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PA Promise
Bayview’s rigorous new residency program for emergency department physician assistants responds to a growing need.


Program Co-Director Tammy Aungst, PA resident Rachel Locker and Co-Director Jonathan Lerner
From left, Program Co-Director Tammy Aungst, PA resident Rachel Locker and
Co-Director Jonathan Lerner.

Rachel Locker was eager to be a pioneer—and a guinea pig—as the first emergency medicine physician assistant resident in a new Hopkins Bayview program launched last April.

Locker’s willingness to roll with the punches as the program got off the ground proved a key reason why she was chosen over seven other candidates, says the program’s director, Jonathan Lerner.

Only the third residency program for ED physician assistants in the country (the other two are at the Medical College of Georgia and the University of Texas), it is also the only one that offers an extensive 18-month tour of duty, according to Lerner, an emergency medicine PA at Bayview for the past nine years. Although the medical center had been unofficially training PAs in emergency medicine for some time, it decided to formalize the program to help with staffing and take advantage of the burgeoning profession.

Locker, 32, a graduate of the University of Texas Medical Branch in Galveston and the daughter of an Air Force surgeon, decided to become a PA because its two-year course of study “offers everything I wanted to do medically without having to be in school forever.” She opted for an additional residency at Hopkins because of its teaching reputation.

She also likes the variety. “I get to put in central lines; I get to intubate; I get to do procedures. Other ERs only use PAs on fast-track cases, those involving minor injuries or things that can be moved along quickly without a physician.”

Locker is particularly grateful for the staff’s support. Not only are the PAs eager to help but “the medical residents also are happy to take a lot of time to teach—probably because they’ve just learned many of the things I’m learning.”

PAs, like nurse practitioners, emerged in the late 1960s, mostly in response to a nationwide shortage of physicians. After completing two years of training, PAs can write orders and practice medicine under physician supervision. Hopkins has been using PAs for some 20 years, says Lerner. The Bayview ED alone has 14 full-time and eight part-time PAs.

The profession is among the fastest growing in the United States and is expected to increase 27 percent annually through 2014.  The boom has been boosted in part by restrictions on the working hours of residents, mandated by the Accreditation Council for Graduate Medical Education in 2003, which created a patient care gap. There are more than 135 educational programs for physician assistants. Residencies, such as Bayview’s ED program, are optional.

Hopkins Hospital has had a surgical PA residency program since 2005 that trains six residents each year. Under physician supervision, the PAs see patients in clinic, perform histories and physicals, write notes and assist in surgery.

Because Bayview’s residency is longer than standard programs, the resident spends a total of nine months in the ED, as well as a month each in the cardiac intensive care and medical intensive care units. In addition, there are rotations in Bayview’s burn unit, anesthesia, internal medicine, orthopedics, ophthalmology, Gyn/Ob, neurology and other specialties at Bayview, and a rotation in the pediatric emergency department at Howard County General Hospital.

Lerner and his colleagues wanted each resident to spend the final six months of the program working “like a chief resident and actually having academic responsibilities to mentor and teach” the incoming resident, he says.

Plans are to expand the program eventually to 15 residents per year. The next PA resident already has been selected and is scheduled to begin this month; Locker will play an important role in that person’s education.

 “There are going to be more PAs in medicine’s future,” she says. “So teach us. We’re here to learn.”

Neil A. Grauer




Johns Hopkins Medicine

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