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Geriatrics/ Nursing Home

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I work in geriatrics and have worked in skilled nursing homes and assisted living facilities (terminology is different in different states). Some health systems are open to PAs and some prefer to NPs but I think the market is opening to PAs. I don't think it's a typical PA job but I really enjoy it, I like having long term relationships with patients and families and having a mix of primary care, chronic illness and end of life care. As PAs, we can't be the attending for hospice patients (hopefully this will change in the future) but we can co-manage hospice patients as their primary care provider.


During a typical day, I have a list of patients that I am going to see for scheduled visits (they need to be seen at certain intervals according to Medicare guidelines) or at admission and whoever is sick. Obviously there are issues that come up during the day too. I also need to sign off on labwork, imaging, verbal orders and other paperwork. There might be a family meeting or phone calls with guardians. I have to handle electronic stuff that comes in through the EMR and pages from the other facilities. There's a certain amount of juggling of needs that happens throughout the day. 


I think there's a lot of job opportunities and job security. I left my old job and was able to find a new one that I'm very excited about. Geriatrics isn't a very popular field among physicians but I think for the people who like it, they tend to stay in it. There's a lot of stigma about nursing homes but there are good ones. I would be careful about programs that want you to see over 20 patients a day or go to more then 3 places a week. The potential for Medicare fraud in SNF and home care is huge and you don't want to wrapped up in that as a new grad. I would also say that there is a steeper learning curve then you think, patients are sick coming right from the hospital and the nurses aren't necessarily helpful. A huge learning moment for me was when I caught a new admit with digoxin toxicity and AKI who had been there for 3 days and no one questioned her altered mental status. 


I would also be comfortable with end of life, pain control, Coumadin, stroke, hypertension. 

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NH work


Show up about 8-9


See patients - urgent first, then work though your regulatory list

Hit each floor/unit to ties up loose ends


Take a few breaks, enjoy the residents


One more time around the facility, out by 3-4



This is once you get up to speed and really settled in and know your patients and medicine


This is likely after 2-4 years of practice and study


Initially you will just be overwhelmed and trying to get though even 10 patients in one day


Also, have to integrate with the practice of the Collaborating Doc.... What ever this has to be.. As a new grad this should be a fair amount of interaction with the doc, as a more senior PA limited interaction...

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