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Former EMS, current FP PA x 3yrs, moving back to ER...Advice?

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I finally got my foot in the door into Emergency Medicine after 3 years! And back at the ER where I was a tech for years.

I am incorporating a per diem ER gig into my  schedule with me current full time (4 days/wk) FP job of 3 years. I'm looking for any advice on prepping for the transition to emergency medicine (reference books, FOAM/podcasts, "boot camps", etc.) so I can focus my studies over the next 2-3 months during the credentialing process.

A little background on me....

In my 20s's I worked EMS as an AEMT for 6 years (911 and transport in the Denver Metro area & ER tech at this same ER where I will be now working as a PA) before PA school.

In PA school I excelled in emergency medicine (trained at Grady Memorial in Atlanta-Lvl1 Trauma/public hospital, a natural at POCUS, and I really excelled at procedures) as well as my rotations in general surgery, orthotrauma surgery, and cardiac ICU. 

Coming out of school I was determined to work in an ER and felt like I was at the top of my game. That didn't work out....

Since graduation I have been working at a rural FQHC primary care clinic with one other provider (a very intelligent,  Up-to-date, supportive, approachable MD who came to the clinic direct from residency from the local University). I try to get in as many minor procedures as I can (skin lesion excisions, biopsies, suturing, casting-rarely, splinting-sometimes, and joint injections).

Overall, I feel like I have a good handle on general medicine but the pace of primary care has been slower (1 week turnaround for labs, lots of time to look stuff up etc. but I do have 20 min appts. and 18-24 pts/day in 9 hours) and our patient population is more like Outpatient Adult Internal Medicine Lite. 


I feel like I've lost some of the sharpness and skills that I had coming out of school in regards to 3 things: managing acute patients, fast decision making, and procedures.

My plan right now is to spend the next 2-3 months on the following:

1. An Emed bootcamp or lecture series. 

2. Reading thru Roberts & Hedges Procedures text, Tintinalli's Handbook (the small one), and Minor Emergencies.

3. Creating flashcards and testing myself on them

4. A POCUS course


A note about this being the same ER that I was a tech at: Multiple providers (PA and MD alike) have gone from techs at this ER to providers and have personally told me their experiences and none of them felt any pushback or weird interactions with staff after their title and position changed. This group is very tight knit and supportive like I've never seen before. Its one of those places that you know is special. Sounds like I'll have a very supportive medical director and MD colleagues. Shift is 2-8pm with 2 hrs before and after of "flex time" that I may be called in early or need to stay late. Per diem only right now. No min. # of shifts required per month. Option to work as many as I want. There are 5 per diem PAs to cover 20 shifts a month.

Other thoughts out there? Is everyone nervous switching specialties or is it just me 🙂 




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I think that it's your wisdom that's making you nervous.   You're not going in blindly to EM, you know what you're getting in to.  I think the best thing that you'll have is a supportive environment.  If you'll be working with other PA's, they'll be a great source of teaching.  They'll help you learn how to do more complicated procedures, when to involve the docs, how to manage typical patients, etc.

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EM:RAP still has good content, and has added a lot of "core content" over the past few years, despite a lot of the monthly topics being fluff pieces. ACEP has an online "academy" for new practitioners that's a good overview. Dr. Smith's ECG blog is excellent. The other recommendations above are also good resources.

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Congrats on the move back to EM. In addition to what folks have said above, consider taking a few courses that may cover stuff you have not seen a lot of. I recommend the following:

FCCS (critical care/vents)


ABLS (Burns)

Difficult airway course (lots of new toys out there).

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  • 2 weeks later...

Thanks to everyone for their advice and general support! I do have a tendency to overprepare for things in my life in general. Usually when the time comes to perform, I'm grateful for the over preparedness (It still gives me anxiety during the preparatory phase though!) I'll take a look into those resources and courses.

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