Your PA/SP Experiences...

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Shark4life

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I am looking for some insight into the PA/MD workplace. I am interested in hearing about your work place and PA/SP setup.
For all the MDs:
Do you (your hospital or group) work with or employ Physician Assistants? If so, in what setting, how many and how exactly are they being utilized?
What do you feel the pros/cons are of the PA/MD working situation?
If you don’t employ or work with PAs : Is there a specific reason that you don’t, and what in general is your view/opinion of the profession?
For all the Physician Assistants:
What is your current work environment, supervising physician relationship, and scope of practice like? What are the pros/cons of your work environment and current position?
What is one aspect of your current job that you would change to make your current situation better?

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For all the Physician Assistants:
What is your current work environment, supervising physician relationship, and scope of practice like? What are the pros/cons of your work environment and current position?
What is one aspect of your current job that you would change to make your current situation better?

after years of working at places where PAs are not respected I have worked my way into several positions in which I am really starting to enjoy my work.
job #1 solo coverage of small urban dept, night shifts only. never see sp. we communicate by email and notes in my box
job#2 solo coverage of rural/critical access hospital. I see SP occasionally at beginning or end of shift at sign out.
job #3 rural/critical access hospital double coverage with doc alternating charts from the same rack. work occasionally with SP. we get along fine.

to get to this point in my career has taken many years. probably only 5% of em pas work solo. my scope of practice at this point is whatever comes in the door as I am either the only one there or 1 of two seeing pts at random. at my dual coverage job a few months ago I was intubating a drug o.d. while the doc was seeing a kid with a fever.
on the downside I have to do a lot of driving to find places which will allow me this much autonomy and a quality scope of practice.
I would like to be able to work with this much autonomy and a quality scope of practice within an hour of my home...
if I was starting over I would definitely go md/do. it has been very hard over the years being a pa and having to put up with constant disrespect from docs/administrators/nurses, etc and having no one know what a pa is. over 10 years of post high school education and many folks still think I am a medical assistant....
 
I am looking for some insight into the PA/MD workplace. I am interested in hearing about your work place and PA/SP setup.
For all the MDs:
Do you (your hospital or group) work with or employ Physician Assistants? If so, in what setting, how many and how exactly are they being utilized?
What do you feel the pros/cons are of the PA/MD working situation?
If you don't employ or work with PAs : Is there a specific reason that you don't, and what in general is your view/opinion of the profession?
For all the Physician Assistants:
What is your current work environment, supervising physician relationship, and scope of practice like? What are the pros/cons of your work environment and current position?
What is one aspect of your current job that you would change to make your current situation better?

The PA job market for solo practice or little SP contact is hard to find. Most of the time you need to go to smaller/ rural area/ smaller hospitals to find this. My shop is in NYC in an academic center. We have PAs that work mostly solo (SP is there when they have doubts/questions etc.) But they only staff the "fast track area" (lacerations, Minor injuries etc) The Main ED is staffed by Attendings and Residents. I have also seen over my years in the ED PAs go from working with attendings/ residents in the entire ED, to working under attendings in the ED, to being limited only to fast track. (press ganey scores for the hospital took a hit because people felt they wanted to see a doctor and complained about seeing PAs.)

Now at the same time at this institution for other non-EM services I see PAs come down to the ED all the time (mostly surgery, ortho, neuosurg, psych etc.) They take the patient H&P and then call their attending who gives them orders and they place it in the computer. It seems less solo and more like they are just buying the attendings/ residents time so they can be in the OR and on the floor more.

Like I said the PA job market varies widely depending on location/hospital. If you want to be in a more metropolitan hospital or at an academic center than as a PA you will likely not be very solo. If you dont care and dont mind being rural than you my find more solo practice. In all is a good profession if you dont mind being a MLP for your entire life, and never progressing out of that role. Its a self choice.
 
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I am looking for some insight into the PA/MD workplace. I am interested in hearing about your work place and PA/SP setup.
For all the MDs:
Do you (your hospital or group) work with or employ Physician Assistants? If so, in what setting, how many and how exactly are they being utilized?
What do you feel the pros/cons are of the PA/MD working situation?
If you don't employ or work with PAs : Is there a specific reason that you don't, and what in general is your view/opinion of the profession?
For all the Physician Assistants:
What is your current work environment, supervising physician relationship, and scope of practice like? What are the pros/cons of your work environment and current position?
What is one aspect of your current job that you would change to make your current situation better?

I'm not a PA, (I'm an RN), but I work in a busy hospital setting in the western US. Most of the autonomy you'll see will be in the outpatient setting, especially if you aren't a PA with quite a bit of experience. When we had PAs in the ER, they were exclusively fast track. When you see them on the floors, they function similar to what NYEMMED said. Surgery... obviously they are paired with the surgeons or doing followups on the recovery floors. I've seen them close up a patient while the physician checks their email on their phones, but I've seen surge techs do that too. There are times when they are harvesting a vein or doing other delicate tasks, but its clearly part of a team effort. I work with PA and NP hospitalists at one location, and another only has physician hospitalists. The PA and NP hospitalists are great and are "in charge" in every important sense. Stuff gets approved just as fast as they would if we were approaching the docs, and we regard them and their instructions just as we would any other provider. They are respected, and know what they are doing, so it doesnt seem from my perspective that there is much of a practical difference between them and a physician provider. We have to run stuff by a provider who can approve it or advise us on what they want done, so whomever can do that is regarded the same, whether they be a PA or a physician.

When you have the solo ER places, its often because its the best they can manage given remoteness, low acuity, other compelling factors limiting resources or not justifying a physician. In those cases, you hope to have a PA or NP with a lot of experience.

I have an acquantance who is a family practice PA, and this person operates as autonomously as their SP (who I never even saw around the office when I shadowed). This PA works really hard, and the buck stops there. Fact is that in that environment, that works a lot better than what can come through an ER. My acquantance probably could handle most of what comes into my facility's ER solo, but the pucker factor would be high for everyone involved, not to mention the staff working alongside.
 
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I work with PA and NP hospitalists at one location, and another only has physician hospitalists. The PA and NP hospitalists are great and are "in charge" in every important sense. Stuff gets approved just as fast as they would if we were approaching the docs, and we regard them and their instructions just as we would any other provider. They are respected, and know what they are doing, so it doesnt seem from my perspective that there is much of a practical difference between them and a physician provider. We have to run stuff by a provider who can approve it or advise us on what they want done, so whomever can do that is regarded the same, whether they be a PA or a physician.

That's interesting. I saw that NYP-Columbia has NP Hospitalists in addition to the physician Hospitalists, so I was curious as to the differences in function between the two.
 
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I am looking for some insight into the PA/MD workplace. I am interested in hearing about your work place and PA/SP setup.
For all the MDs:
Do you (your hospital or group) work with or employ Physician Assistants? If so, in what setting, how many and how exactly are they being utilized?
What do you feel the pros/cons are of the PA/MD working situation?
If you don’t employ or work with PAs : Is there a specific reason that you don’t, and what in general is your view/opinion of the profession? For all the Physician Assistants:
What is your current work environment, supervising physician relationship, and scope of practice like? What are the pros/cons of your work environment and current position?
What is one aspect of your current job that you would change to make your current situation better?

I'm a Psych NP in military hospital. Seems like all the military PA's are trained to run troop medical clinics or specialize in anything but psych. There are some FNP's out in the clinics as well as in specialist roles.
 
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