Wheres the PA / MD line drawn in Trauma ED's

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ghostridermedic

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I am currently a pre-med student, but being in my late 20's time is a factor in my decision to pursue medical school.

I have decent out of hospital experience (paramedic, ACLS instructor, EMT for years) and ED would where I would want to match in after medical school.

If I went the PA route I am concerned that I will be relegated to seeing low acuity non-life threatening emergencies, is this true in your ED?

I really enjoy trauma's, severe COPD etc. Cases where I acutally get to use my skills. Is it more likely I'll be pushed into the "dental pain" beds?

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I am currently a pre-med student, but being in my late 20's time is a factor in my decision to pursue medical school.

I have decent out of hospital experience (paramedic, ACLS instructor, EMT for years) and ED would where I would want to match in after medical school.

If I went the PA route I am concerned that I will be relegated to seeing low acuity non-life threatening emergencies, is this true in your ED?

I really enjoy trauma's, severe COPD etc. Cases where I acutally get to use my skills. Is it more likely I'll be pushed into the "dental pain" beds?

Late 20's isn't bad at all. Several in my class in early 30's MS1 and 2 who where 40+.

And I know that PA responsibility is widely variable. I know there are places where PA's are solo in the dept. Places where PA's can see anything but have to staff with attending. Where I am currently PAs work fast track and not in the primary ED.
 
"Where is the PA/MD line drawn?"

Otherwise known as the Mason-Dixon line.
 
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"Where is the PA/MD line drawn?"

Otherwise known as the Mason-Dixon line.

Maybe it's because it's 1am, but this gave me the giggles.

To the OP, late 20's aint bad, man. I'm 29 and got my application in right now.

As for that line, in the ED where I work PA's staff the fast track area during the day for the most part. At night, they tend to pick up a few Level 3's (in a 1-5 system) that are more medical related. I've seen Level 1 traumas where the PA is directly involved in the decision-making, with the doc supervising, of course. I guess it all depends on where ya work and how willing the doc is to take responsibility for the PA seeing more complicated cases.
 
As the other posters have said, there will be a lot of variability depending on your institution. In my ED, responsibility for trauma coverage is split between the EM folks and the trauma surgery service. The ED trauma shifts can be filled by either an EM PGY-2+ or a trauma credentialed PA, with both reporting to the ED attending.
If you're looking to get more perspective from PA's, you may want to post at www.physicianassistantforum.com; it draws a lot more PA's that SDN.
 
I am currently a pre-med student, but being in my late 20's time is a factor in my decision to pursue medical school.

I have decent out of hospital experience (paramedic, ACLS instructor, EMT for years) and ED would where I would want to match in after medical school.

If I went the PA route I am concerned that I will be relegated to seeing low acuity non-life threatening emergencies, is this true in your ED?

I really enjoy trauma's, severe COPD etc. Cases where I acutally get to use my skills. Is it more likely I'll be pushed into the "dental pain" beds?


i did med school from 28-32 and residency from 32-36. don't worry about being in your late 20s b/c it's not that big of a deal. the oldest guy in my medical school class was 45 when we started medical school, and the oldest guy in my residency class was 36-37 when we started intern year.

the place where i work now has PAs but they are not allowed to work in the highest acuity sides of the ED, nor are they allowed to work on the trauma side. they are relegated to the subacute and fast track areas.

where i did residency one hospital did not employ PAs in the ED and the other allowed them to work on the acute side under the direct supervision of an ED attending (consider it like being a permanent resident physician).

hope that helps!

--sp
 
Don't sweat it...I didn't start med school until 30.

I rarely get depressed and bummed out about it, reaching for the booze...

...until I start reading threads like these when it reminds me that I'm 37 and over 300K in debt with a peanut sized retirement fund. Now, excuse me while I fetch some scotch.
 
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Don't sweat it...I didn't start med school until 30.

I rarely get depressed and bummed out about it, reaching for the booze...

...until I start reading threads like these when it reminds me that I'm 37 and over 300K in debt with a peanut sized retirement fund. Now, excuse me while I fetch some brandy.

ditto... except i prefer scotch. oh, and i don't turn 37 till january :)
 
Mmm. I've got a 27 year Islay right now. Maybe I should hit it up tonight.
 
Mmm. I've got a 27 year Islay right now. Maybe I should hit it up tonight.

Very nice. If it's a Port Ellen... please don't open it. That is...until ACEP some year that I'm around to...ahem, personally verify it's authenticity, which can only be done by tasting said scotch. I've always wanted to sample a $300 bottle of one of those.

All I've got at the moment is a Bowmore 12 and a bottle of JWB.
 
I'm starting to wonder how many threads on here have turned into alcohol discussion. Reaching for the wine after I drink some caffeine. Have to finish a presentation somehow.
 
. Is it more likely I'll be pushed into the "dental pain" beds?

Yes. Why the hell else do you think they hired you? When you have your STEMI or your severe respiratory distress or your trauma or your altered mental status do you want a doc taking care of you or do you want a PA?

I wish all the students considering becoming PAs would/could read what the docs say about mid-levels on Sermo.

A mid-level is just that. Something about halfway between a nurse and a doc. Is there a role for them? Yes. Closely supervised, low-risk cases with no complex medical decision-making. If you don't think that's a good idea as a PA, you have three choices:

1) Find an ED where your boss doesn't care about your patients and will sick you inappropriately on them in order to make a buck off you. There's plenty of these out there, both in and out of the military.
2) Find an ED where they simply can't afford a doc. Think Aleutian Islands. You can go be the cowboy. You're better than nothing and once you pass through your trial by fire and kill off all the sickies on the Island, you'll do just fine.
3) Go to medical school.
 
I am currently a pre-med student, but being in my late 20's time is a factor in my decision to pursue medical school.

I have decent out of hospital experience (paramedic, ACLS instructor, EMT for years) and ED would where I would want to match in after medical school.

If I went the PA route I am concerned that I will be relegated to seeing low acuity non-life threatening emergencies, is this true in your ED?

I really enjoy trauma's, severe COPD etc. Cases where I acutally get to use my skills. Is it more likely I'll be pushed into the "dental pain" beds?

It comes down to a choice. If you don't think you'll be satisfied with being the mid-level provider handling the lower acuity cases then don't do it. There can't be any doubt in your mind because as much as it may suck thinking about four years of medical school after undergrad it's much worse to do undergrad, then two years of PA school, then deciding later that you really wanted to go to medical school and doing 4 years of med school + residency.
 
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I am currently a pre-med student, but being in my late 20's time is a factor in my decision to pursue medical school.

I have decent out of hospital experience (paramedic, ACLS instructor, EMT for years) and ED would where I would want to match in after medical school.

If I went the PA route I am concerned that I will be relegated to seeing low acuity non-life threatening emergencies, is this true in your ED?

I really enjoy trauma's, severe COPD etc. Cases where I acutally get to use my skills. Is it more likely I'll be pushed into the "dental pain" beds?

The only way I could envision taking high acuity cases would be highly rural locales where MD coverage is not available. Even in the most rural areas I have not actually seen this, it has always been a FP doc (DO/MD).

PA's are not trained to handle level 1 acuity and trauma cases.
 
If you want to manage medical care at the level of a doctor, become a doctor. If you want to take a shortcut, then be prepared to deal with patients at your level of training.
 
Hey ghostridermedic, I'm an ex-paramedic in his late 20's doing MS1 right now. You and I are probably similar in a lot of ways, and I went through this same thought process when I was deciding where to apply. Basically I came to the conclusion that my reasons for wanting to get out of EMS (no longer exciting, don't know enough, never get to follow through with patients) would be the same problems that would frustrate me as a PA. Especially if you work in the ED, because you can be fairly certain what kinds of patients you will be seeing. How fun can it be to have the most interesting/challenging cases taken away from you, while the rest of the time you deal with routine "non critical" nonsense. No thank you.
 
Ours staff the urgent care and are permitted to staff out intermediatly acuity area while the residents are at conference one afternoon per week. They don't go to resuscitations or staff our high acuity area. They staff each case with an attending in one of those areas. Although, they are admittedly much faster in their staffing than the residents. Even the youngest has several years of experience and the attendings don't tend to teach, pimp or present alternate "what if" scenarios with them.
 
I would caution you to try to figure out what the average PA does. Whenever people start talking about being a PA versus MD some PA always shows up who says "I run a neuro ICU all by myself with no doctors on site" or "I work in an ER and never talk about any of my patient any MD and see everything that comes in the door."

Great. But that's not what the average PA is doing right now. The average PA at a level one trauma center is seeing level 4 and 5 cases pretty much alone (UTIs, stitches, med refills, URI etc etc). At smaller hospitals they may be seeing level 3s, usually with some interaction with an attending.

The truth is you have to ask yourself what you want to do. If you really love the super sick cases in the ER, the strokes, the septic shock patients who need a central line, being an MD will be much more of that.

You should also think about if you are the kind of person who changes what they want to do every couple of years. A PA has the option to do 10 years of ER, then start working in orthopedics, or nuerosurgery or whatever. Once you finish residency as a doctor is is much harder to make radical changes in career.

As far as time goes, it depends how far away you are from applying. If I were 28, personally it would be a very different equation for me if I would be ready to apply next year, versus still having 2 years of pre-requs to go and then another year of applying, which means I wouldn't start med school until 31 or 32.
 
I would caution you to try to figure out what the average PA does. Whenever people start talking about being a PA versus MD some PA always shows up who says "I run a neuro ICU all by myself with no doctors on site" or "I work in an ER and never talk about any of my patient any MD and see everything that comes in the door."

Great. But that's not what the average PA is doing right now. The average PA at a level one trauma center is seeing level 4 and 5 cases pretty much alone (UTIs, stitches, med refills, URI etc etc). At smaller hospitals they may be seeing level 3s, usually with some interaction with an attending.

The truth is you have to ask yourself what you want to do. If you really love the super sick cases in the ER, the strokes, the septic shock patients who need a central line, being an MD will be much more of that.

You should also think about if you are the kind of person who changes what they want to do every couple of years. A PA has the option to do 10 years of ER, then start working in orthopedics, or nuerosurgery or whatever. Once you finish residency as a doctor is is much harder to make radical changes in career.

As far as time goes, it depends how far away you are from applying. If I were 28, personally it would be a very different equation for me if I would be ready to apply next year, versus still having 2 years of pre-requs to go and then another year of applying, which means I wouldn't start med school until 31 or 32.

excellent post.
regarding em pa's, the fact of the matter is that only 5% have a "see anything, do anything, work alone" scope of practice and that group is almost entirely made up of senior pa's >10 yrs into their careers who were former paramedics, nurses, RT's or military corpsmen/medics. having been active in em for almost 25 yrs, I probably know most of the places that staff that way(and most are very rural) and most of these folks personally from conferences and professional societies. it's a small club. 8000 pa's work in em. 50 of every thousand work to this level so we are talking about 400 jobs nationwide, not even remotely close to evenly distributed. most of these jobs are in very rural states(ME, VT, NH, AK, NC, WY, MT, GA, WA probably account for 50% of these jobs).
that being said, if you are set on a career as a pa there are a few things one can do to try to tip the odds in your favor:
do a postgrad pa residency in em or trauma. see www.appap.org
be willing to leave your current job for new jobs with a better scope of practice even if you will take a huge salary hit or work worse hours(been there, done that-twice).
be willing to leave jobs for better educational opportunities(supportive docs who teach well, etc) despite a big pay hit(also been there, done that).
get all the extra education you can; acls, atls, pals, apls, fccs, difficult airway, also, nals/nrp, u/s, etc
join sempa: www.sempa.org essentially all the high level pa's in the country are members of this group and attend their conferences.
 
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