Author: preparedPA

A Day in the Life: ER Physician Assistant

A Day in the Life: Administrative Physician Assistant

Amanda Reynado

ER/Admin PA

UTMB Galveston, 2010

Amanda pic

  1. What is your specialty? Where do your work?

I am an Emergency Medicine Physician Assistant at Ben Taub General Hospital in Houston, TX. We are one of two Level 1 Emergency Centers (EC) in the city and service Harris County and outskirts. I am the Lead PA in the EC, specifically the Director of Advanced Practice Provider (APP) Operations. I have been practicing for 8 years.

2. What is a typical day like?

I work both clinically and administratively. Clinical days are like everyone else. We work shift work in the EC, and function off of a monthly schedule for different sections of the EC. BTEC is a Level 1 Trauma Center at Houston’s largest county hospital, and we care for cases ranging from primary care needs to blunt and penetrating trauma. We serve a multitude of immigrants and refugees, and work in creative ways to serve a large patient population with limited resources.

Since I’m the Director of APPs, I am the manager of all APPs and responsible for scheduling, HR issues, managerial tasks, faculty retention, clinical productivity, quality assurance/improvement, etc. I work closely with the Department Chief and Medical Directors on the Operations team aiding in practice changes, positive relations among faculty, compliance with regulatory agencies, etc for the department. The day to day consists of meetings and fielding communications from faculty for needs (especially scheduling).

3. What attracted you to your particular specialty originally?

I shadowed an Emergency Medicine PA prior to school and loved the EC. I also favored it during PA school. It takes a certain type of personality to work in the EC, with difficult patient populations and high stress scenarios. I naturally gravitated toward the environment and acute care. I also enjoy the diverse interactions and pathology. I did not want continuity of care or out-patient medicine.

4. What do you find most interesting about your current specialty?

I feel like EM PAs are well-rounded and very flexible. Every patient encounter is unique and mysterious. You see all ranges of medicine in any given shift, and seem to have a surprise behind every door/curtain. PAs are also well-respected in my EC due to our work along-side physicians and residents.

5. What special skills are required? Skills you learn once you were hired?

Emergency Medicine requires a higher skill set due to it being acute care and a wide variety of medicine. Providers have to be experienced in multiple fields and also trained in procedures.

I do not hire APPs without two years of EM experience or a PA Fellowship due to the fast-paced environment and acute setting of our field. We have an Emergency Medicine PA fellowship that has a rolling admission , train new graduates for 1 year, and then hire out of once they’re more equipped to practice.

6. What do you like most about being a PA?

I enjoy the flexibility of the profession and the autonomy of my field. I have the privilege of seeing my own patients with little supervision unless I request help. I love Emergency Medicine because it is shift work, and not structured business hours. I also enjoy being part of the care team, and making decisions on behalf of my patients and carrying them out.

7. What are the challenges of your particular specialty?

I feel the challenges are mostly with politics and hospital administration/budget restraints. This is not specific to PAs, but providers and faculty in general. As a department, you have large goals but have to fit practice initiatives and throughput within budgetary restraints.

8. Any other advice you’d like to share?

  1. Study and prepare during your PA education to be a well-rounded provider. You are studying and learning to practice medicine, not to pass your tests.

2. Practice your procedures.

3. Learn the business of medicine. It is great to be idealistic and passionate, but a lot of medical practice in the U.S. is directed by cost and practice restraints.

4. Choose a practice field that suites your personality and thrive in it.

5. Stay true to your ideals and your belief systems throughout your career.

6. Listen to your patients.

7. Send follow up Thank You cards or emails to your preceptors, interviewers, and       educators. This still goes a long way.

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A Day in the Life: Oncology Hematology Physician Assistant

Erica JErica Jimenez

Heme/Onc PA

Baylor College of Medicine, 2010

1. What is your specialty? Where do your work?

For the past 4 years and worked at M.D. Anderson cancer Center in Stem Cell Transplantation and Cellular Therapy department in the outpatient clinical setting. We primarily see hematologic malignancy such as leukemia, lymphoma, multiple myeloma, and other myeloproliferative diseases.

2. What is a typical day like?

On a typical day, I arrive to the clinic, and review the patient cases that will be seen by our team. If the patient happens to be a consultation from another department, I compose a complete oncologic history including all the specifics of how the patient came to be diagnosed, what their treatment regimen has been so far and how they have responded. Once the patient presents to clinic, I review their entire history including past medical history, family history and social history. I also do a very thorough explanation of what stem cell transplant is and why they are being consulted to our department. I also try to answer the patient’s questions to my best ability, and of course what I cannot answer, I defer to my attending physician. It is also my job, to educate the patient about each process leading up to stem cell transplant. Once a patient is ready for transplant, I review all consents with the patient and review their medical workup to assure they are cleared to proceed with transplant. Once the patient returns to outpatient from transplant, they follow-up with our team to assure that they are still stable.

3. What attracted you to your particular specialty originally?

Honestly, I knew nothing about stem cell transplant prior to this job. I had already peaked at my prior job as a PA at a private internal medicine clinic and I found this position to be very interesting. I applied for the position, and interestingly enough my experience in internal medicine actually proved to be quite valuable in my current position. The department did a diligent job training me in the specifics of hematologic malignancies and the ins and outs of transplant. Of course, with time I gained the experience I needed.

4. What do you find most interesting about your current specialty?

I really enjoy being able to be the primary educator about transplant. My role is to ease anxiety the best I can through good communication and transparency about procedures to my patients. It really provides a great patient-provider bond. You begin to really know your patient as a human and not just as another case. It makes it that much more special once a patient has had a transplant and is in complete remission and comes back to you with stories about them being able to live life again; those stories of seeing their grand-baby’s birth, finally taking that trip they wanted, getting married or just enjoying life again.

5. What special skills are required? Skills you learn once you were hired?

Besides getting an understanding on the indications for stem cell transplant for each malignancy, we are trained on performing bone marrow biopsies, lumbar punctures and skin punch biopsies.

6. What do you like most about being a PA?

I love that I am a valuable voice to my attending physician and that I have a voice in the role of treatment for my patients. I am seen as a vital member to my team. I enjoy the critical thinking and autonomy that comes with the role of a PA.

7. What are the challenges of your particular specialty?

I do have a very heavy load of responsibilities that can get daunting at times, and it can be emotionally and mentally draining too, especially when a patient relapses or does not survive transplant, however the positives clearly outweigh the negative.

8. Any other advice you’d like to share?

I didn’t think I would ever work in oncology, I didn’t think it was a specialty I would ever find interest in, however keeping an open mind and having the willingness to step outside of your comfort zone is essential in finding an environment that works for you and that will allow you to flourish as a medical professional and as an individual.

 

A Day in the Life: Pediatric Surgery Physician Assistant

Peggy Walsh

Pediatric Surgery PA

Baylor College of Medicine, 2010

Peggy1. What is your specialty? Where do your work?

Pediatric Plastic and Reconstructive Surgery, Children’s Hospital Colorado, University of Colorado Anchutz Medical Campus

2. What is a typical day like?

I start my day early and round on patients admitted to the hospital. This generally includes seeing patients in the preop area, those in the pediatric ICU, and on the surgical hospital wards. The rest of the day is a combination of seeing patients in clinic or assisting in OR cases. I generally see new, pre-op and post-op patients in clinic and manage the outpatient wound care program. I also do minor procedures. In the OR, I assist my attending surgeons and residents in general plastics, craniofacial and reconstructive cases. I am also on call during the day and see consults in the hospital and in the emergency room.

3. What attracted you to your particular specialty originally?

I have worked in either surgical or pediatric sub-specialties during the course of my career as a PA. I spent several years in adult reconstructive and plastic surgery and had an opportunity to return to pediatrics in this particular specialty. I love working with kids and families and appreciate the opportunity to establish continuity of care with my patients.

4. What do you find most interesting about your current specialty?

There is a lot of variety in pediatric plastic surgery. There are three main areas that our team practices in, including craniofacial surgery, primarily working with congenital conditions, such as cleft lip and palate and craniosynostosis; trauma and burn reconstruction; and management of smaller lesions and masses that need to be removed. I appreciate the variety and always find challenge in what I do!

5. What special skills are required? Skills you learn once you were hired?

Having familiarity in the OR and being comfortable with a fair amount of autonomy are important aspects of my position. Both of those things come with time and experience as a PA. However, there is always opportunity to gain confidence in the OR or procedural settings during training by seeking out these experiences as you are able. I worked in an OR setting prior to PA school, which gave me a better understanding of the environment and dynamics, and an introduction to the multitude of equipment used in surgical cases. The more exposure you have, the better!

6. What do you like most about being a PA?

I believe that PAs are an integral part of the medical team and appreciate the role I get to play within my clinical team. I love taking care of patients and working with families. I also appreciate how much the PA profession continues to evolve, and enjoy the opportunity to be part of that change to continue supporting PA practice and expanding access to quality care.

7. What are the challenges of your particular specialty?

Pediatric plastics covers a wide variety of conditions, and I feel like I continue to learn something new every day. I appreciate the opportunity to expand my knowledge and experience.

8. Any other advice you’d like to share?

If you are interested in becoming a PA, spend as much time as you can not only shadowing PAs, but seeking opportunities with other health professionals. Medicine is truly a team sport, and this will lend itself to not only understanding more about what role PAs play, but also help in understanding the numerous parts that make patient care possible.

A Day in the Life: Dermatology Physician Assistant

Emily Spinner

Dermatology PA

Baylor College of Medicine, Houston TX, 2011

P8

1. What is your specialty? Where do your work?
My specialty is dermatology.  I work at a private practice Dermatology office in Houston.
2. What is a typical day like?
My first patient is at either 8:30 or 8:45.  I can see around 20 patients (often less) in a morning.  I typically finish around 11:30, then start back again at 1:30.  I am typically done by 4-4:30 (can see an additional 20 patients).
3. What attracted you to your particular specialty originally?
 
When I was in PA school, I did a dermatology elective.  I LOVED it.  I also loved how patients seemed eager to see the dermatologist/derm PA and wanted to follow the treatment regimen.  I loved the variety of conditions that dermatologist treat and the procedures that are performed.  The schedule was also very enticing.  I currently work part time (3 full days a week, I used to work full time which was 4.5 days a week).
4. What do you find most interesting about your current specialty?
 
The variety of conditions that we treat.  From prescribing biologic medications for psoriasis, to injecting bleomycin into warts–it never gets old!
 
5. What special skills are required? Skills you learn once you were hired?
I learned how to do shave and punch biopsies during my dermatology elective.  I also learned cryosurgery (freezing with liquid nitrogen) during my rotations.  Depending on which practice, some PAs do excisions, botox, fillers (and other cosmetic treatments).  Suturing skills are also important for punch biopsies and excisions.
6. What do you like most about being a PA?
I love that I am able to help patients.  I like the autonomy, but also knowing I always have back-up.
7. What are the challenges of your particular specialty?
 
Getting in and finding someone to train you.  Because of the popularity of dermatology, many people want to start their career in it.  It can be very difficult to find a supervising physician to train you.
8. Any other advice you’d like to share?
 
I couldn’t be happier with my career choice.  PA school is very tough–you can do it!  Once you get through it, find an area of medicine that you love and dive into it.
Ask questions, try to shadow in different scopes of medicine, people love to help out (many remember being in your shoes).
Shadow inpatient, outpatient, adults, pediatrics…rotations also help a lot to give you insight and exposure into what you want to do.  GOOD LUCK

A Day in the Life: Family Medicine Physician Assistant

Emily Knochel
Family Medicine PA
Midwestern University, Glendale, AZ 2008
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1. What is your specialty? Where do your work?

I work in family practice in Phoenix Arizona.  I have also worked in pulmonology and critical care before coming to family practice.

2. What is a typical day like?

I see about 16-18 patients on average per day; usual visits are about 15 minutes.  I spend a few minutes in the mornings and at lunchtime and after clinic reviewing labs, answering telephone messages, reviewing medical records, calling patients, and charting.

3. What attracted you to your particular specialty originally?

The long-term relationship with patients and their family members, as well as utilizing ALL the stuff I learned in school.  Practicing general medicine forces me to stay current on all areas of medicine and constantly presents me with challenges, even after practicing this specialty for 5 years.

4. What do you find most interesting about your current specialty?

Personally, I enjoy diagnosing and treating gastrointestinal and cardiac disorders.

5. What special skills are required? Skills you learn once you were hired?

I would say the most important skill to have in family practice is listening to the patient.  Medical histories are important when you are seeing the patient for the first time for a particular problem.  As far as skills I learned since being hired, I have learned several in-office procedures, such as skin lesion biopsy/removal, joint injections/aspirations, nail removal, trigger point injections, hemorrhoid removal, I&D of abscesses.  There are also a variety of physical exam skills I’ve learned or improved since starting family practice.

6. What do you like most about being a PA?

Having a skill set and knowledge base that is constantly growing.  Practicing medicine means lifelong learning!

7. What are the challenges of your particular specialty?

Administrative demands are higher in FP than in most specialties (more time is required to answer telephone calls, request authorization for medications and tests from insurance companies, reviewing labs, medical records, etc).

8. Any other advice you’d like to share?

Prior to PA school, I would advise potential students to get as much hands-on experience with patients in as many different healthcare settings as possible.

A Day in the Life: Psychiatry Physician Assistant

Allyson Gelman, MPAS, PA-C

Psychiatry PA

Graduated from UTMB in 2014

Attachment-1

1. What is your specialty? Where do you work?

I work in Outpatient Psychiatry at Holistic Psychiatry in Kingwood, TX

2. What is a typical day like?

I get to the clinic at 8am after my 40 minute commute from home and I immediately start seeing patients. Follow-ups are 15 minutes and new patients take 30-45 minutes. I typically see about 22-26 patients a day, mostly follow ups and about 2-5 new patients per day. Things are very hectic at our clinic with the amount of patients I am expected to see. My role is primarily medication management. I treat patients for depression, anxiety, bipolar, ADHD, PTSD, opioid addiction, schizophrenia, and OCD. I prescribe antidepressants, mood stabilizers, anxiolytics, sedative hypnotics, and stimulants. Another thing I prescribe is buprenorphine which is an opioid replacement medication to help patients who are addicted to opioids get sober and then maintain their sobriety. Our clinic offers ADHD testing in the office called the TOVA test and we also do TMS (Transcranial Magnetic Stimulation) for treatment-resistant depression. I share a wall with the room where they do those two things so I hear it going on throughout the day in the background. I typically get out on time right around 5pm. I return messages throughout the day between patients. My staff does all the paperwork and prior authorizations for me so I just have to see patients and chart mostly.

3. What attracted you to your particular specialty originally?

I have always had an interest in psychology since I come from a long line of people who suffer from mental illness. Initially I wanted to be a primary care provider but it never really worked out and I just sort of fell into psychiatry because there was a job opening so I took it. So far it is the best specialty I have worked in. I just see patients, talk to them about their problems, and prescribe medications. I don’t have to do any procedures which is something I never enjoyed anyways.

4. What do you find most interesting about your current specialty?

There is never a dull moment. My patients tell me some very interesting stories about their lives. They feel comfortable opening up to me about their love lives, their children, traumas they have experienced, anything you can think of, which I absolutely love. I always wanted to develop long term relationships with my patients instead of being in a setting where I would treat them once and never see them again like in the ER or urgent care.

5. What special skills are required? Skills you learn once you were hired?

There were no special skills required for this job. My knowledge of psychiatric drugs was pretty good before but expanded rapidly as I learned on the job. I also learned about time management and how to make the visits with patients shorter and keep the flow going which was something I really struggled with in my first few years of being a PA.

6. What do you like most about being a PA?

The flexibility to be able to work in different specialties. After PA school I worked in allergy/asthma, then family medicine, and now psychiatry. I like that my job has primarily always been just seeing patients and charting. Working in private practice, it’s usually the doctor who has to do more of the business/administrative tasks to keep the clinic running. I am happy with my supervising physician being the person who owns the clinic and takes care of business decisions.

7. What are the challenges of your particular specialty?

Patients put too much faith in the medications that I prescribe them to fix all their problems. It’s draining when they come back for a follow-up and they are still depressed despite me trying so many different things. I try to explain to them that they need to give the medication time to work and also to do therapy and get out of their house once in awhile. They complain to me for a long time about all the things going wrong in their lives and I have to constantly redirect them to stay on track and discuss the medications in the limited amount of time we have. There are some days it’s hard for me not to want to cry hearing about their problems all day long, but the longer I do this the easier it gets.

8. Any other advice you’d like to share?

There is never going to be a perfect job out there.  You have to decide what you are willing to tolerate and compromise about some aspect whether it’s the amount of paperwork, the amount of patients you are expected to see, the coworkers, the types of patients, or call schedule. No matter what it is going to be challenging, but hopefully it will be rewarding too.

Finally a PA school graduate, now what!?: How to ACE a PA job interview!

photography of a person pointing on something
Photo by Lukas on Pexels.com

The interview is likely the most critical step your prospective employer will have to assess your abilities and suitability for a job. Your cover letter and résumé has already gotten your foot in the door, so your goal in the interview is to “argue” that you are the ideal candidate for this job, while you assess, more importantly, whether this is the best job for you. As a working PA that has transitioned between several different specialties, I want to share my insider tips for acing this critical step on your journey to landing your dream PA job.

Do your research about the job. If you’re in a tight job market or if you’re looking at a job in a big hospital organization, you are likely competing against a number of other candidates. Of course you picked and applied to a particular job for a number of reasons—location, specialty, work schedule—but what makes this job the one you want the most?? Doing your research about the practice or hospital organization may help you stand out from the rest of the pack. Does the hospital have a religious or specialty mission that really appeals to you? Is your potential supervising physician (SP) active in any research protocols or academic pursuits? Knowing these tidbits and being able to sprinkle them in during the course of the interview could help strengthen your case for why you are the best fit for that particular job. “I was an EMT for several years prior to PA school, so this position in the ED is a perfect fit for my experience and interests,” or “Even though I haven’t worked in Ortho before, my job in an urgent care clinic provided me the opportunity to diagnose and treat many Ortho problems.” Talk about how your background plays to this position’s or organization’s particular emphasis. Most importantly, be your authentic self. Do not pretend to be interested in something or stretch the truth about your background, just because you think that’s what the interviewer would like to hear.  Even if you’re only passion is to get any PA job, expounding on what makes you a great PA will help you go far!

SO what makes you a great PA?

If you are interviewing with a gatekeeper HR rep, they may not know exactly what a PA is/does, so talk about the unique role of PAs within healthcare teams and how they are trained in primary care but also practice medicine in different specialties. Remind them that PAs work closely with their SP and don’t mind it! This is a good segue in the interview to squeeze in comments about your great teamwork skills and examples of teams with which you worked well in the past (these examples should also be highlighted on your résumé—see my PA résumé blog for tips!). The goal of the HR gatekeeper interview should be to show that you’re a) a team player and b) obviously not a sociopath 😛

If you are interviewing with another PA, this is an ideal opportunity to gather intel on what exactly you will be doing, how the practice treats PAs, and if you feel like you’d fit. If you are going to be working closely with this person, it’s important to get a feel for whether you’d get along with this person on a professional level.  Communicate what a great PA you are by telling your story.  

Tell your story— Most interviewers begin with an open-ended question like “Tell me about yourself?” This is your opportunity to orate succinctly where you came from and the highlights of your academic/professional life. This is not the interviewer asking to hear your entire life story, so try to get your important points across in 1-2 minutes. For example: I am from Houston, TX, I went to PA school at UTMB and graduated in 2008. After working in family medicine for 3 years, I realized that I enjoyed working with children the most and was most interested in doing small surgical procedures. I really excelled in my surgery rotation in PA school and polished my procedural skills in family medicine. I am a quick learner and not afraid to ask questions…which is why I hope you will consider me for this pediatric surgery position.”  This example highlights multiple reasons why you are a great PA and a great candidate for the job.

If you are interviewing with your potential SP it is critical to hone in on your chemistry as best as you can, potentially projecting out to how it might be to work together. It’s also important to get a sense of their management style—are they more hands-off or inclined to be a micromanager?—and see whether that matches what’s best for you. If you’re new to the PA profession or a particular specialty, it may be better if your potential SP is more hands-on and experienced in training PAs or other practitioners. If you are a veteran in a particular field, you are probably looking for autonomy more than anything else, so it’s important to assess whether you will be getting that once you’re fully on-boarded.

Most importantly, your goal in an interview is to figure out if this is the right job for you, too! One technique is to pretend you are the one interviewing the potential job so that you can feel like you are the one deciding if this is the best job for you. In most cases it’s better to continue to look for more options, than to take a job that the little-voice-in-your-head keeps telling you might not be the right fit.

Approaching the interview as an opportunity to get your questions answered will hopefully result in you coming away with enough information to make an informed decision. I’ve created a list of questions that you should feel comfortable asking, and hopefully be able to get answered during the interview:

Is there call? What is the schedule like?

What are my clinical responsibilities?

What are my administrative responsibilities?

What is the salary or compensation structure?

How many patients am I expected to see an hour? day? month?

What is a typical day’s schedule?

Who is my supervising physician (SP)?

Has my SP worked with a PA before?

Why did the last PA leave? Ask if you could speak with them directly?

What do they see you doing once you are fully trained?

Will there be a training period? What will that look like?

What kind of clinical support will I have? My own MA?

Is there a contract? Non-compete? Tail coverage?

What is the vacation, time off, PTO, sick leave policies?

What is the structure for raises/bonuses?

Is the position more team-based or autonomous?

Is this a replacement or expansion position?

What is the family/maternity/paternity leave policy?

 

Other random tips for interview day and attire:

Dress in business attire (this means a suit or blazer and skirt)

Hair should be clean, neat, and pulled back as necessary.

Be early to your interview.

Try to maintain good eye contact with your interviewer.

Smile and speak confidently.