Working in an Emergency Room as a Physician Assistant

Hopefully if you have arrived on this blog post you already know what a PA (physician assistant) is. For those who don’t know, a PA is a healthcare provider who is licensed to practice medicine under the supervision of a doctor (MD or DO). It isn’t necessarily direct supervision but a doctor has to sign off/ co sign all of your charts before it goes into billing. The doctors do not have to see every patient that you examine or discuss every case before your patient is discharged. Your level of autonomy as a PA depends on your specialty, level of experience, relationship with the attending, and the complexity of the patient (case).  I hope this clears up the role of a PA, if not feel free to read my blog on “What is the role of a PA?”

Now, the emergency room! Possibly the most hectic area in the hospital (besides the Operating Room or Labor unit) is not for everyone. If you are someone who likes excitement, a fast paced environment, seeing a variety of cases, performing lots of procedures and speaking to many specialists this maybe the specialty for you. The best candidate to work in the ER is an individual who is calm and knows how to remain calm under a lot of stress, also a person who is able to work quickly, think quickly and outside the box, has a lot of energy, and is autonomous.

Depending on which ER you work in or the level status of your ER you will see cases that may warrant very complex procedures like chest tube placements, and airway management with intubations. You should be aware that no matter which ER you work in- be prepared for ALL emergencies, mass injuries from nearby fires, multiple vehicle involved car accidents… you name it.

The difference between working in the ER as opposed to any other unit is that the ER is usually the first place that the patient is seen before the decision for them to be admitted is made. It is a critical part of the admission process. This means you must be vigilant in your examination and interview of the patient. Your job in the ER is to rule out life threatening causes to the patient’s complaints. In other words, will this problem or complaint cause death if not resolved; is the cause of this problem life threatening; does this problem need to be observed for a few days? Keep in mind sometimes you may not be able to find the cause for the complaint. The patient may need to follow up with a specialist for further testing. This can be frustrating for the patients and sometimes you as the provider but you have to understand in the ER the focus is life and death. You have to explain this to the patient, and although this problem is not life threatening, it is still important to follow up for further testing with either your primary care provider or a specialist to identify, help manage, or resolve the issue.

What do you see a lot of in the ER? There is a lot of cough, runny nose, sore throat, congestion; shortness of breath, wheezing, chest pain, headache, dizziness, back pain, abdominal pain, falls, car accidents, STD complaints, urinary complaints, and of course lacerations. To be honest you see it all in the ER even medication refills. The ER is exciting because its like picking candy from a bag, you never know what you’re going to get.

Positives for working in the ER. The ER forces you to get comfortable with all complaints, and your physical exam. If you hate eye complaints, stop shying away from them. See those patients and talk the case through with the attending, and your colleagues. If your ED has all specialties in house, make sure if you call a consultation with one of them you learn from them when they come to see the patient. It’s a win-win situation. Although, it may not always be possible since the ED gets pretty busy. If you can spare some time or even ask the specialist some questions it is always a bonus. Learning is the best reward in the ED. Once in awhile you get the craziest cases. The extra pieces of information definitely come in handy. In the ER you don’t really have to form a long term relationship with the patients, you see them for the most part help fix the problem and “set them free” hopefully never to return. Some providers may want to see their patients again to see how they are doing but majority do not, it is one of the reasons for going into emergency medicine as opposed to primary care. Once your shift is done, it’s done; your next shift is a clean slate with a fresh new flow of patients. You get to jump from topic to topic so you don’t get bored with only seeing the same cases, over and over again. It’s like a buffet line, a little abdominal pain, a little chest pain, and some joint pain is very satisfying especially if you are working a 12-hour shift. Oh and that’s another plus 12 hour shifts which means 3 day work weeks!

Negatives for working in the ER. The ER is busy, a lot of the patients that come in are not true emergency cases, and a lot of the patients are “frequent flyers” which means they are there often. It may be frustrating because the patients do not follow up with whomever they should follow up with and that means your hands are tied, you can’t turn them away but you also can’t help them because the ER does not perform the tests they need. It is easy to get burned out in the ER if you do not manage your time well. Seeing a lot of patients means writing a lot of notes, the last thing you want is to have more than 20 notes that haven’t been written or that are incomplete. Also, it is hard to get a chance to eat, you must realize patients in the ER are like the mail, it never stops, rain, sleet, snow, and sunshine they keep coming. Once you understand how to manage your time around pending labs and diagnostic imaging, you can grab a 15-20 minute bite or breather before threading on with the rest of the shift. The ER has crazy shifts sometimes, it maybe difficult to adjust for someone who isn’t a night owl or early bird. Lastly you are on your feet a lot, if you aren’t a walker and talker, I’m afraid this may be a negative for you.

If you would like me to give you a detailed run down of a day in the life of an ER PA let me know. I will specifically go through each patient case, the physical exam, plan and outcome without disclosing the patient’s personal info of course so you can get an idea of whether this specialty is for you. I will also try to do a timeline so that you can see how I manage my time. Thanks for reading!