Kristen, Alberta Neurosurgery PA

Kirsten Luomala is a former military Physician Assistant who transitioned to civilian life and started working as a Physician Assistant in Neurosurgery in Alberta.

From Military to Civilian PA

My Time as a Military PA

I wound up doing clinical medicine for one year, and during that year I was tasked to back at medical school in Borden, Ontario to help teach in various medical courses. One year after graduation, I taught at the PA program in the military. So I taught a total of 3 years between medical technicians and the PAs. And then I took a transfer for Edmonton for my last two years and deployed overseas during that time.

We had a double role in the military at that point in time. We were also senior medical personnel within the rank structure. We were not just doing medicine, we were doing a lot of administrative work. This has changed,  instead of warrant officer, they are now commissioned officers from the Queen. This is part of the process that will change what the dynamics are. The problem with the PA program in the military, is that in order to reach certain ranks, you had no choice to but to become a PA. Some people wanted to advance to those ranks, but not work as a PA. This change was part of our process to develop the PA profession through the military.

PAs now take more of an officer role. In the past it would be the warrant officer would help mentor a Captain. Now the captains will have non-PAs to help mentor them. Right now most military PAs  have been in the military for  10+ years . In the future you will see direct entry PAs being allowed in, this is a way that will allow us to further expand our PAs in the military.

This may happen at some point in the future, however there are a few steps the military will have to taken first. Part of the PA program in the military is specific to military that civilians don’t get. There will have to be a bridging program. When we are stationed on the ships, the North Pole you are the senior medical person on those places and in fact, I did seven months at Canadian Forces Station Alert during my time in between teaching for school, I had to do 4 emergency dental fillings up there. You aren’t going to send someone down on a flight just to do those fillings.

Leaving the Military and Choosing Civilian PA Practice

I was at a crossroads in which I had to make a decision. I was facing a promotion that would not allow me to continue on doing a lot of clinical work, there was going to be more administration. I have some children that are in their later years of schooling, and I was not willing to move them again. It was time to either find a civilian job or stay in the military for another 15 years at that point in time. I was fortunate enough to find a civilian job.

Alberta PA Demonstration Project

I am one of the last bearers of the Alberta PA Demonstration Project. When they were initiating starting the project, there were some positions that were not filled. So they reallocated the funds to other departments, and fortunately the department that hired me was able to scoop up the last of the funding.

When leaving the military, I knew I wanted to go into a surgical specialty. I was really looking at General Surgery or Orthopaedic Surgery. Unfortunately, because my husband is retired, I was not willing to leave the military and take a risk not getting a job – I was not retiring until I had a job.

I did not get the other two positions I applied for. However, I was called over the Christmas holidays and was told that Neurosurgery was looking for PA, however had no funding at the time. They wanted to have a meeting and I agreed to speak with the Neurosurgery department.  I forwarded on my resume and I received a call back to meet.

They told me the head of the department and it happened to the physician who saved my middle daughters’ life in 2003. When he saw the resume he did not make the connection until we met for the interview. So they went in, did an interview, and we discussed how PAs could potentially benefit the department. The next morning, the Neurosurgery department learned that they were approved for funding from the demonstration project and I was offered a position.

The physician did train in the US and had dealt with PAs down there. He had been advocating to get PAs here in Alberta for a significant amount of time. Some of the partners in our department have also trained in the US and seen some successes down there. They were quite interested in having a PA.

Working in Neurosurgery

Adding a PA to Neurosurgery

The first couple of months were challenging, partially because the residents I was working with had never worked with a PA. None of them had trained in the US, so they did not know what PAs were about. The Alberta PA demonstration project had done a lot of leg work in  educating the nurses and the physicians in what to what we could and could not do. And then there was the big, steep learning curve of Neurosurgery. Their attitude was ‘this was going to work’, and they were going to make it work. This particular department already had an IMG as  a hospitalist. They also had a Nurse Practitioner prior to me and found with those two individuals it had not worked. They needed somebody, but they were not sure how it was going to fit in. They were very determined to find solutions to make this a successful endeavour.

PA Training in Neurosurgery

I spent the first month working alongside the physicians majority of the time. After which I was slowly integrated in with the residents. I would join them on morning rounds and get to see all the patients. I would shadow the chief resident and one of the senior residents on consults. I shadowed in the OR and learning some of the skills they needed me to have.

Over time I managed to realize there was a big void that I could fill as a PA in the Neurosurgery service. A lot of resident time is dedicated to learning skills in the operating room, however they needed someone to help cover the inpatient wards. This was a role I could fill.

In Neurosurgery, we  treat patients that may not have great outcomes, and also educate and counsel patients of the family. Their loved one may have Glioblastoma, Gord Downie tumour where the life expectancy is very poor, or they’ve had a devastating trauma that has left their 20-year-old confined to a wheelchair and mentally incapacitated. We spend a lot of time with the families to help guide them through the time next steps are going to be. I spend 20% of my time counselling these families.

The majority of my time is spent on the wards. I have probably 30-50 patients at a time depending on the time of the year, the workload and how many staff are around. I spend the majority of my time performing general hospitalist duties. I do first-assist in the operating room when we are short residents. This can be one day a week, or two days a week depending on the load for what residents. Consults are only on Fridays since that is the academic day with residents. I spend the rest of the time studying, reading and keeping up my medical knowledge.

Neurosurgery Procedures

Procedures I perform include majority of the drains, removing of drains whether it be for back, or external ventricular drains, lumbar drains, subdural drains. I am in the process of learning how to put in EVD and I’m learning how to do lumbar drains which is a huge part of what we do. We are one of the few Neuro units with its one ICU. We have our own intensivist that run our ICU. We are starting to transition to learn how to do central lines and ART lines that are required.

Benefits of Adding a PA

Very similar to the study that was done, by I believe, the Sunnybrook Surgery team, there are fewer surgeries being cancelled, because I am able to free up the beds earlier in the day. There are faster discharges.

We’ve seen a decrease in the amount of complaints coming in from the families, just because there has been somebody that has been able to sit down and talk with the families and guide them through the process.

The overall coverage of inpatient/ward, the nurses are finding that demands are met easier because you are somebody that is able to get onto the wards way sooner than the residents can.

Benefits and Challenges of working in Neurosurgery

In Neurosurgery, the job is stressful because you do not get very many good outcomes. Most of our cases include patients dying of brain tumors, or suffering from traumas. When we get those nice ‘walk out of the hospital’ cases – we really hold on to those.

The most fulfilling part about this position is really the team that I work with. I work for 12 Neurosurgeons, three of whom are Paediatric Neurosurgeons. I do not do Paediatric Neurosurgery, but the Paediatric surgeons do  adult procedures. They are an extremely supportive, close-knit great group of surgeons. The nurses, social workers, our nurses aids, and unit clerks are a phenomenal team. Everybody has everyone’s back. I found that the transition from going from a team in the military, to a team in the civilian has made that transition easier.

Work Life Balance

Anyone who is interested in any of the professions involve working with patients with certain outcomes (e.g. palliative care, oncology, neurosurgery) or even just working in Paediatrics – just because the nature of them can be quite stressful. You need to find a way to disconnect from work. This could be throwing yourself into your family, or family activities. It could be just taking an hour to unwind (e.g. have a bath, glass of wine, go for a run). It’s being able to turn off your brain, and realizing that ‘I am not at the hospital, I’m not talking about the hospital’. When it is weighing too much, you just find the people to talk to.

Living Across Canada

I’m originally from British Columbia, and have lived in one end of the country to the other because of my military career.  We chose to come back to Alberta because of the health care support it offers our one child.

Physician Assistants in Alberta

PAs in Alberta

The environment in Alberta has been very welcoming with the introduction of PAs. Initially there may have been some resistance from people who did not know what we did. There’s been a lot of advocacy, talking to people explaining what we do. In fact, I have just been invited my third conference to speak to another group of nurses to speak about PAs. The word is getting out there that we are here, we are tool that is to be able to be used, and so I think its been very welcoming for the most part.

There is not a big supply of PAs in Alberta. Some PAs we are getting are from Manitoba and Ontario. Our supply will increase when and if they open up a school here in Alberta – that has not been finalized. The interest is there. I’ve had a few pre-PAs get a hold of me to shadow me at work, to find out what the profession is. I get a lot of questions from nurses who are interested in eventually becoming PAs. The interest is there, its just a matter of getting to a point where we have a school here.

PA regulation in Alberta

The regulation piece has been approved in legislation, that was an easy sell. What we are waiting for now is all of the policies to be finalized by the interest parties (e.g. Medical Association of Alberta, Nurses, Pharmacists) to have a look at it, and have it go back to parliament for finalization. We are expecting that to be finalized this year.

PA Advocacy

I would like to be involved more in PA Advocacy. I think its just finding those opportunities to actually get out there and talk to people. I believe the more we educate people, the more we educate our patients, other medical staff – the more we can advocate for ourselves. There hasn’t been much work in advocacy in Alberta, but I’m often speaking with my friends who still live out in BC and encouraging them to go out to their MLAs to fight for PAs. Because I think we have a lot to offer across the country.