dphy83 Posted December 12, 2019 Share Posted December 12, 2019 Just wanted to see if anyone has been the first, or one of the first, APPs for a new service line at a hospital? Specifically, I'm am inquiring about a position with a new trauma service at a state (not ACS) designated level II center. The trauma designation isnt new for the facility, but previously trauma patients were admitted to either medicine or to the individual surgeon/orthopod who is on call for the day. Now they are creating a trauma service to take these patients. Future goal is to achieve ACS trauma center designation. My understanding is that the role of the APP is, generally, to handle admits, round on patients, handle some discharges, and respond to trauma activations in ED if available. No current expectation for OR time (fine by me). While service is getting up and running the plan is for only 2 APPs initially. Would only be day shift with occasional weekend call. I was told that typical census is approximately 10 patients per day, give or take. About 2 or 3 new admits per day. Compensation TBD. What are your thoughts about getting involved in a brand new service line? Expected headaches? Benefits? TIA. Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted December 12, 2019 Share Posted December 12, 2019 Did it in cardiology and then later in the ED at that same hospital. Later went to a different ED where I had worked with the second director at the first ED. I liked being the first and only to start. I set the standard and I don’t think that I let these folks down. We’re talking late 80’s and early 90’s. I also was one of two primary APP hires at my last gig until I retired. It was sometimes challenging for the docs to get an idea as to what I had to offer but we got it to work. Quote Link to comment Share on other sites More sharing options...
SedRate Posted December 12, 2019 Share Posted December 12, 2019 I was the first and only PA with an ortho trauma practice at a newly minted level 1 (both state and ACS) and now again first and only PA for a community hospital cardiothoracic practice which was recently revamped. I guess I'm just the lone ranger type Benefits: set expectations as well as preferences. Headaches: set expectations as well as preferences. No one is going to really know what to do with you or how to devy up duties, so it falls on you to develop and lead the service, train the attendings and nurses, and set your service up for continued future success for you and other PAs who might follow. Two full-time PAs should be more than enough for that kind of census. You might find yourself bored if you're also spliting duties with attendings, but this at least protects you during any absences. I have very much enjoyed developing a new service line from the ground up. You almost get to make it how you want it, which is difficult to do in medicine nowadays, especially as a PA. This is a great opportunity you have. Good luck and enjoy! Quote Link to comment Share on other sites More sharing options...
SedRate Posted December 12, 2019 Share Posted December 12, 2019 And by "train the attendings and nurses" I mean show them what you're capable of and how your role is to be utilized. Some folks don't know how to include PAs in the mix so you gotta "train" them how. Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted December 12, 2019 Share Posted December 12, 2019 What will be the division of labor between the ED staff and your group? When you respond to trauma activations, what will you do vs the ED provider? Who is doing lines, tubes, ordering imaging, labs, blood, etc? Who will make the decision when/if the patient needs to go to the OR, admission vs transfer, etc? 1 Quote Link to comment Share on other sites More sharing options...
dphy83 Posted December 12, 2019 Author Share Posted December 12, 2019 46 minutes ago, ohiovolffemtp said: What will be the division of labor between the ED staff and your group? When you respond to trauma activations, what will you do vs the ED provider? Who is doing lines, tubes, ordering imaging, labs, blood, etc? Who will make the decision when/if the patient needs to go to the OR, admission vs transfer, etc? I'm assuming all still TBD. They are supposed to have a meeting between the trauma director and ED director soon, so I'm assuming this would be discussed then. OR decision and dispo, unless there are clear transfer protocols, would be trauma's call if I had to assume. In fact, if I'm foolishly making assumptions it would be that if trauma is consulted then they would be putting in the orders and otherwise running the show. Procedure-wise, I guess it depends on how emergent it needs to be done. If it's an unannounced trauma then the ED provider may be the one to do it depending on trauma response time. But in all likelihood it will be a shared effort. This isnt an academic center so there isnt a plethora of ED or surgical resident hands floating around to occupy all procedures. If they're admitted to trauma and in the hospital then all responsibilities would be up to trauma team unless they are in an ICU setting. Then the critical care doc may be first to respond. Like I said, a lot to still be determined and a lot that probably wasnt discussed during the interview. All of this is good feedback. Thanks, y'all. Quote Link to comment Share on other sites More sharing options...
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