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Emergency Medicine PA’s

Are you thinking about practicing in emergency medicine as a PA? Are you perhaps thinking about switching specialties to emergency medicine after practicing in another specialty? This article is for you then!

Today we will be discussing the field of emergency medicine and the role the physician assistant (PA) plays and the need for PA's in the emergency department (ED).  Additionally, we will discuss their duties in the ED, how to get a professional certification in emergency medicine, and ER residencies for physician assistants. Without further adieu, let’s get going!

Is there a need for PAs in the Emergency Department?

According to the Academy of Emergency Medicine, the need for physician assistants in the emergency department has never been higher and continues to rise. From 1997 to 2006, the percentage of emergency departments utilizing physician assistants rose from 28 percent to more than 77 percent.

Due to the over 136 million emergency room visits annually nationwide, PA's are valuable assets because of the wide breadth of knowledge and expertise they are able to provide within the ED, and this shows your "worth" to the hospital and the patients in the emergency department setting.

What are the duties of Physician Assistants in the Emergency Department?

Physician assistants are not new to the field of emergency medicine by any stretch of the imagination. Since the 1960s, physician assistants have been providing care in emergency rooms.  When looking at the entirety of physician assistants, around 10 percent are currently working in the ED, with this number continuing the increase.

Physician assistants in the ED not only get the opportunity to provide direct patient care, but they also assist in pre-hospital patient care, administrative positions, ground/air transportation of patients, critical care units, patient triage, and fast track/urgent care settings.

Someone may ask what exactly a physician assistant can do in the emergency department setting? The Society of Emergency Medicine Physician Assistants (SEMPA) has released guidelines for PA's in the emergency department regarding their scope of practie.

These tasks include:

  • Taking a history and completing a physical examination
  • Ordering medication and other treatments
  • Providing instruction and counseling for patients
  • Ordering and evaluating diagnostic laboratory and radiologic studies
  • Referring patients to community resources or specialists
  • Recording information in the patient’s electronic medical record (EMR)
  • Assisting or performing laboratory or non-laboratory procedures (such as placing IV's, splinting, drawing blood, providing CPR; including intubation, central lines, chest tubes, etc.)
  • Obtaining consultations

What hands-on work/procedures can Physician Assistants do in the ER?

The answer to this is not straight forward. But what it truly boils down to is those procedures in which you are trained and comfortable completing and that the hospital in which you are employed have credentialed you to complete.  This can vary largely from facility to facility.

However, SEMPA lists some standard procedures that physician assistants can complete in the emergency department.

These include, but are not limited to:

  • Laceration repair (suturing, stapling, tissue adhesive, etc.)
  • Blood gas sampling
  • Wound care
  • Arterial puncture
  • Cast and splint application
  • Acquiring venous access
  • Abscess incision and drainage
  • Urethral catheterization (male and female)
  • Procedural sedation
  • Thoracentesis
  • Regional block anesthesia
  • Lumbar puncture
  • Joint reduction
  • and arthrocentesis.

How to become a Physician Assistant in Emergency Medicine?

There are a few different routes that one can complete to work in the emergency department as a PA; however, the common thread with all avenues is completing an ARC-PA certified physician assistant program, and passing the National Commission of Certification of Physician Assistants’ (NCCPA) board examination.

Once both of these proverbial boxes are checked, theoretically, you can start working as an emergency medicine physician assistant right away. However, there are some additional education opportunities that one may aspire to complete.

Emergency Medicine Residency Programs

There are negative and positives with everything in life. That includes the decision whether to attend an emergency medicine residency after completing PA school.  Some of the significant positives include being able to garner more experience and knowledge before entering practice.

Positives

Higher levels of education may result in increased opportunities to perform procedures, increased autonomy, more negotiating power regarding salary and a higher scope of practice for the clinician. After completing an emergency medicine residency, this may provide job security for the future, as a resident will have more experience over a new graduate without a residency.

Not only will this improve the PA's influence, in terms of job scope of practice, but it may also open up doors otherwise for teaching opportunities and increased leadership roles due to the extra training.

Negatives

Now for some negatives of residency. The main concern for those applying to physician assistant residencies is financial. In the modern world of costly tuition, many students graduate from PA school with significant debt. Thus, it can be tough to justify another year or more in school, deferring student loans, increasing interest, and a lack of full salary.

Several physician assistant residencies offer stipends of $50,000 to $75,000 per year. For a student with significant debt, it can be hard to pass up a full paying job elsewhere and a quicker time to paying off existing student loans.

Additionally, by the time a PA student has completed PA school, a great deal of educational time has been invested. Many students and professionals look forward to having the “9 to 5” job, as opposed to residencies, which may require up to 80 hours of education and clinic time per week.

 

Take a look at a great article on Physician Assistant Residency Programs

(https://medgeeks.co/articles/physician-assistant-residency),

as well as some videos on Physician Assistant Fellowship opportunities

(https://www.youtube.com/watch?v=4d1bNo0kbGo&list=PLU4UKgzxXhWn_d1e-iT04dOodPZicSzyP&index=1) (https://www.youtube.com/watch?v=ug8qbhUZyTs)

Emergency Medicine Certification for Physician Assistants

Just like with residency for physician assistants, certification in a specific field of medicine is not required. However, it can be worthwhile for those who are attempting to advance their careers. 

The NCCPA has a certificate of added qualification (CAQ) for physician assistants practicing in emergency medicine to achieve professional recognition for their advanced education and qualification.

To be able to take this examination, one must be a certified physician assistant with an active license to practice in at least one state. The applicant must also have 150 hours of continuing medical education (category 1) in emergency medicine, and at least 18 months of full-time working experience in emergency medicine.

This examination covers a wide breadth of body systems and topics including abdominal and gastrointestinal disorders, procedures and skills, cardiovascular, traumatic, dermatologic, pulmonary, endocrine, renal, HEENT, environmental, psychiatric, OB/GYN, immune system, systemic infectious, nervous system, and musculoskeletal system disorders.

In Closure…

I hope this article provides an outlook on how to become a PA who practices in emergency medicine, what we can do in the ED when practicing, as well as ways to further educate and prepare yourself to become an emergency medicine physician assistant. Until next time!

 

Resources

  1. https://www.healthecareers.com/article/career/interview-with-a-physician-assistant-candace-daugherty-discusses-working-in-the-emergency-department
  2. https://www.physicianassistantedu.org/emergency-management/
  3. https://medgeeks.co/articles/physician-assistant-residency
  4. https://www.youtube.com/watch?v=4d1bNo0kbGo&list=PLU4UKgzxXhWn_d1e-iT04dOodPZicSzyP&index=1
  5. https://www.youtube.com/watch?v=ug8qbhUZyTs