RustedFox, I don’t know if you’re burned out or whatever but your bitterness is concerning and kinda sad. There’s no reason to demean and belittle a good PA just participating in some intellectual banter and explaining, respectfully, the MLP side.
At the risk of you mocking me for acting like a bad ass - I have been a PA for three years so far, always learning and trying to get better, and the docs in my ER and I have a great relationship. They have happily guided me when I needed assistance, and I have been eager to learn whatever they have to teach me. They are grateful for the extra hands especially in the fast track, or for help in the main ER when their zone is full or their maxed out with critical patients or they just want to GTFO and go home. They ask me and the other PAs, who they also trust, even to pick up unstable patients. They ask me to do their procedures like suturing and LPs and I and Ds. I don’t advocate for independence for PAs and I LIKE playing the assistant role in those cases - we are a team (although I manage most things on my own). Although some days I feel like I know nothing, I have learned to recognize sick versus not sick, and I listen to my spidey sense. Therefore I talk to the docs about 15% of cases, maybe more if in the main ER. In the fast track area this year I have caught five carotid artery dissections in young females that my attendings have praised me for because they feel they would have missed them. I recently CTAed an old lady with flank pain who “strained my back putting the damn fitted sheet on my bed” because she was hiccuping and my spidey sense kicked in... she had a massive PE / pulmonary infarct. I had a 50 year old come in with a sore throat for a month - throat looked normal. I could have just DCed the guy but had the heebie jeebies and learned he has also lost a lot of weight; I found that he had pancreatic cancer with lung mets (not an emergency but still good pick up nonetheless). Recently a 29 year old with a sudden onset of generalized weakness, syncope, “feeling weird and think I am having a heart attack” - he had elevated troponins too. Attending thought it could be aortic dissection so we scanned the chest, abdomen, and pelvis. Negative. EKG showed no changes. We were puzzled.But I knew to keep frequently evaluating a patient like this. On a third eval, he was clutching his head (yet never complained of a headache or any neurological symptoms really). Scanned his head and the problem was acute subarachnoid hemorrhage; he died eleven days later. Attending said he wouldn’t have caught that one either. He was proud of me. I don’t always get it right and I am sure sometimes I ask inane questions, but what I am trying to say here is that some of us PAs are smart, conscientious, and capable of picking up on subtle presentations of badness. Some of us know when to consult our attending. Some of us are eager to learn. Some of us realize that although our training was good we can’t possibly be as competent as a doc, so we always have to be on our toes.
It would be hard as a doc to have to sign charts of providers you don’t trust. I wouldn’t want to either. If your APPs suck, notify administration about your concerns. Ultimately they need to be fired if they don’t step it up (really). Before it gets to that point they need to be heavily supervised and have their charts audited to ensure competency. Take the proper channels like referring these bad cases you mention to the performance improvement committee or quality committee so that the PA can be investigated. For the good ones who care and want to learn, be open to teaching and supervising because ultimately a competent PA you trust only makes your job easier and makes the department run smoother. We can be useful to you. We can make your shifts easier and more enjoyable. Give us a chance!
PS Don’t get me started on FNPs, though... now FNP training is a joke and I have no freaking clue how they are even staffing ERs legally given their scope of practice and zero ER training.
