jd1111 Posted January 5, 2018 Share Posted January 5, 2018 I work for a fairly low volume ER owned by a private physician group. We also own a 5 bed, low acuity ER which gets occasional cardiac arrests, trauma drop offs etc. Until now, the sattelite ED which is about 20 minutes away has been staffed by an MD, but we are now moving to PA solo coverage. The higher ups approved everything, but now seem to be getting cold feet. Does anyone have any hard data supporting what we are trying to do in order to help persuade? Thanks Link to comment Share on other sites More sharing options...
gbrothers98 Posted January 5, 2018 Share Posted January 5, 2018 24/7 solo PA coverage has been done successfully at the ED's of 2 critical access hospitals in VT, Windsor and Springfield, for 17 and 30+ years respectively. There are places in NY and ME that I am aware of the same thing. Protocols, supervising physician support and continued training are key. As for data, determine the difference between the salaries of a physician covering the place vs a PA. No brainer. Only thing that will stand in the way is that this is a private group making the decision. If the hospital was on the hook for the salaries and benefits, this would have been a move done a decade ago. Good luck. George Link to comment Share on other sites More sharing options...
sas5814 Posted January 5, 2018 Share Posted January 5, 2018 I was solo coverage in a critical access hospital ER for a few years with the local FP docs on backup call. It could stretch me to my limits from time to time but mostly things chugged along just fine. It continued that way for years until one of the backup docs was named in a malpractice suit for an ER patient they never saw and weren't even aware of just because he was on backup. The local docs forced a change and the hospital went to contract physicians who, quite frankly, often did a poor job. Many were burned out or just couldn't find work except under these types on contracts. It was sad but I really can't blame the local docs. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 5, 2018 Moderator Share Posted January 5, 2018 it is a common practice in rural hospitals in WA, AK, MT, ME, VT, WY, TX, ND, SD, MI, NE, MN, and WI. sure there are other states as well. I work full time at a rural critical access hospital ER that has used PAs as solo coverage for > 20 years. Link to comment Share on other sites More sharing options...
SCHW9076 Posted January 5, 2018 Share Posted January 5, 2018 Following this thread for info. This is my dream job. Doing an EM fellowship right now to help me get one of these jobs. Link to comment Share on other sites More sharing options...
lkth487 Posted January 5, 2018 Share Posted January 5, 2018 I have a question for the experienced EM PA's in this thread - how do you see the future of this specialty? EM residencies have increased quite a bit in the last four years (one of the biggest increases I believe) and the grapevine says that new grads are having a little bit of a hard time in the big urban or suburban areas to find the perfect position. How do you see this in the next ten years? PAs will continue to be needed in ERs throughout the country, but I am talking specifically about solo coverage. Link to comment Share on other sites More sharing options...
RuralER/Ortho Posted January 5, 2018 Share Posted January 5, 2018 KS, MO and IA as well Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted January 6, 2018 Moderator Share Posted January 6, 2018 1 hour ago, lkth487 said: I have a question for the experienced EM PA's in this thread - how do you see the future of this specialty? EM residencies have increased quite a bit in the last four years (one of the biggest increases I believe) and the grapevine says that new grads are having a little bit of a hard time in the big urban or suburban areas to find the perfect position. How do you see this in the next ten years? PAs will continue to be needed in ERs throughout the country, but I am talking specifically about solo coverage. Not very experienced in EM, yet. If we don’t fix the priorities of healthcare in this country, I see it nothing but booming jobs. Rural solo jobs can be hard to come by since people who live there don’t tend to leave, but I suspect more rural jobs will open up in the future as more places find it financially unviable to pay a full EM Physician salary for low volume places. If it does get tight, I think the experienced at full scope positions and residency trained are going to be fine. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 6, 2018 Moderator Share Posted January 6, 2018 1 hour ago, lkth487 said: I have a question for the experienced EM PA's in this thread - how do you see the future of this specialty? EM residencies have increased quite a bit in the last four years (one of the biggest increases I believe) and the grapevine says that new grads are having a little bit of a hard time in the big urban or suburban areas to find the perfect position. How do you see this in the next ten years? PAs will continue to be needed in ERs throughout the country, but I am talking specifically about solo coverage. The issue in most cases is that the perfect job for an em pa does not exist in urban and suburban areas because there are too many docs around doing all the cool jobs. I don't know if there are any em pas in the country in urban centers running codes, intubating, placing central lines, etc without discussion with an attending physician. I know they are out there doing it, but all under the watchful eye(best case scenario) or thumb(worst case scenario) of a doc. there will always be fast track and urgent care jobs out there, but folks really interested in em tire of those types of cases within a few years and want to do more and see sicker patients. a residency really helps get you the best job you can in any setting, but is specifically tailored to places that allow PAs a broad and unimpeded scope of practice, and most of those jobs are rural. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted January 6, 2018 Moderator Share Posted January 6, 2018 7 minutes ago, EMEDPA said: The issue in most cases is that the perfect job for an em pa does not exist in urban and suburban areas because there are too many docs around doing all the cool jobs. I don't know if there are any em pas in the country in urban centers running codes, intubating, placing central lines, etc without discussion with an attending physician. I know they are out there doing it, but all under the watchful eye(best case scenario) or thumb(worst case scenario) of a doc. there will always be fast track and urgent care jobs out there, but folks really interested in em tire of those types of cases within a few years and want to do more and see sicker patients. a residency really helps get you the best job you can in any setting, but is specifically tailored to places that allow PAs a broad and unimpeded scope of practice, and most of those jobs are rural. The graduates of my residency who have stayed on to teach are pretty autonomous, which I think is the only time you’ll see such in a urban environment, and my shop is supposed to prepare for rural solo jobs. Link to comment Share on other sites More sharing options...
gbrothers98 Posted January 6, 2018 Share Posted January 6, 2018 14 hours ago, lkth487 said: I have a question for the experienced EM PA's in this thread - how do you see the future of this specialty? EM residencies have increased quite a bit in the last four years (one of the biggest increases I believe) and the grapevine says that new grads are having a little bit of a hard time in the big urban or suburban areas to find the perfect position. How do you see this in the next ten years? PAs will continue to be needed in ERs throughout the country, but I am talking specifically about solo coverage. No crystal ball here but I cannot see the future of medicine in this country without EM. Not sure if you are commenting on EM residencies for PAs or physicians. If commenting on PA EM residencies, this will still fall under the rule of the 3 leg employment stool: salary, specialty, location. No guarantee that after PA residency that any of these 3 will meet expectations. Regardless, particularly in specialty, may get ahead of the pack with residency training. But if no flexibility within those 3 areas, then success may come down to being in right place, right time, know the right people. Ten years from now the last leg of the baby boomers will be turning 65, a demographic that will be in need of healthcare as they age. At the same time, the over 85 demographic continues to increase as will the population in general in this country (https://www.census.gov/prod/2010pubs/p25-1138.pdf). Much demand for healthcare will ensue. Concurrently, the healthcare system will continue to shift and modify due to market and political factors. The ED with solo coverage, PA or physician, will face becoming part of a network unless very rural or very well funded/endowed. Then that will be a local decision as to who and what provides the staffing. If that decision comes down to money, then we win. Lower salary, lower debt to service as compared to physicians. If OTP becomes a reality, even more doors open for opportunity. Another factor not discussed much is the expansion of telehealth. We can 'push the button' at my PA solo coverage, low volume ED and have a board certified ED attending or a specialty consultant be involved in the care of a critically injured or ill patient immediately. A lot cheaper than hiring that individual full or part time to provide care. Anecdotally, the handful of EM resident physicians I have encountered over the last few years have no desire to be in a solo coverage situation at a low volume ED for a variety of reasons. I doubt medical schools and residencies could qualify their candidates to ensure a return to rural and underserved areas. Based upon above, I do not see opportunities in EM for PAs including solo coverage ceasing to exist but anyone that could provide a guarantee of a plethora of solo PA EM positions would have to be extraordinarily prescient. Setting oneself up for success with prior experience in EM as a tech, EMT or paramedic, increased exposure to EM during PA clinical training and pursuing a PA EM residency or fellowship post graduation should be a strong consideration. Good luck. George Link to comment Share on other sites More sharing options...
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