Adam, Manitoba General Surgery PA
Adam Grycko is a Canadian Certified Physician Assistant, and graduate from Manitoba’s Masters of PA Studies Program. He works as a General Surgery PA in Winnipeg, Manitoba.
Before Pursuing PA, Adam discovered a passion for healthcare
Adam's story begins in the tranquil town of St. Francis Xavier, nestled west of Winnipeg. Despite not having any familial ties to the healthcare industry, he was drawn to the world of health sciences from an early age.
Moving to the city for his university years, Adam faced a challenging first year that served as a reality check. Nevertheless, he didn't let the setback deter him from pursuing his dreams. Taking a courageous step, he enrolled in a practical nursing program, which opened up new doors in the healthcare system.
As Adam recalls, "I was a licensed practical nurse, and it was a great exposure to the healthcare system. It reaffirmed why I was pursuing a career in health sciences."
His passion for patient care and thirst for knowledge led him to complete his nursing degree, leading to a fulfilling career as a nurse. Over the years, he gained invaluable experience in various specialties, including dialysis, critical care, and nephrology nursing.
The Quest for Change and Exploration
After a fulfilling tenure as a nurse, Adam found himself yearning for something new, a different perspective within the healthcare field. His insatiable appetite for learning and personal growth motivated him to explore alternative pathways.
It was then that he stumbled upon the Physician Assistant curriculum.
"I wanted to explore a different model, and the big draw was the medical model versus the nursing caring model," he explained. This pursuit of change stemmed from his desire to experience a fresh approach to patient care and gain a diverse perspective of the healthcare system.
The Journey to Becoming a PA
Adam's introduction to the world of PAs came when he joined the Health Sciences Center as a nurse.
He encountered Ian Jones, a pioneer of the Physician Assistant program and a neurosurgery PA. Observing the crucial role PAs played in bridging the gap between medicine and nursing, Adam was intrigued.
He remarked, "I was introduced very early on to a neurosurgery PA who is the program director for our school. I became very interested in that and thought, 'Wow, this is a great model that kind ofnmedicine and nursing.'"
This firsthand exposure to the impact of PAs in surgical subspecialties, coupled with his background as a nurse, solidified his decision to pursue a career as a PA. Adam recognized the potential to retain his bedside skills while also enjoying more variety and mobility in his professional journey.
Challenging Beginnings in 1st year of PA school
Adam's journey into the world of PA school was met with overwhelming excitement and anticipation. With nearly a decade of nursing experience under his belt, he entered the program with a determined attitude, aiming to refine his skill set and specialize further. "I wanted to consolidate and really specialize," he expressed, acknowledging the valuable expertise he could gain from the PA curriculum.
“Like Drinking from a Fire House”
As the first year of PA school unfolded, Adam found himself confronted with the intensity of the program. The pace was relentless, akin to "drinking from a fire hose," a vivid description of the rapid and condensed nature of the medical curriculum. Despite his extensive nursing background, he was pleasantly surprised by how much more he learned throughout the year.
"The content is so fast-paced, condensed medicine in one year of didactic experience," he explained. However, the challenge extended beyond the academic sphere. Attempting to balance work commitments alongside the rigorous demands of the program proved to be more daunting than expected.
A Shift in Focus
Initially, Adam had hoped to work part-time while pursuing his PA education, intending to support his studies financially. However, the demanding nature of the curriculum quickly prompted him to shift his focus entirely to the program. Relinquishing work became a necessary decision to fully immerse himself in his studies.
"With the fast-paced curriculum, it was easy to relinquish work and just fully focus on the program," he confessed. Despite the adjustments, he found immense personal fulfillment in being part of a cohesive group of students who shared a passion for healthcare and learning.
A Supportive Learning Environment
Amidst the challenges and demanding workload, Adam found solace in the camaraderie and support within his cohort. The synergy among the students made the experience all the more enjoyable and fulfilling. "We all really complimented each other very well. It was a great experience just being in that group," he reminisced.
The Rigors and Rewards of 2nd year PA School
As he progressed into the second year of the program, the workload increased exponentially. Now in clinical rotations, Adam was essentially juggling a job while still being a student. He described the complexity of managing obligations, including preparing for exams, working on a capstone project, and engaging in various specialties.
"In year two, it's a lot of juggling," he revealed. "You're expected to present and lecture to other medical learners, whether it's med students, other PA students, nursing students. It's really challenging, but it is a lot of fun."
Exploring Core Rotations
During the second year, Adam's training expanded beyond the classroom, as he was immersed in a series of core rotations. The Manitoba PA program had a particular emphasis on getting PAs involved in primary care, and as such, Adam's main rotations included family medicine, internal medicine, and obstetrics and gynecology.
However, Adam had a special affinity for surgery, given his nursing background. Thus, he opted for core electives in surgical subspecialties. He gained invaluable experience in rotations such as cardiac sciences, general surgery (his current field), and infectious diseases, which proved to be incredibly useful in consolidating his knowledge and honing his clinical skills.
Urban vs. Rural Clinical Rotations
The PA program in Manitoba offered both urban and rural placements, allowing students to gain exposure to different medical settings. While Adam mainly stayed in Winnipeg, he took the opportunity to experience rural medicine as well.
He spent time in Portage la Prairie, a town that offered a different perspective on medical practice compared to tertiary care facilities.
Some of his peers explored even more remote locations, with placements stretching as far as Churchill.
Adam acknowledged that being proactive and seeking out opportunities was essential, especially in the early stages of the PA profession, where showcasing what PAs can do could open doors for others in the province and beyond.
Securing Employment as a PA in Manitoba
Adam’s graduating PA class was presented with a list of potential positions that were protected for newer graduates once they completed the PA program. However, he pointed out that many of his fellow students took a proactive approach, advocating for themselves and the profession. This proactive mindset led some graduates to create their own positions, an impressive feat that showcases the dedication and determination of PAs.
"I see a lot of PAs doing that now. Advocated for it," Adam noted, emphasizing how these trailblazing PAs identified gaps in the healthcare system and actively pursued opportunities in specialized areas.
Crafting a Career in Surgery
Adam considered himself fortunate to have found numerous surgery positions available at the Health Sciences Center, a place that felt like home to him. He highlighted the robust and well-demonstrated models in surgical subspecialties, where PAs play a crucial role in assisting surgeons during procedures. The demand for PAs in surgery was evident, presenting him with a range of locations to interview for and choose from.
However, he also recognized that the job landscape has evolved since his graduation, with funding model issues and regulations impacting job opportunities in some provinces. Despite these challenges, Adam remained optimistic, urging aspiring PAs to be resilient and persistent in their pursuit of their desired career paths.
The Power of Advocacy and Carving a Niche
Drawing from his experience, Adam encouraged aspiring PAs to be proactive in advocating for themselves and the profession as a whole. He emphasized that carving out a niche for oneself in a specialized area is possible with determination and dedication. By showcasing their abilities, volunteering, and demonstrating their potential, PAs can create awareness of the profession's value and potential.
"The take-home message is if you have an interest in a certain area and that's what you want to do, go for it. Push forward, advocate for yourself, advocate for the profession, and try to carve out a little niche for yourself and for the future of the profession," Adam asserted.
Pioneering a PA Role in General Surgery
Adam found his professional home at the Health Sciences Center, a renowned tertiary care facility in Winnipeg, Manitoba. The center offers specialized services across various fields, from neurological surgery to surgical subspecialties and specialized medicine.
Within this dynamic setting, Adam's role as a PA was centered in the Department of Surgery, specifically focusing on two subspecialties: surgical oncology and hepatic pancreatic biliary (HPB) surgery.
As a key member of the surgical team, Adam's expertise spanned diverse areas within surgical oncology. He dedicated himself to diagnosing and treating GI malignancies, such as gastric and colon cancer, as well as breast health, with a focus on breast cancers and melanoma clinics.
In addition to surgical oncology, Adam played a crucial role in HPB surgery, where he and other PAs rotated between the two services every three months. This approach allowed them to maintain their skill sets across both specialties, ensuring a high level of proficiency and adaptability.
Pioneering a New Path
Upon joining the general surgery program, Adam and his fellow PAs faced the unique challenge of breaking new ground in their roles. The program had little prior experience with PAs, and the role was not as well-defined as it would become over time. This presented an opportunity for Adam to shape his own path within the department.
Recalling his first day on the job, Adam shared how he and his attending had a candid conversation about the role he envisioned for himself. This initial discussion set the tone for a dynamic and evolving position, with Adam realizing that he could carve out a niche that aligned with his interests and expertise.
"It's an odd way to start a new job, but in retrospect, it's a great opportunity to build that job around what I wanted to do," he reflected. Over time, as Adam demonstrated his competencies and developed his skill set, his role within the surgical team expanded, encompassing a diverse range of responsibilities and procedures.
Learning on the Go
With limited prior shadowing or formal orientation, Adam hit the ground running, delving into patient care and multidisciplinary collaboration from day one. Relying on his experience as a nurse, he quickly built strong relationships with the nursing crew and other team members. This collaborative approach allowed him to learn from and contribute to various aspects of patient care, including ward management and system efficiencies.
As he navigated his new role, Adam actively sought out opportunities to collaborate with other team members, advocating for himself while also raising awareness about the role of PAs. By blending his skills and expertise with the existing healthcare ecosystem, he discovered new ways to complement and enhance patient care.
A Typical Day in the Life of a Surgery PA
As a surgical PA at the Health Sciences Center, Adam's week is a dynamic blend of diverse experiences, shaped by the specific service he is assigned to. He cautions that the life of a PA varies widely, with each professional tailoring their role based on their interests and the demands of their respective teams.
Adam's typical day begins with rounding on patients as part of a collaborative team effort. The number of patients can range from three to as many as 20, with an average of around 12. Following rounds, the team strategizes to allocate their resources, including PA students, med students, and residents, to manage the day's cases.
A Day on the Ward
On days when Adam is stationed on the ward, his responsibilities involve conducting a second set of rounds, arranging diagnostics and minor procedures, handling unpredictable situations, and responding to consults. He emphasizes the importance of territoriality during ward days, ensuring he is aware of the patient's status across the facility, including any potential bounce backs from the emergency room.
A Day in the Clinic
Another aspect of Adam's role involves clinic days, where he juggles ward duties while also attending to a busy clinic schedule. In specialized surgical subspecialty clinics such as melanoma or breast health, patient assessments are intricate and detailed. Collaborating with the team, they devise comprehensive plans tailored to each patient's needs.
The Thrills of Surgery
Working in surgical subspecialties, Adam encounters a variety of conditions specific to each service. He highlights that the bulk of his practice revolves around GI malignancies, such as bowel tumors and gastric cancer. These cases are often elective, involving a thorough workup and planning, including collaboration with medical oncology and radiation oncology teams.
However, what Adam finds truly captivating are the more intricate and less recognized procedures, such as liver surgeries and the Whipple procedure for pancreatic cancer. These cases require a high level of expertise and skill, and they hold an immense fascination for him. Additionally, the introduction of innovative treatments like heated intraperitoneal chemotherapy (PEC) presents unique challenges and rewards as he continues to learn and grow in his profession.
First Assist: Empowering Learning and Skill-Building: Aspiring surgical PAs often wonder about their role in the operating room and the extent of their involvement. Adam explains that when he enters the OR, he assumes the role of a first assist, working directly alongside the attending surgeon. Being a first assist is a rewarding experience as it allows him to be more actively involved in the procedures. The surgeons value his opinions and legitimate inputs during the precision, presenting a fantastic learning opportunity for him.
From Retractors to Skill Mastery: Adam emphasizes the significance of each learning opportunity, even those that might seem less glamorous at first, such as holding a retractor. Standing in the operating room and observing surgeries provides invaluable lessons in anatomy and technique. As a surgical PA, continuous skill development is crucial, and seizing every chance to observe and learn leads to a comprehensive and well-rounded expertise.
Contributions in the OR: The Versatility of a PA: The extent of a PA's involvement in surgeries may vary based on the complexity of the case and the individual surgeon's preferences. Adam highlights that in his practice, he is actively engaged in both opening and closing cases, particularly those that are less complex. He shares how his contributions extend to tasks like placing drains and ensuring a smooth transition for the patient post-surgery.
A Team Effort to Enhance Efficiency: Working alongside the surgeons, Adam plays a vital role in supporting the team's efficiency. By assuming responsibilities typically handled by the attending, such as closing the wound and allowing the physician to move on to other patients or surgeries, Adam contributes to a more streamlined and effective process. Additionally, with med students present, he takes on the role of a mentor, guiding and educating them on essential aspects of surgery.
Performing Procedures as a Surgery PA
Outside the operating room, a surgical PA's skill set encompasses a diverse range of procedures, all of which are tailored to the specific needs of their service.
Adam shares some of the typical procedures he performs, including wide local excisions of dermatological lesions, paracentesis, NG tube and IV insertions, central line insertions, and wound management.
As a former nurse, Adam was already proficient in certain skills, but he vividly remembers the excitement and wonder of opening a wound for the first time—a pivotal moment that spurred his journey into mastering a wide array of perioperative tasks.
Learning by Doing: Traditional Approaches and Modern Responsibility
In the medical field, the traditional approach of "see one, do one, teach one" has been instrumental in the development of skills. However, Adam acknowledges that solely relying on this method may not be sufficient in the contemporary medical landscape.
He emphasizes the importance of not only knowing the steps of a procedure but also understanding how to respond in case something goes wrong. This responsibility goes hand in hand with ongoing professional development, continuing medical education (CME), and regular reading to stay updated on advancements in the field.
Exposure and Refinement: The Bridge Between Academic and Clinical Aspects:
For a surgical PA, exposure to a variety of cases is crucial for skill development and confidence building. Adam emphasizes the significance of "getting your numbers" by actively seeking opportunities to perform procedures under appropriate supervision.
Bridging the gap between academic knowledge and clinical expertise requires a deep understanding of potential complications and how to address them effectively. It's a continuous process of refinement that extends beyond the academic setting and into real-world experiences.
Continued Learning and a Supportive Team
A surgical PA's quest for excellence is a perpetual journey. The thirst for knowledge should persist beyond graduation, with a commitment to ongoing learning and self-improvement.
Adam credits his supportive team for enabling an environment where he can openly discuss and seek guidance on new procedures and potential complications. This supportive network fosters a culture of continuous learning and enables surgical PAs to grow and flourish in their roles.
What to Expect when working with a PA
Patient Interaction: Providing Holisitic Care
For Adam, patient interaction is a cherished aspect of his role as a surgical PA.
“I love working on the ward. If a patient has an issue, I can walk into the room. I try to be seen by patients as much as possible. I try to interact with staff and come up with plans with the nursing staff on the ward."
He actively engages with patients during his rounds, making sure they feel cared for and supported throughout their journey to recovery.
Taking the time to talk to patients not only fosters a strong sense of trust and comfort but also allows Adam to gain valuable insights into their experiences, which in turn informs his approach to clinic-based medicine.
Collaboration with Nursing and Allied Health: Leveraging Resources
Adam highlights the essential role of nursing and allied health professionals at the health sciences center. Collaborating with them has been instrumental in providing efficient and effective patient care. Adam acknowledges that while he is fortunate to work in an environment with ample support, building strong relationships with the entire multidisciplinary team is crucial in any healthcare setting. Utilizing the expertise of pharmacists, nurses, and other allied health professionals has proven indispensable for Adam in delivering comprehensive care to his patients.
The PA-MD Relationship: Professionalism and Autonomy
Navigating the PA-MD relationship requires professionalism and clear communication. Adam shares that he finds it easy to approach his attending physicians with questions or concerns, and they are readily available to address any issues that arise. Over time, Adam has gained a high level of autonomy, enabling him to independently initiate diagnostics and conduct procedures when appropriate. He values transparency and always ensures that he discusses patient-related matters with the attending physicians during their rounds to facilitate open dialogue and foster a supportive team environment.
Autonomy with Responsibility: Striking the Right Balance
While enjoying the level of autonomy he has achieved in his clinical role, Adam emphasizes the importance of responsible decision-making and seeking guidance when needed.
"I autonomously initiate diagnostics, conduct procedures without necessarily consulting in advance with my attending. That evolves over time when you are comfortable with your skill set and know the expectation.
He advocates for continuously asking questions, especially in complex or uncertain situations, to ensure the best possible outcomes for patients. Ultimately, his autonomy is complemented by a strong commitment to collaboration and communication with the attending physicians, a dynamic that allows for an optimal patient care experience.
The Impact of Adding PAs to Surgery Service
Shortened Discharge Time and Fewer Complaints
Adam shares some of the positive feedback he has received from nursing staff, who highlight that having PAs on the team has shortened the time to discharge for patients. The presence of PAs ensures that patients are not left waiting for residents or physicians, especially during times when other services are not available. Additionally, Adam mentions that patient complaints from wards where PAs work seem to have decreased, as shared by patient advocates. While he admits he hasn't seen the data himself, the feedback suggests that the presence of PAs positively impacts the patient experience.
An Asset to the Multidisciplinary Team
The biggest piece of feedback Adam receives from the multidisciplinary team is that having PAs as part of the team is an invaluable asset. PAs, with their clinical expertise and availability, play a vital role in managing patients perioperatively and facilitating their transition home or to other facilities as needed. Their presence ensures that essential procedures, paperwork, and patient care aspects are efficiently managed, making them an indispensable resource in the healthcare setting.
The Call for Further Research and Recognition
Despite the positive feedback, Adam emphasizes the need for more rigorous studies to quantify the impact of PAs on healthcare outcomes.
He states, "I would really like to see this studied and scrutinized a little bit more and getting some data on it so that we can truly show our worth. Especially in a time when there are a lot of healthcare cuts and reshaping of the healthcare system, especially in Manitoba."
Adam's call for comprehensive research highlights the importance of recognizing and acknowledging the valuable contributions PAs make to patient care and the healthcare system as a whole.
Reflecting on the Decision to become a PA
"Being a PA is the best job I've ever had"
Reflecting on the pivotal moment when he had to choose his educational path, he shares, "I wanted something that I wasn't forfeiting previous skills that I had developed. I wanted the patient interaction aspect, and I wanted portability of my job as well, which is important."
Opting for the PA profession allowed him to build upon his nursing experience and embrace a diverse range of opportunities in the medical field.
The Joy of Versatility: Exploring Different Specialties
One of the aspects that Adam truly cherishes about being a PA is the ability to explore diverse specialties. He explains, "What I love about being a PA is the variety. My ability to dedicate 5, 10 years of my life in a surgical subspecialty, and then maybe even moving on to something else, and just learning something different in medicine perhaps, or going into dermatology."
Unlike physicians, PAs have the freedom to transition between specialties without the need for additional lengthy residencies, providing them with a continuous journey of learning and growth.
Embracing variety not only enriches Adam's career but also enhances the care he provides to patients. The diverse exposure to different medical fields allows him to draw upon a wide array of experiences and knowledge when treating patients.
As a PA, Adam's journey is not confined to a single path; instead, it is an evolving adventure with limitless possibilities for growth and development.
Final Notes
Adam’s journey to becoming a PA in Surgery exemplifies the vast opportunities and versatility PAs can embrace in their careers. PAs can immerse themselves in diverse specialties, learn from various medical teams, and continuously expand their skillsets.
The autonomy and variety of experiences offered by the profession make it a rewarding path for those seeking a dynamic role in healthcare. The ongoing evolution of the healthcare landscape underscores the importance of understanding and documenting the impact of PAs on patient outcomes and system efficiency, which will further solidify their position as key contributors to high-quality healthcare delivery.
With recognition and support, PAs have the potential to shape the future of medicine, enhancing patient care and elevating the standard of healthcare services across Canada.
