What is going on with EM PAs?

[erpa]

My hospital in Philadelphia is desperately trying to hire PAs for ED. The market is empty. 2 NPs were hired instead. Why? Were are all EM PAs?? At this point we need night part-timer Mon. Tuesday , Wed. 21.00 to 5 am. Any leads???? Not for a brand new grad. PAs practice completely independently in fast track. Thank you in advance for any suggestions. 

[JMann]

4 hours ago, erpa said:

PAs practice completely independently in fast track.

There's your answer... PAs that I know that want to work in EM, also want to see sick people and do procedures. Like real procedures, not just some I&D and lac repair. And if it's busy fast track, forget it!

[erpa]

We are all for PA taking care of sick people , we just cannot find any. At all. I have been doing critical care 21 years ago, nowadays I just want to see volume In fast track, make money for my hospital, teach new PAs and help in a small way. Are there any PAs who feel the same way after 20 years? 

Edited November 14, 2019 by erpa

[GetMeOuttaThisMess]

We are all for PA taking care of sick people , we just cannot find any. At all. I have been doing critical care 21 years ago, nowadays I just want to see volume In fast track, make money for my hospital, teach new PAs and help in a small way. Are there any PAs who feel the same way after 20 years? 

 

I’d love to do nothing more than mentor new hires. No equipment, no touching, only being a fly on the wall for assistance.

[erpa]

I appreciate your sarcasm, but question still remains: where are EM PAs? 
Fast track discussion will not produce a single answer for any of us: it is a grey zone and a mine field in one, as we all know. Ectopic pregnancies, tumors, leukemias in young kids,  dangerous abdominal pain and etc, keep me on my toes during 12 hour shifts. I am not proposing a single practice model for anybody, just simply wonder, where we can start looking for mid-level practitioners. And in regards to all glory and no fame, I can attest that this discussion could be very interesting among true veterans of this field:)))

[ohiovolffemtp]

Quite seriously, I think you'll need to grow your own.  I believe there are PA schools in Philadelphia.  I know you said you don't want new grads, but as several folks have already posted on this thread, many experienced EM PA's, myself included, don't want to do fast track only.  So, partner up with these schools.  Create a staffing model that can take a new grad and teach them how to work well in your environment.  Assign experienced PA's to mentor the new folks.  Rotate the mentoring assignments so that the experienced PA's also are spending time on the higher acuity patients. Create a path for the new folks to grow into the experienced PA rotation.

I certainly like a mix of acuity, very much the sicker patients, and procedures like reductions, central lines, intubations, etc.  That variety is missing if you're only in fast track.  In fast track, even if you find something serious, you usually need to turn it over to someone else so you can continue to move the low acuity patients quickly.  My experience has been that the only feedback you get in fast track is if length of stay gets beyond some arbitrary threshold or if there are too many patients waiting to be seen.  For me, the pressure to rush was far more distasteful than the patient mix.  It was the constant push to rush from nursing managers, who would do nothing to help patient flow including helping their nurses, that contributed to me moving to a rural critical access hospital where I see all acuities because I'm the only one there.  Also, check your compensation.  My move from a very busy L3 trauma center to a rural critical access hospital got me a 30% raise.  If you're going to work people hard, you should pay them well.

[erpa]

20 minutes ago, ohiovolffemtp said:

Quite seriously, I think you'll need to grow your own.  I believe there are PA schools in Philadelphia.  I know you said you don't want new grads, but as several folks have already posted on this thread, many experienced EM PA's, myself included, don't want to do fast track only.  So, partner up with these schools.  Create a staffing model that can take a new grad and teach them how to work well in your environment.  Assign experienced PA's to mentor the new folks.  Rotate the mentoring assignments so that the experienced PA's also are spending time on the higher acuity patients. Create a path for the new folks to grow into the experienced PA rotation.

I certainly like a mix of acuity, very much the sicker patients, and procedures like reductions, central lines, intubations, etc.  That variety is missing if you're only in fast track.  In fast track, even if you find something serious, you usually need to turn it over to someone else so you can continue to move the low acuity patients quickly.  My experience has been that the only feedback you get in fast track is if length of stay gets beyond some arbitrary threshold or if there are too many patients waiting to be seen.  For me, the pressure to rush was far more distasteful than the patient mix.  It was the constant push to rush from nursing managers, who would do nothing to help patient flow including helping their nurses, that contributed to me moving to a rural critical access hospital where I see all acuities because I'm the only one there.  Also, check your compensation.  My move from a very busy L3 trauma center to a rural critical access hospital got me a 30% raise.  If you're going to work people hard, you should pay them well.

Thank you very much. Great advice. This was in my proposal already. I do not see another option. The only thing I would worry about is "retention issue": I would hate to train and lose...  And, thank you again . 

[LT_Oneal_PAC]

25 minutes ago, erpa said:

I appreciate your sarcasm, but question still remains: where are EM PAs? 
Fast track discussion will not produce a single answer for any of us: it is a grey zone and a mine field in one, as we all know. Ectopic pregnancies, tumors, leukemias in young kids,  dangerous abdominal pain and etc, keep me on my toes during 12 hour shifts. I am not proposing a single practice model for anybody, just simply wonder, where we can start looking for mid-level practitioners. And in regards to all glory and no fame, I can attest that this discussion could be very interesting among true veterans of this field:)))

Knowing GMOTM, I really don’t think he is being sarcastic.

part of the problem with fast track is there can be serious pathology, but they still want you to burn through 4 an hour. Then when identified as sick you send them over to the main ED. All the work and none of the play. The only people who usually want fast track are new grads and people nearing the end of their career. You say you don’t want new grads and veterans are usually pretty secure in a job so need big money to attract.

[LT_Oneal_PAC]

25 minutes ago, ohiovolffemtp said:

Quite seriously, I think you'll need to grow your own.  I believe there are PA schools in Philadelphia.  I know you said you don't want new grads, but as several folks have already posted on this thread, many experienced EM PA's, myself included, don't want to do fast track only.  So, partner up with these schools.  Create a staffing model that can take a new grad and teach them how to work well in your environment.  Assign experienced PA's to mentor the new folks.  Rotate the mentoring assignments so that the experienced PA's also are spending time on the higher acuity patients. Create a path for the new folks to grow into the experienced PA rotation.

I certainly like a mix of acuity, very much the sicker patients, and procedures like reductions, central lines, intubations, etc.  That variety is missing if you're only in fast track.  In fast track, even if you find something serious, you usually need to turn it over to someone else so you can continue to move the low acuity patients quickly.  My experience has been that the only feedback you get in fast track is if length of stay gets beyond some arbitrary threshold or if there are too many patients waiting to be seen.  For me, the pressure to rush was far more distasteful than the patient mix.  It was the constant push to rush from nursing managers, who would do nothing to help patient flow including helping their nurses, that contributed to me moving to a rural critical access hospital where I see all acuities because I'm the only one there.  Also, check your compensation.  My move from a very busy L3 trauma center to a rural critical access hospital got me a 30% raise.  If you're going to work people hard, you should pay them well.

I agree, home grown is the way to go. As far as retention, if you treat people right and pay them their worth, they don’t leave. I, too, left for CAH and get paid 40% more than if I stayed at the level 1.

[erpa]

2 minutes ago, LT_Oneal_PAC said:

Knowing GMOTM, I really don’t think he is being sarcastic.

part of the problem with fast track is there can be serious pathology, but they still want you to burn through 4 an hour. Then when identified as sick you send them over to the main ED. All the work and none of the play. The only people who usually want fast track are new grads and people nearing the end of their career. You say you don’t want new grads and veterans are usually pretty secure in a job so need big money to attract.

Thank you for writing to me. My ED fast track is called ACT - accelerated team approach . You can take any patients you want from the waiting room and take care of them. It is your level of comfort and nothing more. My administrators are fully aware of that and my numbers should be "two level 3 patients per hour". Nurses would not allow any MI/angina/CVA/Hypertensive emergencies in ACT simply because they have  other patients they need to take care of and can be easily overwhelmed. I will surprise a lot of people, but after doing critical care in main ED for 5 years 20 years ago, I really like taking care of patients in ACT. I am never overwhelmed regardless of volume and hVe been in this hospital for 18 years already. 

[GetMeOuttaThisMess]

12 hours ago, erpa said:

I appreciate your sarcasm, but question still remains: where are EM PAs? 
Fast track discussion will not produce a single answer for any of us: it is a grey zone and a mine field in one, as we all know. Ectopic pregnancies, tumors, leukemias in young kids,  dangerous abdominal pain and etc, keep me on my toes during 12 hour shifts. I am not proposing a single practice model for anybody, just simply wonder, where we can start looking for mid-level practitioners. And in regards to all glory and no fame, I can attest that this discussion could be very interesting among true veterans of this field:)))

NO sarcasm intended.  I was solely pointing out what I'd be willing to do on a part-time basis now that I'm done with direct patient care.  You brought up the mentoring/teaching desire.  To directly address your question, I wouldn't give your job posting a second look based on the hours involved if I were the age that I was when I was in EM.  I missed enough family events/holidays and frankly after midnight my mind became mush.  I worked similar hours for a while and it was the primary force behind driving me out of the FT/ED.  

[LT_Oneal_PAC]

12 hours ago, erpa said:

Thank you for writing to me. My ED fast track is called ACT - accelerated team approach . You can take any patients you want from the waiting room and take care of them. It is your level of comfort and nothing more. My administrators are fully aware of that and my numbers should be "two level 3 patients per hour". Nurses would not allow any MI/angina/CVA/Hypertensive emergencies in ACT simply because they have  other patients they need to take care of and can be easily overwhelmed. I will surprise a lot of people, but after doing critical care in main ED for 5 years 20 years ago, I really like taking care of patients in ACT. I am never overwhelmed regardless of volume and hVe been in this hospital for 18 years already. 

It’s not surprising. People like different things. But if you’re looking for experienced providers who can be taken away from their current job And retain them, you need to offer something others aren’t ( “cool” job with procedures and sick patients, money, benefits, work-life balance) or change your chosen demographic. 

[BirdDogPA]

I’ve seen a strong trend in my area of all the “good” and “great” PAs and NPs for that matter leave the big Level 1/2 trauma centers and go rural or at least to level 3 centers where we could see ESI 2-5.    
 

I think retention will always be hard  in a fast track only or majority facility.  I left my first job for this very reason and pay. And while we all have fast track disaster stories most of us want to take care of the “disaster stories” on a daily basis. 

[EMEDPA]

I did 17 years of low to medium acuity and very high volume with 8-12 hr shifts. I don't want to do that any more. I want medium to high acuity and low volume with 12-24 hour shifts. When I switched from a busy trauma center to a rural , critical access hospital I got a $35/HR raise to practice medicine the way I want to and don't have to report anything to anyone. I get a consult only when I feel appropriate. I turf procedures only when I think I shouldn't do them.

[EMEDPA]

fast track without higher acuity is the road to burnout. been there, done that.

[PACali]

I always recommend new grads to find a job that allows them to work in the main ED. Usually those jobs are in  smaller or undeserved areas. I have seen so many fast track disasters, because they expect you to move fast. As a experience provider that is fine but as a new grad it is dangerous. 

[erpa]

21 hours ago, LT_Oneal_PAC said:

Knowing GMOTM, I really don’t think he is being sarcastic.

part of the problem with fast track is there can be serious pathology, but they still want you to burn through 4 an hour. Then when identified as sick you send them over to the main ED. All the work and none of the play. The only people who usually want fast track are new grads and people nearing the end of their career. You say you don’t want new grads and veterans are usually pretty secure in a job so need big money to attract.

Thank you for writing to me. My ED fast track is called ACT - accelerated team approach . You can take any patients you want from the waiting room and take care of them. It is your level of comfort and nothing more. My administrators are fully aware of that and my numbers should be "two level 3 patients per hour". Nurses would not allow any MI/angina/CVA/Hypertensive emergencies in ACT simply because they have  other patients they need to take care of and can be easily overwhelmed. I will surprise a lot of people, but after doing critical care in main ED for 5 years 20 years ago, I really like taking care of patients in ACT. I am never overwhelmed regardless of volume and hVe been in this hospital for 18 years already. 

[erpa]

I want to thank everyone for the words of wisdom. It looks like the road we have to take is "grow our own PAs". I will be at Chicago SEMPA  Conference in March and will try to network as much as I can. As I have noticed,  lots of folks do not want to work holidays and weekends after being in this field for 20 years:)))) Thank you again!!

[LT_Oneal_PAC]

21 hours ago, erpa said:

Thank you for writing to me. My ED fast track is called ACT - accelerated team approach . You can take any patients you want from the waiting room and take care of them. It is your level of comfort and nothing more. My administrators are fully aware of that and my numbers should be "two level 3 patients per hour". Nurses would not allow any MI/angina/CVA/Hypertensive emergencies in ACT simply because they have  other patients they need to take care of and can be easily overwhelmed. I will surprise a lot of people, but after doing critical care in main ED for 5 years 20 years ago, I really like taking care of patients in ACT. I am never overwhelmed regardless of volume and hVe been in this hospital for 18 years already. 

 

23 minutes ago, erpa said:

Thank you for writing to me. My ED fast track is called ACT - accelerated team approach . You can take any patients you want from the waiting room and take care of them. It is your level of comfort and nothing more. My administrators are fully aware of that and my numbers should be "two level 3 patients per hour". Nurses would not allow any MI/angina/CVA/Hypertensive emergencies in ACT simply because they have  other patients they need to take care of and can be easily overwhelmed. I will surprise a lot of people, but after doing critical care in main ED for 5 years 20 years ago, I really like taking care of patients in ACT. I am never overwhelmed regardless of volume and hVe been in this hospital for 18 years already. 

Senior moment?

[erpa]

1 minute ago, LT_Oneal_PAC said:

Yes, most of the time nowadays

Senior moment?

 

[ohiovolffemtp]

It's important to mention, that just because I work nights in a rural critical access hospital, I'm not just seeing higher acuity patients.  There is the steady flow of URI's, "I've been throwing up for 2 hours", headaches, small lacs, etc.  What's different is that whatever the mix is that night, it's mine.  Some nights are mostly "work-itis" and/or "jail-itis".  Other nights it seems like we're running specials on DKA or A-fib with RVR.  But, it's mine and I can call consultants or the day-time attending doc when I need vs them having to see every ESI 3 or above.