What can you NOT do as a PA?

[EMEDPA]

There are a number of 1 yr em fellowships for FP residency trained docs. 23 per this list:

https://www.aafp.org/medical-education/directory/fellowship/results

The problem is, most places don't recognize them. I believe someone sued the state of florida to gain recognition and pay as an emergency physician with this training years ago and won. But that's florida. I wouldn't try to apply for an em slot in ny or ca with this training and expect to be treated as an equal. 

[sk732]

Mind you, how many 4-5yr EM residencies/spots are there in the US?  That makes for a lot of people that could take some of those really rural spots (though who wants to ?).  This works up here for the most part and would work for those areas where they're not getting long residency trained folks AND where the local FM docs have to cover in their hospitals.

Or you could hire full time EM PA's...and NP's.  Had a bad rotation a few weeks ago with one that I believe had little to no EM/UC training in their schooling...and obstetrics as it turned out as well .

[EMEDPA]

Most EM slots are 3 years now. There are a few 4 year em and a handful of dual 5 year EM/FP, EM/Peds, EM/IM.

I have no issue with an FP doc in the ER who knows what they are doing. My problem is when they hire a warm body just to have a physician there and it is someone with zero em experience and maybe a few months total in the dept between med school and residency. It is possible to graduate from an FP residency and have 16 weeks total time in the ED: one month third year of med school and a month a yr of fp residency. 

16 weeks.

I had more than that in PA school:

22 weeks( 1/2 of my total clinical time)

EM (required) 5 weeks

Peds EM 5 weeks (fulfilled peds)

EM Preceptorship 12 weeks (we could do FP or EM)

clinic docs do not belong covering the ED. ED providers do not belong in clinic. 

 

 

[ohiovolffemtp]

For logical consistency, if we're going to argue that a PA with extensive EM experience can be nearly or fully autonomous, we should respect the same argument for an FP or IM doc with extensive EM experience.  This does and should run counter to the ABEM/ACEP argument that only a doc who completed an EM residency can really manage and ED and should be the person who sees (at least briefly) all EM patients.

All medicine is really learned by experience.  A well constructed residency, physician or PA, is the best way to get that concentrated experience early in someone's career, but it isn't the only way.

[rev ronin]

2 hours ago, ohiovolffemtp said:

All medicine is really learned by experience.  A well constructed residency, physician or PA, is the best way to get that concentrated experience early in someone's career, but it isn't the only way.

In PA school, I was taught the basics, the zebras, and how to learn medicine by critically reading journal articles. I have been averaging 100+ Cat 1 hours yearly, plus other activities I haven't been recording. Medicine is a sport for people who are lifelong learners, and I love that it's that way.

[sk732]

11 hours ago, EMEDPA said:

Most EM slots are 3 years now. There are a few 4 year em and a handful of dual 5 year EM/FP, EM/Peds, EM/IM.

I have no issue with an FP doc in the ER who knows what they are doing. My problem is when they hire a warm body just to have a physician there and it is someone with zero em experience and maybe a few months total in the dept between med school and residency. It is possible to graduate from an FP residency and have 16 weeks total time in the ED: one month third year of med school and a month a yr of fp residency. 

16 weeks.

I had more than that in PA school:

22 weeks( 1/2 of my total clinical time)

EM (required) 5 weeks

Peds EM 5 weeks (fulfilled peds)

EM Preceptorship 12 weeks (we could do FP or EM)

clinic docs do not belong covering the ED. ED providers do not belong in clinic. 

 

 

Being military trained, I had an EM heavy clinical year - 6 direct EM, 6 trauma surgery, 6 Peds EM (again, my peds rotation), 8 rural FM - which included a lot of OR/anaesthesia and ED shifts (my preceptor was also a GP anaesthetist and all the GP's covered the ED), my ortho trauma 2 weeks was split between ED call, cast clinic and OR, Gen Surg had ED coverage for calls as well, and my Psych rotation, though in-patient consult for the whole hospital, we also did ED coverage.  There are two FM tracks here - urban/suburban and rural.  It seems to me that FM docs here get more EM experience in 2 years than the average FM doc in the US does it seems - but I'm willing to bet most are going to urbanish sites any way due to the population distribution.  Much of their EM work is also done on rural rotations, as they'll have to help cover the ED if there is one in the town they're working in, so while not a formal EM rotation, it's still blended.  The rural track is a little heavier in EM as well.  The Society of Rural Physicians of Canada also has access to funds to send folks on paid training to get upgraded skills in EM/Obs/or whatever else they feel they need to be able to be comfy working in Ungabungaluktutuk.  At the end of the day, it's comfort and experience as someone already noted, as well as structuring your residency path to what you'll likely be doing.

[EMEDPA]

16 hours ago, ohiovolffemtp said:

For logical consistency, if we're going to argue that a PA with extensive EM experience can be nearly or fully autonomous, we should respect the same argument for an FP or IM doc with extensive EM experience.  This does and should run counter to the ABEM/ACEP argument that only a doc who completed an EM residency can really manage and ED and should be the person who sees (at least briefly) all EM patients.

All medicine is really learned by experience.  A well constructed residency, physician or PA, is the best way to get that concentrated experience early in someone's career, but it isn't the only way.

Agree- I have no problem with a qualified FP doc in the ER. Unfortunately, there just aren't that many of them. 

[EMEDPA]

5 hours ago, sk732 said:

 It seems to me that FM docs here get more EM experience in 2 years than the average FM doc in the US does it seems - but I'm willing to bet most are going to urbanish sites any way due to the population distribution. 

Yup. Many FP residencies here are at busy level 1 centers so the residents get a bit of exposure everything, but not a lot of being in charge of anything except primary care clinic. There are some rural focused fp residencies that are unopposed(meaning no other residents in the hospital) so those residents really do it all. They cover the ICU, run the traumas, etc. For a while I was thinking of going back and doing one of these. The best known is the program at Ventura county in california. 

[SedRate]

14 hours ago, EMEDPA said:

Many FP residencies here are at busy level 1 centers so the residents get a bit of exposure everything, but not a lot of being in charge of anything except primary care clinic

Yep, just had a fourth year IM/peds resident rotate through the office I'm at that's attached to a level 1. Not really sure the point of her 4 weeks of shadowing as she spent most of her time yawning in the corner. No procedures, barely evaluated any pts. Hopefully she learned a thing or two while following around the attendings and their residents. Although I'm guessing since she's IM/peds she's outpatient only and won't be stepping into the ED.

Edited October 2, 2023 by SedRate

[CAAdmission]

55 minutes ago, SedRate said:

won't be stepping into the ED.

People like to think that, then a hurricane happens. Or a Covid, or a 9/11.

I know I'm old-fashioned, but I think everyone with medical training should be competent in out of hospital first aid and in doing something to stabilize really sick folks. 

[ohiovolffemtp]

1 hour ago, CAAdmission said:

in doing something to stabilize really sick folks.

Like reaching for the phone & calling 911 

Seriously, for many in medicine, that's the safest route because EM, especially field EM, is a very different mindset and skill set.

[ShakaHoo]

In the state of Connecticut - a physician assistant is not allowed to see a workers compensation injury more than 2 consecutive visits. 
 

A physician or APRN can see the patient an unlimited number of times. 

[CAAdmission]

6 hours ago, ShakaHoo said:

a physician assistant is not allowed to see a workers compensation injury more than 2 consecutive visits. 

Based on the very limited number I had to deal with, I would have considered that a blessing. I wouldn't want to see most of them for one consecutive visit. 

[Hope2PA]

This is off the current clinical direction, but Negotiate salary is one thing I've seen PAs do poorly. Recently the facility I work for was seeking 2 providers. 1 full and 1 part time. I told a few PAs about the positions, one in particular who was looking for a 2 day week supplemental job, saw the posting said low salary's range. so didn't bother. Second applied, I had a told both about how the company notoriously low balls initial offer just in case someone is stupid enough to take it. Anyway, the second took the lowball offer and now makes at least FAR LESS  per hr than other providers  with much less experience. She said it was okay, she likes the job and hours, plus house is already paid for so it is enough. I wanted to scream DO YOu NOT HaVE A CLUE what you just did to pull down salaries. I don't give a shit if you don't need the money right now,  you have just screwed others and brought down the value of your experience and PA education. However #3 applicant negotiated and got slightly above average salary for area and experience this was after they were told salary wouldn't go higher, they turned down job saying they couldn't work were undervalued. They were soon called back and ask if they'd reconsider with higher salary. 

[rev ronin]

20 hours ago, ShakaHoo said:

In the state of Connecticut - a physician assistant is not allowed to see a workers compensation injury more than 2 consecutive visits. 
 

A physician or APRN can see the patient an unlimited number of times. 

This is a real shame. I built my practice around being there for injured workers and walking through the various phases of a confusing and alienating process with them.

[ohiovolffemtp]

Ohio and now Indiana have laws which state that any ED must have a physician either in the department or on the hospital campus at all times.

[CAAdmission]

3 hours ago, ohiovolffemtp said:

Ohio and now Indiana have laws which state that any ED must have a physician either in the department or on the hospital campus at all times.

That's great. A lot of them will probably skirt around the law by paying some pathologist to sleep in a call room somewhere. 

[sk732]

15 hours ago, CAAdmission said:

That's great. A lot of them will probably skirt around the law by paying some pathologist to sleep in a call room somewhere. 

That would stop the first time they started doing a PM in the code room in lieu of a rescus...

[ohiovolffemtp]

In Indiana, the day doc who is on call for codes, mass casualty situations, childbirth, etc, will be asleep in the house where we stay whose front door is 115 steps (yes I counted them) from the front door of the hospital, about 2 min total from the ED at a fast walk.