haeriphos Posted November 23, 2009 Share Posted November 23, 2009 I'm curious about the lack of a family medicine residencies for PAs. I'm personally interested in rural family practice and would think that, since that is one of the big goals of training PAs, there would be a residency that addresses family medicine exclusively (or maybe in conjunction with peds or ob/gyn). I realize PAs are trained in primary care at most schools, but but not to an extent where they can work solo at a remote office right out of school. Or am I mistaken? Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted November 24, 2009 Moderator Share Posted November 24, 2009 In my opinion, and probably the opinion of many others on here....PA school IS your family medicine residency. You are trained exactly to step into the role of a primary care provider. If you do not feel this way when you graduate PA school, then your school has failed you. Now, that's not to say that you feel 100% completely confident in your abilities and diagnostic acumen....but you SHOULD be able to start seeing patients once you're legally able to do so as a PA. 1 Link to comment Share on other sites More sharing options...
andersenpa Posted November 24, 2009 Share Posted November 24, 2009 although I would say a new grad should not be remote/solo straight out of school unless there is reliable tele-backup..... Link to comment Share on other sites More sharing options...
caldje Posted November 24, 2009 Share Posted November 24, 2009 As a newish grad that went into rural FP solo at a sattelite clinic I would say that a residency would have been helpful. Having good telephone backup is essential and almost any level of practice. I am shocked almost every day by the things that walk into my clinic. 2 DKAs in 1 week, along with a 9 year old with mrsa sepsis/septic hip, and an AMI/acute CHF. Then there are my two MM patients. sigh. Not all clinics are the same. Some are quite slow and you'll only see 10 patients a day. In that case you have time to look plenty of things up and make calls to docs. If you are see 25-30 a day it becomes hard to balance your inexperience with the need to quickly see a number of patients any of which could have emergent illness or simply have multiple comorbidities and have been poorly managed or not managed at all for years. So, I think my vote would go for a rural FP fellowship that gives you some more exposure to practicing medicine with limited resources, doing procedures that may usually be done by specialist, and understanding the psychosocial aspects of being a PCP in an underserved rural clinic. We say we learn to be PCPs in PA school but out in the boonies when nobody else is available we end up seeing the whole family for a VAST number of issues including sexual abuse, drug abuse, social work cases, and of course the emergencies that require quick decision making. Then of course there is our own psychosocial well being. As a boonie-PA-C you will have feelings of isolation, significant stress and fear of doing something wrong, and have to develop a set of skill realted to human resources and management that weren't taught in PA school either. Its a tough job, thats why they pay our loans back for us. In the long run I think there is a need for rural FP fellowships, even if only 6 months, to help the new PA transition into a role of being in charge when they are taking on such responsibility. chris 2 Link to comment Share on other sites More sharing options...
rcdavis Posted November 24, 2009 Share Posted November 24, 2009 So, I think my vote would go for a rural FP fellowship that gives you some more exposure to practicing medicine with limited resources, doing procedures that may usually be done by specialist, and understanding the psychosocial aspects of being a PCP in an underserved rural clinic. We say we learn to be PCPs in PA school but out in the boonies when nobody else is available we end up seeing the whole family for a VAST number of issues including sexual abuse, drug abuse, social work cases, and of course the emergencies that require quick decision making. Then of course there is our own psychosocial well being. As a boonie-PA-C you will have feelings of isolation, significant stress and fear of doing something wrong, and have to develop a set of skill realted to human resources and management that weren't taught in PA school either. excellant post. chris, do you have any suggestions on how that would/could be run? eg, place a new grad with a seasoned for 6 months before posting him alone? hadn't thought of the psychologic issue of being alone and scared: did some in the military as the only corpsman on independant duty, and in alot of places i have been the only PA, but to be the only medical provider out in the field where there is not other medical personnel to simply vent to... hadn't thought of that... my hat's off to you solo FP practitioners...while I am sitting here in the safety of a well equiped hospital with great back up. and the abiltity to get instant data - all labs, ct, mri, echos, ... i need a kick in the a$$ sometime for forgetting how very lonely and stranded you all must feel at times. I am getting a sense that there may well need to be an extension of training.. at least for those PAs who are finding themselves in as much a physician replacement/ surrogate role as assistant. chris v/r, davis Link to comment Share on other sites More sharing options...
LESH Posted November 24, 2009 Share Posted November 24, 2009 So, I think my vote would go for a rural FP fellowship that gives you some more exposure to practicing medicine with limited resources, doing procedures that may usually be done by specialist, and understanding the psychosocial aspects of being a PCP in an underserved rural clinic. Its a tough job, thats why they pay our loans back for us. In the long run I think there is a need for rural FP fellowships, even if only 6 months, to help the new PA transition into a role of being in charge when they are taking on such responsibility.chris There are folks out there looking at doing exactly what you have suggested, it's working thru accreditation and developing the clinical affliations that are holding things up.;) Link to comment Share on other sites More sharing options...
haeriphos Posted November 24, 2009 Author Share Posted November 24, 2009 The program that caldje described is exactly what I would be looking for. The fact that it's currently in development is awesome. I graduate in 2012 so with luck I'll have at least one to consider! Thanks for the responses. Link to comment Share on other sites More sharing options...
primadonna22274 Posted November 24, 2009 Share Posted November 24, 2009 I honestly can't add much to Chris's excellent post; but as someone who has certainly been in the trenches of family medicine, and often on my own, I can categorically state that PA school did NOT give me enough to manage "flying solo"...in fact it was my first job, where my SP had a mini-residency for me in mind, and which she committed to training me for the first 6-9 months of our working relationship. It was great actually--she had mini-lessons (asthma treatment, diabetes management, hypertension workup/initial treatment, abnormal pap workup/management, all kinds of stuff....) and the administration at our group practice was supportive and allowed us "teaching time" for the first half-year or so. I look back on that time and realize how fortunate I was to get that, and I realize that many PAs (and NPs I'll bet) have nothing like that experience. I did not work solo until I had been out a few years, although I did do urgent care (but there was always someone around the corner, in another hallway, or who I could reach by phone). Now I almost always work alone when I'm in outpatient urgent care, and I really do miss the support of the hospital--and the camaraderie. I've said before that those who belittle family medicine have obviously never done it. We really do have to know a little bit about everything--more than a little bit really. It's hard to keep up. Of course we all develop niches of expertise--and it does get lonely out there. Keep the faith Chris, you're doing great. Link to comment Share on other sites More sharing options...
Guest FamMedPA Posted November 24, 2009 Share Posted November 24, 2009 Well, I started my first job in family medicine and felt very overwhelmed by eveything at first. The doctor was gone most of the time and just kinda threw me into things without much communication. To be honest after a year of working there I cannot really think of a time when he has ever educated me about anything. I had to learn a lot just from seeing what he did by reading his notes and getting progress notes from other physicians. It took me a very long time to get comfortable with things. I am sure I would know much more now if I had a more structured learning environment. I have learned a lot by myself, but it sure would have been nice to have had more guidance. Its scary when you have never done certain procedures before and then you have to do them alone with no direct supervision. So, far I have done well, but it is still stressful. However, I know I would never do any residency that was 80 hours a week. I would take a pay cut in order to get the advanced eduucation, but only if it was 40-50 hours a week. I guess I don't have the same amount of energy as other people on here have. Link to comment Share on other sites More sharing options...
COTA for now Posted November 25, 2009 Share Posted November 25, 2009 I think that is a huge factor, the 80 hour workweeks. I don't understand that. Who wants to spend a year doing such insane amounts of work? That's the big deterrent for me. Link to comment Share on other sites More sharing options...
andersenpa Posted November 25, 2009 Share Posted November 25, 2009 I think that is a huge factor, the 80 hour workweeks. I don't understand that. Who wants to spend a year doing such insane amounts of work? That's the big deterrent for me. Depends on your current lifestyle and home situation. When I did it, I was 27 and single. I lived in the subsidized resident apt (slept there occasionally) and was at the hospital all the time. Was it great? Yes. Did it suck major some times? Definitely. A good group of fellow PAs and other MD residents made the experience great (just like having a good support system in PA school). And of course, good precepting PAs/docs. I knew PA residents with spouses and families, and it's hard- but for 12 months, certainly worth it (for my program at least). Link to comment Share on other sites More sharing options...
caldje Posted November 29, 2009 Share Posted November 29, 2009 I've said before that those who belittle family medicine have obviously never done it. We really do have to know a little bit about everything--more than a little bit really. It's hard to keep up. Of course we all develop niches of expertise--and it does get lonely out there. Keep the faith Chris, you're doing great. Thanks prima. I agree family practice is quite challenging and the scope blurs in rural areas between general practice and specialties because of the lack of resources and lack of providers. It is a tough but very rewarding job. chris Link to comment Share on other sites More sharing options...
caldje Posted November 29, 2009 Share Posted November 29, 2009 rcdavis, thanks for the comments. I think the residency would be pretty easy to set up and I dont think it would require more than 6 months to a year. I would set it up with 2-4 week outpatient rotations in each major specialty (cards, neuro, em, ortho, derm (very important). The only purpose of those rotations would be how to manage the common specialty problems based on EBM (headache, CHF, HTN, lipids, fractures, exanthems). I would also add a 1-2 day seminar in office management and HR concepts (how to fire, how to hire, how to oversee a clinic operation). Then I would finish it up with 1-2 months of supervised practice. After that, I think you would be pretty well trained to practice rural FM. In fact, in my experience a good PA with that training would certainly be able to fill the shoes of many of the FP/GP docs that practice in the rural areas as long as they have good support. In fact, we just got a grant to send our providers to "mini fellowships" at the local teaching hospital to train our primary folks in managing these more common specialty referrals because the specialist have absolutely no time to help us out. IN fact, they sometimes simply decline referrals and it is up to us to figure things out anyways. Just a thought. chris p.s. this could easily be done in 40-50/hr work weeks. No inpatient training necessary and I would actually HIGHLY recommend against it. Stay focused on the goal of "finding your place" in the outpatient world and becoming comfortable managing common problems and developing the confidence to know when it really is nothing more than a headache, GERD causing chest pain, etc. Link to comment Share on other sites More sharing options...
ldona Posted January 11, 2012 Share Posted January 11, 2012 Hi, I was wondering if any additional info regarding further training in FP has become available? I graduate in 6 months and am debating if it would be best to do some form of residency for general practice. Thanks. Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 18, 2012 Moderator Share Posted February 18, 2012 As a 10+ yr PA I may have a different perspective. I think a 12 month intership followship for non surgical pa's should be highly encouraged. Pay should be in the 60's and everyone should do 9 months of core rotations and three months of electives or even go to work for your future employer. This could occur off cycle to the residents twice per year at an medium to large hospital. Great recruiting tool for hospitals and it would provide broad based exposure to burn in e knownledge taught in school. Cold be markeyed to hospitals with out a residency programs so the hospital and PA's benefit Heck i am half heartedly looking at the new VA residency just as a challenge Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 18, 2012 Moderator Share Posted February 18, 2012 Does anyone have info on he 6 VA internal medicine residency site's? Link to comment Share on other sites More sharing options...
PACali Posted February 18, 2012 Share Posted February 18, 2012 Does anyone have info on he 6 VA internal medicine residency site's? this is all I can find http://www.mdnews.com/news/2011_12/va-uf-to-collaborate-on-new Link to comment Share on other sites More sharing options...
PACali Posted February 22, 2012 Share Posted February 22, 2012 http://www.marquette.edu/physician-assistant/news-veterans-residency-program.shtml New PA Residency Program in Primary Care at the Milwaukee VA Hospital There is an exciting new opportunity for Physician Assistants interested in postgraduate primary care training available at the Zablocki VA Medical Center, Milwaukee, WI beginning July 1st, 2012. The Milwaukee VA Hospital in collaboration with the Marquette University Physician Assistant Program was one of six sites chosen nationally to establish a PA Residency Program in Primary Care. The focus of this residency program is to train the PA clinician with advanced clinical knowledge and skills to care for complex patients in a VA primary care clinic while also exposing the clinician to the VA Patient Aligned Care Teams or PACTs. The PACT methodology of care reflects the ongoing efforts of the VA to transform its primary care delivery system to one that is patient-centered, continuous, team-based, efficient, comprehensive and coordinated. The PA Residency Program hopes to increase the availability of providers that can assist in the care of Veterans within the Patient Aligned Care Teams. The year-long residency curriculum will include a mix of more advanced general medical topics including EKG review, radiologic studies, chest pain, MI, diabetic emergencies and sepsis as well as VA specific didactic topics including hepatitis C, PTSD, TBI, military culture and women in the military to name a few. Several of the didactic lectures will be integrated into lectures provided to the Marquette University Emergency Medicine Residency Program PA trainees. Clinical rotational settings will include primary care, including a continuity clinic within a VA Patient Aligned Care Team, cardiology, geriatrics, emergency medicine, behavioral medicine, pain management, home care and spinal cord injury rehab along with other medical subspecialties, surgical electives and procedural clinic opportunities. PA residents will discover the potential of the VA’s outstanding Computerized Patient Record System and also receive training in quality improvement and patient safety. Upon completion of the program the physician assistant resident will gain a deep and broad evidence-based knowledge base about the common disease processes which they will see in veteran patients. This is an excellent opportunity to “serve those who have served” and to establish a career within the VA system. Interested applicants must be a graduate of an ARC-PA accredited program, be NCCPA Certification eligible and be a US citizen. The program begins July 1st, 2012 with two positions available. Residents will also receive a stipend for their year of training. Contact Krista Berner at 414-384-2000 extension 41747 or Krista.Berner@va.gov for more information. Link to comment Share on other sites More sharing options...
sailordeac Posted February 23, 2012 Share Posted February 23, 2012 I think there will be one at the Salisbury, NC VA affiliated with Wake Forest. Link to comment Share on other sites More sharing options...
jsfelder0417 Posted April 5, 2012 Share Posted April 5, 2012 I would love to return to NC for the FP residency when I graduate. I am a Ft. Bragg kid (82nd Abn Div) after all... Link to comment Share on other sites More sharing options...
joanna.nola Posted June 9, 2012 Share Posted June 9, 2012 Any word on these residencies? Anyone planning to start in July? I would have considered it, but alas, I graduate at the end of July.... It sounds like they are all FM residencies and the one in Houston is Geriatrics... Link to comment Share on other sites More sharing options...
joanna.nola Posted June 9, 2012 Share Posted June 9, 2012 Any word on these residencies? Anyone planning to start in July? I would have considered it, but alas, I graduate at the end of July.... It sounds like they are all FM residencies and the one in Houston is Geriatrics... Link to comment Share on other sites More sharing options...
joanna.nola Posted June 9, 2012 Share Posted June 9, 2012 Any word on these residencies? Anyone planning to start in July? I would have considered it, but alas, I graduate at the end of July.... It sounds like they are all FM residencies and the one in Houston is Geriatrics... Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 24, 2013 Moderator Share Posted July 24, 2013 [TABLE=width: 790] [TR] [TD][h=2]Physician Assistant Residency[/h]OAA has long recognized a need for developing and recruiting highly skilled Physician Assistants (PA), particularly in the areas of Geriatric/Disease/Complex Care specialty. This has become particularly salient with the emergence of Patient Aligned Care Teams throughout VA and with the continuing national shortage of primary care physicians. Accordingly, OAA committed to develop a PA Residency program pilot to determine if these needs can be met through the introduction of a new model of development. In pursuit of this goal, OAA solicited proposals for new PA residency programs with a particular emphasis on integration into an interprofessional model of collaborative care with physician and other associated health trainees. The RFP cited a plan for award of up to 12 resident positions to be located in 3-6 sites for the first year. A distinguished panel of educational leaders and experts in the Physician Assistant program, both from within VA and from prestigious universities around the country, met to review and provide recommendation for award from the fourteen submitted proposals. Two residency positions were awarded to each of these six sites: • Atlanta, GA • Houston, TX • Milwaukee, WI • North Florida/South Georgia • Salisbury, NC • Sioux Falls, SD OAA would like to recognize the hard work and dedication of all who submitted proposals and bestow a hearty congratulations to all selected for award! [/TD] [/TR] [/TABLE] Link to comment Share on other sites More sharing options...
jsfelder0417 Posted September 8, 2013 Share Posted September 8, 2013 Bump. Anyone in these residency programs? I would love to hear how they are going. Link to comment Share on other sites More sharing options...
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