John Bielinski, MS PA-C 
There continues to be an increase in the demand for physician assistants (PAs) in emergency medicine. Their expertise in all aspects of emergency medicine makes them a valuable asset to emergency departments across America. Like any other job, there are always some “tricks of the trade” that can help you succeed. Here are my top seven secrets of being a Physician Assistant that now works in emergency medicine:
1) Love Your “Family.”
Your nurses are your family! Don’t treat them like they are just a random team member. Treat them like a member of your family as if you were at Thanksgiving dinner. Be polite, show respect, and be helpful – this goes absolutely without compromise. Answer a ringing phone, clean up your own suture/I&D mess, and use your actions to display how much you care.
2) Embrace The Underdog.
You are a medical underdog. Meaning, PAs are usually not up to the same knowledge that a board certified EM physician has. That means you have to work extremely hard to learn. Your first five years in emergency medicine should almost be considered as a “self-imposed residency”. Constantly assess your skills, find your weaknesses and address the areas that you know you need to improve. Another helpful tip: Your first CME should be an Emergency Medicine Review Course. Check out our IMPACT Emergency Medicine 4-Day Conferences for 2017.
3) Bill Well.
You will be judged to a huge degree by your documentation. Maintain your attention to detail and make sure you optimize billing.
4) Perception is key.
Good medicine is based on patient perception and the perception of your physician. You need to master influence and perception – How will your approach/action be viewed by the patient or physician? What can you do differently to ensure their reactions are positive? This is a social skill that can be learned/mastered.
5) Judgment.
Your documentation needs to reflect judgment, not negligence. The key is one word, because. For example, let’s document why a headache isn’t a SAH: “This is not a SAH because patient indicates gradual onset, said this is not the worse headache of their life, and claims this is a chronic headache.”
6) Productive Paranoia.
Be an effective clinician but, keep yourself on edge and stay aware of the scenarios you may be involved in. This is a key feature of being a great EM provider. You should constantly have the thought in the back of your mind, “what is the worse case scenario?”. It’s like riding a motorcycle and all of a sudden you get hit by a car and die. If a car pulls out in front of you and causes the crash, it’s obviously their fault. But, you can’t reverse the fatal damage. This is how you need to practice medicine! Stay aware of your surroundings and avoid the crash.
7) Talk to the Plumber.
Your chart is the enemy. Meaning, when it comes to medical malpractice, you have to “fight” someone. It’s healthy to think of med-mal defense as a battle. You are not fighting your patients, the lawyers of human nature. You are using the chart to defend yourself – thus, think of your documentation as killing the enemy. Who is going to judge your actions? Ultimately it’s the plumber. It’s the plumber who has a 9-5 job, a wife and two kids. Why him? Because he’s the guy who is going to be on the jury.
Want to improve your knowledge of Emergency Medicine?
Click on one of our new conferences for 2017 to learn more:
IMPACT Emergency Medicine 4-Day Conference
CORE 5-Hour LIVE Acute Care Workshop
