John Loehner, MD
The Attending Service at Montefiore Medical Center's Moses Division is a physician assistant (PA)-managed medical service of over 90 PAs who care for an average of 250 adult medicine and cardiac patients with a wide range of illnesses and disease severity. The Attending Service is the largest, fastest-growing service at Montefiore, and high patient volumes, continuity, and rapid growth are continual challenges. The Moses PA service is estimated to be the largest in the country.
An aggressive recruitment effort, now underway, will more than double the size of the service. Each incoming PA participates in an intensive three-month period of orientation, training and assessment, and credentialing before taking on clinical responsibilities.
While highly autonomous, the PAs on Montefiore’s Attending Service are well supported by medical leadership, with 24/7 oversight by dedicated hospitalist physicians, senior PAs, and chief PAs. Supervising physicians dedicate each morning to advise PAs on the 40-50 new patients admitted nightly, assisting in patient chart reviews, answering questions, planning discharge, and supporting PAs in case-by-case patient care challenges.
Anonymous peer evaluations and detailed chart reviews provide continual markers of the quality of PAs' performance.
Continuing medical education for PAs is a major priority. In addition to the rigorous three-month orientation, all PAs have an opportunity to take the Fundamentals of Critical Care Support course offered by the Division of Critical Care Medicine. Weekly CME-credit-eligible, quality-of-care lectures enable PAs continued opportunity to grow in their ability to develop and maintain standards of excellence in caring for Montefiore's widely diverse patient population.
The Attending Service is currently working to establish more consistent patient rounding practices; test and treatment protocols for patient satisfaction; and a more self-sufficient service with more PAs supported and credentialed for invasive procedures including paracentesis, central line placement, and lumbar puncture.