Wednesday, January 29, 2014

PAs in ER

For the past year we have had physician assistants in the emergency room where I work. It hasn't gone well.

They see every kind of patient except mental health patients. Mostly they have worked in the main ER (non urgent care).  I know they work well in some ERs but after working with them for a year, I don't think they belong in the emergency room taking care of non urgent care patients.

In this day and age, ERs have changed.  They are no longer seeing fractures, lacerations and simple illness. We see acutely ill, complicated patients.  The acuity in ERs has gone way up.  I really don't think PAs are up to seeing these kinds of patients. I think they should be seen by docs.  I think patients in the ER expect to be seen by docs.

Physician assistants have a bachelors degree.  I'm sure the classes they take are pre med type classes. They don't have to have a major in a science as I understand it.  They then go to a 2 or 3 year program where they are trained in the "medical model" of medicine.

Two or three years isn't much to be caring for acutely ill, complicated patients. To be honest, they make me nervous as a nurse. I don't trust them like I do the docs.  Working with them feels like working with 1st year residents. You always have to be on your guard with them.  Docs supervise them, but  they are ordering stuff before they talk to the doc.

I think if ERs are going to hire non doctors they would be better off hiring NPs.  NPs have a degree in nursing, they have worked in a medical environment.  The thing is the reimbursement is less for NPs.

This whole thing has made our ER harder to work in.  No one likes it.  It has impacted patient care negatively.


Anonymous said...

Wowza! We use PAs but ONLY in urgent care. If they were seeing regular patients they would have to consult with an MD on every single patient so I don't see how it saves the docs much time. And from a patient perspective, I would be less than confident too.

Anonymous said...

PA programs are 3 years long, end in a masters degree, and generally require a bachelors degree prior to admission to the program. The classes are often taught by the same faculty that teaches the med students. NPs do have experience in the medical environment but many NP programs are taught as online programs in the nursing model. How does that make NPs better? I have worked with both and there are good and bad in both professions. I work ER and have worked with many midlevels (NP and PA) that I would trust more than some of the docs.

Anonymous said...

I disagree. I have worked with PAs for years and have a lot of respect for them. The PAs I work with have had years of experience and are much more empathetic than most MDs. They actually listen to the patients. How many doctors do you know who do that?

girlvet said...

Sorry I just don't think they, or Nps for that matter are cut out for complicated patients.

Aesop said...

I must be lucky, I've generally only worked with good ones, both in a Level I trauma center, and a top 20 Busiest ER.

I think what makes it work for us, them, and the patients is that they know when they're in over their head, and they hand off the ones out of their depth back to the docs.

If anyone, RN, NP, or PA doesn't know when they're in over they're head, ain't nobody gonna win that deal, least of all the patient.