ER Roles - What do/can you do?

[TeddyRucpin]

Rotations have been a good experience to see what I am looking for in a future role as a PA. I am curious of your roles in the ER. For example,

• Are you running codes? As a follow up, are you involved with talking to families for end-of-life care or after someone dies?
• Are you running every case, no matter how low acuity/BS it may be, by an attending physician?
• Performing procedures such as RSI, placing chest tubes, etc?
• Able to staff higher acuity patients, like level 1s/2s?
• Do you need chart or medication cosignatures?

So far, I have seen some EMPA roles at large and medium-sized academic medical center. For reference, I am interested in a residency and would like to work in a community hospital setting. To put it bluntly, I don't want to be in a "lifelong resident" position. TIA.

Edited January 21, 2023 by TeddyRucpin

[ohiovolffemtp]

In my experience, the answer varies widely by state - which places limits in law and rule and facility, which can be more restrictive than state law.

For me, it varies by state & facility, so to answer your specifics:

• Codes: Ohio: not really, CO & AZ: yes, but with physician at bedside most of the time.  End-of-life discussions and death notifications: yes, everywhere.
• Running cases by physicians: at all locations: in a few cases by site policy: codes, childbirth, thrombolytics, but no across the board requirement.  Docs available for consult if I want them.  This is more often of the form - this is weird and I've not seen it before, have you or do you have any thoughts.
• RSI: Ohio: can't, but do intubate, RSI & intubation in CO & AZ: yes, chest tubes & central lines - yes, with doc at bedside because I don't get enough to maintain proficiency.  Otherwise, I'd be doing them solo.
• I do solo coverage with the doc on call, so I see everything.
• No medication cosignatures, after the fact chart signatures in most places, usually of the form, "I did not see the patient but was available for consultation."

In KY, the rules are more restrictive - which is a major reason I don't work there even though I've kept my KY license.

[Boatswain2PA]

Yes (and yes), no, yes, yes, yes

[TeddyRucpin]

2 hours ago, Boatswain2PA said:

Yes (and yes), no, yes, yes, yes

Thanks. How does the charting/cosignatures work?

[Boatswain2PA]

I sign the chart and send it to my SP.  Never really hear anything again...

[EMEDPA]

Late seeing this post.

• Are you running codes? Yes
• As a follow up, are you involved with talking to families for end-of-life care or after someone dies? Yes
• Are you running every case, no matter how low acuity/BS it may be, by an attending physician? No, not a single case. Work solo without doc on site.
• Performing procedures such as RSI, placing chest tubes, etc? Yes
• Able to staff higher acuity patients, like level 1s/2s? Yes, see every pt without required consult.
• Do you need chart or medication cosignatures? No, my state requires zero cosignatures.

[TeddyRucpin]

32 minutes ago, EMEDPA said:

Late seeing this post.

• Are you running codes? Yes
• As a follow up, are you involved with talking to families for end-of-life care or after someone dies? Yes
• Are you running every case, no matter how low acuity/BS it may be, by an attending physician? No, not a single case. Work solo without doc on site.
• Performing procedures such as RSI, placing chest tubes, etc? Yes
• Able to staff higher acuity patients, like level 1s/2s? Yes, see every pt without required consult.
• Do you need chart or medication cosignatures? No, my state requires zero cosignatures.

Sounds like the life. 

[EMEDPA]

1 hour ago, TeddyRucpin said:

Sounds like the life. 

It wasn't always this good. This is the result of years of clawing my way through crappy jobs being treated like crap by docs who "don't talk to PAs", etc, learning new skills and taking many courses, and working my way from ER tech to paramedic to fast track PA to community hospitals to trauma centers, and finally to 100% rural settings over 36 years. Only about 2% of EMPA jobs are this good(high autonomy, no restrictions on practice or procedures), so 250 of them or so nationwide. These jobs go to residency grads and/or folks with decades of experience and good connections.

[TeddyRucpin]

2 minutes ago, EMEDPA said:

It wasn't always this good. This is the result of years of clawing my way through crappy jobs being treated like crap by docs who "don't talk to PAs", etc, learning new skills and taking many courses, and working my way from ER tech to paramedic to fast track PA to community hospitals to trauma centers, and finally to 100% rural settings over 36 years. Only about 2% of EMPA jobs are this good(high autonomy, no restrictions on practice or procedures), so 250 of them or so nationwide. These jobs go to residency grads and/or folks with decades of experience and good connections.

This is why we appreciate y'all paving the way for this/us.

Applying to EM residencies this summer; current medic. Interested in rural options afterwards. Enjoyed the learning in the big city/level 1 trauma centers but for the most part, I'm not a fan of how PAs are used in at least some of the ERs. 

[Apollo1]

Context, I'm in FL.

1. No

2. No

3. Depends

4. Yes (but Lvl 1 would only occur if doc is with another critical patient)

5. Yes to chart, no to meds

 

I was hired as a new grad out of school, but had worked in the same ED beforehand so knew the docs/PAs in the group. We have new grad docs who are big on supporting PA practice, but at the same time they want to be involved with higher acuity patients so it wouldn't fly to not loop them in (even if the PA is seasoned). My site is community with > 80k volume, so there's plenty of opportunity for managing sick people. 

IMO, even with post-grad training it takes time to develop rapport with SPs (i.e. demonstrate capability b/c your residency won't necessarily be standardized as compared to theirs) and get the knack for patient management/flow (someone on here once posted about it taking +/- 3 yrs). Even with your interest in rural medicine, you may be better served on taking a community position first to fine-tune skills, then transition to rural position(s).

[ohiovolffemtp]

18 hours ago, Apollo1 said:

Even with your interest in rural medicine, you may be better served on taking a community position first to fine-tune skills, then transition to rural position(s).

Most definitely.  I worked for 5 years in a very busy high acuity level III trauma center before going to rural critical access hospitals.  Those 5 years were critical to laying the foundation for what I do.