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How many of you are working in solo coverage EDs?


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I've worked the past two years as a paramedic in a Mid Level run emergency room.  Rural MN although fairly busy 9500 patients a year.  About 60% of our Pa's are staff and the rest locum.  The Pa's where I work seem to like the autonomy but had years of experience prior to working there.  I start school in May and afterwards hopefully do an EM PA residency and return there in roughly five years from now.  Rural MN & ND have many places that are PA run 

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On 1/4/2018 at 1:07 PM, kettle said:

I've worked the past two years as a paramedic in a Mid Level run emergency room.  Rural MN although fairly busy 9500 patients a year.  About 60% of our Pa's are staff and the rest locum.  The Pa's where I work seem to like the autonomy but had years of experience prior to working there.  I start school in May and afterwards hopefully do an EM PA residency and return there in roughly five years from now.  Rural MN & ND have many places that are PA run 

many in MN and WI are mayo affiliated.

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I do some solo coverage at a 7500 visit/year critical access hospital in  Maine.  Same experience as above.  Rural Maine (well all Maine) folks are tough--and SICK, so it can be interesting.  It's been solo PA coverage since I was a kid (I'm nearing 40).  Great gig.  15-20 per 24 hour shift so pretty manageable.  Hoping a full timer will leave sooner than later so I can jump into a full time role.  

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2 hours ago, BirdDogPA said:

If  you consider being the only provider on site with Telemedicine backup coverage then yes I will be starting solo coverage at a critical access facility soon. 

at most of these places the "telemed backup" is just a machine that gathers dust in the corner and is maybe pulled out for stroke consults every now and then. at one of my per diem jobs we were required to do an orientation on the machine and have it in the dept. In 2 years here I have never used it.

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On 1/25/2018 at 11:47 PM, MrsGPAC said:

I do some solo coverage at a 7500 visit/year critical access hospital in  Maine.  Same experience as above.  Rural Maine (well all Maine) folks are tough--and SICK, so it can be interesting.  It's been solo PA coverage since I was a kid (I'm nearing 40).  Great gig.  15-20 per 24 hour shift so pretty manageable.  Hoping a full timer will leave sooner than later so I can jump into a full time role.  

Ellsworth?  I keep getting job offers for Bar Harbor but the pay is ridiculously low.

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VT - along the 91 drug corridor.  I like to call where I work "the hood in the woods."  PA-only, anywhere from single to triple coverage, depending on the time of day, and we see anything and everything.  We ship a lot to the tertiary facility an hour up the road, are good friends with the nurses and medics on the local helo service (some have even come to work with us eventually), and we do all the EMS medical control for the district(s) in the hospitals we staff. 

Full scope, full practice.  Can't ask for a better gig... except maybe on the ocean.  But mountains will suffice. 

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13 hours ago, kargiver said:

VT - along the 91 drug corridor.  I like to call where I work "the hood in the woods."  PA-only, anywhere from single to triple coverage, depending on the time of day, and we see anything and everything.  We ship a lot to the tertiary facility an hour up the road, are good friends with the nurses and medics on the local helo service (some have even come to work with us eventually), and we do all the EMS medical control for the district(s) in the hospitals we staff. 

Full scope, full practice.  Can't ask for a better gig... except maybe on the ocean.  But mountains will suffice. 

have been by this hospital and know this group. In my opinion this is the best em pa job in the country right now.

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60 hr solo coverage shift could be brutal. 24s are great. no matter how busy it is I can stay awake for 24 hrs, but 60 or 72....I realize they probably see 5-10 pts/24 hrs if the shift is 60 hrs long, but every now and then it might be 20/24 hrs a few days in a row during flu season or something....brutal...I have done 24s every other and that is doable for short runs.

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E- I agree that it could be brutal in the right setting. The facility is covered by a PA every other weekend and by physicians the remainder of the time for the most part. 5-10/ 24hrs is the pt load usually. 

I'll be commuting by air to work this one and will usually string it together is another 24hr shift on the front or back end with a day off between. Puts me working 8-9, 24hr shifts per month with opportunity to work part time at my community ED here near home if I want. 

Finding solo coverage jobs here in the southeast is near impossible so if I want to work that kind of job, commuting is the only way. There are some solo coverage jobs in MS and AL but the PA practice laws in those states are not agreeable. NPs can do it, but PAs have to have "supervision".... 

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Used to work in the rural ER in MN that Kettle describes above....its referred to as the mini- Hennepin County Medical Center.  Most per capita trauma cases of any hospital in MN.  Near a major tourism highway, major walleye fishery, reservation, casino, and the busiest ATV/snowmobile trail in the world.  Fun place for plenty of experience, but when you are 8 hours into your shift and you have 4 simultaneous IVDU arrests inbound and a full ER, and agitated psych patients without security or sheriff's office help it can become taxing (moreso on the stress you bring home to the family). 

2008-2016 full-time hospitalist in a community hospital with lots of autonomy

2009-2014 moonlighting rural very low volume solo coverage ERs in MN and IA

2014 - present - Employed full-time 5 24hr shifts/month in a 5000/yr solo coverage ER in MN

2014 - present - Independent contract/run my own S-corp business doing solo coverage ER/house officer at 3 places, and solo hospitalist at another in MN.  

Happy as a clam in my current situation.  

I do not work at any of the Mayo facilities in MN, and many of my cohort solo coverage PAs in MN prefer to avoid them as well. 

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On 4/1/2018 at 10:02 PM, rgnellis1 said:

Used to work in the rural ER in MN that Kettle describes above....its referred to as the mini- Hennepin County Medical Center.  Most per capita trauma cases of any hospital in MN.  Near a major tourism highway, major walleye fishery, reservation, casino, and the busiest ATV/snowmobile trail in the world.  Fun place for plenty of experience, but when you are 8 hours into your shift and you have 4 simultaneous IVDU arrests inbound and a full ER, and agitated psych patients without security or sheriff's office help it can become taxing (moreso on the stress you bring home to the family). 

2008-2016 full-time hospitalist in a community hospital with lots of autonomy

2009-2014 moonlighting rural very low volume solo coverage ERs in MN and IA

2014 - present - Employed full-time 5 24hr shifts/month in a 5000/yr solo coverage ER in MN

2014 - present - Independent contract/run my own S-corp business doing solo coverage ER/house officer at 3 places, and solo hospitalist at another in MN.  

Happy as a clam in my current situation.  

I do not work at any of the Mayo facilities in MN, and many of my cohort solo coverage PAs in MN prefer to avoid them as well. 

I am an older second career new PA grad from rural NE MN (but with prior ER experience) interested in eventually working in rural ER’s, which would also mean solo ER practice. Do you have any insight into the value of doing a fellowship/residency vs. starting a job in a more high volume location if the end goal is to work more rural positions? Thank you!

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I work in a critical access hospital in western Indiana, near the Illinois border.  Doc does 8A-8P.  I do 8P-8A.  I'm the only provider in the hospital: 9 bed ED, 16 in patient beds.  I call the doc back for codes and thrombolytics, that's pretty much it.  I still run the code, but doc has to be there and pronounce if needed.  I cover responses to the floor at night.   I do 12-14 12 hour shifts/month.  I travel in, do 3-5 shifts in a row,  sometimes as few a 2 shifts or as many as 7.  Typical nightly volume is about 12-13.

Best job I've ever had.

Prior to this I spent 5 years in a busy level 3 trauma center and have 35+ years in EMS.  That prep really helped.  I did not do a residency because PA is my 3rd career and I needed to get back to the family.  However, just from the learning point of view, I really wish I had.  I learned a ton in the busy shop, but didn't get the learning you would from the off service rotations.

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I work critical access EM in rural ND. Only about 1800 pts annually. Work two 87hr shifts a month over the weekend. Physician back-up for critical cases with requirements to consult on all pts that are admitted or transferred. Before this job, worked in a rural critical access job doing about 80% mostly solo FM and 20% 2 provider ED coverage for a couple years right out of school though wasnt solo FM very much my first year. Its a great position and am very happy to be in the current situation. It seems the best EM jobs are on the great plains. A busy day is 10 pts in 24hrs. A quite day is 0-1pts and does happen on occasions.

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I found my position on Craigslist (not a typical method).  Constant monitoring of a variety of job boards, also check state PA organization sites and SEMPA.  Some companies, like Wapiti, specialize in this type of job - there may well be others.  These locations typically want PA's with prior ED experience.

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3 hours ago, dphy83 said:

Does one just pick random, isolated towns and search the job boards, or how does one find these positions?

Found my first from just googling jobs in my area and the second was a place I did locums. My part time job was a referral from a friend who put my name out there, without asking but worked out 🙂

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