working with supervising physicians as an ER PA

Working with supervising physicians in the ER (Recent story)

Let me tell you a little story about a patient I saw recently in the emergency room. The point of this story isn’t to complain (though perhaps I’m venting a little). It’s just to give you a taste of what it can be like as a PA working with supervising physicians (sometimes also called “collaborating” physicians), particularly in the emergency department.

There’s a whole range of possibilities, and every situation is different. So take all of this with a grain of salt.

The Story

As I write this, it’s July 2020, so we’re in the middle of the coronavirus pandemic. Basically that means every patient has covid-19 until proven otherwise (it’s currently very common, and can cause almost any symptom, so it makes sense to have an extremely high level of suspicion).

The other day, I took care of an older Asian gentleman who presented with fever, body aches, and cough for about 5 days. He had been exposed to coronavirus a few weeks earlier, but had tested negative around that time.

There was a “sepsis alert” on the computer system, and a “code sepsis” called by the ER staff. Basically those alerts mean there is a high amount of concern for the patient having some type of infection, and possibly even sepsis (when an infection spreads to the bloodstream). This is based on things like the patient’s fever, heart rate, and breathing rate.

(Side note: I kind of think all these sepsis codes do more harm than good, overall. A lot of patients get loaded up with fluids and antibiotics that they don’t necessarily need, and which can be harmful, just based on their vital signs. Of course, this is debatable, because a lot of people do die from sepsis every year in the United States and worldwide.)

Okay, that was a pretty substantial tangent, let’s get back to the story. 🙂

I went to see this patient, did a thorough evaluation (discussion, physical exam, etc.), and ordered tests in a carefully nuanced manner. 1-2 hours later, some of the results started to come back, right around the time that I went to speak with the supervising physician (who shall remain nameless).

It’s certainly not always this way, but in this case it was kind of a ridiculous interaction.

I suppose the physician was in a big hurry, and that happens a lot–so from that standpoint it made sense. But he literally took about 10 seconds to look at the tracking board (a list of patients on the computer screen, with a little info about each one) before saying, “Okay, he’s sick, I guess we’ll admit him to the hospital.”

And that was that.

He didn’t even wait for me to give even the most concise or brief explanation about what was going on–something I’m pretty good at doing in a very concise way, by the way, because I’m so used to people being in a big hurry when I explain things to them. If he had listened for even 30 seconds, he could have understood just enough to make a slightly more nuanced and rational decision, as opposed to this rushed decision.

What’s the Point of This Story?

Now, don’t get me wrong, there are plenty of more thorough and relaxed discussions between myself and the various supervising physicians I work within the emergency department, about the patients we’re taking care of. So this is not the norm, necessarily.

But it is something that happens quite often in the emergency room, to varying degrees–depending on the situation, and your rapport with the physicians you work with.

That’s one reason why being very adaptable is an essential characteristic of a physician assistant. You’ve got to be able to go with the flow, pick your battles, and generally adapt to the personality and preferences of your “superiors” (usually meaning your supervising physicians). The buck stops with the supervising doc, so ultimately they’ll have the final say on most things.

Even so, situations like the one I described above make for a rather frustrating experience. If they would just give me those thirty seconds to explain…

(And they often do. Sometimes much more than that. Like I said, each situation is different.)

Despite the frustrating nature of the situation, I basically forgot about it in the next few minutes, because I’m used to dealing with situations like that. We have to account for a wide range of personalities, styles ,and circumstances, so we learn to not only adapt to these different situations, but also to accept things and move on.

How busy it was right at that moment, combined with that physician’s particular personality, led to a quick / oversimplified decision. Would the end result have been different if we’d discussed it longer? In this case, probably not. But there are certainly other times when it would be.

Final thoughts

Every supervising physician is different, and every situation is different. That’s why, if you want to work in the emergency room as a physician assistant, you have to get used to silly things like this happening from time to time.

You learn that some doctors are a lot easier (and more enjoyable) to work with than others. But either way you gotta deal with it. Welcome to life as a PA.

It can certainly be challenging, and sometimes annoying, but it may be a good preparation for life as well. After all, learning to effectively adapt to new circumstances is one of the most useful skills you can have in life.

If you wanna learn more about PA’s, why don’t you check out one of my other posts, like How to Address Physician Assistants, or How Many Hours do PA’s Work per Week.