List of EM programs that have PA/NP residents

[MedicineZ0Z]

Given the situation at UNC, thought it would be useful to copy this list over from the med student forum. It's important for MS4s to be aware of what they're walking into or considering walking into.



Albany Medical Center - Albany, NY
Albert Einstein Medical Center - Philadelphia, PA
ArrowHead Regional Medical Center - Colton, CA
Atrium Health - Charlotte, NC
Baylor College of Medicine - Houston, TX
Capitol Emergency Associates of TeamHealth - Austin, TX
Carilion Clinic - Roanoke, VA
Gunderson Health Emergency Medicine PA Fellowship - La Crosse, WI
St. Luke's Hospital - Bethlehem, PA
Jane R. Perlman / NorthShore University Health System - Evanstone, IL
Johns Hopkins Bayview Hospital - Baltimore, MD
University of Kentucky - Lexington, KY
Marquette University Aurora Health - Milwaukee, WI
Mayo Clinic Minnesota - Rochester, MN
University of Missouri - Colombia, MO
Nemours/Alfred duPont Hospital for Children - Wilmington, DE
New York Presbyterian Weill Cornell Medical Center - NY
NYU Langone Health Advanced Practice Provider Fellowship in Emergency Medicine - NY
Regions Hospital - St. Paul, MN
Staten Island University Hospital - Staten Island, NY
Team Health EMAPC Fellowship - OKC
Team Health EMAPC Fellowship - Orlando FL
University of Iowa - Iowa City
University of New Mexico School of Medicine - Alberquerque, NM
UCSF Fresno
Yale New Haven Hospital - New Haven, CT
Post-Graduate Advanced Practice Provider (APP) Emergency Medicine Fellowship At Lakeland Regional Health - Lakeland, FL

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[Dr Mantis Toboggan]

to be fair, some great programs on this list.

if I were applying now I’d look hard at the volume/acuity per resident and integration of these other learners. if they are picking up belly pains, fine, if they are taking tubes and lines, that’s another story.

if you refuse to consider these places due to moral objection, respek, but odds are you’ll end up working with or supervising these people at some point down the road.

Given the situation at UNC, thought it would be useful to copy this list over from the med student forum. It's important for MS4s to be aware of what they're walking into or considering walking into.



Albany Medical Center - Albany, NY
Albert Einstein Medical Center - Philadelphia, PA
ArrowHead Regional Medical Center - Colton, CA
Atrium Health - Charlotte, NC
Baylor College of Medicine - Houston, TX
Capitol Emergency Associates of TeamHealth - Austin, TX
Carilion Clinic - Roanoke, VA
Gunderson Health Emergency Medicine PA Fellowship - La Crosse, WI
St. Luke's Hospital - Bethlehem, PA
Jane R. Perlman / NorthShore University Health System - Evanstone, IL
Johns Hopkins Bayview Hospital - Baltimore, MD
University of Kentucky - Lexington, KY
Marquette University Aurora Health - Milwaukee, WI
Mayo Clinic Minnesota - Rochester, MN
University of Missouri - Colombia, MO
Nemours/Alfred duPont Hospital for Children - Wilmington, DE
New York Presbyterian Weill Cornell Medical Center - NY
NYU Langone Health Advanced Practice Provider Fellowship in Emergency Medicine - NY
Regions Hospital - St. Paul, MN
Staten Island University Hospital - Staten Island, NY
Team Health EMAPC Fellowship - OKC
Team Health EMAPC Fellowship - Orlando FL
University of Iowa - Iowa City
University of New Mexico School of Medicine - Alberquerque, NM
UCSF Fresno
Yale New Haven Hospital - New Haven, CT
Post-Graduate Advanced Practice Provider (APP) Emergency Medicine Fellowship At Lakeland Regional Health - Lakeland, FL

 

[MedicineZ0Z]

to be fair, some great programs on this list.

if I were applying now I’d look hard at the volume/acuity per resident and integration of these other learners. if they are picking up belly pains, fine, if they are taking tubes and lines, that’s another story.

if you refuse to consider these places due to moral objection, respek, but odds are you’ll end up working with or supervising these people at some point down the road.

Can tell you for a fact that they are taking tubes and lines at these places among other things.

 

[Modanq]

Can tell you for a fact that they are taking tubes and lines at these places among other things.

I know with direct knowledge of APPs taking lines, Plural drains and several other procedures from ICU residents and even from Anesthesiology Fellows at some big name programs on the east coast. We have surgeons in the ICU who need to learn how to intubate and the CRNA comes up and tubes. We have Anesthesiology intensivists who have never done thoracentesis and the surgery or ICU APP get dibs over it. Its time to put an end to this ridiculousness.

 

[jw3600]

I know with direct knowledge of APPs taking lines, Plural drains and several other procedures from ICU residents and even from Anesthesiology Fellows at some big name programs on the east coast. We have surgeons in the ICU who need to learn how to intubate and the CRNA comes up and tubes. We have Anesthesiology intensivists who have never done thoracentesis and the surgery or ICU APP get dibs over it. Its time to put an end to this ridiculousness.

Yuuuuup.

 

[Modanq]

Yuuuuup.

I also want to remind every one of us when we literally burned the midnight oil studying for MCATs, Shelf exams, Step exams - Literally for months. Then Boards and oral exams and find ourselves starting our careers in our early to late thirties. Let alone the amount of ass kissing towards senior residents, attendings, and countless "research projects" just to get LORs and then a shot at practicing this field, doing all these interviews for medical school and then residency just keeping our **** together. So when time comes to even doing the most basic line or procedure, or cardioversion - yes. I am going to do it and sorry you chose the wrong pathway but this is my Profession and you are doing your Job.

 

[TheSingularity]

There are NPs at an extremely well known PICU who want to "co-lead" rounds with the PICU fellows and think they are equivalent to them.

I know with direct knowledge of APPs taking lines, Plural drains and several other procedures from ICU residents and even from Anesthesiology Fellows at some big name programs on the east coast. We have surgeons in the ICU who need to learn how to intubate and the CRNA comes up and tubes. We have Anesthesiology intensivists who have never done thoracentesis and the surgery or ICU APP get dibs over it. Its time to put an end to this ridiculousness.

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[MedicineZ0Z]

I know with direct knowledge of APPs taking lines, Plural drains and several other procedures from ICU residents and even from Anesthesiology Fellows at some big name programs on the east coast. We have surgeons in the ICU who need to learn how to intubate and the CRNA comes up and tubes. We have Anesthesiology intensivists who have never done thoracentesis and the surgery or ICU APP get dibs over it. Its time to put an end to this ridiculousness.

Holy ****. At least at my shop they're just doing their own patients' procedures (which I think is still criminal). I fully consider that stealing procedures still given that it's something that a real resident could be doing if the midlevel wasn't there. But you're saying that they will do actual residents' procedures?? That's literally insane. I'd flip out.
I'm FM and when I'm off service in the PICU or NICU or any ICU, I'd straight up become verbally defensive and expect a response as to why another person is doing my patient's procedure let alone a fkin midlevel trainee. To some degree, I even expect the employed midlevels to hand off procedures to me since most are older and I'm the trainee.
The only thing I tolerate others doing are PICC lines. Anything else, I expect to have 2 full attempts before anyone else takes over.

Just to clarify though, they are doing other patients' procedures?? And not just their own?

 

[MedicineZ0Z]

I also want to remind every one of us when we literally burned the midnight oil studying for MCATs, Shelf exams, Step exams - Literally for months. Then Boards and oral exams and find ourselves starting our careers in our early to late thirties. Let alone the amount of ass kissing towards senior residents, attendings, and countless "research projects" just to get LORs and then a shot at practicing this field, doing all these interviews for medical school and then residency just keeping our **** together. So when time comes to even doing the most basic line or procedure, or cardioversion - yes. I am going to do it and sorry you chose the wrong pathway but this is my Profession and you are doing your Job.

All that work and some random comes out of nowhere and takes your stuff. Highway robbery at its finest.

 

[jw3600]

There are NPs at an extremely well known PICU who want to "co-lead" rounds with the PICU fellows and think they are equivalent to them.

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I mean it does happen does not have to equate to should happen or shouldn't be addressed. Name and shame bruh.

 

[boolin_1]

all those places are off my list. I talked to my whole medical class about this whole thing and about we should not be anti-NP/PA, but anti-mixing of our education. residency training becomes the backbone of our careers and we should not standby and let it become diluted.

I think as a whole, my class was appreciative was my little soapbox talk and I have had some students say they were starting their audition rotation process for UNC but then stopped.

 

[TooMuchResearch]

But really, would you rather match at an HCA residency where the faculty didn't even want a residency program?

all those places are off my list. I talked to my whole medical class about this whole thing and about we should not be anti-NP/PA, but anti-mixing of our education. residency training becomes the backbone of our careers and we should not standby and let it become diluted.

I think as a whole, my class was appreciative was my little soapbox talk and I have had some students say they were starting their audition rotation process for UNC but then stopped.

 

[boolin_1]

But really, would you rather match at an HCA residency where the faculty didn't even want a residency program?

as a 3rd year DO student, I am now trying to set up my audition rotations. as of now, most VSAS programs are not open. the only programs open are really on Clinician Nexus, another service used to schedule aways. Most of the programs on Clinician Nexus are HCA's. right now I am applying to HCA sites for SubI's because VSAS isn't open and I need to create my 4th year schedule. it pains me to apply to these places, and write these essays, but I don't have a choice at the moment.

for residency, I have no desire to go to an HCA program. but I am couples matching and in the end, if I must, I guess I'll have to suck it up. I am trying my best to avoid everything HCA

 

[pb34]

as a 3rd year DO student, I am now trying to set up my audition rotations. as of now, most VSAS programs are not open. the only programs open are really on Clinician Nexus, another service used to schedule aways. Most of the programs on Clinician Nexus are HCA's. right now I am applying to HCA sites for SubI's because VSAS isn't open and I need to create my 4th year schedule. it pains me to apply to these places, and write these essays, but I don't have a choice at the moment.

for residency, I have no desire to go to an HCA program. but I am couples matching and in the end, if I must, I guess I'll have to suck it up. I am trying my best to avoid everything HCA

Why not apply to the few VSAS programs that are open now and then apply to others as they open? Or, you can email programs to get a timeline of when they will open? It is certainly do-able to plan a 4th year by only applying to programs on VSAS and sending emails to advocate for yourself. I would rather get a SLOE from a more reputable program than a brand new HCA program.

 

[boolin_1]

Why not apply to the few VSAS programs that are open now and then apply to others as they open? Or, you can email programs to get a timeline of when they will open? It is certainly do-able to plan a 4th year by only applying to programs on VSAS and sending emails to advocate for yourself. I would rather get a SLOE from a more reputable program than a brand new HCA program.

only one is open in FL so far. mt sinai in miami

still waiting for more to open

 

[pb34]

only one is open in FL so far. mt sinai in miami

still waiting for more to open

Are you only trying to stay in FL?

 

[MechEDoc]

I'll add one to the list. University of Wisconsin (Madison) - PICU NPs stealing procedures from residents.

F-that.

They have legions of PAs in the ED. No idea what they are doing though.

 

[Boatswain2PA]

.....So when time comes to even doing the most basic line or procedure, or cardioversion - yes. I am going to do it and sorry you chose the wrong pathway but this is my Profession and you are doing your Job.

And I was serving our country for 20 years (while you probably were a little rug-rat through your college years) before going to PA school.

Oh....and I work independently in hospitals hundreds of miles from BCEPs (let alone tertiary care).....intubating, inserting chest tubes and central lines, reducing fractures and dislocations, cardioverting, administering thrombolytics, etc.....

It's my (second) profession too.

The world isnt all academic or tertiary care medicine.

 

[MechEDoc]

And I was serving our country for 20 years (while you probably were a little rug-rat through your college years) before going to PA school.

Hurr-durr.

 

[Boatswain2PA]

I understand (and agree with much of) the frustration y'all feel on this, but to think of yourself as so much better, with your CAREER and all, than us little people with our JOBS is just over the top.

Nursing isnt a career?

 

[deleted480308]

And I was serving our country for 20 years (while you probably were a little rug-rat through your college years) before going to PA school.

Oh....and I work independently in hospitals hundreds of miles from BCEPs (let alone tertiary care).....intubating, inserting chest tubes and central lines, reducing fractures and dislocations, cardioverting, administering thrombolytics, etc.....

It's my (second) profession too.

The world isnt all academic or tertiary care medicine.

They are clearly referencing hospitals that have residents, and no resident would be in your PA independent hospital. So no conflict between you all for procedures

 

[scoopdaboop]

I understand (and agree with much of) the frustration y'all feel on this, but to think of yourself as so much better, with your CAREER and all, than us little people with our JOBS is just over the top.

Nursing isnt a career?

Nobody's saying that. The frustration isn't about PA/NP's existing at all (although some do think PA/NP's don't need to exist), it's about how hospitals and residency programs are compromising the ability for residents to learn by having tons of PA/NP's.

 

[TheSingularity]

Was thinking we were overduedue for @Boatswain2PA to come in here with his uppity "I saved the world while you were in diapers" shtick.

 

[Tenk]

And I was serving our country for 20 years (while you probably were a little rug-rat through your college years) before going to PA school.

Oh....and I work independently in hospitals hundreds of miles from BCEPs (let alone tertiary care).....intubating, inserting chest tubes and central lines, reducing fractures and dislocations, cardioverting, administering thrombolytics, etc.....

It's my (second) profession too.

The world isnt all academic or tertiary care medicine.

Except that’s exactly what this entire thread is about: academic and tertiary care medicine...

 

[RustedFox]

And I was serving our country for 20 years (while you probably were a little rug-rat through your college years) before going to PA school.

Oh....and I work independently in hospitals hundreds of miles from BCEPs (let alone tertiary care).....intubating, inserting chest tubes and central lines, reducing fractures and dislocations, cardioverting, administering thrombolytics, etc.....

It's my (second) profession too.

The world isnt all academic or tertiary care medicine.

Non sequitur is non sequitur.

 

[RustedFox]

I'm good buddies with an ex special forces guy who is a tech in the ER. He's starting PA school this year. Unlike some folks, he has and expresses a real grip on what he will versus will not learn, and in few words, is clear that he is not clamoring for equivalence.

I'm a pretty good marksman and woodsman myself. For 20 years now. But I don't walk around thinking that I could be compared to a special forces soldier.

 

[MediMike]

Hey all...short time reader, first time poster. I'm a PA in the upstairs world not in the ED so pardon any misconceptions I may come into this with.

Are there actual physician residencies where individuals are having trouble meeting their procedural or case numbers? If so then I'm in agreement that those locations certainly shouldn't have a PA/NP residency/fellowship/post-grad program in place. I think it's pretty evident to all that these programs are more designed as cheap labor for these organizations than anything else...but I guess my question to you as physicians is if there is no true detriment to your tribe's training, and there IS a constant bemoaning about the lack of education obtained by PA/NPs during their training... wouldn't more education be a boon to you? Especially those of you who have signed into groups which require you to co-sign charts of patients you never evaluated (which was never our idea for the record, definitely the corporate overlords).

These programs have been around in some shape or form for a long long time, essentially formalizing the apprentice-journeymsn type relationship the PA profession was originally based on.

And in regards to the salary discrepancy noted for the training, and this is an honest question, why in the hell have you as a group put up with that ridiculous pay scale as long as you have? How have there not been revolts?

 

[jw3600]

Hey all...short time reader, first time poster. I'm a PA in the upstairs world not in the ED so pardon any misconceptions I may come into this with.

Are there actual physician residencies where individuals are having trouble meeting their procedural or case numbers? If so then I'm in agreement that those locations certainly shouldn't have a PA/NP residency/fellowship/post-grad program in place. I think it's pretty evident to all that these programs are more designed as cheap labor for these organizations than anything else...but I guess my question to you as physicians is if there is no true detriment to your tribe's training, and there IS a constant bemoaning about the lack of education obtained by PA/NPs during their training... wouldn't more education be a boon to you? Especially those of you who have signed into groups which require you to co-sign charts of patients you never evaluated (which was never our idea for the record, definitely the corporate overlords).

These programs have been around in some shape or form for a long long time, essentially formalizing the apprentice-journeymsn type relationship the PA profession was originally based on.

And in regards to the salary discrepancy noted for the training, and this is an honest question, why in the hell have you as a group put up with that ridiculous pay scale as long as you have? How have there not been revolts?

1) Change the name. Residency and fellowship are doctor words. It’s not very subtle “word speak.”
2) Written policy that residents take priority on all critical patients and all procedures.
3) Midlevels stop pushing equality to doctors.
4) Resident salaries will never get better. There’s this thing called leverage. They are on the wrong side.

If these conditions are met I see some positives out of progams like this as you mentioned.

 

[deleted547339]

Hey all...short time reader, first time poster. I'm a PA in the upstairs world not in the ED so pardon any misconceptions I may come into this with.

Are there actual physician residencies where individuals are having trouble meeting their procedural or case numbers? If so then I'm in agreement that those locations certainly shouldn't have a PA/NP residency/fellowship/post-grad program in place. I think it's pretty evident to all that these programs are more designed as cheap labor for these organizations than anything else...but I guess my question to you as physicians is if there is no true detriment to your tribe's training, and there IS a constant bemoaning about the lack of education obtained by PA/NPs during their training... wouldn't more education be a boon to you? Especially those of you who have signed into groups which require you to co-sign charts of patients you never evaluated (which was never our idea for the record, definitely the corporate overlords).

These programs have been around in some shape or form for a long long time, essentially formalizing the apprentice-journeymsn type relationship the PA profession was originally based on.

And in regards to the salary discrepancy noted for the training, and this is an honest question, why in the hell have you as a group put up with that ridiculous pay scale as long as you have? How have there not been revolts?

Yes, there are some places where MD/DO trainees do struggle to get numbers and some programs that sacrifice their training to appease their long-term NPs. There’s one service at my hospital that treats the residents like trash and the mid levels are untouchable. This is in part because of militant midlevels and in part because of poor leadership.

I may be wrong, but I believe CMS sets the base salary rate for trainees which obviously wouldn’t apply to midlevel “residencies.” And, at the end of the day, I don’t think we really care that much that we’re underpaid in training. It sucks, but it’s a temporary stepping stone and we all get that (for the most part). The frustration was that an NP or PA in training would get paid more, not the absolute number. Similarly, our second year residents are much better and quicker than our midlevels and sometimes moonlight in that role in our other sites. They get paid the midlevel rate which is higher than the resident payscale. It’s silly that we pay our NPs/PAs more to be slower than the residents.

And not to derail the thread, but I would say the militant NPs who question everything in spite of being wrong and want to walk around calling themselves doctor probably number between 1/5 to 1/3 whereas the militant PAs are probably more on the order of 1/10. I think there is just a different mentality. I think a lot of nurses come from the mindset of being around doctors, following orders and then coming to the thought “I’ve seen this, it’s not that hard, I could do this” then think that the training that they’ve received is adequate to make all of the same decisions. I don’t think that the PA training system puts PA students in that same position so I rarely get the “well I though this lady’s belly exam was fine and her VS were good and she doesn’t have a white count so I think we don’t need to scan her” in spite of them being 85 with 4 prior surgeries, persistent vomiting without flatus and other worrisome findings.

 

[Boatswain2PA]

Nobody's saying that.

Yeah...pretty sure Modanq did say that when they said:

I am going to do it and sorry you chose the wrong pathway but this is my Profession and you are doing your Job.

The frustration isn't about PA/NP's existing at all (although some do think PA/NP's don't need to exist), it's about how hospitals and residency programs are compromising the ability for residents to learn by having tons of PA/NP's.

And that frustration is completely understandable. Seems there will always be a conflict on who gets procedures, especially relatively rare procedures. Now these systems are throwing in another cohort who will be fighting for these procedures/patients. Of course EM residents (and those who support them) will push back.

They are clearly referencing hospitals that have residents, and no resident would be in your PA independent hospital. So no conflict between you all for procedures

So where should PAs who practice in the small rural hospitals learn procedures?

Except that’s exactly what this entire thread is about: academic and tertiary care medicine...

My point was how it all fits together. Where are the rural providers (frequently PAs) supposed to learn? It's always been from the local family practice doc. I could certainly see the benefits of an EM specific training ("residency" for the lack of a better word) for PAs in improving care. How would that fit into the bigger academic picture (and what should it be called) I don't know.

Non sequitur is non sequitur

Here, since you are having problems following along, let me spell this out for you:

literally burned the midnight oil studying for MCATs, Shelf exams, Step exams - Literally for months. Then Boards and oral exams and find ourselves starting our careers in our early to late thirties. Let alone the amount of ass kissing towards senior residents, attendings, and countless "research projects" just to get LORs and then a shot at practicing this field, doing all these interviews for medical school and then residency just keeping our **** together.

So Modanq spells out the lengthy steps that they went through to get where they are (assuming in EM residency). My reply was to remind him that other people have gone through some adversity as well to get where they are.

My comment about procedures was to let him know that PAs ARE doing those procedures, so therefore should have some method of learning them.

Hope you can see where that might tie together and be a little more sequitur.

1) Change the name. Residency and fellowship are doctor words. It’s not very subtle “word speak.”
2) Written policy that residents take priority on all critical patients and all procedures.
3) Midlevels stop pushing equality to doctors.
4) Resident salaries will never get better. There’s this thing called leverage. They are on the wrong side.

If these conditions are met I see some positives out of progams like this as you mentioned.

1) The terminology is a big problem for PAs, and we are fighting to catch up with the NPs. Adminscritters often preferentially hire NPs because (despite frequently abysmal NP training) they are "independent" and we are simple "assistants". This is, unfortunately, leading us down the path the NPs blazed into fighting for more independence as well (something I disagree with). NPs are also leading the charge in taking over the term "doctor" with their movement toward the DNP. With the growth of doctoral level PA programs I'm sure PAs will once again unfortunately follow suite. Now with the growth of "residencies" we have another verbage conflict.

2. There should be a careful balance done by the attendings to ensure the residents, AND the PAs undergoing training, get enough. To say that residents take priority on all critical pts/procedures would allow the young, procedure hungry residents to take them all.

3. Concur. While there are some really good NPs and PAs, our "minimum standard" is much lower than for BC EPs. I'm pretty good at what I do, but when I work alongside EPs I am constantly reminded how much I have to learn. One shift recently I saw my medical director put in a CVL in about 1/10 the time it takes me to do one.

4. But at least they know they are close to getting that massive payraise!

 

[deleted480308]

Yeah...pretty sure Modanq did say that when they said:






And that frustration is completely understandable. Seems there will always be a conflict on who gets procedures, especially relatively rare procedures. Now these systems are throwing in another cohort who will be fighting for these procedures/patients. Of course EM residents (and those who support them) will push back.


So where should PAs who practice in the small rural hospitals learn procedures?


My point was how it all fits together. Where are the rural providers (frequently PAs) supposed to learn? It's always been from the local family practice doc. I could certainly see the benefits of an EM specific training ("residency" for the lack of a better word) for PAs in improving care. How would that fit into the bigger academic picture (and what should it be called) I don't know.




Here, since you are having problems following along, let me spell this out for you:



So Modanq spells out the lengthy steps that they went through to get where they are (assuming in EM residency). My reply was to remind him that other people have gone through some adversity as well to get where they are.

My comment about procedures was to let him know that PAs ARE doing those procedures, so therefore should have some method of learning them.

Hope you can see where that might tie together and be a little more sequitur.



1) The terminology is a big problem for PAs, and we are fighting to catch up with the NPs. Adminscritters often preferentially hire NPs because (despite frequently abysmal NP training) they are "independent" and we are simple "assistants". This is, unfortunately, leading us down the path the NPs blazed into fighting for more independence as well (something I disagree with). NPs are also leading the charge in taking over the term "doctor" with their movement toward the DNP. With the growth of doctoral level PA programs I'm sure PAs will once again unfortunately follow suite. Now with the growth of "residencies" we have another verbage conflict.

2. There should be a careful balance done by the attendings to ensure the residents, AND the PAs undergoing training, get enough. To say that residents take priority on all critical pts/procedures would allow the young, procedure hungry residents to take them all.

3. Concur. While there are some really good NPs and PAs, our "minimum standard" is much lower than for BC EPs. I'm pretty good at what I do, but when I work alongside EPs I am constantly reminded how much I have to learn. One shift recently I saw my medical director put in a CVL in about 1/10 the time it takes me to do one.

4. But at least they know they are close to getting that massive payraise!

Where are the PAs who want go rural are supposed to train? Anywhere they don’t get in a resident’s way of getting a resident’s training. Once a shop opens a residency it should be open season for the residents to get all the experience they can tolerate. Full stop.

The PAs can open some training programs elsewhere or learn on the job. As you say their minimum standard is lower anyway. And (here’s where we will part ways) they should only be working with a doctor physically there to supervise anyway.

 

[TheSingularity]

At a "well known children's hospital" (no, I'm not going to name and shame), midlevels steal airways from the PICU fellows

Sent from my Pixel 3 using SDN mobile

 

[RustedFox]

Here, since you are having problems following along, let me spell this out for you:

So Modanq spells out the lengthy steps that they went through to get where they are (assuming in EM residency). My reply was to remind him that other people have gone through some adversity as well to get where they are.

My comment about procedures was to let him know that PAs ARE doing those procedures, so therefore should have some method of learning them.

Hope you can see where that might tie together and be a little more sequitur.

Except that nowhere did military service enter into the conversation until you had to shoehorn it in, like you do every 3-4 months or so.
Thus, non-sequitur. I think everyone here sees that but you.

But hey:

 

[alpinism]

Hey all...short time reader, first time poster. I'm a PA in the upstairs world not in the ED so pardon any misconceptions I may come into this with.

Are there actual physician residencies where individuals are having trouble meeting their procedural or case numbers? If so then I'm in agreement that those locations certainly shouldn't have a PA/NP residency/fellowship/post-grad program in place. I think it's pretty evident to all that these programs are more designed as cheap labor for these organizations than anything else...but I guess my question to you as physicians is if there is no true detriment to your tribe's training, and there IS a constant bemoaning about the lack of education obtained by PA/NPs during their training... wouldn't more education be a boon to you? Especially those of you who have signed into groups which require you to co-sign charts of patients you never evaluated (which was never our idea for the record, definitely the corporate overlords).

These programs have been around in some shape or form for a long long time, essentially formalizing the apprentice-journeymsn type relationship the PA profession was originally based on.

And in regards to the salary discrepancy noted for the training, and this is an honest question, why in the hell have you as a group put up with that ridiculous pay scale as long as you have? How have there not been revolts?

It's surprisingly common especially with these new CMG residencies at non trauma center hospitals. I'd say at least 50% of EM residents aren't getting their required procedure numbers for ortho reductions. For example I'll commonly get residents who rotate with me down in Haiti who've never seen a dislocation with neurovascular compromise during their entire 3 years of residency.

 

[allantois]

Residency is not a term reserved for physicians. Pharmacists, psychologists, optometrists, podiatrists, dentists, PTs, and I'm sure I'm forgetting some all have residences.

Also, let me just say that it's not the PAs/NPs who are gonna dilute physician salaries. It will be new EM docs from the many newly opened programs. And the difference won't be a few thousand dollars either.

 

[67552931811]

Residency is not a term reserved for physicians. Pharmacists, psychologists, optometrists, podiatrists, dentists, PTs, and I'm sure I'm forgetting some all have residences.

Also, let me just say that it's not the PAs/NPs who are gonna dilute physician salaries. It will be new EM docs from the many newly opened programs. And the difference won't be a few thousand dollars either.

You are 100% incorrect. The term originated when physicians back-in-the-day worked so much that they were literally RESIDENTS of the hospital (ie lived there). It is a healthcare term that has no basis or reality in literally any field except for medicine and the physician pathway

So, no, those fields do not have residencies despite what label they place on them, or claim.

 

[allantois]

Where are the PAs who want go rural are supposed to train? Anywhere they don’t get in a resident’s way of getting a resident’s training. Once a shop opens a residency it should be open season for the residents to get all the experience they can tolerate. Full stop.

The PAs can open some training programs elsewhere or learn on the job. As you say their minimum standard is lower anyway. And (here’s where we will part ways) they should only be working with a doctor physically there to supervise anyway.

Somebody who believes in free market and free for all sure has a lot of ideas on what somebody should be forced to do with their training

 

[deleted480308]

Somebody who believes in free market and free for all sure has a lot of ideas on what somebody should be forced to do with their training

You misunderstand. I don't want the govt to require it

 

[VA Hopeful Dr]

You are 100% incorrect. The term originated when physicians back-in-the-day worked so much that they were literally RESIDENTS of the hospital (ie lived there). It is a healthcare term that has no basis or reality in literally any field except for medicine and the physician pathway

So, no, those fields do not have residencies despite what label they place on them, or claim.

Then what would you call the orthodontist pathway for dentists?

 

[MechEDoc]

I know of a an east coast level I trauma center with an EM residency where the residents see so little trauma and pediatrics that they have to do extensive (multi-month) away rotations in other states to see a minimum amount of pediatrics and trauma. Not what I would call well trained!

 

[RustedFox]

I know of a an east coast level I trauma center with an EM residency where the residents see so little trauma and pediatrics that they have to do extensive (multi-month) away rotations in other states to see a minimum amount of pediatrics and trauma. Not what I would call well trained!

For how valuable we are to society as a "social safety net" in that we take all comers regardless of anything, you'd think that the federal government would have an interest in protecting us, or even fostering our growth; especially since we're far more convenient (thru necessity) than family care, and that family care has been overrun by zeros who panic when they see an unwell patient and immediately punt them to the ER.

Yet, they don't. They'd rather dicker our salaries down in any way that they can; whether it be thru the false equivalence fallacy of the MLPs, or pointing the fingers of blame at we, the "greedy physicians" for their Byzantine billing mazes. We're caught between the Devil and the Deep Blue Sea.

One thing I will tell you that the Millennials are now getting correct (in my experience) is that I see a LOT of them calling the MLPs out on their nonsense. They're asking the Jenny McJennysons the HARD questions, and Jenny doesn't know how to answer because she can't fake it beyond a certain point.

Unfortunately, so many kids who opt to take the "easy way" around high-school Chemistry-II... now want to be Jennies. They want to wear a white coat and to be a boss and to assert equivalence, but without taking those HARD TESTS and having to STAY UP PAST MIDNIGHT to learn the actual practice of medicine.

Harrumph.

PROTIP: To any child reading this forum with aspirations of being a physician... if you catch yourself trying to dodge "hard classes" in either high-school or undergraduate, or feel like "the ACT is better that the SAT because it like, feels easier and might help me more"... then you likely either don't have what it takes to be the real deal [OR], you need to find your inner courage, take measure of your actual academic horsepower, and make decisions accordingly... because:

This nation doesn't need any more Jenny McJennysons.

 

[maxxor]

One thing I will tell you that the Millennials are now getting correct (in my experience) is that I see a LOT of them calling the MLPs out on their nonsense. They're asking the Jenny McJennysons the HARD questions, and Jenny doesn't know how to answer because she can't fake it beyond a certain point.

Could you elaborate on this a little more?

The Radiology version of this is “unexpected important finding on a scan” where you call Jenny McJ and tell them, and get silence. You know they don’t understand the importance so then you debate waking up the attending because you don’t want this to wait.

 

[RustedFox]

Could you elaborate on this a little more?

The Radiology version of this is “unexpected important finding on a scan” where you call Jenny McJ and tell them, and get silence. You know they don’t understand the importance so then you debate waking up the attending because you don’t want this to wait.

Sure.
I frequently run into young parents who bring their child to the ER for whatever, and I ask who their pediatrician or FP is. Sometimes, they respond not with a name, but with a practice.

"Oh. We go to SunnySide Care Clinic."

Okay. I know that practice.Who do you see there; Jenny McJennyson?

"Oh. No. We WON'T see Jenny. It's clear that she has little idea what she's doing."

Same with young DINKs or professionals. They're starting to become very leery of the MLP crowd in the outpatient world.

 

[txterp98]

I don't want to derail from the spirit of this conversation because I do think it's important to ensure EM residents get strong, unimpeded training in all things Emergency Medicine.

Just a note, though, that the PA program listed above for Austin, TX (Capitol Emergency Associates of TeamHealth) is NOT where the UT Austin EM Residency is located. That is the crosstown group and they do not have an MD/DO EM Residency. Conversely, the UT Austin EM Residency does not have an NP or PA residency.

 

[OneTwoThreeFour]

I don't want to derail from the spirit of this conversation because I do think it's important to ensure EM residents get strong, unimpeded training in all things Emergency Medicine.

Just a note, though, that the PA program listed above for Austin, TX (Capitol Emergency Associates of TeamHealth) is NOT where the UT Austin EM Residency is located. That is the crosstown group and they do not have an MD/DO EM Residency. Conversely, the UT Austin EM Residency does not have an NP or PA residency.

I mean, Johns Hopkins Bayview Hospital is not their main campus either. If the concern is interference with resident training, those programs aren't affected. If the concern is midlevel providers being given more autonomy than their training is designed for, both programs are guilty.

 

[txterp98]

I mean, Johns Hopkins Bayview Hospital is not their main campus either. If the concern is interference with resident training, those programs aren't affected. If the concern is midlevel providers being given more autonomy than their training is designed for, both programs are guilty.

No, what I'm saying is that this PA program is at St David's Healthcare. UT Austin teaches out of the Seton Family of Hospitals. This PA EM program is at the rival crosstown network from where the MD/DO residency is located. There is absolutely no PA EM residency program at any site that the UT Austin EM residents rotate at. Actually, one step further, UT Austin has no training program in place for PA students at all.

 

[Splenda88]

to be fair, some great programs on this list.

if I were applying now I’d look hard at the volume/acuity per resident and integration of these other learners. if they are picking up belly pains, fine, if they are taking tubes and lines, that’s another story.

if you refuse to consider these places due to moral objection, respek, but odds are you’ll end up working with or supervising these people at some point down the road.

Belly pain and chest pain probably make up 90% of ED complaints 🙁


You see people sitting in the ED waiting area playing with their phones... 9 out 10 times it is not an emergency if you are playing games on your phone...