The world of a P.A.

 

Today I worked my ass off….

I first assisted in 5 surgeries and covered two operating rooms. It’s tiring but it’s also hella exciting. I love what I do.

I love being a Physician Assistant.

A Physician Assistant, to those who are wondering, is a mid-level health practitioner also known as a physician extender.  In 2017, Forbes magazine listed Physician Assistant as #7 of the 25 Highest Paying Jobs in the U.S. We are trained in a medical model (like a doctor) and function as an independent practitioner.  (https://www.forbes.com/pictures/feki45eigdm/7-physician-assistant/#113418977c98).

PAs can:

  • See and examine patients
  • Prescribe medications
  • Order and interpret diagnostic tests
  • Formulate diagnoses and treatment plans
  • Perform surgical procedures: e.g. suturing wounds, placement of access catheters, place casts
  • First and second assist in surgeries

Everything we do is under the direction and supervision of a physician. It’s a promising career with many benefits but choosing the right position in the right area is essential.

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Photo by Hush Naidoo on Unsplash

Education

When I started as a PA almost 15 years ago, there were 7 PA programs in NYC.  At that time, most programs were offering Bachelor’s Degrees, some were combined degree undergraduate programs and maybe one or two offering Master’s Degree programs.  Now, there are 21 programs in New York. Most programs now offer a Master’s Degree.

Entry requirements vary from program to program. To obtain a Master’s degree, a bachelor’s degree is required.  Prerequisites for admission include, but are not limited to the following coursework:

  • Anatomy and Physiology
  • Biology
  • Microbiology
  • Chemistry (Inorganic and Organic)
  • Statistics
  • Psychology
  • Social Sciences
  • English Composition

In addition, a minimum of 500 volunteer hours in an observed patient care environment are required for admission. Some programs require 1000 hours. Volunteering is not limited to shadowing a physician assistant. Shadowing a physical therapist, medical doctor or even a medical assistant counts towards observed patient care. An applicant can also volunteer in an office or a hospital setting.

The duration of a PA program is from 24 to 36 months. The program is usually split in two sections didactic and clinical. Didactic is primarily learning basic and medical sciences. Clinical is a hands-on environment in a hospital or clinic with direct patient care. Every program organizes their didactic and clinical years differently.

Physician Assistant Pay

The Bureau of Labor Statistics websites states in May 2016 the median annual wage for physician assistants was $101,480. Pay varies by state and discipline.  A PA in surgery and surgical sub-specialties will likely earn more than a PA in internal medicine, family practice and pediatrics.  (https://www.bls.gov/ooh/healthcare/physician-assistants.htm)

 

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Photo by Martin Shreder on Unsplash

Career Outlook

As the need for mid-level providers increases, the need for physician assistants becomes more pressing.  Physician assistant employment is projected to grow 37 percent from 2016 to 2026, much faster than the average for all occupations.

The role of PAs are more prevalent. Years ago when I was asked by my patients, family, friends or a stranger on the street what I did, no one really knew what a physician assistant was. I was asked if I was a just a nurse or medical assistant. I was asked if I can really see patients AND write prescriptions.  I was asked if a physician could really trust my judgement. I would need to explain what I did and what I was qualified to do over and over again.  My grandmother, one of my biggest cheerleaders, would readily say “Well, my granddaughter is a Physician Assistant!” when everyone else was still trying to understand.

Now….

I don’t need to explain as much anymore. Most people now have been seen by a physician assistant in lieu of or before being seen by a physician. Now with states allowing physician assistants more autonomy there shouldn’t be as much hesitancy as in the past.

PAs work in many fields including internal medicine, family practice, pediatrics, surgery and even anesthesia.  As I said previously, finding the right place to work is essential for a PA.  In my case, I was always looking for autonomy and working with the right physician that would trust me enough to do what I was trained to do.

 

The Nitty-Gritty

There are some very good and not so good things about being a PA. What it boils down to is what YOU want. I’m speaking from my experience only. But  read this first.

PROS

1. Flexibility

One of the best perks of being a PA is the ability to switch careers without going back to school. If a physician decided to leave the world of surgery behind and become say a psychiatrist (I know someone that did this) a fellowship is requires in that field. That’s an additional 1 to 2 years of a person’s life not to mention the drop in salary.  As a PA you can switch careers from Emergency Medicine to Otolaryngology or Surgery to Pediatrics. Being a PA is an on the job kind of learning and there are definitely steep learning curves when switching specialties. However, if you are motivated, eager to learn and have a good work ethic then switching should be a breeze and easy on your pocket.

2. Salary
The pay of PAs has improved dramatically in the last 10 years. As the PA field increases as well as the autonomy, the salary is expected to go up. A new graduate can easily make $90,000 right out of school. This is far more than a medical or surgical resident will earn in their training. Fifteen years ago PAs were making about $55,000 out of school. Newly graduated Registered Nurses were making about $65,000 to $70,000. PAs have come a long way!

3. Autonomy

As written above I can see patients, formulate diagnoses and direct treatment as well as prescribe medications. I can discuss all with my supervising physician but every step doesn’t need to be followed or discussed. I’m not attached to the hip of my physician but he is a phone call away. PAs can be Directors of a service e.g.  surgery, anesthesia or purely administrative like a Chief Operating Officer.  There are PAs that are freelancers. For example, a surgically trained physician assistant can travel and work locum tenems as a first assistant in the operating room at various hospitals.  The scope of practice for PAs has definitely increased.

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Photo by Jon Tyson on Unsplash

CONS

1. MD vs PA

As much as PAs are being recognized as mid-level providers or physician extenders, there are still many who have reservations about working with PAs or even accepting a working diagnosis/treatment plan from a PA. There are many doctors whom I have come across who feel that a PA is “acting like a doctor” and therefore trying to replace a doctor.  FALSE!!! This is so far from the truth.  We are trained to think like doctors but we cannot replace a doctor. PAs can have their own practice but will still require a physician to review charts. PAs can deliver care in a private office setting but notes are still signed by a supervising physician. We can’t replace doctors.

There are also doctors who will not listen or accept a PAs diagnosis or treatment because the MD is not behind that PA’s name.   Unfortunately, this mindset does not stop with MD. It can come from nurses and even patients. I remember doing an ACLS (Advanced Cardiac Life Support) class in a class full of nurses. PAs weren’t trusted or even seen as providers. I’ve also had patients refuse to be seen by me and wanted a doctor. When this first happened to me, I was offended and upset. Eventually, I learned and understood the patient has a choice on whom he or she wants to be seen by. Its not something I could control however, I could take a moment to educate this patient about a PA’s role in their care. I also got some small joy having the patient leave my clinic room and tell him or her to please wait when the next physician became available :)).

2. Being a PA ≠ Medical Assistant

As much as I hate to say it, being a PA can border on a medical assistant, depending on where you are working.  To be fair, being in the medical field definitely requires a good deal of paper pushing. There are so many FORMS to fill out. From disability forms to return to work letters, there are a plethora of forms.  When working in a clinic, I was given forms to fill out ALL THE TIME. Even when its not a patient I’ve seen or treated. I would fill out the form and give it to my supervising physician to sign (his hand was broken up until that point). Also when you are working with Resident physicians (physicians who are learning), the forms get pushed to you more because the residents don’t have time (not really) to fill it out. (This is a SUPER sore subject with me).  I will say this doesn’t happen everywhere BUT be aware depending upon where you work, its a strong possibility that you may become the Physician Medical Assistant.

Ultimately, its important that once you are a PA, find a position that allows you have as much autonomy as possible (if you want autonomy, that is).

 

Featured Photo by: Photo by Piron Guillaume on Unsplash

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