A Day in the Life: ER Physician Assistant

A Day in the Life: Administrative Physician Assistant

Amanda Reynado

ER/Admin PA

UTMB Galveston, 2010

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).

With Emergency Medicine, we owe a total number of annual hours to the college (our employer). We break that up into monthly hours that averages out (give or take changes some months). It varies, but average 36-45 hours a week. It is variable on the month, holidays, and colleagues taking vacation (i.e. if a lot of people are out, you work more to cover but when they return you have less shifts). We also have sick call, where you are on call that day but not actually scheduled. We are open 24/7, so everyone shares in weekday, weekend and night shift responsibility. There aren’t specific days we work.

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.

A Day in the Life: Oncology Hematology Physician Assistant

Erica 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.

I work four 10-hour shifts, Tues-Friday at MD Anderson.  I also moonlight in Urgent Care at the VA two Saturdays a month 8am-4pm for extra income.

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

1. 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.

I generally work Monday through Friday, 7am to 4-5pm. I don’t work any weekends or holidays.

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

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?

I work 3 days a week: Monday, Tuesday, and Wednesday. My first patient is at either 8:30 or 8:45.  I usually see around 15 patients in a morning.  I typically finish around 11:30, then start back again at 1:30-1:45.  I am typically done by 4-4:30 (can see an additional 15-20 patients). I average about 30 patients a day.

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