practice. What is the definition of a double blind study? Two orthopods reading an EKG...... That is why I moved specialties over 25 yrs and made a skill set and knowledge base that can treat bacterial vaginosis AND reduce a shoulder dislocation. Just my two cents.... 25 yr PA been there, done that Link to comment Share on other sites More sharing options...
RealityCheck Posted July 21, 2015 Share Posted July 21, 2015 It gets better --- sorry, on a roll tonight 3 doctors (or PAs but more likely docs) are sitting in a duck blind. Something flies by The first one says - well, it looks like a duck, has the shape of a duck but could be a goose. Damn, I missed it - The radiologist The second one sees somethings - well, it flies. It could be a duck or a goose or an albatross. Damn, I missed it - The internist The third one sees something fly by - BOOM. Um, what was that? - The orthopedist……... Sorry, tough day - needed a giggle Link to comment Share on other sites More sharing options...
Guest JMPA Posted July 21, 2015 Share Posted July 21, 2015 Neither. Both are surgical and may know squat about otitis media, CHF, diabetic DKA or bee stings. It takes a lot of skills to do urgent care/ER but way more to do family practice. What is the definition of a double blind study? Two orthopods reading an EKG...... That is why I moved specialties over 25 yrs and made a skill set and knowledge base that can treat bacterial vaginosis AND reduce a shoulder dislocation. Just my two cents.... 25 yr PA been there, done that OM is not an er dx, but mastoiditis certainely is. i disagree with you. surgical backround gives a great exposure to the "emergency" / do not miss dx. the mistakes of the family practice ends up in the er then ultimately the surgeons table. DKA and CHF are well known to the surgical community because they must be taken into account when considering a surgical procedure. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted July 21, 2015 Share Posted July 21, 2015 As a PA who went the other way from ED to GS & Ortho I say that neither would prepare you for the broad spectrum of ED patients. I experienced the " forget that medicine s+++ " from the Ortho & GS folks just pay attention to what was in the surgical field and what impacted on it and yes call a consult and turf to medicine if they "get sick". Not the way to think in the ED. Link to comment Share on other sites More sharing options...
RealityCheck Posted July 21, 2015 Share Posted July 21, 2015 JMPA - have you BEEN in an ER at 3 am? The ER IS primary care to the over 30 million uninsured or underinsured folks in this country. In all the years in the ED - I saw oodles of otitis and strep throat and lice and UTIs and BV and tinea versicolor and countless other NON ER type issues. Yeah - you cannot miss the big stuff like perfed bowel or MI, etc but the bulk of ED work is still by and large Family Practice in the middle of the night. Also - psych - the ED is "anonymous" and a lot of psych happens in the dark. So, the ED is "emergency" but serves as a primary care to millions of people. You have to know a lot about a lot. It is not "treat and street" as some of my colleagues try to make it. You ARE the only contact for some of these folks - do it right the first time! Link to comment Share on other sites More sharing options...
Guest JMPA Posted July 21, 2015 Share Posted July 21, 2015 JMPA - have you BEEN in an ER at 3 am? The ER IS primary care to the over 30 million uninsured or underinsured folks in this country. In all the years in the ED - I saw oodles of otitis and strep throat and lice and UTIs and BV and tinea versicolor and countless other NON ER type issues. Yeah - you cannot miss the big stuff like perfed bowel or MI, etc but the bulk of ED work is still by and large Family Practice in the middle of the night. Also - psych - the ED is "anonymous" and a lot of psych happens in the dark. So, the ED is "emergency" but serves as a primary care to millions of people. You have to know a lot about a lot. It is not "treat and street" as some of my colleagues try to make it. You ARE the only contact for some of these folks - do it right the first time! Surgery, its where the ER mistakes end up Link to comment Share on other sites More sharing options...
CAdamsPAC Posted July 21, 2015 Share Posted July 21, 2015 JMPA - have you BEEN in an ER at 3 am? The ER IS primary care to the over 30 million uninsured or underinsured folks in this country. In all the years in the ED - I saw oodles of otitis and strep throat and lice and UTIs and BV and tinea versicolor and countless other NON ER type issues. Yeah - you cannot miss the big stuff like perfed bowel or MI, etc but the bulk of ED work is still by and large Family Practice in the middle of the night. Also - psych - the ED is "anonymous" and a lot of psych happens in the dark. So, the ED is "emergency" but serves as a primary care to millions of people. You have to know a lot about a lot. It is not "treat and street" as some of my colleagues try to make it. You ARE the only contact for some of these folks - do it right the first time! One of the smartest physicians I ever worked with was my ED supervisor who instilled in me that there are only two things that need to be answered in the ED, #1 Do they have something that is going to kill or cripple them? treat as indicated #2 After you answer #1 where do you send them, one should not manage chronic care issues in the ED as follow up and monitoring is non existent, Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 21, 2015 Moderator Share Posted July 21, 2015 JMPA - have you BEEN in an ER at 3 am? The ER IS primary care to the over 30 million uninsured or underinsured folks in this country. In all the years in the ED - I saw oodles of otitis and strep throat and lice and UTIs and BV and tinea versicolor and countless other NON ER type issues. Yeah - you cannot miss the big stuff like perfed bowel or MI, etc but the bulk of ED work is still by and large Family Practice in the middle of the night. Also - psych - the ED is "anonymous" and a lot of psych happens in the dark. So, the ED is "emergency" but serves as a primary care to millions of people. You have to know a lot about a lot. It is not "treat and street" as some of my colleagues try to make it. You ARE the only contact for some of these folks - do it right the first time! really depends on the ER. I have had a lot of ER jobs just as you describe here, but over the last 10 years have woked myself into rural ER gigs with high acuity and low volume. worked at 1 of them last night. saw 4 pts in 13 hrs : urosepsis, 7 mm kidney stone, significant facial lac involving lips and tongue from dog bite, and wound dehiscence in a 500 lb pt s/p ventral hernia repair. at one of these jobs I have had days with no pt younger than 70 and no dx other than ACS, CHF, sepsis, acute DTs, major trauma, and stroke. I am tired of doing ambulatory care in the ER. that's why I am in the process of transitioning out of urban depts and into rural ones. the folks in both rrural areas have pcps who they bug about their runny noses, bug bites, and vag d/c. Link to comment Share on other sites More sharing options...
medic25 Posted July 21, 2015 Share Posted July 21, 2015 It gets better --- sorry, on a roll tonight 3 doctors (or PAs but more likely docs) are sitting in a duck blind. Something flies by The first one says - well, it looks like a duck, has the shape of a duck but could be a goose. Damn, I missed it - The radiologist The second one sees somethings - well, it flies. It could be a duck or a goose or an albatross. Damn, I missed it - The internist The third one sees something fly by - BOOM. Um, what was that? - The orthopedist……... Sorry, tough day - needed a giggle You forgot the 4th doc in the duck blind: Group of birds flies by, BOOM, BOOM, BOOM, BOOM fires off four shots and takes them all out. Throws the pile of birds to a nurse and says, "send these to pathology and tell me which one was a duck"!- The general surgeon Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 21, 2015 Moderator Share Posted July 21, 2015 You forgot the 4th doc in the duck blind: Group of birds flies by, BOOM, BOOM, BOOM, BOOM fires off four shots and takes them all out. Throws the pile of birds to a nurse and says, "send these to pathology and tell me which one was a duck"!- The general surgeon the internist actually aims, but then says " wait, let's collect feather and stool samples in a 3 acre area around here. if most of them come up duck-related then and only then will I fire. " The pediatrician aims, says" I don't know what those are. I just hope they will go away" and puts her gun down. Link to comment Share on other sites More sharing options...
Guest JMPA Posted July 21, 2015 Share Posted July 21, 2015 the radiologist hides in the cave and says "clinically correlate" Link to comment Share on other sites More sharing options...
sk732 Posted July 22, 2015 Share Posted July 22, 2015 https://www.youtube.com/watch?v=ULvRfqNDn3M https://www.youtube.com/watch?v=q0S5EN7-RtI SK Link to comment Share on other sites More sharing options...
RealityCheck Posted July 22, 2015 Share Posted July 22, 2015 A surgeon's creed used to be "a chance to cut is a chance to cure". However, a smart surgeon realized that "a chance to cut is a chance to kill". There is no one specialty in medicine that is smarter than another just by specialty - arrogance based on specialty has no place in medicine. So, whomever works in the ER should damn well know what they are doing for ALL entities that show up - otitis media or perfed ulcer alike. It is not professional to diss other specialties or profess that one has more skill and knowledge than another. I know some rockin' dermatologists that I would trust more than some of the neurologists and vice versa. Individual skill and pride in work is more important with a healthy dose of humility. And, as PAs we should be well versed to know where to go - you don't have to know everything but you should know where to look or ask. Link to comment Share on other sites More sharing options...
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