PRE-PA • BY ANNE, CCPA

If you ask a PA why they chose to work in the “PA Profession”, they’ll list more answers than the “work life balance” you often hear about on Career websites. Here we outline many reasons PAs choose to pursue a career in medicine in terms of career flexibility, hours worked, quality and return on education, opportunities for growth and the work you do with patients and other health care colleagues.

• PAs practice medicine, but do not spend 6-10+ years in school the way physicians would, can work contracts that include part time, evening hours, no call, overnight shifts etc.  This is not to say that there are PAs that do choose positions (e.g. ER, different surgical specialties) that take on the same shift work, evening hours, call, full time schedule, but that there is the flexibility not to depending on the practice institution.
  • Example 1: A full time PA at a busy downtown Emergency may do shifts from 8 am to 4 pm, then 4pm to midnight – but do not do the overnight shift
  • Example 2: A PA at an Orthopaedic Surgery department, hired by the hospital works 9 am to 5pm, but does not do overnight call (unlike their staff physicians who are required to do 1 call every 6 week weeks as an example).
  • Example 3: A family PA who formerly worked full time, may negotiate with their employer to work 3-4 days per week after returning from a paternity leave to spend more time with their little one at home, with one day being evening hours – no weekends.
• PAs are hired on as employees, and can take advantage of benefits offered through their employers (paid vacation, paid CME, medical, dental, vision, etc.). Some PA contracts pay in lieu of benefits. Physicians (unless salaried through a hospital/university) must pay for their own benefits.
• PAs do not “run a practice” the way a physician would. There is a business side of medicine that isn’t often discussed. When a physician practices, they must pay rent for office space, telephone and internet, electronic medical record bills, pay for a medical secretary and billing to be done, accounting software to pay your employees  in addition to paying for yourself.

• PAs can work regular office hours (eg. 9 am to 5pm), evening hours (4pm to 9pm), shift work, and call (day call, overnight call, or weekend call).
• I get to work in a specialty practicing medicine, with the option of choosing a contract that has no call, working 8 hours during the day, and no shift work. There are some PAs who choose to take on contracts that include night or evening shifts, call and more fast-paced environments. Work-life balance is what you choose to make of it.

Table 1 – Comparison of a Sample Family PA, vs Ortho PA, vs Orthopaedic Surgeon

This is a table comparing a “sample PA” in family, Orthopaedics and then the schedule of an Orthopaedic Surgeon. Note that this is sample – PAs in Family and Ortho can have schedules, hours, and responsibilities that are different than what is presented here. This is just an example of a full time family PA that works regular hours (no evenings), and an Ortho PA that is one day a week in fracture clinic, OR, two days Orthopaedic outpatient clinic, and one day with a physiatrist one day per week. There are some Orthopaedic PAs who are strictly inpatient/ward management, those who work outpatient only, or others who are a combination of the different Orthopaedic settings depending on their practice location, and supervising physician.

Adding a PA to an Orthopaedic Surgery practice helps to reduce time in clinic (PAs do follow ups, consults, pre-ops, post-ops, injections), while increasing volume of patients seen and reduces administrative work (paperwork, medical dictation, medical legals, insurance papers, teaching, facilitating referrals, answering patient questions over phone, etc.).

• Time in School – You spend 24-25 months in PA education, and then get to practice medicine (no “residency” to apply to) as a staff member. This means you get to pay back your student loans sooner.
• Earnings after Education – for a Master’s (in Manitoba) / Bachelor’s (in Ontario) PA degree, and 2 years of your time, you earn $75,000 to $130,000+. To see how this compares to other health care careers, be sure to download our PA Education and Earnings Comparison Chart which compares 19 other health care professions. It’s a challenging career, making a difference in patient’s lives with good flexibility.
• Student Debt – Due to the duration of time you are in PA school (2 years), and subsidized university education, you accumulate less debt. In November 2017, McMaster PA program tuition is $13,922.53 per year for 2 years, the McMaster University Medical program is $28,201.34/year for 3 years of their medical school.

• PAs are trained under the medical model, this means you are trained to think, speak the same terminology, and diagnose the same way physicians do. PA education is essentially the medical school curriculum compressed into 24-25 months, and instead of completing a “residency” the way physicians do you go straight into practice, where learning takes place on the job.

CanMEDS-PA is the framework on which the comprehensive competency profile is based for Canadian Physician Assistants.

“CanMEDS is a framework that identifies and describes the abilities physicians require to effectively meet the health care needs of the people they serve” – Royal College

The term ‘lateral mobility’ refers to the ability for a PA to easily switch specialties.

• Switching full time positions – One my mentors actually started in Plastic Surgery as a PA, then switched to Cardiothoracic Surgery, then finally settled on a position as a PA in the Emergency Room.
• Another benefit is that when you leave a practice, you do not have to shut down your practice and transfer your patients to another provider.
• Compare this to an MD, if they decide to pursue family medicine after medical school, and several years down the line they wish to go into Cardiology – Cardiology is a subspecialty that is not available to a family medicine physician to practice unless they have completed a residency in Internal Medicine.

• I work full time, however four out of five days per week I work in Orthopaedic Surgery practice, and 1 day per week a I work with a physiatrist.
• My PA colleague works 3 days a week in a family medicine practice, and two days per week at an Orthopaedic Surgery practice. What she learns in Ortho supplements her practice in family medicine. Prior to the Ortho Job, she worked 3 days per work in family medicine and two days per week in a Dermatology practice.

Table 1 – Sample schedule of Canadian Physician Assistants who have different schedules

• PAs practice medicine, and we function as diagnosticians. PAs perform histories and physicals (information collecting), but they also use the information collected from their history, physical and investigations (imaging, blood work, etc.) to diagnose and formulate a treatment plan – which is the same medicine that physicians practice. You get to see a wide variety of problems that range from routine common conditions that walk in to your family medicine office, to medical “zebras” that are not common to your region or area.
• A PA position is not “the same thing, over and over again”. Each patient is different and requires individualized approach and treatment plan.

• PAs work under the supervision of physicians, but can also function relatively autonomously.  Some PAs see patients autonomously, and only speak with the physician should there be a complex case or concern. Other PAs see patients alongside the physician for every single case – this depends on the practice setting, country, province and billing model of that practice/specialty.
• In addition to being my boss/employer, my supervising physician is my mentor. Even after several years of practice there are always opportunities for learning.

• PAs do have the time to spend with patients to educate on acute and chronic disease (i.e. Diabetes, COPD) and preventative health (i.e. smoking cessation, cancer screening) in a variety of settings.

• Medicine is moving away from one provider providing all treatment and having many allied health providers. Physician Assistants are extensions of the physicians, can can assess, interpret investigations, diagnose and manage patients. This includes facilitating referral to other health care providers (e.g. dietitians, physiotherapists, massage therapists, social work, other specialists like Orthopaedic Surgeon).
• PAs can conduct family meetings in collaboration with other health care providers
• PAs often communicate with other health care providers if any questions come up about care. For example, at my Orthopaedic Surgery practice I often answer questions from physiotherapists who have questions about when to advance physio exercises depending on patient’s progress from a surgery they recently underwent.
• PAs work with nurses by helping to facilitate discharge, clarify medication orders, and answering questions about patient care.

• You’re always learning and developing your knowledge, as medicine is an ocean. The PA programs promote evidence-based medicine, and problem-based learning whether its the foundation or a component of their education program.
• If you wish to experience a large learning curve after many years of practice in one specialty, you can switch specialties (e.g. going from family medicine, to Emergency medicine) to see a different acuity of patients.

PAs work regular hours and, if not juggling too many other responsibilities (whether personal or professional commitments) have the margin in their life to be able to pursue other areas of focus:

• PAs can (and do) publish research. Topics can range from case studies, research commentary, conducting their own studies about PA productivity and education, or doing research about disease processes and treatment options.

• PAs can (and do) start their own businesses, this is especially apparent in the United States. Examples:
  • Medelita is a company that sells scrubs and white coats to health care providers, was started by a PA.
  • Medcomic, a PA who is also a author and illustrator for medical illustrations.
  • Some PAs author books, write medical textbooks and study guides.
  • Some work on businesses that are unrelated to medicine.

• Some PAs opt to take on additional education, including a Master’s of Public Health Policy, Master’s of Medical Education, an MBA, or PhD in an area of interest.

• PAs, with their clinical experience, can serve on the Board of Directors for different organizations (whether health related or not). This includes hospital boards, national/provincial health association’s, office manager team leads, advocacy for the PA profession or patient populations, and AFHTO board

• A lot of alumni from the PA programs go back and help teach the programs.
• Doing one-time workshops – I have helped to teach the Orthopaedic Surgery Fracture, Casting and Splinting Workshop, in addition to speaking to 2nd year PA students and contracts, medical directives and medical billing as part of preparation for employment.
• Taking on a long-term teaching commitment – My colleague Ohood teaches IER, which focuses on teaching clinical skills in the 3rd medical foundation at McMaster. This commitment is once per week for several months.
• Taking on student observers – Whether these are Pre-PA students for shadowing of 1st year PA students who are there to complete horizontal electives, longitudinal placements (LPs), longitudinal clinical experiences (LCEs). Taking on a 2nd year PA student is more involved as you are taking them on 2-6 weeks on at a time everyday as a clinical clerk.