Introduction and Banter

Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

John S. -

I've noticed on #2 of your EM RAP episodes you've spoken in tones that are professionally disparaging towards Physician Assistants in Emergency Medicine. In the May episode of Bouncebacks: Back Pain, you stated under LESSONS LEARNED:...It is wrong to assume that PAs are capable of handling all cases that MDs do...
I believe your statement is misleading. I have been a PA for 30 years working primarily in critical access hospitals located in physician underserved areas. Most of my PA, and Emergency Medicine colleagues who live and work in the world I do have views that do not reflect this bias and consequently make my work much easier. It may be true that a new graduate PA or one who has minimal experience in such an environment requires much more scrutiny that one who is more seasoned, but this would also be true for a physician. The case you mention is unfortunate and is a sobering reminder for the need of a thorough and thoughtful workup. Most ER's I'm familiar with have in place professional criteria required for their staff PAs to evaluate and treat ER populations which are potentially more acute or unstable. In my view to suggest as you do that there should be a wholesale relegation of PAs to "handle" safer patients is conterproductive.
By the way, I really enjoy EMRAP as do my ER PA and MD colleagues.
John Steigner, PA-C

Adam N. PA-C MS -

I got the impression from the bounce back case and midlevel topic was that some of you guys don't put much trust in your midlevels. I agree that there are a number cases that the attending needs to be involved with or see all together. Like the 104 y/o full code patient with 42 meds and 35 medical problems with vision changes, fever, rectal pain, and hallucinations. But the urge to see every patient that the PA sees, especially the minor cases, is somewhat insulting. Part of our training is to know our limitations and know when something is out of our comfort zone. I understand the need for close supervision of new grads and newer PA's, but not a seasoned EM PA. MD's have every right to want to see all patients since ultimately its there butt on the line also, but in a busy ER its extremely counterproductive and duplication of work. If I have been practicing EM for 10 years as a PA do you really need to come see my guy with a plantar wart for 3 years or the 12 y/o with a scalp lac? Your answer may be yes, but from my experience 99% of MD's would say no. I guess it all comes down to trust and the MD/PA relationship. In the EDs where many new grads work its hard for MDs to trust PA's. New grad PAs are the equivalent to first year resident, and I have yet to meet an MD that has complete trust in a new resident. For the many of us that have been doing EM for a long time its hard not to feel insulted when the attending wants to come see your simple dental pain. I guess all I am saying is that PA,NP,MD, DO.....we all miss things and make mistakes. Its not the initials after your name that counts.....its what you know and what your willing to take responsibility for. And a big part of medical wisdom is knowing how much you DONT know and to always remember that and being willing to keep learning. Love the show guys! I learn a lot every time I listen and much of my knowledge has been from this show. Thanks

Adam Nyarady PA-C
Emergency Medicine

Nathaniel T. -

I am working back to get exposure to relevant topics to my practice. I disagree with the both of you and these guys to a degree. The comment, "It's wrong to assume that PAs are capable of handling all cases that MDs do". I agree. Call yourself equivalent to any level of PGY... PAs aren't Emergency Physicans. An SP should be poaching on complex patients and either take the complex patients or if they are looking to develop their PA collaborate on their patients. As far as the SP seeing every patient, no matter how small... I agree with you Adam. If you can't trust me to see basic stuff and collaborate with you on complex stuff, fire me.

Nate Taylor PA-C
Military and Remote Medicine

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
Episode 116 Full episode audio for MD edition 256:07 min - 107 MB - M4AC3 Written Summary 232 KB - PDFEpisode Summary 167 KB - PDF