So what are the duties of a PA in urgent care?

[place123]

I was going to post this in the specialties subforum but didnt see a spot for urgent care. Hopefully it is okay that I ask this question here. 

 

Urgent care is a field I could see myself in. I am wondering if anyone could give a list of duties a PA will be doing on a day to day basis by order of frequency.  (Hopefully not being too demanding)

 

I have only shadowed primary care docs/PA/NP so far. And being a perfectionist I like knowing everything before making a decision. 

[JPMiller]

Exactly the same as a doc in UC. See lots and lots of patients.

[DiggySRNA]

Not a PA....but have worked with a PA in urgent care as a MA. 

 

The PAs that I have worked with is the sole provider for said shift;

• Evaluate, treat, and street
• Pelvic exams (lots and lots of em)
• Suture, wound packing, wound care.
• Remove foreign body/bodies (anywhere from head to toe) 
• Prescribe meds (or delegate the task to the MA)
• Put in orders for the MAs and X-Ray Tech to complete
• Complete preliminary xray findings
• Conduct DOT physicals and general wellness physicals
• Call surrounding EDs to notify them of a possible arrival
• Travel consults/travel vaccinations
• Review lab results and relay the information to the patient or delegate the task to a MA.

[Katera]

 

Not a PA....but have worked with a PA in urgent care as a MA. 

 

The PAs that I have worked with is the sole provider for said shift;

• Evaluate, treat, and street
• Pelvic exams (lots and lots of em)
• Suture, wound packing, wound care.
• Remove foreign body/bodies (anywhere from head to toe) 
• Prescribe meds (or delegate the task to the MA)
• Put in orders for the MAs and X-Ray Tech to complete
• Complete preliminary xray findings
• Conduct DOT physicals and general wellness physicals
• Call surrounding EDs to notify them of a possible arrival
• Travel consults/travel vaccinations
• Review lab results and relay the information to the patient or delegate the task to a MA.

 

 

 

 

I do Urgent Care full time and have since before there were Urgent Care clinics.  We use to call them "Minor Emergency" clinics and they were almost universally hospital owned and ran.  Anyway, I would agree with the list quoted above except for pelvic exams.  I guess it depends where you are, but I rarely do them.  Urgent care clinics can be broken down into two main groups..

 

1.)  Non-aggressive mostly corporate owned and ran.  Any questionable chest pain, abd pain etc will be sent out.  They don't do IV's or aggressive procedures.  They are about high volume and low acuity.  Coughs, cold, minor lac's and abscesses and of course sprains and strains.

 

2.)  ER docs that are sick of the ER...open an Urgent care....then run it like an ER......These are almost universally owned privately by ER docs.  Be VERY careful with these unless you are not alone onsite.  These are frequently an exercise in liability.  You basically have docs that want to work up everyone, except you frequently don't have the support system to do it.  Imaging for example....Abd pain?  Oh I've got a deal with the imaging center down the street, just write the order and send them down there.  That's great until they crash on the way over there.  Real ER's are almost universally built right next to radiology for a reason.  That's because people crash there....a lot.  There is one doc I know of that owns an urgent care who runs cardiac enzymes on pt's with CP, and when you are there alone, expects you do do the same.  Except as we all know, one set of enzymes does NOT rule out an MI.  It's ridiculous.  He is setting up his PA's for massive failure.  I know the ER PA's will hate this, but the fact is...Urgent Care is no place for pt work ups.  That's what the ER is for, and why they get paid $15 an hour more then we do :P

 

So, long story short the most important take away here is to ASK any UC you might work at what their policy is on work-ups and ER referrals.  I interviewed at one place that said every pt you send to the ER is looked over by the medical director and if it is found to not have been in their mind an appropriate referral then you were written up for disciplinary action.  LOL , I'm not sure if I actually laughed in her face...but I might have.

 

Good luck!

 

 

 

p.s.  Both places will do lots of worker's comp.  So if you have not been DOT certified yet....go do it.

[sas5814]

I do Urgent Care full time and have since before there were Urgent Care clinics.  We use to call them "Minor Emergency" clinics and they were almost universally hospital owned and ran.  Anyway, I would agree with the list quoted above except for pelvic exams.  I guess it depends where you are, but I rarely do them.  Urgent care clinics can be broken down into two main groups..

 

1.)  Non-aggressive mostly corporate owned and ran.  Any questionable chest pain, abd pain etc will be sent out.  They don't do IV's or aggressive procedures.  They are about high volume and low acuity.  Coughs, cold, minor lac's and abscesses and of course sprains and strains.

 

2.)  ER docs that are sick of the ER...open an Urgent care....then run it like an ER......These are almost universally owned privately by ER docs.  Be VERY careful with these unless you are not alone onsite.  These are frequently an exercise in liability.  You basically have docs that want to work up everyone, except you frequently don't have the support system to do it.  Imaging for example....Abd pain?  Oh I've got a deal with the imaging center down the street, just write the order and send them down there.  That's great until they crash on the way over there.  Real ER's are almost universally built right next to radiology for a reason.  That's because people crash there....a lot.  There is one doc I know of that owns an urgent care who runs cardiac enzymes on pt's with CP, and when you are there alone, expects you do do the same.  Except as we all know, one set of enzymes does NOT rule out an MI.  It's ridiculous.  He is setting up his PA's for massive failure.  I know the ER PA's will hate this, but the fact is...Urgent Care is no place for pt work ups.  That's what the ER is for, and why they get paid $15 an hour more then we do :P

 

So, long story short the most important take away here is to ASK any UC you might work at what their policy is on work-ups and ER referrals.  I interviewed at one place that said every pt you send to the ER is looked over by the medical director and if it is found to not have been in their mind an appropriate referral then you were written up for disciplinary action.  LOL , I'm not sure if I actually laughed in her face...but I might have.

 

Good luck!

 

 

 

p.s.  Both places will do lots of worker's comp.  So if you have not been DOT certified yet....go do it.

Great description! I worked at a private UC that was basically a family med, UC, ER. 1 doc/owner who was there 2 days a week. All PAs otherwise. Need someone to follow your IDDM? Sure! HTN? Sure! See you in 3 months for your follow up. Chest pain? No problem. We can do cardiac enzymes and an EKG (and anything else that we could charge for). The owner actually told me I was costing him money by not ordering unnecessary tests as well as injectable antibiotics and steroids for every cough/cold/runny nose.

Now I work at an institutional UC that does just that.  no HTN except for crisis that gets transferred to the ER. Chest pain? ER. Abd pain of questionable origin? ER. Pain management? Nope. Refill long term meds? Here is 3 days to last until you speak to your PCP. The only injectable antibiotic is 250 Rocephin for GC. Steroids for trigger point or joint injections only and those are rare. We are advised and policy developed based on guidance from specialists in the organization in infectious disease, emergency med, ortho etc. Everything based on evidence based medicine. Acute illness and injury. No DOT physicals. Transfer to the ER? Call the dedicated line for the transfer coordinator and tell them what you are sending. They advise the ER. NEVER any blowback for a transfer.

Bottom line is there are a lot of different flavors of UC. If you want to work in one make sure you know what they do and how they do it.

[beattie228]

Katera's breakdown is spot on.

 

I work full time for a hospital owned Urgent Care. I'm always schedule 1:1 with a doc, but we function independently. I really enjoy the autonomy that the field provides. I see and treat all of the things one would expect to encounter in an Urgent Care setting. Additionally, my job entails sifting through the patients to find out which patients are inappropriate for the Urgent Care setting and need to be turfed out to the ER via EMS.

 

As with most PA jobs, but especially so with ER and UC gigs, it is crucial to have a full understanding up front what your expectations and physician support will look like (physician support, malpractice insurance, policies for sending patients to the ER, etc). This is especially true for a new graduate. I'm always scheduled with a physician, and I have a wonderful collegial relationship with the docs I work with. I'm able to bounce ideas off of them and we often discuss interesting cases in our down time as there is always something to be learned from each patient encounter. 

[place123]

Great replies here thank you all!