Carly's Bananas: PA Week

Everyday lately I walk into a hospital or clinic, put on my white coat and reposition my name badge. My name badge is like any name badge that large institutions make you wear. It has my picture, and the department I am affiliated with. Underneath the rainbow LGBTQ ally sticker, and the decal indicating I am up to date on my flu shot, there’s a large orange fluorescent label that says “PA STUDENT”. This post is devoted to answering the many questions I get about that title, starting with the most obvious: WHAT IS A PA? It’s an especially pertinent topic because this week is PA week, a week devoted to promoting the profession for which I am paying the price of a brand new small sedan every three months. The truth is, it’s a very justified question, and one I am still figuring out the answer to myself.

In short, Physician Assistants are graduate level health professionals who can diagnose, prescribe and treat patients. That’s it. You can click back to your other tabs now! But for a fuller description, keep reading.

The brief history of PAs starts in the Vietnam war era. The Physician Assistant profession started at Duke university in the late 60’s because they didn’t know what to do with several MALE Vietnam vets who had been highly medically trained while they were serving their country. So one doc started an abbreviated medical program for these handful of men that focused on some practical aspects of civilian medical care. Most of the training was in surgery, because that’s the education these guys had, and that’s where this doctor thought they could be most helpful. Since that time, the PA profession and PA programs have evolved a lot. PAs work in far more fields than surgery right now. They are most populous in fact in primary care. Also, the profession is substantially more female dominated now (I’ll save my breath for a separate post about that) but despite the rapid and continuing evolution, the medical community agrees on this definition of a PA: a health care professional with graduate level medical training that works in association with a [many] physician[s] to diagnose, prescribe and treat medical conditions. They work in every specialty of medicine: from primary care, to women’s health, ob/gyn, orthopedics, surgical specialties of all kind, endocrinology, nephrology, cardiology, pediatrics, psychiatry. In hospitals, in clinics, in offices, in research— PAs are in all those places.

At this point I know you're wondering- how's it different than med school?

Medical school is universally four years long, and then you go into a residency, and sometimes a fellowship, and then become an attending, aka a full-fledged doctor. The time between graduating medical school and becoming an attending physician is between 3 to 8 years. PA training is shorter in length and slightly less standardized, but still legitimate, comprehensive and thorough. PA programs range between two years to three years long. They usually have a classroom component to the education, that we call the didactic portion. That’s where you sit in a lecture hall for 6-8 hrs per day and learn about every cell, tissue and organ in the body and how it can go wrong, and then how it can be fixed again. You take a lot of tests in that period, and have a little bit of experience with actual patients when you learn how to do physical exam skills, have difficulty conversations and place IVs and catheters. After that you plunge into clinical rotations. Usually the rotation phase lasts about a year. My rotations are 4 weeks long, and I have twelve of them total. Every program is different, but also similar. You generally rotate through primary care, inpatient medicine, emergency room, surgery, psych, pediatrics, women’s health. Med school is not dissimilar, they just have a few more rotations. In rotations you are hopefully with a supportive PA or physician preceptor who lets you see and learn a lot. You interview patients, and write notes, and learn how to do procedures and place orders for medications and fluids and all the things you have to learn to write orders for. You act like a junior doctor, or junior PA in this case, and pretend you’re the sole person who is managing someone else’s health. Arguably the most important thing in their life, no pressure. Rotations can be intense. They can be calm too. But often they are overwhelming because you feel like you are trying to prove yourself and your worth at all times. You’re also changing your work and learning environment approximately every month! Sometimes moving across the state or country to do so. It is an exciting time that comes with some inevitable stress.

After rotations, you finish paying tuition and you pay to take a national standardized test called the PANCE. It’s like any standardized test, it’s 5 hours long and hundreds of questions about the most important things you could potentially screw up in medicine. If you pass it, you pay a state licensure fee and BOOM you’re a PA. When I write it like that it seems pretty simple, and if you’re confident with standardized tests, and making it through 3 years of school with your mental health and bank account intact, I guess it is. But the real challenge comes when you get a job, and put it all into action.

PA jobs vary depending on hospitals and state laws. Some PAs function almost completely independently. Like in primary care, sometimes doctors just have to sign off on 10% of a PAs charts to make sure they’re in general doing “the right thing”. A classic example of this is when I told one of my friends I was going to PA school, he said what is a PA? And I knew he saw a PA as his Primary Care Provider. So I said, it’s like what Ella is. And he said, oh I thought she was a doctor. Ella represents perhaps the most autonomous example, she had a supportive supervising physician that really wasn’t consulted except in a regulatory way. In hospital or “inpatient” settings, PAs work like residents (junior doctors) in the hospital. They go around and manage patients who are staying in the hospital, and then they check in with the supervising doctor about the final plan. Or, if they are in surgery, PAs are often the “first assist”, or the one standing across from the surgeon, helping in the operating room.

In all, PAs are versatile, independent thinking, medically trained health professionals who have their own license to diagnose, prescribe and treat people, but who legally function in conjunction with a supervising doctor. You can call your PA friend when you have a sore throat or pain with urinating or when your kid has a rash, they have studied all that. They know CPR, they know how to treat a heart attack, they know what antibiotics to give for basic infections. Some may have forgotten some of those things, because they work in specialties that don’t deal with those, just like some doctors have forgotten some of those things. But overall, here is the answer to the question I know many of you are wondering: yes we can prescribe pain medication. But, we can withhold it too.