Experienced ER PAs needed San Jose level 1 trauma center

[Marinejiujitsu]

I'm looking for a couple seasoned ER PAs at a level 1 trauma center in San Jose, Ca. I have worked there for 5 yrs then went away for a couple years but my group took over the contract. I have a bunch of new PAs at the site. Pm me of you're interested.

 

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[Boatswain2PA]

Is this for VEP?  They were begging for PAs there a year ago, promising referral bonuses to get people.  I sent the recruiter two names...VEP never even called them. 

[sk732]

Still only "South=>North" reciprocity...so no can do.

 

SK

[EMEDPA]

On ‎10‎/‎11‎/‎2017 at 10:10 PM, Marinejiujitsu said:

 

I'm looking for a couple seasoned ER PAs at a level 1 trauma center in San Jose, Ca. I have worked there for 5 yrs then went away for a couple years but my group took over the contract. I have a bunch of new PAs at the site. Pm me of you're interested.

 

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scope of practice/autonomy? Advanced procedures done by PAs?

[Marinejiujitsu]

It is VEP. Northern California. Scope-fast track, express care/UC (abdominal/vaginal bleeding, eye, misc.), soon to be main with all the crazy sick people (just about everyone gets admitted here), ED intake and XC intake. Numerous different positions, hard to get bored here.

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[Marinejiujitsu]

Is this for VEP?  They were begging for PAs there a year ago, promising referral bonuses to get people.  I sent the recruiter two names...VEP never even called them. 

Have them get a hold of me. We need experience ER PAs though.

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[Boatswain2PA]

Sorry, I won't do it again.  VEP didn't care enough to even call the two PAs I sent info on.  Later got an email from recruiter saying they were "focusing on finding physicians".  My reply was why the hell were you sending out emails begging for people to refer PAs to youvthen?

Also, other experiences with VEP (I work part time at a busy VEP shop)....PA/NPS don't matter to them.  Constant changes to schedule, poor pay, and unfathomable bonus structure.  Hell, it took almost a year for me to get one CME item approved (only got it because I kept showing them their own emails promising it)

I enjoy working at that shop, but it's because the docs and staff at that hospital, it has nothing to do with VEP.

[Boatswain2PA]

Emed - VEP has pretty strict policies limiting PA practice.  For example, supposed to get MD approval before ordering a CT.  

My shop is well run, with docs who understand some PA/NPs are more autonomous than others.  I do pretty much everything there...but thats not VEP policy.  (I did get talked to about doing procedural sedation on a kid...VEP really didn't like that).

[EMEDPA]

I wasn't asking for myself. I can't see leaving my current job unless it's to go work with Kargiver at his shop in VT, which is likely the best em pa job in the country. 

I have no restrictions in scope of practice at my current job. My credentialing packet is the same as the docs. I declined being privileged for thoracotomy and bronchoscopy, because neither really makes sense in my setting. I am privileged for all procedural sedation, airway issues, lines, chest tubes, perimortem c-section, etc

[Marinejiujitsu]

I work at one VEP site where I do pretty much everything myself. I've never worked at a place where getting a CT approved by an attending except by CEP. At least it was never enforced. This place is more of a teaching institute meaning the newer PAs are meant to be more supervised by the senior PAs and docs.

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[Marinejiujitsu]

This place is next best thing to a residency. Imo.

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[Marinejiujitsu]

This place is next best thing to a residency. Imo.

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But I have plenty of new PAs from the group switch.

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[Boatswain2PA]

Marine - Most of VEPs "APP" rules are not enforced at my shop either, we are all just too busy.  The EPs get KILLED when they drop to single coverage (more $$ for VEP).

Take a look at the VEP handbook though, corporate want to limit what we do.

[SoCalPA]

This place is next best thing to a residency. Imo.

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How can this be when it's mostly new grads? I will do a real residency upon graduation to avoid getting stuck in fast track.

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[Marinejiujitsu]

How can this be when it's mostly new grads? I will do a real residency upon graduation to avoid getting stuck in fast track.

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New group to the ER, hired all new grads. Experience ER PAs are a hot commodity. We get offers everyday. I'm trying to hire a few experienced PAs, we work along the attending, residents, pharm D. Tons of knowledge all around.

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[Boatswain2PA]

Marine (et al):  From VEPs own website:

SCOPE of PRACTICE for ADVANCED PRACTICE CLINICIAN (APC) STAFF: PHYSICIAN ASSISTANTS and NURSE PRACTITIONERS 09/18/15

INFANT < 90 DAYS The APC may manage infants initially. However, the ED physician must examine the infant and provide complete documentation signifying independent assessment.

EKG’S EKG must have final interpretation documented by the ED physician prior to discharge.

CPR ED physician must be immediately contacted for assistance, but the APC can direct resuscitation in the absence of, or at the direction of, the ED physician.

CT, ULTRASOUND, MRI Patients must be presented to ED physician prior to ordering these tests.

PROCEDURAL SEDATION The ED physician must be in the exam room throughout the entire procedure.

ED PHYSICIAN MUST SEE OR DISCUSS WHILE PATIENT IN ED. THIS MUST BE DOCUMENTED.

1. Abdominal pain with possible surgical etiology: a. Age > 65 years b. Peritoneal signs (rebound tenderness, pain with cough, percussion tenderness) c. RLQ tenderness d. Uncontrolled co-morbid factor (diabetes, hypertension, immune disorder) e. Trauma: high velocity, significant blunt force, roll-over MVA f. Bright red blood per rectum or melena g. Pregnancy test positive

2. Shock or hypotension

3. Bleeding that is significant from any orifice

4. Pregnancy with bleeding, abnormal fetal heart rate, or fever

5. Chest pain that suggests possible myocardial ischemia, pulmonary embolism, aortic dissection, or pneumothorax

6. Chest pain with syncope, dyspnea, EKG abnormality, or arrhythmia

7. Arrhythmia of recent onset or with unstable hemodynamics

8. Drug overdose

9. Acute change in mental status or coma

10. Neurological deficits of acute onset

11. Head trauma with loss of consciousness, neurologic findings, or associated injuries

12. Headache with fever or neurological or meningeal findings

13. New onset seizure

14. Alcohol or drug withdrawal with confusion, hallucinations, fever, seizures, delirium, or abnormal vital signs

15. Allergic reaction with dyspnea, wheezing, or hypotension

16. Third degree burns; second degree burns > 10% body area

17. Burns of the eye, face, hand, foot, or perineum

18. Burns with electrical injury or inhalation injury

19. Laceration involving muscle, nerve, tendon, or blood vessel

20. Sickle cell crisis

21. Acute vision loss

22. Acute eye pain of uncertain etiology

23. Acute hearing loss

24. Findings consistent with abuse or rape

25. “Hot” joint suspicious for infection

26. Displaced fractures

27. Hypothermia < 95 F or hyperthermia > 105 F

28. Petechiae or widespread bruising

29. Hyperglycemia with blood sugar > 400 mg/dL

30. Fever of unknown origin

 

[True Anomaly]

Man, I'm an experienced ER PA and I have really never received any offers to go anywhere else.  Not that I would go anywhere else, but it feels nice to be wanted every once in a while :D

[Marinejiujitsu]

Marine (et al):  From VEPs own website:

SCOPE of PRACTICE for ADVANCED PRACTICE CLINICIAN (APC) STAFF: PHYSICIAN ASSISTANTS and NURSE PRACTITIONERS 09/18/15
INFANT EKG’S EKG must have final interpretation documented by the ED physician prior to discharge.
CPR ED physician must be immediately contacted for assistance, but the APC can direct resuscitation in the absence of, or at the direction of, the ED physician.
CT, ULTRASOUND, MRI Patients must be presented to ED physician prior to ordering these tests.
PROCEDURAL SEDATION The ED physician must be in the exam room throughout the entire procedure.
ED PHYSICIAN MUST SEE OR DISCUSS WHILE PATIENT IN ED. THIS MUST BE DOCUMENTED.
1. Abdominal pain with possible surgical etiology: a. Age > 65 years b. Peritoneal signs (rebound tenderness, pain with cough, percussion tenderness) c. RLQ tenderness d. Uncontrolled co-morbid factor (diabetes, hypertension, immune disorder) e. Trauma: high velocity, significant blunt force, roll-over MVA f. Bright red blood per rectum or melena g. Pregnancy test positive
2. Shock or hypotension
3. Bleeding that is significant from any orifice
4. Pregnancy with bleeding, abnormal fetal heart rate, or fever
5. Chest pain that suggests possible myocardial ischemia, pulmonary embolism, aortic dissection, or pneumothorax
6. Chest pain with syncope, dyspnea, EKG abnormality, or arrhythmia
7. Arrhythmia of recent onset or with unstable hemodynamics
8. Drug overdose
9. Acute change in mental status or coma
10. Neurological deficits of acute onset
11. Head trauma with loss of consciousness, neurologic findings, or associated injuries
12. Headache with fever or neurological or meningeal findings
13. New onset seizure
14. Alcohol or drug withdrawal with confusion, hallucinations, fever, seizures, delirium, or abnormal vital signs
15. Allergic reaction with dyspnea, wheezing, or hypotension
16. Third degree burns; second degree burns > 10% body area
17. Burns of the eye, face, hand, foot, or perineum
18. Burns with electrical injury or inhalation injury
19. Laceration involving muscle, nerve, tendon, or blood vessel
20. Sickle cell crisis
21. Acute vision loss
22. Acute eye pain of uncertain etiology
23. Acute hearing loss
24. Findings consistent with abuse or rape
25. “Hot” joint suspicious for infection
26. Displaced fractures
27. Hypothermia 105 F
28. Petechiae or widespread bruising
29. Hyperglycemia with blood sugar > 400 mg/dL
30. Fever of unknown origin
 

That's pretty much all big groups, most places use it loosely. I know you are in an independent shop and you will never be happy with a big group. Quit PA blocking me. Lol.

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[Marinejiujitsu]

Man, I'm an experienced ER PA and I have really never received any offers to go anywhere else.  Not that I would go anywhere else, but it feels nice to be wanted every once in a while :D

Norcal? You can PM me for details if you'd like.

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[Marinejiujitsu]

Marine (et al):  From VEPs own website:

SCOPE of PRACTICE for ADVANCED PRACTICE CLINICIAN (APC) STAFF: PHYSICIAN ASSISTANTS and NURSE PRACTITIONERS 09/18/15
INFANT EKG’S EKG must have final interpretation documented by the ED physician prior to discharge.
CPR ED physician must be immediately contacted for assistance, but the APC can direct resuscitation in the absence of, or at the direction of, the ED physician.
CT, ULTRASOUND, MRI Patients must be presented to ED physician prior to ordering these tests.
PROCEDURAL SEDATION The ED physician must be in the exam room throughout the entire procedure.
ED PHYSICIAN MUST SEE OR DISCUSS WHILE PATIENT IN ED. THIS MUST BE DOCUMENTED.
1. Abdominal pain with possible surgical etiology: a. Age > 65 years b. Peritoneal signs (rebound tenderness, pain with cough, percussion tenderness) c. RLQ tenderness d. Uncontrolled co-morbid factor (diabetes, hypertension, immune disorder) e. Trauma: high velocity, significant blunt force, roll-over MVA f. Bright red blood per rectum or melena g. Pregnancy test positive
2. Shock or hypotension
3. Bleeding that is significant from any orifice
4. Pregnancy with bleeding, abnormal fetal heart rate, or fever
5. Chest pain that suggests possible myocardial ischemia, pulmonary embolism, aortic dissection, or pneumothorax
6. Chest pain with syncope, dyspnea, EKG abnormality, or arrhythmia
7. Arrhythmia of recent onset or with unstable hemodynamics
8. Drug overdose
9. Acute change in mental status or coma
10. Neurological deficits of acute onset
11. Head trauma with loss of consciousness, neurologic findings, or associated injuries
12. Headache with fever or neurological or meningeal findings
13. New onset seizure
14. Alcohol or drug withdrawal with confusion, hallucinations, fever, seizures, delirium, or abnormal vital signs
15. Allergic reaction with dyspnea, wheezing, or hypotension
16. Third degree burns; second degree burns > 10% body area
17. Burns of the eye, face, hand, foot, or perineum
18. Burns with electrical injury or inhalation injury
19. Laceration involving muscle, nerve, tendon, or blood vessel
20. Sickle cell crisis
21. Acute vision loss
22. Acute eye pain of uncertain etiology
23. Acute hearing loss
24. Findings consistent with abuse or rape
25. “Hot” joint suspicious for infection
26. Displaced fractures
27. Hypothermia 105 F
28. Petechiae or widespread bruising
29. Hyperglycemia with blood sugar > 400 mg/dL
30. Fever of unknown origin
 

I'm gonna start raising a ruckus about some of these things. I feel veterans will just or the test but some will manipulate there charts reasoning why it wasn't ordered which is a dangerous game.

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[True Anomaly]

18 minutes ago, Marinejiujitsu said:

Norcal? You can PM me for details if you'd like.

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Nah, I'm nowhere near there- it was more a general statement in contrast with others who have noted that ER PA's are a "hot commodity".  I just haven't felt the same love :D  Carry on

[PACJD]

Have a couple of friends that work for VEP and they love it. According to them, the list posted above is really just a formality and a way to save themselves during lawsuits. They said that they have good autonomy from what they're telling me. Just saying what they said though don't know if its actually true. 

[Boatswain2PA]

I enjoy the VEP-staffed shop I work at.  Great docs, terrific nurses, and good facility.   I work there strictly because it gives me the ability to work beside BC EPs and pick their brains.

Regarding autonomy, they generally let me have it.  Like I said, the only thing I've done where I got in "trouble" was procedural sedation. There are a couple of full time PAs and a NP who are also given significant autonomy.  On the flip side, because they pay so poorly, they have difficulty keeping the experienced PAs.  This leads them to hiring a lot of new grad NPs who don't know how to read an EKG., etc, and are effectively relegated to fast-track.  Understandably VEP then has these significant formal restrictions on what we can do.  

My problem is the lack of value that VEP, as in corporate VEP, places on APCs.  One BIG example of this is they don't let us work as contractors.  It's either full time (with benefits), part time (with limited benefits), or PRN (no benefits).  Meanwhile all (??) their EPs are contractors which allows them to A) vary between full, part time, and PRN hours as they desire, and  B) Get paid a higher rate ecause they don't receive benefits from VEP.  

Since the APCs don't have that option, the full timers are just put on the schedule where they are needed, meanwhile there aren't any part-timers (dedicated to 20+ hrs/week), so the majority of us PRN folk just pick & choose where we want.  Meanwhile they pay us all the same hourly rate which, since most of us don't get benefits, is far below regional average.  This leads to quick burnout for the new hires.  If they would just allow us to become 1099 contractors it would fix a lot of this problem (pay me 20% more and I would double or triple my shifts there).  Just as an example- I am working locums at a cough/snot clinic RIGHT NEXT to the VEP staffed ED and making 20% more per hour handing out rx's for sudafed and tessalon perls.  The local ED director wants to increase pay, but can't get it through VEP. 

Another example of how VEP doesn't seem to care about APCs - they are CONSTANTLY jacking with our schedule so they can cut costs.  Even to the point of adjusting start/stop times only a week out.  So, in an environment with mostly PRN folks staffing the ED who have other primary jobs (and family lives!), some bureaucrat in California sends out an email saying they are changing the T/W/Th shift from 9a-9p to 1130a-1130p.  Well, that doesn't work for me because I have to drive 100 miles by 0800 the next morning and took that into account when I signed up for the 9a-9p shift!

And then there is the responsiveness from corporate VEP.  As I said earlier, about 6 months ago VEP was blasting out emails offering $5000 referral bonuses for providers to cover the San Jose ED.  I don't remember if I posted something here or if I sent some PMs through the PA forums, but I found two PAs who were interested.  One was literally driving, at that very moment, across country moving to the San Fran area and didn't have a job lined up yet.  I got contact information and passed it on to the VEP recruiter (the one promising the $5000 referral bonus).....and then didn't hear a damn thing.  Following up with the two PAs they said nobody ever contacted them.  When I saw another EP email, once again promising a referral bonus for PAs I wrote the recruiter back asking why he hadn't contacted the two I sent him.  His reply was "they were looking for physicians."  

So, not bad-mouthing VEP, and certainly not bad-mouthing the shop I work in.  Just realize that working for VEP as a PA means you are treated like a second-class citizen...kind of our lot in life, isn't it!
 

[Marinejiujitsu]

I enjoy the VEP-staffed shop I work at.  Great docs, terrific nurses, and good facility.   I work there strictly because it gives me the ability to work beside BC EPs and pick their brains.

Regarding autonomy, they generally let me have it.  Like I said, the only thing I've done where I got in "trouble" was procedural sedation. There are a couple of full time PAs and a NP who are also given significant autonomy.  On the flip side, because they pay so poorly, they have difficulty keeping the experienced PAs.  This leads them to hiring a lot of new grad NPs who don't know how to read an EKG., etc, and are effectively relegated to fast-track.  Understandably VEP then has these significant formal restrictions on what we can do.  

My problem is the lack of value that VEP, as in corporate VEP, places on APCs.  One BIG example of this is they don't let us work as contractors.  It's either full time (with benefits), part time (with limited benefits), or PRN (no benefits).  Meanwhile all (??) their EPs are contractors which allows them to A) vary between full, part time, and PRN hours as they desire, and  B) Get paid a higher rate ecause they don't receive benefits from VEP.  

Since the APCs don't have that option, the full timers are just put on the schedule where they are needed, meanwhile there aren't any part-timers (dedicated to 20+ hrs/week), so the majority of us PRN folk just pick & choose where we want.  Meanwhile they pay us all the same hourly rate which, since most of us don't get benefits, is far below regional average.  This leads to quick burnout for the new hires.  If they would just allow us to become 1099 contractors it would fix a lot of this problem (pay me 20% more and I would double or triple my shifts there).  Just as an example- I am working locums at a cough/snot clinic RIGHT NEXT to the VEP staffed ED and making 20% more per hour handing out rx's for sudafed and tessalon perls.  The local ED director wants to increase pay, but can't get it through VEP. 

Another example of how VEP doesn't seem to care about APCs - they are CONSTANTLY jacking with our schedule so they can cut costs.  Even to the point of adjusting start/stop times only a week out.  So, in an environment with mostly PRN folks staffing the ED who have other primary jobs (and family lives!), some bureaucrat in California sends out an email saying they are changing the T/W/Th shift from 9a-9p to 1130a-1130p.  Well, that doesn't work for me because I have to drive 100 miles by 0800 the next morning and took that into account when I signed up for the 9a-9p shift!

And then there is the responsiveness from corporate VEP.  As I said earlier, about 6 months ago VEP was blasting out emails offering $5000 referral bonuses for providers to cover the San Jose ED.  I don't remember if I posted something here or if I sent some PMs through the PA forums, but I found two PAs who were interested.  One was literally driving, at that very moment, across country moving to the San Fran area and didn't have a job lined up yet.  I got contact information and passed it on to the VEP recruiter (the one promising the $5000 referral bonus).....and then didn't hear a damn thing.  Following up with the two PAs they said nobody ever contacted them.  When I saw another EP email, once again promising a referral bonus for PAs I wrote the recruiter back asking why he hadn't contacted the two I sent him.  His reply was "they were looking for physicians."  

So, not bad-mouthing VEP, and certainly not bad-mouthing the shop I work in.  Just realize that working for VEP as a PA means you are treated like a second-class citizen...kind of our lot in life, isn't it!
 

Totally get it. It depends on the shop too, bottom line, medical director support for the PAs, and bargaining. VEP has treated me well. That's one of the reasons I've like working at this place is to pick the brains of multitude of docs.

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[Boatswain2PA]

I'm glad you like it!

VEP just picked up San Jose about a year ago, right?  Did you work there before VEP got the contract?  Or did you come in with VEP?   

The reason I ask is the shop I work at had a very deserving TERRIBLE reputation until they finally brought in VEP.  The reputation is slowly improving as it is truly a good place.