ARDS and Prone Positioning: A Review of the Literature

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Bridging The Gap: PA's in Critical Care

Since its inception, PA’s have been bridging the gap in healthcare. In fact, the role of the PA is to expand and increase access to care for those who otherwise might not get seen in a timely manner, or not seen at all.  After all, that was the basis for implementing PA’s fifty years ago. This is most true in underserved area’s like small counties where PA’s have always filled the gap, but the gap is also being filled in an area that very much interests me; critical care.

One of the many things that attract me to the field of PA medicine is the diverse field of medicine in which PA’s can see and treat patients, while still being supervised by a physician. In other words, I like the diversity PA’s enjoy. Since I have worked as a respiratory therapist for the last two decades, primarily in adult critical care, I feel pretty strongly that that’s where I’ll end up once I become a PA. I realize I need to keep an open mind as I begin the PA program this coming Fall, but in the end, it is critical care that I am really gravitating towards.

Since I have a predilection for the intensity, challenge, and diversity that critical care offers (along with familiarity), I’ve often wondered how MD’s view PA’s (and other advanced practice providers) as they pertain to critical care. I have especially wondered about MD’s in training, which may have to compete or share with PA’s for procedures. I currently work at an academic medical center and know that jockeying for procedures can create conflict amongst those on a team. However, many ICU’s have incorporated teaching teams and non-teaching teams in the ICU. The separation of these teams within a particular ICU seems to have made great inroads at reducing such conflict.

Another issue that is present in the academic ICU, is a gap in physician coverage that has been created with the implementation of work-hour restrictions. The Accreditation Council for Graduate Medical Education (AGGME) implemented these restrictions in 2003. With the imposed work-hour restrictions, there has been a real gap placed on workflow and manpower in labor-intensive areas of care, like what is standard in the ICU setting. With this gap, PA’s have been able to successfully fill the void. But…how are PA’s being perceived in this setting?

According to the first article listed below, advanced practice providers (APP’s) are viewed by most residents as either having a “positive” impact or a neutral impact on their overall ICU experience. As a person that is looking to work in an ICU setting after PA school, and possibly at an academic center, it is nice to know that PA’s and NP’s are viewed in this manner. So, for someone like me who is seriously contemplating a career as a PA working in the ICU, knowing that this is a place I can successfully hang my hat is nothing short of exhilarating and exciting to contemplate.

Impact of advanced practice providers (nurse practitioners and physician assistants) on surgical residents' critical care experience

Kahn SA, Davis SA, Banes CT, Dennis BM, May AK, Gunter OD.

J Surg Res. 2015 Nov;199(1):7-12. doi: 10.1016/j.jss.2015.05.036.

PMID: 26173380

Commentary on: Impact of Advanced Practice Providers (Nurse Practitioners and Physician Assistants) on Surgical Residents' Critical Care Experience

Tsai PI. J Surg Res. 2015 Nov;199(1):13-4. doi: 10.1016/j.jss.2015.08.033. No abstract available.

PMID: 26456354