Aurthi, Emergency Medicine PA

Aurthi, an emergency medicine physician assistant trained in Canada at the University of Toronto Physician Assistant Program. Aurthi shares her experiences and insights as she embarked on her journey to become a practicing PA.

Reflecting on her decision to become a PA and the experiences she's encountered since graduation, Aurthi's story sheds light on the evolving landscape of this rewarding profession in Canada.

"I am actually grateful to be where I am. This is beyond what I had hoped for," Aurthi expressed when asked about her satisfaction with choosing the PA career path.

She added, "I think the beauty of practicing in Canada is that you see the profession grow even from when I was a pre-PA a few years back until now, we have more PAs joining the community and more and more people interested in pursuing it as a profession."

The Path from PA Student to Practicing PA

Aurthi's journey began as a PA student at the University of Toronto. She recalls the excitement and anticipation she felt about clerkship while in the midst of first-year PA school.

She embarked on her clerkship year, engaging in diverse rotations that enriched her knowledge and skills. From working in the southern regions to traveling north for emergency medicine and family medicine rotations, Aurthi embraced every opportunity to broaden her horizons.

"I always knew I wanted to work in Orthopaedic Surgery, but I still kept my options open and applied to family medicine and emergency medicine," Aurthi mentioned, emphasizing her dedication to exploring different specialties during her clinical rotations.

Navigating the Ontario PA Job Market

Aurthi shared her experiences in finding a job after graduation. She navigated through various options and kept her career choices open. She applied to positions both through HealthForce Ontario’s Career Start Grant and positions outside of the Career Start Program.

“In Ontario, the government provides a program called "Career Start" to support new PA graduates during their job search. For Southern PAs, the program covers half of their salary for the first year, while for those working in underserved areas up north, the coverage extends to two years.”

Aurthi's approach to the job hunt was flexible, considering different specialties. Her commitment to exploring various options eventually led her to secure a job in emergency medicine.

Aurthi recalled her post-graduation job search process with a sense of fulfillment, describing it as a period of self-discovery and growth. "I found the interview process to be very rewarding because you learn a lot about yourself as you speak about yourself to employers and also learn about the understanding of the PA role with all these different supervising docs and different specialties," she shared.

As she delved into interviews with various employers, Aurthi gained valuable insights into her own strengths and aspirations. Simultaneously, she had the opportunity to understand how different medical specialties utilized the skills of a PA.

"After that, I did a lot of self-reflection to see what specialty would be best for me to start off," Aurthi explained. The process of introspection allowed her to align her interests and abilities with the most suitable area of practice.

Choosing Emergency Medicine

Aurthi found herself drawn to emergency medicine, a specialty she hadn't initially considered. "I landed on emergency medicine, which funnily enough is not a specialty I thought I would start off in, but I'm very grateful for, especially for all the learning I have gotten in the last few months," Aurthi shared with gratitude.

Her decision to start her journey in emergency medicine proved to be a transformative experience. With each passing day, she immersed herself in the dynamic environment of an emergency department, handling a wide range of cases and challenges.

The fast-paced nature of emergency medicine tested her abilities and pushed her to grow as a healthcare professional.

Firstly, Aurthi believed that starting in general medicine fresh out of PA school would help solidify the extensive learning she had undertaken during her two years of training. The fast-paced and diverse nature of emergency medicine provided her with the perfect environment to put her knowledge into practice and continue her journey of learning and growth.

"I really like the mix of procedural medicine," Aurthi continued, highlighting one of the aspects that captivated her interest in emergency medicine. The opportunity to perform procedures such as suturing laceration repairs allowed her to apply her skills in a hands-on manner, an aspect she found particularly rewarding.

Moreover, emergency medicine presented Aurthi with the chance to work closely with orthopedic cases, enabling her to see fractures and participate in casting, as well as transition patients' care into fracture clinics. The collaboration with orthopedic specialists enriched her experience and provided her with a broader perspective on patient care.

"I like that you get an exposure to different physician preferences as well," Aurthi emphasized. Working with more than 50 different physicians in the emergency department exposed her to a diverse range of medical perspectives and approaches. Collaborating with these doctors offered her the chance to provide comprehensive and well-rounded patient care.

Aurthi highlighted the value of working collaboratively with physicians, stating, "They always say that working with PAs in the emerge, you have two great minds thinking about a patient case instead of just one." This collaborative environment not only allowed her to contribute her expertise as a PA but also provided her with an invaluable opportunity to learn from experienced MD colleagues. As a new grad PA, she valued the chance to expand her toolbox of patient care strategies and gain insights into different approaches when presenting cases and proposing next steps.

Her passion for emergency medicine was evident as she spoke about her role in the field. Aurthi's decision to pursue this specialty exemplified her commitment to making a positive impact on patient care, embracing new challenges, and collaborating with a diverse group of medical professionals.

Working in Emergency Department

Impact of PAs in the ED

The organization and role of Physician Assistants (PAs) in the Department of Emergency Medicine were crucial aspects of Aurthi's experience. The department's patient flow is efficiently managed by categorizing patients based on the Canadian Triage and Acuity Scale (CTAS).

The rapid assessment zone, where PAs primarily operated, saw patients with CTAS three to five, dealing with various conditions such as lacerations, broken bones, and suture removals. Aurthi emphasized the versatility and diversity of patients that PAs encountered in this zone.

In discussing the impact of adding PAs to the department, Aurthi highlighted the benefits experienced by both physicians and patients.

"We hear a lot of physicians who are thankful for PAs being able to do procedures," she noted. PAs' ability to perform procedures such as suturing and casting alleviated physicians' workload, allowing them to focus on higher acuity cases.

PAs played a vital role in reducing wait times for patients, particularly in the rapid assessment zone. "From the patient's side, we actually help reduce wait time," Aurthi explained. By sharing the workload with physicians and managing quick patient visits, PAs contributed to smoother patient flow and timely care.

The collaboration between PAs and physicians brought a balanced approach to patient care. Aurthi emphasized the advantages of this partnership, stating, "We help see them, and the doctor checks in/reviews at the end and makes sure that everything looks good before the patient leaves the department."

Orientation and Onboarding as a new PA hire to the ED

As a new graduate joining the emergency department, Aurthi expressed her gratitude for the well-established team of PAs at the institution. "Yeah, no, that's a great question because I was very lucky to be joining a team of PAs who were already well established at the institution that I was working at," she emphasized.

Her orientation into the role of a PA involved a month-long transition period, during which she had the opportunity to shadow one of the senior PAs. This hands-on experience allowed her to observe the department's workflow, understand established protocols, and learn the preferences of her senior colleagues.

Aurthi appreciated her mentor's teaching style, which encouraged learning through active participation and provided valuable feedback. She shared, "I really like the teaching style of my mentor, where it was kind of just doing it and learning, and then getting feedback from her, as well as when I present to the MDs, she was supportive but also letting me learn from the MDs as well."

The team-based approach to orientation was a hallmark of the department's supportive environment. Senior PAs acted as mentors, guiding new graduates and providing a strong support system. "There were different teaching styles; other senior PAs were very supportive and they would ask you what your comfort level was," Aurthi remarked. This personalized approach ensured that each new PA felt empowered to grow and excel in their role.

Beyond shadowing experienced PAs, Aurthi and her fellow new graduates participated in various workshops designed to further enhance their skills and knowledge. These sessions covered critical aspects of emergency medicine, such as casting, teaching methodologies, and the use of point-of-care ultrasound (POCUS).

Aurthi found the ultrasound workshop particularly enjoyable, as POCUS played a vital role at her workplace. "POCUS which is point of care ultrasound, is commonly used at the bedside," she explained. "So that's something that PAs are involved in, and something we got exposure to. So we know when we can use that, when a patient presents with different complaints like appendicitis or even like a ruptured ectopic pregnancy, you want to do a bedside ultrasound and see if you have to expedite their care."

Through a combination of practical experience, mentorship, and targeted workshops, the orientation process equipped Aurthi and her peers with the necessary skills and confidence to embark on their journey as fully-fledged PAs in the emergency department.

Treating a Diverse Patient Population in the ED

Aurthi illuminated the dynamic nature of the patient population in the emergency department, stating, "There's a lot of variety in terms of the patients we see in emerge." From infants just a few months old to geriatric patients who have surpassed the age of a hundred, the range of ages treated is extensive.

However, age is not the only factor that contributes to the diversity of patients seen in the emergency department.

"Cultural background plays a significant role," Aurthi continued. At her particular location, speaking Tamil proves to be invaluable in addressing language barriers and connecting with patients.

Aurthi observed how this common language provides a sense of relief for patients, allowing them to express their concerns more openly without the need for additional interpretation. By breaking down language barriers, Aurthi fosters a greater level of trust and understanding with her patients, facilitating smoother communication and providing reassurance in patient care.

Moreover, Aurthi acknowledged the importance of considering socioeconomic backgrounds in the emergency department. Patients from varying socioeconomic statuses seek care, adding another layer of complexity and diversity to the cases she encounters.

Common Conditions seen in the ED

When discussing the range of conditions that present to the emergency department, Aurthi emphasized the sheer variety of cases encountered, explaining that patients may present with anything from headaches and sore throats to upper respiratory infections (URIs), chest pain, shortness of breath, and abdominal pain. Musculoskeletal issues are also common, spanning various areas of the body, including the shoulder, knee, hip, ankle, and back.

As a skilled Physician Assistant, Aurthi shared her approach to assessing patients and considering differential diagnoses. "You would want to rule out the scary ones and the emerge," she stated. For chest pain, potential diagnoses such as myocardial infarction (heart attack), pulmonary embolism, and pneumothorax are carefully evaluated. Similarly, for abdominal pain, conditions like cholecystitis, cholangitis, appendicitis, and ectopic pregnancy are taken into consideration.

Aurthi's dedication to patient care lies not only in ruling out serious conditions but also in providing reassurance and ensuring proper follow-up for patients with less severe issues.

Procedures Performed in the ED

When asked about the procedures she performs as a PA, Aurthi's enthusiasm was evident. "Yes, I am smiling because I really enjoy the procedures that we get to do in emerge," she replied. Among her skill sets are suturing lacerations, a task that plays a crucial role in managing patients with wounds. Additionally, Aurthi takes pride in her ability to perform casting for various fractures, whether under sedation or in the rapid assessment zone.

The range of procedures Aurthi performs also includes draining abscesses, irrigating ears, and managing peria, a type of soft tissue infection. Foreign body removal is another common procedure she expertly handles, from removing earring backings to dealing with objects embedded in patients' feet.

What patients can expect when being seen by a PA

When asked about what patients can expect when seen by a PA, Aurthi confidently stated, "The first thing that comes to mind is that a patient can expect two great minds to work on their patient visit."

From the moment a patient is seen by a PA, a collaborative approach is initiated. The PA meticulously takes a comprehensive medical history and conducts a thorough physical examination.

The collaborative aspect of patient care becomes evident as the PA discusses the case with a supervising physician. This collaboration involves exploring potential differential diagnoses and determining the most appropriate next steps, including necessary investigations and management options.

The patient thus benefits from the combined expertise and insights of both the PA and the supervising physician, ensuring they receive the best possible care.

Working with a PA

IS working with a PA the same as working with a resident/fellow?

Addressing the issue of unfamiliarity with PAs, the interviewer raised the analogy of working with a resident or a fellow who never leaves the rotation. Aurthi agreed that the comparison is valid, but she also offered a deeper insight into the role of PAs in the healthcare setting. "I think that comparison to residents that never leave is a good example or analogy," she began. "However, I always hear that PAs extend physician services."

Though not identical in title, PAs fulfill a versatile role in filling various aspects of patient care, reflecting the competency and expertise they bring to the healthcare team.

“The PA's scope of practice usually mirrors that of their supervising physician in the emergency department," she clarified. Depending on the physician and the specific needs of the day, PAs might find themselves engaging in a diverse array of tasks and responsibilities.

Aurthi narrated a typical day when her role as a PA encompassed multiple facets of patient care. "From 6:00 PM to about 11:00 PM, I'll be seeing patients, reviewing the patient cases, and then making sure their investigations are there, following up on that, and then management options and discharge," she described.

The PA/MD Relationship in the ED

Aurthi illuminated the harmonious relationship between PAs and supervising physicians in the emergency department. She acknowledged the well-established peer role that PAs have assumed over the years. The dynamics of the PA-MD relationship are characterized by trust, collaboration, and a growing level of autonomy.

The level of guidance and autonomy depends on the supervising physician and the PA's experience. Initially, there is more guidance as PAs familiarize themselves with the physician's preferences and gain their trust. Aurthi explained, "When you start off, there's a bit more guidance in terms of learning their preferences, but also gaining that trust with that supervising physician."

As PAs gain experience and demonstrate their thought process in patient care, they earn more autonomy in their practice.

Aurthi highlighted how this progression varies based on individual physician preferences and the nature of the cases they handle. For example, when Aurthi began suturing patients, she would ask the physician to check her work to ensure their satisfaction. However, as her skills and trustworthiness grew, she found herself performing certain tasks independently, such as providing discharge instructions and starting patient orders under the physician's supervision.

Working with a multitude of physicians has its challenges, but it also presents valuable learning opportunities. Aurthi expressed, "There's the opportunity to learn, but there's also this other side to it where you have to keep adapting based on their preferences and depending on who you're presenting to, kind of tweaking what you would propose as the next steps." This adaptability allows PAs to accommodate different physician styles and facilitates effective collaboration.

As PAs gain experience and develop their own preferences, their contributions to patient care evolve. Aurthi's mentor once advised her on this aspect, encouraging her to develop her approach to proposing next steps during patient consultations. "You'll learn the physician's preference, but then you start figuring out what your preferences are when you propose," Aurthi shared, highlighting the importance of sparking discussions and fostering a productive exchange of ideas with supervising physicians.

The PA-MD relationship in the emergency department is characterized by mutual respect, open communication, and a commitment to providing the best possible care for patients.

Aurthi’s Tips for PA Students on Excelling on their Emergency medicine rotation

The emergency medicine rotation can be both exhilarating and daunting for PA students. To help future PAs excel during this crucial stage of training, we sat down with Aurthi, an experienced emergency medicine physician assistant, to glean insights and advice. We have combined direct quotes from the interview with narrative to offer a comprehensive guide on thriving in emergency medicine rotations.

1. Embrace Challenges and Seek New Experiences

"Going in with an open mind and trying to always challenge yourself," Aurthi advised, emphasizing the importance of venturing beyond one's comfort zone.

Rather than choosing familiar cases, she encourages PA students to opt for challenging cases that offer new exposure and learning opportunities. By embracing challenges, students can gain invaluable experience that will prepare them for future endeavors.

2. Learn from Preceptors and Observe the Dynamic Team

Aurthi highlighted the significance of learning from preceptors, both PA and MD, during the rotation. By observing different healthcare professionals, including nurses and clerks, PA students can grasp the dynamics of the emergency department and appreciate the collaborative team-based approach to patient care.

Understanding the roles of various team members will help PA students envision their future role within such a dynamic setting.

3. Expand Your Knowledge with Case Reading

To enrich their knowledge and toolbox, Aurthi suggested reading around cases encountered during the rotation. When a patient case stands out, PA students should delve deeper into the details, exploring the patient's presentation, potential differentials, and proposed next steps. This continuous learning approach equips students to tackle similar cases with confidence and adaptability.

4. Prepare Strategically for End-of-Rotation Exams

To excel in end-of-rotation exams, Aurthi shared her own preparation strategy. She recommended reading exam blueprints to gain insight into the test structure. Making notes of encountered patient cases and practicing with clinical vignettes can sharpen students' testing skills and bolster their confidence in tackling exam questions.

5. Leverage Valuable Resources for Your First Year of Practice

As a new practitioner in the emergency department, Aurthi found certain resources to be indispensable. Among them, "UpToDate" emerged as a go-to platform for evidence-based medicine guidelines and patient education materials.

Additionally, Aurthi recommended "EM:RAP" for continuing medical education credits and staying updated with the latest developments in emergency medicine. However, she emphasized the immeasurable value of learning from experienced supervising physicians and colleagues who are eager to share their expertise.

Tips for the PA Job Hunt for New Grads

As PA students prepare to embark on their professional journey, the prospect of seeking employment can feel both exciting and overwhelming. Aurthi shared a few tips on navigating this journey:

1. Embrace Self-Reflection for Career Clarity

Aurthi emphasizes the importance of self-reflection when approaching the job search. Taking the time to consider where one sees themselves in the future, which specialties intrigue them, and the type of work environment they desire is crucial. Whether it's a clinic setting with a smaller team or a bustling hospital with a larger group, each preference influences the ideal career path.

2. Keep Options Open and Be Open-Minded

During the job search, Aurthi encourages PA students to keep their options open. Applying to various positions, even those that might not have been initially considered, can lead to unexpected opportunities. Aurthi's decision to explore both family medicine and emergency medicine allowed her to gain a well-rounded foundation, proving the value of keeping an open mind.

3. A Promising Job Market for PAs

Reflecting on her own experience, Aurthi notes that the job market for new PA graduates is currently favorable. She believes there are more job opportunities than there are PAs, attributing this trend partly to the profession's significant impact during the pandemic. PAs have proven their value in patient care, prompting supervising physicians to embrace the role and seek PAs to share the workload and prevent burnout.

4. Advocacy and Trailblazing Opportunities

Aurthi's optimism extends to the future of PAs, assuring PA students that employment opportunities are promising. She encourages aspiring PAs not to shy away from creating their own opportunities if none are readily available. PAs have demonstrated their ability to pave the way for new roles in patient care, and mentorship from experienced trailblazers can guide future generations in shaping their own career paths.

A Gratifying Journey: Embracing the PA profession

As Aurthi reflects on her decision to become a PA, her satisfaction and gratitude shine through. The PA profession has exceeded her expectations, offering a rewarding and fulfilling path in healthcare. "It sounds too good to be true," she admits, "but it really is very, very rewarding."

Witnessing the growth of the PA profession in Canada fills Aurthi with pride. From her early days as a Pre-PA and PA student, to becoming a practicing PA, she has seen the profession flourish, attracting more passionate individuals eager to join the community. The potential for the PA profession is vast, and Aurthi feels fortunate to contribute to it.

When asked about the specific aspects of her job that bring her joy, Aurthi eagerly shares her enthusiasm for collaboration. As a PA, she has the opportunity to work closely with MD colleagues and other PAs, fostering a dynamic environment of learning and skill-building. "You can always find ways to contribute," she emphasizes, likening the PA profession to an ever-expanding toolbox.

One of the most rewarding aspects of being a PA is the chance to interact with patients, to hear their stories, and make meaningful connections. Aurthi recalls a recent experience suturing a laceration in a senior patient. Amidst the procedure, the patient shared a heartwarming tale of meeting her husband, who was present during the patient visit. Such moments of human connection make Aurthi's work as a PA deeply fulfilling.

In her role, Aurthi also finds gratification in practicing preventative medicine, a passion she held dear even as a pre-PA. Counseling patients on healthy habits and preventive measures allows her to make a positive impact on their lives.

Final notes

Aurthi's journey as a Physician Assistant (PA) in the emergency department is a testament to the immense possibilities and rewards that the PA profession offers. From her early days as a PA student, she embraced the challenges and opportunities with an open mind, constantly seeking to expand her knowledge and skills. Through a collaborative approach, Aurthi found her place within a supportive team of healthcare professionals, learning from experienced physicians and PAs alike. Her dedication to patient care, passion for preventative medicine, and genuine connection with patients have made her a valued asset in the healthcare community.

As the PA profession continues to grow and gain recognition in Canada, Aurthi's experience serves as an inspiring example for aspiring PAs and those considering this career path. Her advice on self-reflection, keeping options open, and continuously learning from experiences resonates with anyone navigating the path to becoming a PA.