Physician Assistant Specialty: Inpatient (Hospitalist) Medicine

Alright, everyone. Welcome again. This is Paul from Inside PA Training. I have my good buddy and former classmate from when
we were in PA school, Jevone. With us. Hi. Jevon’s going to talk about his specialty today which is…Hospital Medicine. Hospital medicine. Inpatient medicine, also known as Hospitalist. or Inpatient Internal Medicine. I would think that they didn’t know that that was something that PAs did. my guess is that the way a lot of
people are going to view this is they didn’t know that that was something that PAs did. You’re obviously evidence that they do. Can
you say a little bit about it? Sure. I think it is kind of new. It’s
definitely a newer way that PAs are being utilized. But I think it’s quickly becoming widespread. Just as hospitalist medicine in general is becoming more widespread. That’s sort of a new model in medicine, to have, you
know primary care doctors not admitting their own patients to the hospital anymore, you know, having specialized doctors that just do inpatient care. So as more
and more hospitals adopt that model, I think more and more groups are going to be using midlevels, both physician assistants and nurse practitioners in various hospitalist roles. So, just for the people who don’t know – I
mean a lot of people are just starting to investigate this profession, tell us, what is a hospitalist? What do they do? A hospitalist doctor, say, is usually an internist – usually an internal medicine specialist who only takes care of you once you come into the hospital. so, you go into the Emergency Room, you have pneumonia, the Emergency Room physician says, “Okay, I think we
need to keep you here in the hospital, give you I.V. antibiotics, and then the hospitalist physician
will come and admit you to the hospital. Write orders, put you in, and then the hospitalist will come and see you the next day, and round on you daily, and then discharge you when you have progressed to that
point when you can be managed as an outpatient. And then you go back under the care of
your primary care provider at that point. So, really a physician assistant in that hospitalist role does virtually the same kind of job that hospitalist doctor does. But obviously, it can vary a little bit from institution to institution. There can be certain restrictions, maybe, on what kinds of procedures you perform, but the general kind of activities are the same. Can you say a little bit about what kind of autonomy you have versus you know, I think people watching these videos would get the sense that as physician assistants we’re practicing under the supervision of a licensed physican but what that actually looks like and how that plays out really depends on the setting. Can you speak to that? Yeah. I mean, really, I have a lot of autonomy, and almost, I would say, as much autonomy as I’m comfortable with, as long as there is sort of a trusting relationship
with my supervising doctor, I’m able to have that doctor knows that if you get into a case where
you’re in a little bit over your head, you’re going to ask for help, and that they can trust you with cases that you feel aren’t over your head, so I work pretty independently. So like, how many decisions do you make during a typical day many decisions do you make during a typical day that you run by your supervising physician? We should throw out there that you’re a relatively new PA… Like, you haven’t been doing this for years – you graduated last June. Yeah, and the first four months or so I was
doing kind of like urgent care, so really I’ve only been a hospitalist for like 8 or 9 months. So, I’ll go through the whole process of talking with the emergency room doctor about a patient that we’re going to admit and ordering some extra tests that I think I want to have before I write all the admission orders, I go see the patient. I do a history and physical on the patient, I write my orders up, what kind of fluids they’re
going to get, what kind of antibiotics, consults, labs, imaging, and then the patient gets admitted, and I kind of care for that patient for the rest of the shift, and and take calls from the nurses on the
floor if any kind of issues arise. So typically, that whole process will occur without
talking with my supervising doctor at all. And if there is some kind of collaboration, it might
be maybe one question about “oh, should I start the patient on this antibiotic versus this one, or… “Or here’s where I was thinking I would go with this.” “I just wanted to run this by you
– does that sound good to you?” In other words it would probably be just a
one call here or there kind of thing. So in other words, there’s not a doctor by your side all the time There’s not a doctor approving everything you do, and I think that’s important to people joining this field – they’re kind of like You know, I don’t want to be a glorified, you know, medical assistant. Right. You’re very much an autonomous practitioner, but really it’s great, because you’ve got some one who
knows more than you do, and has more experience than you do, and that you can go to when you have questions. So you’re never stuck. You’re never in a position where you feel like “I
don’t know if I’m making the right call here.” because if you’re not comfortable, there’s someone you can talk to. So what kind of patients do you come across, typically? I deal with a lot of patients with
a lot of lower respiratory infections, COPD exacerbations, pneumonia, lots of CHF patients (heart failure), renal patients, severe skin and soft tissue infections that can’t be managed
on an out patient basis. Does your hospital see trauma patients at all? A little bit. So
sometimes I’ll assist on admitting trauma patients, so one thing I don’t do is take care of patients in the ICU. at least at my facility, the mid-level providers don’t have ICU privileges. But at some facilities they do. So that would be critical care medicine. Right. So hospitalist medicine tends to be on the regular hospital floors. Well, hospitalist doctors will often have ICU privileges, and will sort of co-manage ICU patients either with intensivists, or with other specialists that work in the ICU. It kind of varies from hospital to hospital. But I think it’s somewhat common in hospitalist models that use PAs that even if the doctors on the team have
ICU privileges, that the PAs don’t so much. unless you were in a kind of a critical
care position as a PA where you were working alongside the intensivists. full time in the ICU. What kinds of things do you get
to do? I mean, are you allowed to do procedures? I haven’t had the opportunity to do that yet, but
a lot of programs do use their mid-levels to do procedures like central lines, arterial lines, intubations, paracentisis, thoracentisis Those sorts of procedures are definitely within the scope
of a physician assistant working within the inpatient setting. Yeah, you and I chatted and I sort of knew the answer before
I asked the question, but for everybody else’s sake, you don’t currently do a lot of them, but that’s certainly within your
reach as a PA, depending on where you work. What do you like about your job? What do you like about your job? I should
say, what do you like about being a hospitalist? It’s fascinating medicine, I mean, the complexity, the
kind of patients I’m caring for, is high, and I like that. These are pretty sick people, obviously. Yeah, exactly. It’s hard to get admitted to the
hospital nowadays unless you’re pretty sick. Yeah. So they’re different patients than you would
deal with in an outpatient primary care clinic. You know, some of them are similar patients and
the severity of their illness is greater but I just find the pathology very interesting. I enjoy working with colleagues in nursing and medicine, physical therapy, occupational therapy all of those kind of allied health professions that
I have the opportunity to collaborate with in the hospital. I enjoy that. And I like the pace of being able to kind of
really focus on one patient at a time, and be really thorough, and have time to you
know – step back and think about what’s going on, kind of look at the big picture, What’s a typical patient load for a hospitalist? So it depends. Like what I do –
is like I’m kind of an admissionist. So I do a lot of admitting patients from the ER into the hospital and then some spot rounding on patients in the hospital as needed. Another role that physician assistants typically will fill is where they don’t admit, but they just round on patients
regularly, so maybe there would be like 12-15 patients that the PA would take on a shift, and they would be responsible for seeing each
one of those patients during a shift So they might get the patient handed over to
them by someone like you. Right. What about this job are you maybe not so fond
of, or may not be for some people? I think at this stage people might get curious about
what kind of specialty they might be interested in. I did some urgent care when I first started
and I kind of miss the procedures like getting to do suturing and that kind of thing. I don’t like getting to do suturing and that kind of thing. I don’t do that at all right now in my job
so I miss that a little bit. My job is pretty specific to adult patients internal medicine type issues, so like
I don’t do any womens’ health, so I miss sort of that broadness a little bit that was my job before when I was doing outpatient medicine. How does inpatient medicine pay as a specialty,
in general? It pays well. I can’t remember what the stats are exactly, but hospital
medicine is one of the higher paying specialties. compared to a lot of the outpatient work. The shift work can be good or bad depending on whether you
like that kind of thing. I do 12 hour shifts. How many a week? It varies a lot.
Sometimes I’ll do 3 shifts, sometimes I’ll do 7 shifts, And you can kind of have blocks of time.
When you get off work, are you totally off? I am – I am not on call. That’s nice. That’s nice. We’re just about out of time. I did
want to ask you what kind of advice you might have for someone who wants to become a PA and possibly go into this specialty. What would you tell them? That’s a good question. I would say…study hard. Because it’s just one of those specialties where
you have to know a lot about a lot of different stuff. You can say that about any specialty really, but it
is a broad specialty compared to say, dermatology. I should throw out there for folks who don’t know you,
which is most people who would watch this video, you Jevon is super studious, clinical guy. You’re very good
at the medicine and you’re very humble but You’re sharp, man, I mean this is not a
specialty for somebody who has just become kind of casually interested in medicine. And you also have another role we’re going to talk about in another video and that is that you’re a nurse practitioner as well. Your listeners probably know that our program, UC Davis school of medicine’s
family nurse practitioner and physician assistant program is a dual certification program. Yeah. I was not a nurse, so I got a
PA, but most of us who were nurses got PA and NP training. Yeah, and as far as I know, that’s really only found at UC Davis. Okay, hey, Jevon, thank you so much for talking
to us. Hey, thank you. Good luck with your job. Thanks, Paul –
good luck to everyone out there. Thanks.

1 comment

  1. Thank you for the video! I am a FNP who is taking on a role in the inpatient setting I was wondering if your colleague could contact me for some questions regarding a job description or duties of for his hospitalist role. This is new for our facility and am wanting some guidelines 🙂 [email protected]

    Thank you so much Ali

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