Specialty Spotlight: Emergency Medicine

This is the first installment in a new series I’m planning on implementing! I consistently see all sorts of questions related to PAs and what kind of specialties they can practice in, and I couldn’t find any one good resource of interviews with actual PAs out there.

So I decided to create my own!

Each post will go through some standard questions (created by you guys on Instagram), as well as speciality specific questions. Ideally, this series will give everyone a better look as to what it means to be a PA in that particular specialty, and open up eyes to new possibilities.

I’m so incredibly thankful to all of my friends and colleagues who have already agreed to help me out with this – but if you know any great PA-Cs (or are a great PA-C), please, please send them my way. You can email me at stethoscopeandsparkle@gmail.com

Also make sure to send me an email if there is a specific specialty you would like covered, and I will do my best to find someone for you!

This first feature is actually me! I figured what better way to start off sharing about specialties than sharing my own. This way I could actually gauge all y’alls interest in this and get the ball rolling.

What specialty do you practice in?

I’m an Emergency Medicine PA-C in Florida! Roughly 9% of PAs are practicing in EM, making it the third most common specialty.

What is the setting of your specialty?

Emergency Medicine is technically considered an outpatient specialty. I work at a trauma center and my ED (emergency department) is attached to the hospital. I have now worked in 2 different EDs – one during my APP fellowship and one in my current position!

What does your “average” day look like?

Honestly, in emergency medicine no two days are alike and its really hard to give an example of an average day! My days are very dependent on what physician I’m working with, what the weather is like, what day of the week it is, etc…

I see everything from levels 4 and 5 – your colds, sprain ankles, “I need a work note” – to levels 3 and 2 – abdominal pains, head injuries, seizures, strokes, traumas, etc. The only things I do not see are active resuscitations (ie the patient comes in actively coding). This is not true for all EMPAs and is very hospital dependent. For me, this has been true of both of my positions.

My shifts are typically 9-12 hours long. I see 15-30ish patients depending on the day and the acuity level. Typically my patients are a mixture of all of the levels. I also spend a good portion of my shift doing procedures like laceration repairs, incision and drainages, lumbar punctures, fracture reductions, etc.

Probably even more of my day is spent doing charting. Charting is the bane of my existence! In the ED, its very important that we do “real time” charting, since our patients can be so complex (and we have a tendency to get sued, especially in the state of Florida).

What made you choose a job in this specialty?

I honestly never thought I would enjoyed emergency medicine, however, the further I got into didactic year of PA school, the more I realized I liked so much of medicine! Then I got to clinical year, and I loved my emergency medicine rotation! I really enjoy the outpatient hospital setting and being able to have a plethora of tests and treatments at my fingertips. Doing procedures and being “hands-on” with my patients was very important to me, and I loved all of the procedures that went along with the Emergency Department. Lastly, I loved the complexity and fast paced nature of the ED. Seeing diseases from all the different organ systems appealed to me. I liked how much I needed to think and remember during just one shift.

How did you stand out as an applicant in this specialty?

Originally as a new grad, I had a ton of difficulty finding a job. My area seemed to require that you either had experience or knew someone high up on the totem pole. I had neither. This led to me to applying to and completing an Emergency Medicine Fellowship – which ultimately has led to my being a very strong candidate for jobs.

So how did I stand out on my application for the fellowship? I had some really amazing letters of recommendation, and I spent a significant amount of time working on my letter of intent – just as much time as I spent working on my personal statement.

I typically recommend that individuals interested in emergency medicine use their elective rotations to complete additional emergency medicine rotations. Especially if you have the opportunity to complete a Pediatric Emergency Medicine rotation.

Other things would be getting involved with SEMPA (society of emergency medicine physician assistants), completing procedure workshops, and going to EM conferences! All of those things show a dedication to the field and that you are thinking outside the box to get a position.

What kind of training did you receive when you started?

My experience is different in the fact that I completed an APP Emergency Medicine Fellowship, so there was a lot more focus on training me when I started. I went through a three-month orientation period where I was an extra person on shift. This meant my only focus was on learning and becoming confident in the ED. Even once I moved past that orientation period, there was still a ton of focus on my education. I got pulled in to every interest case for the entirety of my fellowship (something Im so, so grateful for. I also completed several hours of didactic lectures every Wednesday.

Once I started my new position, I also had several shifts of being an “extra” person on duty. This allowed me to get used to the EMR, the set up and flow of the ED, consulting, etc. I would absolutely recommend having these extra shifts no matter how far along you are in career, because every hospital is going to be so different!

In what role do you function? What are your responsibilities?

I am completely responsibly for my patients! If my name is on their chart, I am the person managing their care. That said, I do staff most of my patients with the attendings. By this I mean I talk about patients with the attending, and they lay eyes on everyone. Sometimes this could be as simple as “Hey Patient A has otitis media and I’m sending them home”, and other times it’s a complicated care and we’re bouncing ideas off of each other to come up with a true management plan.

Personally, I love that this is how my hospitals have been set up! I’m still new at 18 months out, and knowing that someone else is laying eyes and hands on my patients gives me reassurance. My collaborating physicians and I have a great relationship. They trust me (which I worked hard to earn), and I value their guidance.

Healthcare is a team sport. Remember this.

What resources do you love?

Tintinalli’s is considered the “bible” of the ED for a reason! Its a fantastic book. I own both the manual that I bring to work (this tends to stay in my bag unless I have “down time” and the full version that stays at home.

I always have my EMRA Antibiotic Guide (they also have a great app for your phone!), EMRA EM Fundamentals, and Tarascon Pain Pocketbook. A lot of the residents I work with also use the EMRA Ortho Guide, but I haven’t yet gotten one for myself

Up-to-Date is also an incredible resource to use. I’m lucky that my hospital provides us with a subscription, but I created my own account to log CMEs as well

My favorite book for procedures is either Wounds and Lacerations or Roberts and Hedges’ Clinical Procedures.

How do you balance studying for your specialty with working?

Every day at work I look several things up during shift. This is typically using either Up-to-Date or my pocket resources (EM Fundamentals, Antibiotic Guide, Tintinalli’s). I also keep a running list of things I need to study. This can be diagnoses I’ve never seen before, medications I’m not 100% confident on, or something the attending tells me to review. On my days off, I work through several topics on this list. It keeps me from getting overwhelmed, and it keeps me learning more.

What do you love about your job?

I love the procedures, my patient interactions, and the fast-paced nature of what I do. I have the ability to make a serious impact in my patient’s lives, and I love that. I’m also a huge nerd and being in the ED makes me feel like I’m constantly learning.

Is there anything you don’t enjoy about your job?

It can be very mentally and emotionally exhausting, especially working with kiddos. There are definitely some days when I feel like everything that could go wrong, does go wrong. And it can be very draining.

My friends and I who work in EM always joke that a good day is a good day, but a bad day is a bad day and there’s no in between.

What specialty did you see yourself going in to when you started PA school? Why did this change?

Honestly, I thought I was going to go in to dermatology! I’ve always had a fascination with skin care and skin cancers, and I thought this was going to be the perfect field for me. But once I started school, I realized I was in love with all of medicine and I didn’t want to specialize so narrowly. I wanted to be able to practice generally, using as much as my knowledge I worked so hard to gain for as long as possible.

Do you have any contract negotiation musts?

Make sure you have a good amount of CME money and money for any licensing/professional memberships. If you can, try and make those two things separate – because licensing can really eat up CME money. I also worked hard to find a job that included PTO (something less common in the ED). Lastly, make sure that if you’ll be getting a productivity bonus that you fully understand what is included in that bonus.

How did you know your position was the right fit for you?

I knew that my post-fellowship position was perfect for me because during my interviews they placed as much value on continuing my education and growth as a provider as I did.

It’s a common suggestion that new grads go in to a “general” practice (family medicine, internal medicine, emergency medicine) before specializing later. What do you think of this?

Personally I felt this way, and it did have a role in my decision to do Emergency Medicine rather that another specialty. I felt like I had worked so hard to learn all of this general medicine during PA school that I really wanted to be able to use it.

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Now for some Emergency Medicine specific questions:

Do you feel like a residency is a requirement for getting a job in the ED?

Absolutely not! I think it depends on your location. If you can find a job as a new graduate that is going to place an emphasis on your education and growth as a provider – you should absolutely take that job!

However, if you can’t find a position or you have this huge desire to have a structured first job – go the residency route! I know I don’t regret it.

How do I get a job in the ED without doing a residency?

This is a tough question for me to answer, especially because I was not successful in this! I would say there is several important things to do

• be willing to relocate to find a job! Some markets will not hire new grads
• apply to every job you find, even if you don’t have the required experience. Get in touch with recruiters and be persistent!
• write a strong, personalized cover letter for every opening
• network, network, network. Join your state academy. Make friends with ED providers. Be professional.
• do as many rotations in ED, and go the extra mile during them. I know a lot of my classmates who ended up in the ED got their positions from rotations.

Do you think doing the Emergency Medicine CAQ is necessary?

Honestly, I don’t know. I am planning on doing it eventually, because I do not think it will hurt me or my CV in any way. But I don’t think its going to become a standard requirement, just like I don’t think completing a residency is going to become a standard requirement.

Should I join SEMPA?

Absolutely! SEMPA has great conferences and learning opportunities available, and they do a lot for the PA profession in Emergency Medicine.

What is the salary like for an Emergency Medicine PA?

Per the AAPA 2018 Salary Report, the average (50th percentile) salary of a EMPA is $110,000 with a bonus of $7250.

New grads (0-1 years of experience) have an average of $98,500.

These numbers also vary greatly by state.

I cannot emphasis how important it is for you to join the AAPA to get the complete copy of the salary report, as well as then having the ability to fill out the yearly salary survey. The more PAs who fill this out, the more accurate these averages are!

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Well, I hope all y’all enjoyed this first edition of #PASpecialtySpotlight ! Please let me know your thoughts below!

And as always, feel free to subscribe to get emails with new posts sent directly to your inbox! I promise not to spam you (I actually probably send less emails than I should). And follow along on social media (FACEBOOK, INSTAGRAM, TWITTER) as I try to survive life as a PA-C with a stethoscope and some sparkle

-ER