PAs in Emergency Medicine

[technocrat626]

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I'm currently trying to decide between pursuing medical school vs pursuing PA school. One of my primary specialty interests is Emergency Medicine. Could any of the residents or attendings in this forum give me an idea of the scope of practice available to emergency medicine PAs? What sorts of procedures are the PAs you work with allowed to perform, if any? Are the PAs just there to evaluate patients and do triage?

 

[docB]

The most common use of midlevels in EM is to staff fast track type settings. Fast track is where sprains, lacerations, colds and other less severe conditions are seen. There are EDs/EM groups that use midlevels in the main ED as extenders to assist with all levels of patients including the most acute but this set up is not as common as the fast track arrangement. I would say that fewer still (I don't know of any) use midlevels for triage as that is most often a nursing function.

 

[RustedFox]

There's some heated debate going around on this topic in a few other threads.

Do I smell smoke ?

 

[docB]

Here or on other forums?

 

[RustedFox]

Both. The "how many spots didn't fill" (or something similar) thread was hijacked (largely in part by me) and has some good arguments regarding the role of PAs.

 

[WilcoWorld]

I love (good) PAs, it's the NPs that have me worried.

Where I work PAs work alongside the docs, mainly to see lower acuity patients with a healthy amount of procedures thrown in. However they occasionally get a sick patient that needs an MICU admission (not by design, but because sometimes "low acuity" isn't so low). If something like a central line or intubation needs to get done, a doc will do it. Lacerations/I&D's/fracture care without sedation and the like can be done by the PA independently.

 

[turkeyjerky]

I'm curious, how are mid-levels utilized in your residency-affiliated EDs and how do you think they should be used in residency programs?

 

[gutonc]

I'm curious, how are mid-levels utilized in your residency-affiliated EDs and how do you think they should be used in residency programs?

At my institution they do fast-track (at the VA), along with (mostly off-service) residents. At the University they run the obs unit and are an extra set of hands if things go completely sideways on the acute side.

 

[Croooz]

I'm not a PA nor physician I'm just an old fart who was debating whether to apply to med school or PA school with the final goal of working in EM. It was suggested by EM PA's that it is by far a better experience in the ER if you're the physician. From the types of patients, to the work schedule, and finally the pay. The myth in EM, for PA's, is that they will have the same type of schedule and see the same patients as the physicians. All the EM PA's I spoke to reassured me that the "lifestyle" myth for EM PA's is only a myth. PA's work longer hours, more frequently, for naturally 1/2 -1/3rd the pay. After years of experience as an EM PA you can find rural hospitals where you can "be the boss" but if that is your goal just spend the years in med school and residency.

I've also spoken to a EM PD and he would never ask a doc to stay an extra hour but he routinely asks 2-3 PA's to stay and he tells me this is very common. The physicians here can comment how widespread that practise is or is not. I know as an administrator type that if I can have three people for the price of one I would have the three stay the extra hour. Naturally it depends on the type of patient but 3 for 1 is always a deal. I'm also not referring to PA's replacing physicians, I'm only talking about coverage at the end of shifts.

I was told to buck up and just bite the bullet and apply to medical school...and like I said I'm an old fart so assuming you're younger, I would advise the same thing. Apply to med school and work hard to get into EM. That's my decision. 😎

 

[AlmostJesus]

There are emergency medicine PA residencies. University of Iowa has an 18 month PA residency. That might improve your chances of working as a PA in the acute parts of the ED. Also going to a rural area significantly helps. Areas with populations ~10,000 seem to like PA's to staff their EDs and let their family practice physicians work in clinic (and as the PA's backup).
That being said, you might be happier if you just bite the bullet, take the extra few years and it will pay off in the long run. You will have a lot more portable of a job and a lot more confidence in your position.

 

[docB]

I'm not a PA nor physician I'm just an old fart who was debating whether to apply to med school or PA school with the final goal of working in EM. It was suggested by EM PA's that it is by far a better experience in the ER if you're the physician. From the types of patients, to the work schedule, and finally the pay. The myth in EM, for PA's, is that they will have the same type of schedule and see the same patients as the physicians. All the EM PA's I spoke to reassured me that the "lifestyle" myth for EM PA's is only a myth. PA's work longer hours, more frequently, for naturally 1/2 -1/3rd the pay. After years of experience as an EM PA you can find rural hospitals where you can "be the boss" but if that is your goal just spend the years in med school and residency.

I've also spoken to a EM PD and he would never ask a doc to stay an extra hour but he routinely asks 2-3 PA's to stay and he tells me this is very common. The physicians here can comment how widespread that practise is or is not. I know as an administrator type that if I can have three people for the price of one I would have the three stay the extra hour. Naturally it depends on the type of patient but 3 for 1 is always a deal. I'm also not referring to PA's replacing physicians, I'm only talking about coverage at the end of shifts.

I was told to buck up and just bite the bullet and apply to medical school...and like I said I'm an old fart so assuming you're younger, I would advise the same thing. Apply to med school and work hard to get into EM. That's my decision. 😎

I agree with some of that. If you want to be "the boss" then go med. But we are discouraged from asking our PAs to stay late. The docs stay late all the time. In my market good PAs are sought after so they can get good hours. They are paid less than the docs.

 

[KYTNOH]

I'm not a PA nor physician I'm just an old fart who was debating whether to apply to med school or PA school with the final goal of working in EM. It was suggested by EM PA's that it is by far a better experience in the ER if you're the physician. From the types of patients, to the work schedule, and finally the pay. The myth in EM, for PA's, is that they will have the same type of schedule and see the same patients as the physicians. All the EM PA's I spoke to reassured me that the "lifestyle" myth for EM PA's is only a myth. PA's work longer hours, more frequently, for naturally 1/2 -1/3rd the pay. After years of experience as an EM PA you can find rural hospitals where you can "be the boss" but if that is your goal just spend the years in med school and residency.

It's rare to have a situation where the PA sees exactly the same types of patients. Most PAs see fast track type stuff with some abd pain thrown in. They typically don't see acute strokes, big trauma, sepsis, etc. Work hours are pretty similar between docs and PAs. The one change would be that there aren't many PAs that work overnight. Many EDs have their PA shifts from 11A-11P or 9AM-9PM or something similar. You care correct about the pay...except it is probably more along the lines of 1/3-1/4 total pay. Of course they also have 1/3 or 1/4 the liability too......

I've also spoken to a EM PD and he would never ask a doc to stay an extra hour but he routinely asks 2-3 PA's to stay and he tells me this is very common.

My experience is that PAs typically leave earlier than the MDs. For good or bad I've seen many MLPs have the mindset that "My shift is over because it's now 7PM" instead of staying 45 minutes longer to make sure things are wrapped up appropriately. Not all are like this, and some MDs regularly do things like this. It's also my experience that NPs do this more than PAs. In general I HIGHLY prefer PAs over NPs.

 

[deleted6669]

IF you are in a position to go to medschool do that.
if you are older or have issues that prevent it pa is a good gig if you put in the time and work nights/weekends/rural.
I have a pretty good scope of practice but it has taken years to get there....and I still think about med school. if you want the autonomy, respect, and pay go to med school.
I work solo and see high acuity, do procedures, run codes, etc but the trade off is small depts, rural coverage, nights/weekends/holidays for 1/3 the pay and 1.5 x the hrs every month.
docs hire pa's to work when and where they don't want to work seeing the pts they don't want to see.

 

[Cmaj7th]

IF you are in a position to go to medschool do that.
if you are older or have issues that prevent it pa is a good gig if you put in the time and work nights/weekends/rural.
I have a pretty good scope of practice but it has taken years to get there....and I still think about med school. if you want the autonomy, respect, and pay go to med school.
I work solo and see high acuity, do procedures, run codes, etc but the trade off is small depts, rural coverage, nights/weekends/holidays for 1/3 the pay and 1.5 x the hrs every month.
docs hire pa's to work when and where they don't want to work seeing the pts they don't want to see.

OP listen to this. emedpa is very active in the PA community and knows what he's talking about. If you're an older/non-traditional student with extensive health care experience then maybe PA is for you. But if you're of typical college age just go for pre-med. It's only a minimum of 5 extra years of school/residency to be a BE physician.

Think about it. You'll be 30 one day. You can be a 30 year old PA or a 30 year old attending. I think by the time you retire you wont care about the 5 years of training you got to avoid by going to PA school.

I'm not knocking the profession by any means. I was very close to giving up on medical school all together and soley preparing for PA school. Ironically it was emedpa who convinced me otherwise on the physician assistant forum (I had a different name so I doubt he remembers).

Cheers