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What specialty has both complex medicine PLUS procedures?!

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I have a dream job... I just don't know what it is yet... What PA gig combines cerebral/IM type medicine with lots of procedures? Here's the best I can come up with: rural-ED, level 2 trauma-surgery, or cardiac surgery... my one caveat is that I do want some level of work/life balance...  

 

I was an anesthesia tech in the Navy w/ 5000+ IVs, 400+ intubations (nasal, fiber optic, peds, bougie, etc...), and a litany of other procedures... and I absolutely love doing procedures.... And uber complex medical workups and management make me giddy... 

 

Observations from my rotations:

  • general surgery... I enjoy the challenge of constantly refining a skill... i.e., suturing and learning to hand tie one handed (left & right)... but I really missed the medicine and want a gig with more autonomy or responsibility..
  • internal medicine I absolutely loved the heady/cerebral thinking through complex diagnoses and management... but missed the procedures... critical care maybe?
  • emergency med. I think this may be my best shot at getting balance of procedures & medicine. I also really like the challenge of having to think globally about patients... but I struggle with the tendency to laser focus r/o the bad-n-street - "follow up with PCP/Specialist." Also - I get serious main-ED envy when I'm working fast-track...

Please help me think broadly... even if its a job that I'd have to work towards... (I graduate in August and want to live in central Washington...)

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When I was a student I rotated through a community hospital ICU ran by one attending and a team of PAs. No residents or other physicians. The attending rounded with the team once a day as able and was available for consult when needed. Lots of complex issues, lots of procedures. In the right gig you can get a good schedule. If you work with residents then you may be competing with them for procedures however.

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Burn center with plastics/wound care. You would get surgery, trauma, ICU, procedures and cerebral medicine. Burn centers are not numerous though and I'm not sure if they have one in central Washington. The old argument of salary vs. specialty vs. location...

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Thanks for the replies everyone! Several mentioned IR, which I hadn't really considered... Do PAs get pretty good autonomy and scope? With my background in anesthesia, I've had a few people suggest IR but I've written it off thinking that it lacked the general medicine aspect that I at least think I want... But my presumptions are largely conjecture... I really don't know what an IR PA does... I will look into it - anyone want to share a brief "day in the life"??

 

EMEDPA, do you happen to know of any EDs with full scope that are comuteable from Wenatchee/central WA? Or possibly Seattle, though I imagine I would have to travel a pretty good distance away from the city to get main ED/full scope...

 

 

Thanks again everyone!!

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yup, there are a few in WA (and 1 in OR), but they all require 5+ years experience and a lot of other requirements. I know of 3 full scope solo coverage ER gigs in WA(there are probably others) with a total of maybe 10 pa slots. I work per diem at one of them in OR and 1 in WA. I applied every year form a decade before I even got an interview for the WA one. I think the EM CAQ probably made the difference in getting me the job.

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IR doesn't have the cerebral component you're looking for.  It's just non-stop procedures.  It sounds like you're looking for critical care.

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IR doesn't have the cerebral component you're looking for.  It's just non-stop procedures.  It sounds like you're looking for critical care.

 

What type of procedures? 

 

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Have you done your OBGYN rotation yet?

 

After finishing my rotation, I was pleasantly surprised at the variety of hats an obgyn wears, granted it only has certain aspects of IM and FM with rounding and office work... But you also do a good amount of surgery mixed in with some emergent cases from the ED. 

 

Obgyns also do a good amount of outpatient procedures and of course.. L&D.

 

Downside is that from what I can gather, there are not that many obgyn pas, apparently it is especially rare for pas to deliver? It definitely isn't as cerebral or management heavy compared to IM... and only focused on one type of patient population. My experience is that your either really relaxed.. or super stressed with nothing in between.

 

I just completed my IM rotation and I loved the cerebral complex diseases and management side of it too.... but I also enjoy procedures and seeing outpatient, so I'm in a similar boat as you (also graduating in the summer)

 

Currently researching and thinking more about doing pulm, cardio thoracic.. possible a critical care residency..working two different jobs or.. getting a gig for IM where I can split time inpatient and outpatient with some small procedures in a rural setting.

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Thanks again everyone! One more question... for now.

 

-- CT Surge sounds like a dream except for the whole work/life balance thing. I absolutely love working hard - pedal to the metal until the works done. However, my kids are getting to the age that I'd rather not work tons of hours... I've missed enough being in the military.  Is there such thing as CT surgery gig that is <50hr / week? I absolutely love the idea complex surgery with major room to grow and complex medicine/SICU management.

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I can tell you that CWH does utilize PAs in their CT Surg department, when I saw them they look pretty harassed but also very involved.  My interactions with the surgeons were brief, and while they were very distant, they weren't your typical CTS guys.  The PAs were well respected throughout the hospital.

 

I have seen PAs running the show up in the Brewster ED on nights, solo coverage or at least FP back up only.  The other option would be Samaritan in Moses Lake.  The ED physician group that runs CWH/WVMC took over Samaritan's ED and have been looking for a PA to work down there.  They've talked huge talk regarding scope of practice etc., and they are an outstanding group of guys and gals.  I had the great opportunity to work with them for a number of years.  If that opening is still there, could be worth the commute from Wenatchee etc.

 

Good luck, central WA is lacking in the type of job you're describing.  There's a reason I'm in Seattle and not back in the Valley.

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Critical care. In smaller community hospitals with no residents PAs staff the ICU with the intensivist. Tons of procedural opportunities like intubation, central line placement, arterial lines, lumbar puncture, thoracentesis, paracentesis, chest tubes, management of invasive and non-invasive ventilation. At the smaller hospital where I per diem the PAs also respond to rapid response anywhere in the hospital and run codes.

 

Need a very substantive understanding of pathophysiology and how multiple organs affect each other.

 

Once you work in critical care, you learn how to initially react to almost any emergent situation... an invaluable skill that makes you highly demanded for the rest of your career. Requires a lot of self motivation and drive to learn things on your own.

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In regard to your can you work CV/CT less than 50hrs a week.  I have yet to hear of a position but I'm sure they exist somewhere.  After completing a surgical fellowship, I would absolutely say you should look into Critical Care.  Try and get into a place where PAs have high autonomy and there isn't four thousand learners that your competing with for procedures.  Additionally critical care has the hours you want. 

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Thanks again everyone! One more question... for now.

 

-- CT Surge sounds like a dream except for the whole work/life balance thing. I absolutely love working hard - pedal to the metal until the works done. However, my kids are getting to the age that I'd rather not work tons of hours... I've missed enough being in the military.  Is there such thing as CT surgery gig that is <50hr / week? I absolutely love the idea complex surgery with major room to grow and complex medicine/SICU management.

 

no.

 

if they tell you otherwise, they're lying. plus, you can't the kind of immersive experience you need to be really good at CT surg with less than 50 hrs/week. its really, really intense (I worked CT SICU and it was def not for me).

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I vote for EM. I'm not confined to fast track though. Honestly procedures get pretty boring to me...and repetitive... but I imagine that's everywhere. Every once in a while there's something cool/different to do though. Medically I love the variety. This weekend I've seen trauma, ectopic preg, "syncope"/GI bleed, CPs, COPDer, lots of sick babies, cholecystitis, a person with a weird ecchmyotic rash that we aren't sure about, person that glued their eye shut, psychotic pt on meth. If you want variety EM is the place. You will never get really good at one thing tho. And will have to learn not to fuss over things that aren't emergent/urgent and refer. If you are really cerebral in terms of wanting to fix everything, it may not be for you

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