Trauma Surgery

[queenofhearts]

To those PAs who work in or are familiar with the life of a PA who works in trauma surgery, can you elaborate? What is you day in the life like? Responsibilities, schedule, quality of life, work environment, etc? Thanks!

[armand81]

Hey! I am a trauma PA at an ACS Level 2 trauma center. I work 7a-7p, 7 on 7 off. a typical day for me is first rounding on our ICU patients. if there is an abundance of floor patients I sometimes help out with those as well. I respond to trauma activations and assist with the work up of those patients. I also see consults in the ED. As needed will first assist with our trauma surgeon in the OR. I am also trained in procedures including chest tubes, central lines, intubation, art line placement, bronchoscopy, assist with bedside trach and PEG tube placement. manage the ICU patients as needed including labs, rads, some vent management, pressors, blood products, etc.

the work weeks can be hectic and doesn't leave much time in the evenings to do a whole lot but I am also off 26 weeks a year not including my accrued leave time. so, I would say I have a pretty good quality of life.

the work environment can be hectic and stressful but that is medicine in general. and its trauma so it can be very heartbreaking as well. one thing is for sure and that is it makes you appreciate life and to be responsible with regards to safety; i.e. seatbelts, distracted driving, properly restraining children, etc.

personally, it is a very fulfilling job and not to be cliché but for me is the 'dream job' as it encompasses most everything that interested me and little of what did not.

[AspiringPA2015]

Armand,

 

What career steps did you take to get this position? Residency, fellowship, on the job training?

 

[armand81]

actually its kind of an interesting sequence of events. when i was still in school one of my elective rotations was trauma surgery. it was my last rotation just before we did our 8 week preceptorship. i had originally set up my preceptorship for emergency department. I was supposed to do the trauma rotation at the hospital that our school was at but i had heard it wasn't that good. so with some personal connections i was able to be the first student of any kind on the trauma service at the trauma center where i live. a week in i absolutely loved it. by the second week i was already asking the trauma director if i could do the 8 week preceptorship with them and he said ok. so i had it switched from ED to trauma. So i ended up doing 12 weeks basically in a row just before graduation. it was kind of neat b/c they had no idea all the stuff that PAs could do. so, i graduated and stayed in contact with them and he told me that they would be hiring. so i applied for and got the job. unfortunately, the initial job was not 100% trauma but also to help out with neurosurgery. after signing the contract and joining the service it kind of caught me off guard that i would be doing some nsg too especially since i really disliked it. so I had a conversation with the director and he worked out a deal that i would be 100% trauma unless someone on nsg was out and needed to take time off, etc. during this time i was working night shift and basically just seeing consults, answering calls from ICU/Floor, trauma activations, and first assist. about 6 months in i was informed of the creation of the strictly trauma days position and i applied for and got that position. its been a really cool situation for me because although they did have PAs that helped out writing notes, etc at night they definitely didn't use us to their full potential. Since i came on i have been very compassionate about them utilizing me to my full potential. So, i have pushed to be trained on the invasive procedures, care for the ICU patients, first assist, etc. i also brought up the fact that we as PAs can also be billing as first assist so i have created that extra revenue stream for the service. we do have some older trauma surgeons that have been a little less adaptive to utilizing us fully but with time and trust i think that will change. I am really in a very cool place being the first PA dedicated to the trauma service and kind of forging the path for us on this service. i have been with them almost 3 years but still stay humble knowing that i have so much more to learn and try to do that on a daily basis. 

 

So, to answer your question directly it has all be strictly on the job training!

[maypa]

Hi @armand81

I am also the first PA introduced to our trauma service at a level II facility. I was offered the job during my last rotation in surgery. I suppose the surgeons liked my personality and saw a lot of potential in me. Like you, Trauma is truly my “dream job”. I love the variety that comes with each day from being in the ICU, ED, OR and continue to learn every day (only 1 year in). Now because I am the first PA here, it has been difficult getting a lot of the old school surgeons to provide me with autonomy. Some are eager to teach me everything and allow me to run the service (aside from the OR), while others don’t even let me round on the patients by myself. What was your strategy or materials you used to show the surgeons what PA’s are capable of legally and to trust you more? Did you find with time, some have loosened the reigns?

thanks for your insight!! 

[ryebread203]

Maypa and Armand81, what textbooks/resources would you recommend for a new grad in general surgery/trauma?

Emergency Medicine has Rosen's and Tintinalli's. ICU has texts like Marino and the Ventilator Book. Roberts and Hedges covers lots of EM and acute care procedures. A while back a surgery gave me a copy of Schwartz but sometime this feels like the material it covers is too summarized.

[jmelville]

Hi,

I work as a Trauma Surgery PA at a level 1 trauma center and academic teaching hospital. I work 3 12's, 6am-6pm, no nights, no call. I get to work at 5:30am, do a quick chart check on my patients (mostly looking at vitals to make sure no is critical) then go to get sign out from night team at 6am. I go see any patients that have had major issues overnight right away. If everyone's been ok, I go back to my office, review patients (get to know them if it's my Monday, review tests, other specialties' notes, etc) then go round on patients, seeing everyone by 8am. We typically have between 4-12 patients each depending on our census. We do table +walking rounds on Mondays when we get a new attending for the week ( the depth of this can vary from attending to attending), other days we do table rounds only and attendings go see the patients or just the ones with issues. We are split into two teams so that we can alternate who is admitting for the day so that each team can have a day to try and get people discharged, have patients go to OR if needed, cover clinic etc. We have clinic two afternoons out of the week. We work with residents integrated into our teams, typically a chief resident and at least an intern. We all respond to level 1's, the residents see the level 2's (this recently changed, it was previously split between the residents and APP"s).

Pros: amazing schedule, very flexible on when I can work, no nights, no call, great team, we see a lot

Cons: like any teaching hospital, residents are prioritized (understandably) but this does mean getting to do far less in the form of procedures (chest tubes, central lines, etc) and going to OR. I have made a point to try to go to the OR but it can be difficult/not worthwhile when there's already 4 people there. 

Overall, I really enjoy what I do, have a supportive team, have had nothing but great interactions with the residents and have little to complain about. I do wish I could get more hands on experience, but a big part of this is just roll of the dice of what patients come in, who is there, what everyone else on the team is doing.