Family practice vs. Emergency/Urgent Care questions

[Lemon Bars]

If anyone has experience working/rotations in both family medical practice and an emergency room or urgent care settings, I could really use some advice. I'd like to know how long a PA or doctor gets to spend with each patient in a family practice, how much charting they have to do, and how much back and forth between patients there is in family practice. For example, in an ER the docs do a review of systems and physical exam for each patient which must be charted. Labs are ordered for most patients and often x-rays or CT scans as well. These exams and test results, combined with many very sick patients, results in an avalanche of information to process and constant interruptions as EKG results, labs, etc. come back for review and new patients are seen.

 

It's all very interesting yet overwhelming. I really like the idea of serving my community as a PA and my pre-requisite grades are very high. But I have unfortunately discovered, after failing training as an ER scribe, that I cannot function in a high-speed environment with constant distractions. Perhaps I have some sort of minor learning disability? I'm currently searching for a family practice physician or PA who will let me shadow them, but I'd love to hear from the many experienced people on this forum. I'm guessing an urgent care walk-in clinic would be almost as bad as the ER, but maybe a family practice is a bit less crazy?

 

I'd possibly make a good ICU nurse, with just one or two patients to focus on at a time, but I really don't think I want to be a nurse.

 

I have posted similar threads in the past. Thank you so much to anyone who reads this. I've got to make a decision soon whether to pursue PA or downshift into respiratory therapy, or maybe cardiovascular tech/ultrasound, or MRI or something. Thanks for reading!

[Lemon Bars]

If anyone has experience working/rotations in both family medical practice and an emergency room or urgent care settings, I could really use some advice. I'd like to know how long a PA or doctor gets to spend with each patient in a family practice, how much charting they have to do, and how much back and forth between patients there is in family practice. For example, in an ER the docs do a review of systems and physical exam for each patient which must be charted. Labs are ordered for most patients and often x-rays or CT scans as well. These exams and test results, combined with many very sick patients, results in an avalanche of information to process and constant interruptions as EKG results, labs, etc. come back for review and new patients are seen.

 

It's all very interesting yet overwhelming. I really like the idea of serving my community as a PA and my pre-requisite grades are very high. But I have unfortunately discovered, after failing training as an ER scribe, that I cannot function in a high-speed environment with constant distractions. Perhaps I have some sort of minor learning disability? I'm currently searching for a family practice physician or PA who will let me shadow them, but I'd love to hear from the many experienced people on this forum. I'm guessing an urgent care walk-in clinic would be almost as bad as the ER, but maybe a family practice is a bit less crazy?

 

I'd possibly make a good ICU nurse, with just one or two patients to focus on at a time, but I really don't think I want to be a nurse.

 

I have posted similar threads in the past. Thank you so much to anyone who reads this. I've got to make a decision soon whether to pursue PA or downshift into respiratory therapy, or maybe cardiovascular tech/ultrasound, or MRI or something. Thanks for reading!

[Lemon Bars]

If anyone has experience working/rotations in both family medical practice and an emergency room or urgent care settings, I could really use some advice. I'd like to know how long a PA or doctor gets to spend with each patient in a family practice, how much charting they have to do, and how much back and forth between patients there is in family practice. For example, in an ER the docs do a review of systems and physical exam for each patient which must be charted. Labs are ordered for most patients and often x-rays or CT scans as well. These exams and test results, combined with many very sick patients, results in an avalanche of information to process and constant interruptions as EKG results, labs, etc. come back for review and new patients are seen.

 

It's all very interesting yet overwhelming. I really like the idea of serving my community as a PA and my pre-requisite grades are very high. But I have unfortunately discovered, after failing training as an ER scribe, that I cannot function in a high-speed environment with constant distractions. Perhaps I have some sort of minor learning disability? I'm currently searching for a family practice physician or PA who will let me shadow them, but I'd love to hear from the many experienced people on this forum. I'm guessing an urgent care walk-in clinic would be almost as bad as the ER, but maybe a family practice is a bit less crazy?

 

I'd possibly make a good ICU nurse, with just one or two patients to focus on at a time, but I really don't think I want to be a nurse.

 

I have posted similar threads in the past. Thank you so much to anyone who reads this. I've got to make a decision soon whether to pursue PA or downshift into respiratory therapy, or maybe cardiovascular tech/ultrasound, or MRI or something. Thanks for reading!

[Friction]

I remember your initial post about becoming a scribe and your worries... I can't speak to whether or not you have a learning deficiency, but I think you should look into other options just as a "plan B." It's never bad to have a back up plan especially when considering you future/income. Have you considered a college studies skills course or something similar that would help you prioritize tasks better?

 

If PA doesn't work out, I would definitely look into ultrasound. They make great money, can work in the ER, and get to spend a good amount of time with each patient (depending on the test).

[Friction]

I remember your initial post about becoming a scribe and your worries... I can't speak to whether or not you have a learning deficiency, but I think you should look into other options just as a "plan B." It's never bad to have a back up plan especially when considering you future/income. Have you considered a college studies skills course or something similar that would help you prioritize tasks better?

 

If PA doesn't work out, I would definitely look into ultrasound. They make great money, can work in the ER, and get to spend a good amount of time with each patient (depending on the test).

[Friction]

I remember your initial post about becoming a scribe and your worries... I can't speak to whether or not you have a learning deficiency, but I think you should look into other options just as a "plan B." It's never bad to have a back up plan especially when considering you future/income. Have you considered a college studies skills course or something similar that would help you prioritize tasks better?

 

If PA doesn't work out, I would definitely look into ultrasound. They make great money, can work in the ER, and get to spend a good amount of time with each patient (depending on the test).

[UGoLong]

The ER tends to be a problem-focused place, though your notes still have an HPI, PMHx, PSgHx, social history, allergies, and current meds, along with the exam, labs, and a plan. Depending on your setting, a number of different people may help gather the data.

 

In our office, we have 15 minutes for an old patient, maybe 20-25 for a new one. You do have to keep moving. On the other hand, you also have to know when you need to slow down and spend more time. The new 69 year old new patient who never had medical care before, had a stroke, and has dyspnea and intermittent chest pain. The 80 year old woman with a blood pressure of 180/100 who has enough meds on her list to solve that (MA calls pharmacy and finds out she hasn't picked up a refill in 7 months). That's why the day runs long. In our office, we chart as we go (in EMR).

 

No matter who you are, in the begining, you will be slow. That's even after PA school. Your goal is to get more efficient over time, but not miss anything important. As my ER preceptor told me "From the moment you lay eyes on them, start thinking how you are going to get them out of here." As you progress in your area, you will learn templates for what you would do for certain situations. Probably the best way to develop them even further is to precept and have another practitioner ask you what they should do.

 

I'm in a specialty, so I don't have to solve all of their problems today. In my family practice rotation, we tried to deal with the top few issues and get them back for the others.

 

You've been a scribe, focusing on collecting data. I don't know if you can be a PA; only you do. I do except that you will get better with training and time.

 

Good luck!

[UGoLong]

The ER tends to be a problem-focused place, though your notes still have an HPI, PMHx, PSgHx, social history, allergies, and current meds, along with the exam, labs, and a plan. Depending on your setting, a number of different people may help gather the data.

 

In our office, we have 15 minutes for an old patient, maybe 20-25 for a new one. You do have to keep moving. On the other hand, you also have to know when you need to slow down and spend more time. The new 69 year old new patient who never had medical care before, had a stroke, and has dyspnea and intermittent chest pain. The 80 year old woman with a blood pressure of 180/100 who has enough meds on her list to solve that (MA calls pharmacy and finds out she hasn't picked up a refill in 7 months). That's why the day runs long. In our office, we chart as we go (in EMR).

 

No matter who you are, in the begining, you will be slow. That's even after PA school. Your goal is to get more efficient over time, but not miss anything important. As my ER preceptor told me "From the moment you lay eyes on them, start thinking how you are going to get them out of here." As you progress in your area, you will learn templates for what you would do for certain situations. Probably the best way to develop them even further is to precept and have another practitioner ask you what they should do.

 

I'm in a specialty, so I don't have to solve all of their problems today. In my family practice rotation, we tried to deal with the top few issues and get them back for the others.

 

You've been a scribe, focusing on collecting data. I don't know if you can be a PA; only you do. I do except that you will get better with training and time.

 

Good luck!

[UGoLong]

The ER tends to be a problem-focused place, though your notes still have an HPI, PMHx, PSgHx, social history, allergies, and current meds, along with the exam, labs, and a plan. Depending on your setting, a number of different people may help gather the data.

 

In our office, we have 15 minutes for an old patient, maybe 20-25 for a new one. You do have to keep moving. On the other hand, you also have to know when you need to slow down and spend more time. The new 69 year old new patient who never had medical care before, had a stroke, and has dyspnea and intermittent chest pain. The 80 year old woman with a blood pressure of 180/100 who has enough meds on her list to solve that (MA calls pharmacy and finds out she hasn't picked up a refill in 7 months). That's why the day runs long. In our office, we chart as we go (in EMR).

 

No matter who you are, in the begining, you will be slow. That's even after PA school. Your goal is to get more efficient over time, but not miss anything important. As my ER preceptor told me "From the moment you lay eyes on them, start thinking how you are going to get them out of here." As you progress in your area, you will learn templates for what you would do for certain situations. Probably the best way to develop them even further is to precept and have another practitioner ask you what they should do.

 

I'm in a specialty, so I don't have to solve all of their problems today. In my family practice rotation, we tried to deal with the top few issues and get them back for the others.

 

You've been a scribe, focusing on collecting data. I don't know if you can be a PA; only you do. I do except that you will get better with training and time.

 

Good luck!

[laurac]

Lemon Bars, don't give up on being a PA because your scribe job didn't work out. You were taking notes on someone else providing patient care, not providing care yourself no matter what some schools might say.

 

I have read your posts and doubt very much you have a learning disability. You don't have to love the ER to be a PA. You may find that being with outpatients (in any specialty) suits you better and in that case you might want to become a medical assistant and get your HCE that way.

 

You seem like a thoughtful and intelligent person. Keep going. You'll figure out where you belong and become a great PA.

[laurac]

Lemon Bars, don't give up on being a PA because your scribe job didn't work out. You were taking notes on someone else providing patient care, not providing care yourself no matter what some schools might say.

 

I have read your posts and doubt very much you have a learning disability. You don't have to love the ER to be a PA. You may find that being with outpatients (in any specialty) suits you better and in that case you might want to become a medical assistant and get your HCE that way.

 

You seem like a thoughtful and intelligent person. Keep going. You'll figure out where you belong and become a great PA.

[Maverick87]

If anyone has experience working/rotations in both family medical practice and an emergency room or urgent care settings, I could really use some advice. I'd like to know how long a PA or doctor gets to spend with each patient in a family practice, how much charting they have to do, and how much back and forth between patients there is in family practice. For example, in an ER the docs do a review of systems and physical exam for each patient which must be charted. Labs are ordered for most patients and often x-rays or CT scans as well. These exams and test results, combined with many very sick patients, results in an avalanche of information to process and constant interruptions as EKG results, labs, etc. come back for review and new patients are seen.

 

It's all very interesting yet overwhelming. I really like the idea of serving my community as a PA and my pre-requisite grades are very high. But I have unfortunately discovered, after failing training as an ER scribe, that I cannot function in a high-speed environment with constant distractions. Perhaps I have some sort of minor learning disability? I'm currently searching for a family practice physician or PA who will let me shadow them, but I'd love to hear from the many experienced people on this forum. I'm guessing an urgent care walk-in clinic would be almost as bad as the ER, but maybe a family practice is a bit less crazy?

 

I'd possibly make a good ICU nurse, with just one or two patients to focus on at a time, but I really don't think I want to be a nurse.

 

I have posted similar threads in the past. Thank you so much to anyone who reads this. I've got to make a decision soon whether to pursue PA or downshift into respiratory therapy, or maybe cardiovascular tech/ultrasound, or MRI or something. Thanks for reading!

 

Family practice is pretty crazy....just in a different way.

 

You'll be fine. It all comes with experience.

[Maverick87]

If anyone has experience working/rotations in both family medical practice and an emergency room or urgent care settings, I could really use some advice. I'd like to know how long a PA or doctor gets to spend with each patient in a family practice, how much charting they have to do, and how much back and forth between patients there is in family practice. For example, in an ER the docs do a review of systems and physical exam for each patient which must be charted. Labs are ordered for most patients and often x-rays or CT scans as well. These exams and test results, combined with many very sick patients, results in an avalanche of information to process and constant interruptions as EKG results, labs, etc. come back for review and new patients are seen.

 

It's all very interesting yet overwhelming. I really like the idea of serving my community as a PA and my pre-requisite grades are very high. But I have unfortunately discovered, after failing training as an ER scribe, that I cannot function in a high-speed environment with constant distractions. Perhaps I have some sort of minor learning disability? I'm currently searching for a family practice physician or PA who will let me shadow them, but I'd love to hear from the many experienced people on this forum. I'm guessing an urgent care walk-in clinic would be almost as bad as the ER, but maybe a family practice is a bit less crazy?

 

I'd possibly make a good ICU nurse, with just one or two patients to focus on at a time, but I really don't think I want to be a nurse.

 

I have posted similar threads in the past. Thank you so much to anyone who reads this. I've got to make a decision soon whether to pursue PA or downshift into respiratory therapy, or maybe cardiovascular tech/ultrasound, or MRI or something. Thanks for reading!

 

Family practice is pretty crazy....just in a different way.

 

You'll be fine. It all comes with experience.

[Lemon Bars]

Lemon Bars, don't give up on being a PA because your scribe job didn't work out. You were taking notes on someone else providing patient care, not providing care yourself no matter what some schools might say.

 

I have read your posts and doubt very much you have a learning disability. You don't have to love the ER to be a PA. You may find that being with outpatients (in any specialty) suits you better and in that case you might want to become a medical assistant and get your HCE that way.

 

You seem like a thoughtful and intelligent person. Keep going. You'll figure out where you belong and become a great PA.

 

Thank you, Laurac! I really need to shadow a family PA. And maybe a public health nurse.

[Lemon Bars]

Lemon Bars, don't give up on being a PA because your scribe job didn't work out. You were taking notes on someone else providing patient care, not providing care yourself no matter what some schools might say.

 

I have read your posts and doubt very much you have a learning disability. You don't have to love the ER to be a PA. You may find that being with outpatients (in any specialty) suits you better and in that case you might want to become a medical assistant and get your HCE that way.

 

You seem like a thoughtful and intelligent person. Keep going. You'll figure out where you belong and become a great PA.

 

Thank you, Laurac! I really need to shadow a family PA. And maybe a public health nurse.

[nebula]

Hi Lemon Bars,

 

I read your scribe posts too and really felt for you- to be honest, that sounded like a living hell to me and something I would absolutely have struggled with, and I consider myself a fairly sharp person. I am just a lowly pre-PA, but I would really recommend shadowing if you can. I have been shadowing a PA in the PCU (stepdown from PICU) and while the patients are quite sick, I would not have described it as a frenetic environment at all. I don't think you need to feel like it's ER, family practice, or nothing, you know? And I really do think there will be a difference when you are providing care to your own patients vs. (as LauraC said above) basically taking dictation.

 

I actually do have a learning disability as well as ADHD, and while it might be something to look into with your provider, it's probably more effective just to recognize it and try to address it/develop workarounds to deal with it. In my case, I just have to work much harder to follow conversations and not be shy about asking people to repeat things- obviously that doesn't work when your job is to catch things the first time and transcribe them accurately (i.e. as a scribe) but I really don't think you should give up on becoming a PA just because of this.

 

Good luck!

[nebula]

Hi Lemon Bars,

 

I read your scribe posts too and really felt for you- to be honest, that sounded like a living hell to me and something I would absolutely have struggled with, and I consider myself a fairly sharp person. I am just a lowly pre-PA, but I would really recommend shadowing if you can. I have been shadowing a PA in the PCU (stepdown from PICU) and while the patients are quite sick, I would not have described it as a frenetic environment at all. I don't think you need to feel like it's ER, family practice, or nothing, you know? And I really do think there will be a difference when you are providing care to your own patients vs. (as LauraC said above) basically taking dictation.

 

I actually do have a learning disability as well as ADHD, and while it might be something to look into with your provider, it's probably more effective just to recognize it and try to address it/develop workarounds to deal with it. In my case, I just have to work much harder to follow conversations and not be shy about asking people to repeat things- obviously that doesn't work when your job is to catch things the first time and transcribe them accurately (i.e. as a scribe) but I really don't think you should give up on becoming a PA just because of this.

 

Good luck!

[Longmire86]

I echo the opinions of others here...don't give up! I am a new PA who is in Family Med and loving it. I did not apply for any ER jobs, maybe partly because I had such a horrible ER rotation experience (nasty preceptor who refused to teach, just pimped me constantly in front of docs, nurses, and whoever else was in the vacinity)...but I marched on through my other rotations, met wonderful prectors who taught and led by example. If a particular specialty is not your thing, just move on and find one that is.

[Lemon Bars]

Thank you for all the encouragement folks! :)

[thanh.ha.ca]

Lemon Bars, I am a back office MA, in the beginning when I first started as a MA, I was really slow in rooming patients and sometimes the physician would come in when I'm still in progress of finishing off the patients. But later, I was able to improve on that, I was able to room patients in a timely manner and efficiently. I thought I was slow in general, but It takes time, eventually you'll get used to the routine in the medical office, and find ways to prioritize things.

[ToppDog]

Do not mistake an inability to be a roving secretary as a sign that you are not cut out to be a PA. Being a scribe requires a certain skill set that is not necessarily representative of working as a PA, or even as an MA while you're getting HCE. And, it also doesn't necessarily mean you can't multitask either.

 

With that being said, working in Family practice as an MA can be very fast paced & stressful. Working in the ER is also stressful, but in a different way. There are times where you're slammed with lots of trauma & things are intense, & there are slow periods where nothing is going on. With Family Practice you are just constantly busy all day every day. Providers are constantly pressured to see more patients per day with the less staff. You may find an MA position in a setting where you're doing more hands on patient care, & less typing at a keyboard more rewarding, & a better test of your future abilities to provide care as a provider. Good Luck!