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Which Residency Specialty Offers Most Procedural Responsibility


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Hi everybody,

 

I was hoping to get some opinions on which surgical residencies (in terms of specialty) y'all think provide more independence for a PA? Concerning performing procedures, are cardio PAs doing more autonomous work than ortho PAs, or EM PAs doing more than ortho, etc...?

 

Thanks.

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Thanks, EMEDPA, I really appreciate your response. I work as an ER Tech and I have been a little disheartened by the work allotted to the PAs. They basically are only allowed to work the fast track and have no responsibility on any critical cases that come in. Granted, they are young. Only been practicing for a couple years but they also didn't go to a residency. Seeing that kind of turned me off to EM as a PA but if I could bypass that, then I think I could be more content with the work I was performing. With a residency under your belt, would you suppose PAs could do central lines, lumbar punctures, run a code, etc...?

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yes. senior EM PAs can do all those things. several of us on this forum provide solo coverage of emergency depts without a doc on site. last year I intubated 20 times, cardioverted a bunch, ran several codes, etc. do an em residency if you want the better jobs. don't be content with fast track scut if you want to see sick pts.

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Only been around for a short time, but it seems PAs doing the above kind of work are fairly rare - the challenge is you have to dedicate yourself to getting that training yourself.  You can do this with a great job with docs willing to teach, or you can do a higher acuity residency/fellowship.  

 

They are definitely not all created equal.  Some are pretty much just cheap slave labor, practically bait and switch scams.  

 

On the other end, some are really intense and produce graduates able to function at a very high level.  Maybe you have seen the in-depth, excellent blow-by-blow that Serenity Now posted in this section.  

 

Most are somewhere in between, with decent off service rotations and respectable procedural training and numbers.  Good luck.  It can be done!

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Thank you guys for your valuable input. I'm very interested in surgical specialties as well and would love to be able to go that route if I knew a residency would enable me to work side by side with a SP in the OR. I'm just really concerned that I would not get the respect and responsibility I desire in that setting as a PA, but I suppose that also depends on the SP, himself/herself. Anyone who has some experience in a surgical specialty, I would greatly appreciate your thoughts/encouragements.

 

I'm young and still somewhat considering going med school so that I would not have to worry about this matter but the painstaking number of years to become a surgeon or even EM doc seem almost too daunting in my and my wife's mind.

 

Becoming a PA and then seeking a residency seems like a more favorable intermediate. Of course, a greater level of responsibility can equal longer work hours/week, more on-call time, and overall, more time away from family. I would love to hear from anyone on this matter if that has been the case for you.

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Yikes. The fraction of money sounds about right because of the significantly greater number of years of education they must go through, but the lack of respect and co-dependence is what bothers me more.

If Phd of electrical engineering and an electrician fix your TV equally well, would pay the electrical engineer 3x more? I'm not saying MDs don't deserve more pay, but they should get it for bringing value, knowledge, and skills that a PA doesn't have. For a well trained, experienced, and well read PA like EMED, that isn't much.

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I completely agree, LT Oneal Pac. I'm not saying the pay is fair for the amount of training and work that a PA goes through and does. And I hope that the pay continues to increase. I'm not looking to get rich off medicine, but I would like to be financially valued for my time put in.

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I work in cardiac critical care and our team of APPs have a lot of autonomy. Our CCU is a tertiary hospital and we generally see the sickest of the sick cardiac patients. We perform a lot of procedures: Swans, VasCaths, Icy Caths, a lines, and for those really crashing we will first assist putting a patient on ECMO. As far as management of the patients we get to make many of the treatment decisions and always have docs available if we have questions.

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residency specialty?  i cannot say, but having worked in several different surgical specialties i would say that ct surgery by far offers the most opportunities for significant procedures. i have placed lines in almost every part of the body. there is chest tube, pig tail, cv cath, arterial cath, evh, intubation, ng tube, the list goes on. personally the thrill of procedure tires quickly for me. good luck

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So I just started my residency/fellowship that is geared toward pediatric surgical specialties. We rotate through all major sub specialties-- congenital heart surgery, general/trauma, neurosurgery, urology, plastics, ophthalmology, otolaryngology, PICU, ortho, etc. because we are at a major teaching hospital we get much of the didactic, procedural, and simulation training that the physician surgical residents and fellows get. This week we re working on Trachs/G-tubes/LP/Lines etc. we also have cadaver labs monthly to maintain our knowledge of anatomy for the OR and procedures. We also have an ICU boot camp that is several days in which we learn and practice procedures and simulation of scenarios related to high acuity cases. Some procedures are complex (we have difficult airway intubation training) and some are fairly simple (like circumcisions/casting) but you come out of the year long fellowship with the training to hop into a specialty and contribute to the team. Surgery isn't just about OR time for PAs as we are involved in all aspects of care and can perform some really cool bedside stuff. Many of the surgical PAs here are first call to the ER to perform complex lac repairs and other surgical procedures that the ER isn't as comfortable with, especially with kids.

 

I agree that the ER/ICU has some great procedure opportunities but if you aren't really sure where you fit... a general surgery fellowship can give you exposure to most procedures in different subspecialties including the ER and ICU and you can make your own path from there.

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Any other PAs out there taken advantage of a cards residency or ortho surg residency who can attest to an expansion of procedural responsibility in their field? Perhaps performing coronary angioplasties and/or stents, or independently performing one side of a bilateral ortho procedure.

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Charlottew, I completely understand your suggestion. I'm definitely considering med school; however, I am married and the thought of med school + residency (approx 10 yr for any surg specialty or cards) kind of intimidates her with how many hours I would be pulling during those years. My decision is not just going to affect me. We have not ruled med school out, but I also know ortho and cards docs work a ton of hours even as attendings, and at the end of the day, my wife and future fam is more important and I want to put their needs before my own. It would be my hope that as a PA in one of those specialties, and with a residency, I may be able to have a bit wider range of independence along with a bit more reasonable hours (around 45-50/wk). But I know I can't have it all.

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Well, I hate to put it this way, but if you want a position with more responsibility then you will have to put in the time, into training (ie. med school, residency and maybe fellowship).

 

As a PA you will (in general) have less responsibility than an MD. Although there are certainly PA positions where you have more autonomy (primary care, some ED positions), it is still by definition a dependent profession.

 

If you want to 'put (the family's) needs before your own', then you have to recognize that the higher-hour/higher intensity specialties may be incompatible with that goal. If long hours for many years is out of the question, then sure, consider PA school, and use your time on rotations to figure out what might work best for you and your family.

 

If you really can't decide between medical and PA school, do some more shadowing to see how the roles differ. Boots on the ground experience is superior to Internet fiddle-faddle, any day of the week.

 

good luck with your decision

 

ps. I'll add that I work critical care, pretty independent especially on the overnights. Medicine is still a team endeavor but I do A-lines and central lines, run codes and cardiovert as necessary. Write meds, order tests, call for consults. We call anaesthesia for intubations. I can do LP's in theory but not sufficiently trained as yet. No residency, I got this job straight out of school.

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Hi guys,

 

I graduated from my PA program 2 years ago and have been working in a community emergency department since.  Although I have heard about ED PAs who are pigeon-holed into working fast track only, I have not had that experience.  In a very short time I have become reasonably comfortable (sometimes I have to "tag out" to the doc) with bedside ultrasound, intubation, central venous catheterization at all sites, procedural sedation, joint reduction, lumbar puncture (which I do still suck at), and all of the less acute procedures.  I have even had the pleasure of draining a priapism without the MD present, it went pretty well. 

 

We are dependent practitioners, this is immutable.  But, with you will find that if you are persistent in asking the MDs/DOs to take the first crack at intubating a code, or ask to get involved with more invasive procedures, you will be rewarded with increasing autonomy and prove yourself to be skilled with these interventions.  Some attendings will be pretty averse to allowing you to do these things, but the squeaky wheel gets the grease my friend.

 

The point has been made that not all jobs are created equal, but there are jobs out there that allow a PA to really practice critical medicine, so my recommendation would be to make that an up-front question during interviews.  Don't sell yourself short  and good luck with everything  : )

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