Ask a PA: What’s it Like to be an Emergency Medicine Physician Assistant?

What's it like to be an Emergency Medicine Physician Assistant?

This question popped up in my inbox, and – although the inquirer had no way of knowing it – I actually began my career as an emergency department physician assistant, so I can offer you my perspective and tell you about my experience.

It is important to remember that Emergency Medicine physician assistant duties vary – it all depends on the state you practice in, as each state has its own regulations regarding scope of practice. I refer you to your state’s regulatory statutes for the specifics in your respective state. In all cases, however, PAs practice medicine as members of a team with their supervising physicians and must, at a minimum, have the following basic qualifications:

  1. Graduated from an accredited physician assistant training program
  2. Be certified or eligible to be certified by the National Commission on Certification for Physician Assistants (NCCPA)
  3. Be in compliance with licensure and other regulations of the PA practice statues in the state in which he or she practices
  4. Maintain ongoing emergency medicine training and CME (Continuing Medical Education) in emergency medicine

PAs practice medicine with the supervision of licensed physician and, although by law PAs are dependent practitioners, they typically exercise a great deal of autonomy in clinical decision-making. PAs work in all areas of the ED and in all settings, from being the solo provider in a rural ED to providing patient care at a Level I Trauma Center. An EDPA typically sees the same patient acuity mix as the physician or physicians with whom they work.

In emergency medicine, the ED medical director, physicians, and the EMPA usually reach decisions about delegation jointly. There are not any “typical” restrictions on what a PA does in the ED. Examples of scope of practice include, but are not limited to the following:

  • Membership on the medical staff
  • Involvement in the quality improvement activities in the ED
  • Taking and recording of patient histories and performing physical examinations of a patient for the medical record.
  • Performing diagnostic and therapeutic studies
  • Ordering medications, ordering and interpreting diagnostic laboratory tests, radiological studies or various other therapies
  • Diagnostic decision-making
  • Instructing and counseling patients
  • Referring patients to specialists, health facilities, and agencies
  • Conversing with consultants in regard to patient care
  • Performing diagnostic/therapeutic procedures, subject to state regulation and PA training/experience, such as, but not limited to:
    • Abscess incision and drainage
    • Administration of medications and injections
    • Advanced Cardiac, Pediatric, and Trauma Life Support including all procedures
    • Anoscopy
    • Arterial puncture and blood gas sampling
    • Arthrocentesis
    • Cast and Splint application
    • Central line placement
    • Dislocation reduction management
    • Debridement of burns, abrasions and abscesses
    • Epistaxis management
    • Extensor tendon repair
    • Fracture Reduction
    • Foreign body removal: ears, nose, rectum, soft tissue, throat, vaginal
    • Immobilization techniques (spine, long bone, etc.)
    • Intubation – Endotracheal/Nasal
    • Interosseous needle placement
    • Laceration repair – simple intermediate, complex
    • Lumbar puncture
    • Nail trephination/removal
    • Nasogastric/Orogastric tube placement, lavage and management
    • Obstetrical patient evaluation
    • Ordering and initial interpretations of radiological studies
    • Ordering of EKGs with interpretation
    • Paracentesis
    • Procedural sedation management
    • Regional block anesthesia including double cuff method/bier block
    • Slit lamp diagnostic and rust ring removal
    • Tonometery, ocular
    • Thoracentesis
    • Thoracostomy tube insertion
    • Urethral catheter placement and management
    • Emergency ultrasonography
    • Venous access, peripheral/cutdown
    • Wound care
    • Other interventions or procedures as directed by the supervising physician

In general, PAs provide similar (in most cases identical) medical services to those that are being provided by their supervising physician. Utilizing EDPAs allows more patients to be seen faster, reducing patient waiting times and improving patient satisfaction.