The first few months working as a physician assistant

Before I get started I want to announce that all my classmates, class of 2014 from the University of Manitoba, passed the national exam!!! We can now call ourselves Canadian Certified Physician Assistants (CCPA). CONGRATS!! 

The Transition from PA-S to PA what to think about 

1. Finding a job which I have :) I have wrote about my experience earlier.

2. Writing the certification exam (which I hope to get started on for review tips next year)

3. DEBT – I now constantly feel broke and my student loans are haunting me. If anyone has any advice on how to get a handle on that that would be welcomed! 

AND now the long awaited question. 

HOW IS IT LIKE TO OFFICIALLY WORK AS A PHYSICIAN ASSISTANT?

The First Month 

At first it seems like any medical rotation as a student but there are BIG DIFFERENCES

1.       You are now asked for orders
2.       You are now WRITING orders with no co-signature  
3.       Not writing/saying physician assistant student
4.       Your supervising doctor does not need to see all your patients

At times I felt...

1. more of a burden than a help
2. that I did not know anything

I realized that it will take time to learn (lifetime learning). You need to take it day by day. I would also find myself comparing my knowledge/work to the doc and be dissapointed in myself. But you have to realize that you can't compare yourself, the doctor has 6+ years experience where I was fresh out of 2 years of school.

The first month I was also studying for my certification exam so it felt like a lot of new things were happening at once. 

**The most important transition was learning how to work with your supervising physician. Trust and communication is the most important part of the PA – physician relationship. It is also important to know your own limitations and to ask for help when you need. 

3-4 Months as a physician assistant 

1. I’m more confident in my assessments and orders
2. I’ve started to feel that I am now actually helping the doctor (Of course there are days where I would ask my doc millions of questions) 
3. The staff is starting to know and feel more comfortable with my role 

MY TYPICAL DAY 

- 9 AM – I look at the new admissions on the medicine and surgical floor (Ranges from 0 –8  patients, average is 2-4. I try to do the most I can and the doctor and I split the load if there are a lot)

- Review new admissions with the doctor

- See patients I’m following. Currently I am responsible for the surgical floor which are normally patients who have one issue ex. pancreatitis, ulcerative colitis exacerbation, febrile neutropenia etc.

- I’m also responsible for any reassessments that come in for outpatient IV antibiotics. This includes assessing their need for IV antibiotics and if I can transition them to oral medications or end treatment.

What I’ve seen/managed/done 

NSTEMI

CHF
Pneumonia
Asthma exacerbation

Peds – (asthma, pneumonia, UTI, hyperbilliubinemia, etc)
Cellulitis
Ulcerative colitis exacerbation
AKI
Diabetes
HTN
Consults – cardio, neuro, GI, ortho, peds etc
Fractures
Electrolyte abnormalities
Palliative care
Dictate discharge summaries
AFIB
Bedside ultrasound
And you know how it is in medicine (most patients have more than one problem plus co-morbidities)

I’ve learned a lot and I have a lot to review and improve on. One advice I received on one my clinical rotations was to learn one thing a day. If you do that you would learn about 365 topics in one year. (I might be doing that every second day :P ) 

What I miss 

My classmates and having the support of the PA program. You don't realize how great having their support is until it's gone. Of course we keep in touch but we are not all at the same place anymore.

(Christmas/certification celebration with the ladies. We are now working in different specialties and don't see each other as often - nephrology, emergency, pediatrics and medicine)

 

I ALSO WANT TO SAY… CONGRATS to the first year PA students for completing their first semester of PA education.
                                                                                                             

3 Months Post School….a quick update

I know it’s been awhile … :) 

- I started a new position as a hospitalist physician assistant

- I had my official convocation

- studied and wrote my PA certification exam

- participated in the CAPA conference in Halifax 

- and went on a long awaited overseas vacation.

I have a lot to write about and will try to break it up for you all. (In the mean time enjoy some convocation photos. Yes convocation is long and boring but wearing the gown is awesome)

I have also been thinking about the direction of my blog and what I should write about now that I am done PA school (Still strange that it actually happened)

 

My goal for this year is to try to create a study guideline to the Canadian certification exam. This will be a good way for me to review medical topics as well as continue to help PA students and hopefuls on topics that come up in class/certification. (I haven’t yet got my results so maybe I’ll wait till I know that I passed before passing on advice. Or it would be a good way to review again :p)

Only the odd 1/3rd of the class showed up to convocation

Will be posting soon! Thanks!

WE'RE DONE!! GRADUATION DINNER :)

Ended the year as we started. A group picture. (Kind of reminds me of the dove commercial :P)

The end of physician assistant school wrapped up so quickly with last minute paperwork, meetings and job interviews/offers. After our final rotations we had our final OSCEs. It was well organized and very fun. Comparing my last OSCE to the very first one I had I can’t believe how much I’ve learned in the past 2 years. I also didn’t realize how much I’ve grown as a person. I still believe that I am that shy smiley girl that entered the program but I hope to think that now I have a little more spunk.

Looking back it was a whirlwind experience. I can now officially call myself a physician assistant yey!! Here are some celebratory pictures of our grad dinner. 

To my family. Thank you for being supportive through every step of the way.

To my longest and oldest friends (from high school aka "the beakers") Thank you for being there when I needed and understanding when I wasn't able to make it to some events.

Highlights

- Dr. Bosma - (special guest voted by the class) gave a fabulous speech

- Kaira (Class president) - gave a heart felt remark about the last two years bringing the room to tears

- Kodley - Gave a fabulous laugh out loud class roast about all the quirks of our classmates. 

Amy - Medical Director Award (Outstanding Capstone Paper and Presentation)

Kaira - Faculty Award for Student Exemplifying the Future of the Physician Assistant Profession

:( I don't have a picture of Gisoo

Gisoo & I (yey!) - Collegiality and Leadership Award, as Determined by the Class 

To the Class of 2014,

We have learned together, partied together, cried together and grown together. The past two years was made great because of your friendships. I am proud to have you as my colleges and most importantly be able to call each of you part of my family. It has been awesome!! I am sad that we now go our separate ways but excited that we begin our careers as physician assistants. 


We made it!! Congratulations!

Celebrating with family and friends :)

** Oh I forgot... I guess I still need to study for the certification exam in October :S

THE JOB HUNT

Time to look for jobs :P

As the year came to an end we began getting introduced to different job opportunities. It was beginning to feel strange as employers are coming to us. We were given free pizza lunches (good brand name pizza), we had a nice outing to look at rural opportunities and we got good schwag from them :)

Our field trip to rural Manitoba

 At the beginning of the summer we were given a booklet of job opportunities available in the province. There were a few in the city and a lot rurally. The applications were in and I began going to interview after interview. It was strange to be competing with your fellow classmates/friends and I admit there were times where I wanted to give up as most opportunities weren’t offered to me at first. It’s hard to determine what employers are looking for.

Free coffee!!! yey

I am excited to say that I have accepted a position in internal/hospitalist medicine in rural Manitoba. It will be a long commute 45-60 min (depending on traffic) one way but the position is what I am looking for. I am hoping to get good teaching and to continue writing about my experience in my first year working as a physician assistant. 

Have two weeks off. Start my position Sept. 15 :P -

ELECTIVE #2 - OCCUPATIONAL MEDICINE

For my last rotation I went to a diamond mine to see what occupation medicine is all about. In the mine the only medical provider are PAs. It sounds exciting that PAs are able to provide medical care in remote areas. These PAs have had years of experience in emergency medicine and are fully capable to treat patients with the common cold to trauma accidents, heart attacks and strokes 

TYPICAL DAY

6:30 am – 10:00 am – OPEN CLINIC – patients walk in similar to a walk in clinic. I saw mainly things you would see in a family office. One of the biggest differences is since there are no nurses or pharmacists you need to be all those roles. This includes placing IVs if needed and counting, labeling and bottling prescriptions that you've prescribed.The PA also has appointments for audiology and spirometry testing for all employees. 

10:00am – 12:00pm – PAPERWORK/HEALTH PROMOTION – the PA has tons of occupational health related paperwork such as workers comp etc. We also did wellness promotion with surveys on wellness.

I had ice cream everyday :P

12:00pm – 1:00pm – LUNCH – all I can say is ALL YOU CAN EAT 24hrs breakfast/lunch/dinner/snacks (and yes a self-service ice cream bar)

Best pastries ever!

1:00pm – 3:30pm – PAPERWORK/HEALTH PROMOTION

3:30pm – 6:30pm – OPEN CLINIC

Days were long especially when there were not many patients coming in. There weren’t many workplace accidents as you would think and no life threatening emergencies that I saw. The mine places a great importance in safety. I did get some awesome one on one teaching with the PA that works there. They have all the training equipment that you need especially for emergency medicine. I didn’t have to fight for it with the med students or my fellow classmates :P

I was taken out to tours of the pits. This was crazy. I didn’t realize how much is required to run a mine. There are always employees working 24 hours in the day. I didn’t get to see much wildlife. I did see some caribou and siksik (artic ground squirrel).

My steel toed shoes were one size to big for me :P 

WHAT I SAW

Pharyngitis

Pneumonia

Finger lacerations

Closed fibula fracture – had to send to the closest city for an x-ray

Syncope

Cornea abrasions – yes they have their own slit lamp

One diamond :P 

The only diamond I saw - displayed in a case. This was found during there first exploration digging.

Yes there were other activities offered in the camp. They had a gym open 24 hours as well as exercise rooms. I participated in yoga, basketball games and movie nights.

What made this rotation awesome was the PAs. Working with PA preceptors are great as you are able to see their full scope of practice and learn a lot from them.

Here are some more pictures from my adventure. 

ELECTIVE #1: PLASTIC SURGERY

I wanted to have more opportunity to suture so I chose plastics surgery as one of my electives. Plastics surgery currently has PAs working for them. This was a great opportunity to witness how PAs function in surgery.

A normal day 

7:00am – meet with the PAs and determine the OR slate for the day 

7:30am – head to the OR and help assist the OR nurses set up the equipment needed for surgery 

8:00am – 5pm – OR assist – It was difficult to do much in the OR as there were plenty of residents to assist. I did get some good suturing practice. Practiced some dermal and running stitches

CLINICS: These were fun. They were quick visits and I was able to see the outcomes of the surgical procedures that were done. 

WHAT I SAW

- Mastectomy and breast reconstruction DIEP method – using abdominal fat to reconstruct the breast and the patient got a free tummy tuck :P. This was amazing. 

- Breast lift

- Liposuction

- Scar revision

- Traumatic hand reconstruction

- Flaps 

- Latissimus dorsi breast reconstruction 

- Carpal tunnel

- Dupuytren contracture

Plastic surgery had more possibilities and depth than I knew coming in. My perceptions of plastic surgery was what I've seen on TV ie. greys anatomy and celebrities. I did not see any cosmetic surgery on this rotation. Most cases were cancer patients that were getting their cancer surgically removed. Plastics was responsible for fixing the area and making it functional. Microsurgery was awe-striking. I never knew such surgery existed. You can literally take any part of your body and attach it somewhere else on your body. Plastic surgery are for those who are detailed orientated as it requires a lot of time and patience to attach small arteries, veins and ligaments.

Picture I found on the internet- microsurgery

I was amazed at what the PAs got to do. One PA who has been working for only 2 years was cutting, suturing on their own and was well respected by the residents. I could see the trust the surgeons have with the PAs. They prefer the PA in assisting in certain cases especially the PAs who have been working there for years. The PAs truly function as physician extenders. Here they were like residents that never leave. I recommend this elective for those who are interested in surgery. I admit it was difficult standing for more than 2 hours, my hips would start acting up :P . Some cases we would stand even up to 7 hours. 

This was a great rotation with awesome PA mentors.