Rural Medicine

[AB799]

How many others have an interest in rural medicine, especially trauma/ER?  I already know that's where I want to end up, did that influence anyone's decision on what PA program they went to?  Any recommendations for schools best suited to prepare you for a PA career in a quieter/underserved area?

 

Thanks!

[ohiovolffemtp]

Here's my perspective as a PA who does solo overnight ED coverage at a rural critical access hospital with a doc on-call.

Just like docs who don't really know medicine after medical school and do a residency and possibly fellowships to learn their trade, new grad PA's don't really know medicine.  They need to work a number of years, often 3+ (similar to the length of residencies) and/or do a PA residency to really learn their trade.

You need a lot of experience with someone close at hand to really learn enough to be safe and productive.  It's very hard to do that in a rural setting: the volumes are low and often the people you need to learn from are not on site but rather are at the far end of a phone call.  If rural practice is your goal, and I really recommend it, it needs to be your 2nd or 3rd job.  You need significant experience 1st.  For me, it was 5 years in a busy high acuity level 3 trauma center's ED, preceded by 30+ years in fire/EMS.  For others on this forum, it was a EM residency, like Iowa's, that's targeted at prepping PA's for rural environments, but still had significant pre-PA medical/nursing experience.

Create your own path, but don't go rural before you get that experience.

[TheFatMan]

Some would argue that being trained in a busier, more urban ER will expose you to more pathology and therefore will better prepare you compared to a more low-volume rural ER. On the other hand, busier, more urban ERs tend to have more residents and trainees and therefore you may not get to be hands on and could be excluded from interesting cases.

You should ask about this during interviews. What are your EM rotations like? How much volume do the students see and how hands on are they? 

[EMEDPA]

Good thoughts above. I think someone looking into rural EM today should seriously consider a postgrad program. The other option(my route and Ohio's above) was years in EMS followed by years in busy places aka working your way up the ladder. If I had to do it again I would go the residency route after PA school.

[GetMeOuttaThisMess]

3 hours ago, EMEDPA said:

Good thoughts above. I think someone looking into rural EM today should seriously consider a postgrad program. The other option(my route and Ohio's above) was years in EMS followed by years in busy places aka working your way up the ladder. If I had to do it again I would go the residency route after PA school.

If you had it to do over again you'd have gone a different route as we've discussed!  

Edited April 23, 2021 by GetMeOuttaThisMess

[EMEDPA]

22 hours ago, GetMeOuttaThisMess said:

If you had it to do over again you'd have gone a different route as we've discussed!  

yup, if I had to do it again as a PA I would do the residency route. All options on the table, I would have done DO school then dual FP/EM residency. 

[ohiovolffemtp]

Had I started down the path to medicine about 10 years earlier in my life, I would have gone the DO route to an EM residency.  Getting my PA license at 55, I needed to return to work and to family, so a PA residency wasn't a good option for me.

I do believe that some experience in a busy ED even after a PA residency would be good preparation for solo rural ED coverage.

[EMEDPA]

8 hours ago, ohiovolffemtp said:

 

I do believe that some experience in a busy ED even after a PA residency would be good preparation for solo rural ED coverage.

depends if that busy ED allows one to work to the extent of their skills. I know a few residency grads who took jobs in which they are not allowed to see level 1 and 2 patients, so their critical care skills are atrophying and they are less prepared to manage critical patients today than when they finished residency. One says she wished she had not done the residency, because she is not allowed to use any of the skills gained in it. I tried to get her to do some solo per diem work, but I don't think she feels up to it any more 10 years out from residency, having spent the last decade doing fast track and intermediate level care. 

[LT_Oneal_PAC]

10 hours ago, ohiovolffemtp said:

Had I started down the path to medicine about 10 years earlier in my life, I would have gone the DO route to an EM residency.  Getting my PA license at 55, I needed to return to work and to family, so a PA residency wasn't a good option for me.

I do believe that some experience in a busy ED even after a PA residency would be good preparation for solo rural ED coverage.

Agree with EMED, and it also depends on the level of specialist involvement. Some places I know with ortho residents, it is expected they are consulted for EVERY fracture and they perform all reductions, A colossal waste of time and loss of skills. I’m sure it depends on the residency, but I don’t see much point in level one experience afterwards. I think more beneficial would be community experience. Small enough where you don’t have ultrasound or MRI 24 hours a day, big enough to have other PAs and physicians to ask questions about what they do in a place with limited tests. It can be hard for people to transition from having every tests to having almost none besides basic labs and CT.

[Colorado]

I found that Level 2 and 3 trauma centers were great places as a student to train at. Typically none or few residents. My favorite were places that regularly took students and residents but were not flush with residents. That way, they know how to train a student and you'll get a good experience but also, not lose all opportunities to the hord of residents and medical students. I did my emed rotation at a level 1 trauma center (Grady in ATL) and the volume was just so high that I was able to perform a decent amount of procedures.

My BEST rotations to actually get hands on experience and procedures were:

-Cardiac ICU at my school's hospital (Emory). Arterial lines, assist with intra-aortic balloon pump placement and removal, performed central lines myself with intern/attending observing.

-Level 2 Trauma center General Surgery (core rotation) followed by orthopedic trauma surgery (elective rotation) at the same hospital. More central lines, myself and a resident performed a lap chole all by ourselves with the surgeon and PA scrubbed in watching over our shoulders (neat!), joint injections, reductions, suturing galore, rib plating (always a good rotation when the drill is in your hands

If you can manage to get two rotations at the same facility, even if not consecutive, with some of the same people you worked with during the first rotation, they will know you and trust you more. You will get more opportunities. ie: Emergency medicine and trauma team or general surgery at  the same facility. Trauma and general surgery are often called into the ER and the ER providers know them well, vice versa. Even internal medicine and ER at the same facility is helpful because guess who the ER admits to....you!