How much MD support are you getting in your ER?

[Guest ERCat]

I am past my two year mark in the emergency department, and it’s still a rollercoaster mentally and emotionally. i alternate between A and B.

A) Some days I feel like a rockstar, and I walk out of my shift feeling like I knew what to do with every patient and feeling like I connected with my patients.

B) There are other days when I’m running around like a chicken with its head cut off, forgetting things, having long patient stays because things aren’t getting done and I don’t have time to hound the nurse, and I go home and lay awake and realize things I forgot to do, some small and some big.

I hate B days and I am realizing is that what it comes down to in part is lack of physician support. Usually during a B day the department is slammed and everyone is  struggling to keep their heads above water and so the physicians seem annoyed to be hounded with questions. I get the vibe that they think I should know this by know or that I do already know it so why am I talking to them about it?! At the same time, two years out how am I to be expected to function as an independent provider? The pressures are on to do so and I truly yearn for my early days when I staffed every single non straightforward case with a doc. Without that collaboration I don’t feel like  I am growing as much as I used to.

I guess what I am asking is, at this stage in the game, how much physician involvement is reasonable for me to ask for? 

[PACJD]

With 2 years experience under your belt there is no doubt that you are going to need physician involvement. ER residency is 4 years and even after they finish residency new ER physicians still need support from seasoned vets. There is no way that they expect you, a PA with 2 years experience, to go to work each day and not have questions to ask them. It will take you several more years to become comfortable with reading x-rays/CTs, interpreting EKGs, deciding patient disposition on difficult/unusual cases, and even then you will still have days where you are clueless on what to do. That is the beauty of medicine. 

Now when it comes to lower acuity, fast-track stuff, you should be comfortable with a majority of the things you see. At this point I wouldn't run every ear ache or sore throat by the physicians, but you should be able to differentiate when you need a second opinion. 

[kargiver]

You are right where you should be.  Some days you know stuff, some days you don't - you are still learning what is sick, not sick, how to differentiate the subtleties of what is what, and when you need physician involvement and/or consultant involvement.  Expect this until about year 5 - when you have seen enough to know what is normal vs. not normal, and how to differentiate it.  It's not by accident EM residencies are 3-4 years in length and most EM residents are doing fellowships as well.  There are things you should be comfortable seeing at this point - but the most important thing to know is what you don't know.  That pool shrinks over time - but it never goes away completely. 

G