What does a PA do in the ER?

[Tawantinsuyu]

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[TooMuchResearch]

Really depends on the ED. One of the PAs I know works in a slightly beyond exurban ED w/ mostly IM, not EM, docs staffing the department. He says he does the majority of the critical care because the IM docs don't want to do it. He also has 10+ years experience in EM, follows the literature, and keeps up with the major blogs/podcasts in EM and EM Critical Care.

PAs in locations with EM residencies often cover lower acuity patients and give up procedures to residents.

 

[crimsonkid85]

Speaking of PAs. You know what really irritates me? As a medical student, PAs steal tasks away from me. PAs are essentially glorified medical students that are forever medical students. This is why when I open the door and see a PA scrubbed into a case, I literally turn around walk out, and try to find another OR case.

 

[WillburCobb]

Speaking of PAs. You know what really irritates me? As a medical student, PAs steal tasks away from me. PAs are essentially glorified medical students that are forever medical students. This is why when I open the door and see a PA scrubbed into a case, I literally turn around walk out, and try to find another OR case.

Glad to see you truly exude the humility that's looked for of those in the medical profession.

 

[crimsonkid85]

Glad to see you truly exude the humility that's looked for of those in the medical profession.

this has nothing to do with humility, and everything to do with wanting to learn. I have no problems doing 'scut.' I jump at the chance to help turn over OR rooms. I have no problems with helping to transport patients, move patients onto and off of the OR table, put on SCDs, position the patient's arm for anesthesia, bringing in warm blankets after a case, etc. As a medical student, I think it's absolutely critical that I learn how to do these things, even if one day as an attending I might not do it very often. The point is that as a physician, I see it as my responsibility to be the bottom line -- thus, I should have the capability of stepping in for someone if they cannot be present. There are a lot of PAs who are great about helping teach medical students. I met one in the ED when I was doing my peds rotation. After I worked with her long enough for her to realize I'm not ******ed, she would always page me if there was a lac to be sewn, and she would get me first dibs on any interesting case that would come in.

Alternatively, I have also met PAs who view medical students as a threat. They will try to exclude medical students every chance they get. And at this point in my life I have zero tolerance for this. My philosophy in life is: you don't have to help me achieve my goals, but so help me if you are going to stand in my way.

 

[darkjedi]

Speaking of PAs. You know what really irritates me? As a medical student, PAs steal tasks away from me. PAs are essentially glorified medical students that are forever medical students. This is why when I open the door and see a PA scrubbed into a case, I literally turn around walk out, and try to find another OR case.

That worries me that your institution has faculty that doesn't prioritize the teaching of medical students.

 

[crimsonkid85]

That worries me that your institution has faculty that doesn't prioritize the teaching of medical students.

honestly, 99% of the time PAs are great; i just had a bad experience today with one so wanted to get it off my chest. 🙂

 

[WillburCobb]

Alternatively, I have also met PAs who view medical students as a threat. They will try to exclude medical students every chance they get.

Perhaps this has to do with your attitude? Also, learning and humility aren't as mutually exclusive as you suggest.

 

[Life Sucks]

Get your lazy butt and go shadow one... 😛

 

[crimsonkid85]

Perhaps this has to do with your attitude? Also, learning and humility aren't as mutually exclusive as you claim.

I'm tired of justifying myself to you. My attitude is the most praised aspect about me, and that's saying something considering my peers. Perhaps you denigrate yourself too much. Medical student means doing a lot of work that others don't want to do -- but I view this as an educational opportunity. It does not, however, mean that one should expect to be disrespected. Will it happen sometimes anyway? Sure. Does this mean you should let this affect your education? No. Because at the end of the day, it's not you who suffers from your shoddy education. It's your patients.

Honestly, you sound like a 21 year old pre-med about to go to some tiny community hospital. You'll get what I'm saying when you're 28.

 

[WillburCobb]

I'm tired of justifying myself to you. My attitude is the most praised aspect about me, and that's saying something considering my peers. Perhaps you denigrate yourself too much. Medical student means doing a lot of work that others dont' want to do -- but I view this as an educational opportunity. It does not, however, mean that one should expect to be disrespected. Will it happen sometimes anyway? Sure. Does this mean you should let this affect your education? No. Honestly, you sound like a 21 year old pre-med about to go to some tiny community hospital. You'll get what I'm saying when you're 28.

Glad I only have to wait 3 months to be old enough to understand your deep wisdom and not the 7 years you suggest.

Edit: and yes I am looking forward to the time I'll get to spend at a community hospital in 2 years, where I won't have to let a myriad of med students, interns, residents, and god forbid PAs detract from my educational opportunities.

 

[crimsonkid85]

Glad I only have to wait 3 months to be old enough to understand your deep wisdom and not the 7 years you suggest.

that's not something I would advertise, lol. i was trying to give you an out; i suppose you would be the living proof that age != wisdom.

 

[TooMuchResearch]

Really depends on the ED. One of the PAs I know works in a slightly beyond exurban ED w/ mostly IM, not EM, docs staffing the department. He says he does the majority of the critical care because the IM docs don't want to do it. He also has 10+ years experience in EM, follows the literature, and keeps up with the major blogs/podcasts in EM and EM Critical Care.

PAs in locations with EM residencies often cover lower acuity patients and give up procedures to residents.

Hey OP, I just wanted to point out I sort of delivered an answer. I didn't want you to miss it in the pile of crap this thread has rapidly become.

 

[Tawantinsuyu]

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[WillburCobb]

I'm really sorry for derailing this thread. Just feeling a bit surly tonight I guess, and I get kind of annoyed seeing future medical professionals on SDN putting down their future colleagues. That said, like other have said it really depends on the ERs and the attendings. I shadowed at an ER where the PAs were given all the minor cases and took a lot of slack from the attendings who constantly talked **** behind their backs. Subsequently I worked at a larger hospital where the PAs still generally took the easier cases and did more urgent care work, but ultimately felt like they had more autonomy and were treated much better by the attendings. It's kind of sad because the ER I shadowed at was a big training site for several PA programs.

 

[prettyNURSEtoMD]

I work in a Level 1 ER and our mid-levels both NP and PA see high acuity patients. Of course, none on the ESI level of acuity 1, but definitely 2s, which are your chest pains, COPD Exacerbations, SOB, etc, they will see what is limited in their scope, and what they feel comfortable with. We do have an area in our ED desinated for lower ESI patients such as 3s, 4s and 5s, which are your abdominal pain, vag bleed, sutures, sore throats, etc. Our mid-levels have great autonomy and our physicians stick by them and are great. If yall don't know what ESI means or the numbers sorry for putting that. It means Emergency Severity Index which is a tool used to rate patient's bases on acuity. Hope this helps.

 

[AlbinoHawk DO]

Glad to see you truly exude the humility that's looked for of those in the medical profession.

I would do the same. My educating costing several thousands of dollars takes precedent over some PA.

 

[gabyoh23]

I work in a radiology practice overnight, and we get plenty of emergency department requests to look at images that have NPs and PAs listed as the ordering providers. Furthermore, these are the people that I communicate with when I need to relay information about the patient, so I would say that they definitely have the same responsibilities as an ED doctor. However, they have these same responsibilities for cases that are a little more cut and dry such as those mentioned by prettyNURSEtoMD. Generally, for the more complicated, extremely urgent cases, it'll be a physician taking care of these patients. It does differ from ED to ED though.

 

[Being]

Get your lazy butt and go shadow one... 😛

Or shadow a couple, given how their roles and responsibilities can vary greatly. Might also give some good answers for the "why not nursing/PA/etc?" question if you do decide on MD/DO school: "well, I considered that route but after shadowing several PA's I discovered that..."

 

[Pacna]

Why do threads always turn into arguments? Thank you for the answers.

Welcome to the internet.

Also, I'm currently working in a trauma 2 hospital, and I can report that we have no PAs in the ED (I actually work in 3 locations and we have none in any of those). The only PA interaction I get is that the hospitalists upstairs have PAs employed in their service who basically do the hospitalists' job while they sleep/vacation/masturbate/etc. PAs admit about half of the patients personally. It seems to me like they're doing much of the leg work for hospitalists. That's my limited perspective as a scribe. ^^

 

[NorthernMav]

Honestly, you sound like a 21 year old pre-med about to go to some tiny community hospital. You'll get what I'm saying when you're 28.

Hahah, oh daaammnn.. oh no he didn't!

 

[link2swim06]

That worries me that your institution has faculty that doesn't prioritize the teaching of medical students.

The problem is 90% of a hospital is not a med schools faculty. It's not the PAs job to teach you.

Any teaching hospital is 95% focused on patient care, 5% on your learning. This means you will be ignored most of the time.

 

[darkjedi]

The problem is 90% of a hospital is not a med schools faculty. It's not the PAs job to teach you.

Any teaching hospital is 95% focused on patient care, 5% on your learning. This means you will be ignored most of the time.

It's not the PAs job to teach, but the attendings, fellows and residents job, since they are working for an academic institution. An attending that is ignoring the med student is not doing the school justice.

 

[WillburCobb]

It's not the PAs job to teach, but the attendings, fellows and residents job, since they are working for an academic institution. An attending that is ignoring the med student is not doing the school justice.

Hmmm, I wonder what school crimsonkid85 attends...🙄

 

[SouthernSurgeon]

As far as I can tell, the PAs at my hospital's ED pretty much just page surgery without working up the patient...

/endtroll

 

[link2swim06]

It's not the PAs job to teach, but the attendings, fellows and residents job, since they are working for an academic institution. An attending that is ignoring the med student is not doing the school justice.

No idea if you are pre-clinical, but 90% of the learning on wards is what you teach yourself.

Residents and attendings are busy with patient care. They may tell you a few thing during rounds or pull you aside for a 15 minute impromptu lecture if you are lucky. Most of the time you will be ignored and figuring out stuff on your own. We had a few hours of formal lecture a week but this hardly covered all the material.

I have rotated at multiple different institutions and this was my experience.

This is how adult learning works, you figure it out yourself.

 

[WillburCobb]

...90% of the learning on wards is what you teach yourself...

Granted you're the bottom line when it comes to responsibility for learning, how much you learn on the wards is largely dependent on the attendings and hospital environment (e.g., number of residents and fellows, community v. teaching hospital, etc.).

 

[Microglia]

I'm tired of justifying myself to you. My attitude is the most praised aspect about me, and that's saying something considering my peers. Perhaps you denigrate yourself too much. Medical student means doing a lot of work that others don't want to do -- but I view this as an educational opportunity. It does not, however, mean that one should expect to be disrespected. Will it happen sometimes anyway? Sure. Does this mean you should let this affect your education? No. Because at the end of the day, it's not you who suffers from your shoddy education. It's your patients.

Honestly, you sound like a 21 year old pre-med about to go to some tiny community hospital. You'll get what I'm saying when you're 28.

As far as the poster this post was directed at, I don't think age has much to do with it. Frankly, you come off in these posts as judgmental of PAs by their title, institutions by their name, people by their age. I understand and agree that it's important to learn for your patients, however the attitude you display shows a closed-mindedness that could hurt them far more in the future. I am positive you are a very bright person and will one day be a leader in medicine. This is my appeal to you to consider how you evaluate those around you.

OP: it varies highly by the institution. Some will let them handle whatever procedures the IM docs don't want, some (teaching hospitals) tend to give them the smaller cases.

 

[darkjedi]

No idea if you are pre-clinical, but 90% of the learning on wards is what you teach yourself.

Residents and attendings are busy with patient care. They may tell you a few thing during rounds or pull you aside for a 15 minute impromptu lecture if you are lucky. Most of the time you will be ignored and figuring out stuff on your own.

I can't say that has been my experience rotating in the clinics. While it is true I do a ton of self driven learning, I still feel integral to the medical or surgical team and don't feel ignored. There may be the occasional jerk resident who is burnt out and takes it out on the med student, but I find that more to be the exception rather than the rule.

 

[SpartanWolverine]

To add another response: I do some work in a level-1 trauma center ED. They generally have a PA to do initial screenings and a PA for the "fast-track" treatments. So, yes, basically the low to mid-acuity patient cases as well as triaging. I'm not sure if this is typical or not, since this hospital is pretty elitist (and a huge teaching hospital for the area)...

 

[Mr Roboto]

I work in a level-2 trauma center ED. The PA's at our ED normally see ESI level 4's and 5's. Occasionally they'll see a level 3. I don't think I've ever noticed one pick up a level 2, though. So they're doing lacs, twisted ankles, low-acuity MCV's, flu sxs, asthma attacks, low grade peds fevers—stuff like that. It's different depending on which ED you're in, though.

 

[KnuxNole]

The problem is 90% of a hospital is not a med schools faculty. It's not the PAs job to teach you.

Any teaching hospital is 95% focused on patient care, 5% on your learning. This means you will be ignored most of the time.

This is true. The attending is the only person who is usually the one responsible for that. Even then, some attendings hate all medical students, which questions why they agree to it. The residents aren't obligated to do any teaching. The ones that do, do so cause they genuinely like to teach people.

 

[dbeast]

No idea if you are pre-clinical, but 90% of the learning on wards is what you teach yourself.

Residents and attendings are busy with patient care. They may tell you a few thing during rounds or pull you aside for a 15 minute impromptu lecture if you are lucky. Most of the time you will be ignored and figuring out stuff on your own. We had a few hours of formal lecture a week but this hardly covered all the material.

I have rotated at multiple different institutions and this was my experience.

This is how adult learning works, you figure it out yourself.

This is completely true. In fact it's just like studying on your own during pre-clinical years except you keep getting interrupted to go take care of patients.

 

[styphon]

At the suburban ER I did residency work at, the PA staffed the "fast track" and did mostly level 4-5 (lacs, asthma, STDs) and sometimes level 3 when the fast track was slow. They were not involved in codes, as there was usually 2 residents on during every shift + the attending.

In the childrens hospital ER I did a rotation at the midlevels had their own area - which consisted of mostly Lacerations, fractures, dislocations, sprains. They very rarely were involved in Level 3s. During codes, they were not involved at all - although neither was i (The peds and ER residents got preference over me 🙁 )