Off Service Rotation Questions...

[MediMike]

Evening...

So I currently work in pulm/CC at a community shop, we've been having a heck of a time recruiting experienced individuals and as such are looking at doing an in-house extended onboarding which would include off service rotations for our new hires (CTS/IR/NSx)

For folks that are involved in residencies/have completed them, how does the collaboration agreement work when you are off on separate services? I know the pulm attending wants nothing to do with someone doing a nephro consult...

[Randito]

Not sure what you mean by the collaboration agreement. In my fellowship at an academic center we basically functioned like the physician residents. For instance on SICU, I did daily rounds and patient care along with 2 surgery residents and an EM resident. On ortho, I hung out with one of the ortho PAs seeing all the ED consults and if slow would see a few clinic patients. 

At a community site, I think that you would have to have buy in from the other departments. Basically, making the argument to the specialists that “if our newly hired ICU PAs better understand your scope and more rapidly develop their own skills, they will make more appropriate consults, etc” While a new hire is on their outside rotation, there should be no expectation for them to check in with or be supervised by the MICU attending. 

[MediMike]

28 minutes ago, Randito said:

Not sure what you mean by the collaboration agreement. In my fellowship at an academic center we basically functioned like the physician residents. For instance on SICU, I did daily rounds and patient care along with 2 surgery residents and an EM resident. On ortho, I hung out with one of the ortho PAs seeing all the ED consults and if slow would see a few clinic patients. 

At a community site, I think that you would have to have buy in from the other departments. Basically, making the argument to the specialists that “if our newly hired ICU PAs better understand your scope and more rapidly develop their own skills, they will make more appropriate consults, etc” While a new hire is on their outside rotation, there should be no expectation for them to check in with or be supervised by the MICU attending. 

Thanks for the reply Randito...

The concern is that any tasks/procedure/assessment performed on a specialty service that does not fall under the scope of practice of the collaborating physician on record leaves one open to liability.  For instance, I work pulmonary critical care, I would not be able to open the belly of an ACS patient at bedside as that would fall outside of the scope of my collaborating/supervising physician. 

EM world is likely easier due to the breadth of what you manage and I'm curious if due to that width you are able to bounce around the hospital easier.  I clearly don't reduce joints and neither do the attendings I work with, if I went and popped a shoulder back in with resultant nerve/vascular injuries I'd be up a brown creek, lacking any propulsive devices.

Academia may have some way around it, as in maybe the off service attendings were listed in your filed practice plan with the state? Or maybe in the land of true GME they just don't care...And regardless of what service you're on, at least in the states I'm familiar with, you are required to be supervised/collaborated(?) with by whatever physician is listed with the state.  Unless you live in a cool state.

Edited July 29, 2020 by MediMike
Clarification