Episode #19: Maggie, PA in Physiatry
“As a physician assistant, you’re rarely stagnant. You’re always looking at improving the patient experience, improving the efficiency of clinic, and how to continue to grow in your role.”
Maggie is a PA practicing physiatry in Hamilton. She divides her time between an outpatient MSK clinic and a spinal cord injury unit. After graduating from McMaster with a background in kinesiology, she secured her first position by building professional relationships during her clinical electives.
Physiatry focuses on the intersection of musculoskeletal medicine and neurology. In this role, Maggie performs ultrasound-guided injections and manages Botox treatments for spasticity. Her daily responsibilities also include conducting new consults, seeing follow-up patients, and completing medical documentation.
The transition into a specialized field required a significant learning curve. To manage this, Maggie spent her first six months working closely with her supervising physician. They debriefed after clinics and she observed his appointments to understand the clinical reasoning behind his decisions.
Maggie also addresses common misconceptions about the profession. She views being a PA as a distinct career choice rather than a backup for medical school. For those interested in physiatry, she suggests completing an elective and speaking directly with clinicians in the field.
WHAT YOU’LL LEARNHow to use clinical placements to secure a job
The daily responsibilities of a PA in physiatry
How to navigate the learning curve of a specialized role
The professional distinction between a PA and a physician
GUEST BIOMaggie is a certified physician assistant practicing in Hamilton, Ontario, where she works alongside a physiatrist at Hamilton General and McMaster in a busy outpatient MSK and spasticity clinic. She completed her Bachelor of Science in Kinesiology at McMaster, spent a gap year in multiple sclerosis research, and entered the McMaster PA Program in 2015 after a chance encounter with a practicing PA changed the direction of her career entirely.
During her training, Maggie completed clinical rotations across Hamilton, Toronto, Cambridge, Whitby, and an international elective in India, building a broad clinical foundation before narrowing her focus. A longitudinal placement and elective at Hamilton's Regional Rehab Centre where she worked with seven physiatrists across spinal cord injury, brain injury, amputee care, and sports medicine, with this leading to her first job offer.
Now two years into her role, Maggie has built out a clinical scope that includes ultrasound-guided injections, spasticity management with Botox, new consults, follow-ups, medical directives, and disability documentation. She precepts PA students, is working toward quality improvement research on PA integration in physiatry, and continues to expand her skills through specialty conferences including CAPM&R and ultrasound-guided MSK intervention courses.
ON WHAT PAs CAN OFFER WORKING IN PHSYAITRY“I think that’s really what a PA can offer is efficiency within the clinical role. We have changed the way that clinics have ran since I’ve started. Whether that’s changing the length of appointments or the number of patients that are being seen in a day or the type of patients that are being seen to allow the clinic to run a little bit smoother and allow my supervising physician to do the work that needs to be done during the day and not have to stay late afterwards.”
— Maggie Hitchon, CCPA, PA in Physiatry
ON PBL & LEARNING“The first couple of months were very difficult. But once you figured out how to do that, it was exponentially better than a typical didactic lecture-style education.”
— Maggie Hitchon, CCPA, PA in Physiatry
ON ADVICE FOR PA STUDENTS“I always recommend Physiatry as a placement, whether it’s a half day or a full elective to any PA’s that are interested in Family Medicine, Emergency Medicine, Orthopaedic Surgery, Neurology, because we really see it all.”
— Maggie Hitchon, CCPA, PA in Physiatry
ON THE PA/MD RELATIONSHIP“Having a physician assistant in your practice is much like having a permanent resident- except we stay, and we mould our practice specifically to the clinic's needs”
— Maggie Hitchon, CCPA, PA in Physiatry
ON BENEFITS OF ADDING A PA“I do a number of different roles within our clinic, whether that’s procedural, whether that seeing new consults, seeing followups, and that’s able to offload the pressure on my supervising physician.
We work very well as a team (PA and MD). We look at our day and say, “Where can we or what can we accomplish in this day and how can we make it beneficial for, for both of us for time management and efficiency?”
— Maggie Hitchon, CCPA, PA in Physiatry
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Maggie's Background and Path to Becoming a PA
Maggie [0:00] I'm a physician assistant. I currently practice in Hamilton. I work in physiatry with one supervising physician in quite a busy physiatry practice, both at the Hamilton General and at McMaster.
Maggie [0:16] I did my undergraduate education at McMaster in kinesiology — a four-year Bachelor of Science. After that I took a gap year and worked in research focusing on multiple sclerosis and physical activity. That was when I figured out what I wanted to do with my career. After that year of research, I applied to the PA program and started my journey in 2015.
Interviewer [0:38] Were you contemplating other careers at the time?
Maggie [0:41] Since a very young age I knew I wanted to be in medicine — I just didn't know in what capacity. Doing kinesiology was natural for me. I had a background in sports and physical activity and was very interested in that kind of profession. After kinesiology there are a few paths: chiropractic care, physiotherapy, occupational therapy, working as a kinesiologist, medical school, and a couple of others. I always thought I was going to go to medical school, so I wrote the MCAT and applied a couple of times — until I found out about the PA program. It was during that gap year that I met a PA, was able to shadow her, and thought, wow, this career is really excellent, and I think it's something I'm quite well suited to. That's what led me to the profession, and I'm so happy I ended up here.
Interviewer [1:37] What was your experience like in PA school?
Maggie [1:42] I found the McMaster program amazing. I wasn't sure what problem-based learning would entail. Coming from Mac kinesiology, we did a lot of small-group tutorial work, so I had some of that experience — but I wasn't sure how I'd feel in full PBL. The first couple of months were very difficult. You had to adjust to a lot of independent self-directed learning. But once I figured out how to do that, it was exponentially better than my undergrad, which was typically didactic lecture-style learning. I really enjoyed PBL because everyone brought something different to the table. Once you learn how you can study and what you can contribute to your peers in a small group, I found I came out with knowledge and skills that were lifelong and genuinely beneficial for my career.
Clinical Rotations and Choosing a Specialty
Interviewer [2:42] Where did you do your clinical rotations?
Maggie [2:46] In second year, during clerkship, I was all over. I did a few in Hamilton, psychiatry in Whitby, emergency medicine in Toronto, family medicine in Cambridge, and general surgery in Hamilton. For electives I went back to Toronto for an emergency elective, did an elective at my current workplace at the Regional Rehab Centre in Hamilton, and went abroad to India for an elective as well.
Interviewer [3:16] Did you know what specialty you wanted while going through school?
Maggie [3:19] I knew what specialty I wanted. I was always interested in orthopedics, neurosurgery, or physiatry. I had early exposure to physiatry in my undergrad — I worked at the Mac Wheeler Spinal Cord Injury Rehab Centre, and all of the patients I worked with had physiatrists. That kept me in line with my kinesiology background. I was debating between the three, but once I was able to do placements in physiatry, I had my heart set on it.
Interviewer [3:54] What was your process for finding your first job?
Maggie [3:56] I did a longitudinal placement at the Regional Rehab Centre with a physiatrist. We set up four half-days, and I ended up going for about eight half-days because I was so interested. It was in the amputee and prosthetics division. I then set up a four-week elective at the rehab centre and worked with about seven different physiatrists — getting experience on the acute brain injury ward, the spinal cord injury ward, amputees and prosthetics, sports medicine, and general musculoskeletal medicine. At the end of my elective, one of the physiatrists approached me and said he was interested in hiring a PA and asked if that was something I'd want to discuss.
Exploring Physiatry: Scope, Treatments, and Conditions
Interviewer [4:47] How would you describe physical medicine and rehabilitation as a specialty?
Maggie [4:51] A lot of people haven't heard of physiatry. Physical medicine and rehabilitation is a broad specialty that can encompass a number of sub-specialties: sports medicine, general musculoskeletal medicine, spinal cord injury, brain injury, amputees and prosthetics, and spasticity management. Physiatrists tend to pick a few of those domains and specialize within them. What you see really depends on who you're working with.
Interviewer [5:32] How is a physiatrist different from an orthopedic surgeon, sports medicine physician, or neurologist?
Maggie [5:38] Physiatry is a non-operative specialty. People often come in and say, "You're going to do the surgery" — but I have to make it clear that we are conservative, non-operative management. That's how we differ from orthopedic surgeons, though we work quite closely with them to manage patients conservatively either before or after surgery. We wouldn't do surgery ourselves. It's a combination of non-operative orthopedic management and neurology — we focus on both the neurological and musculoskeletal systems together, looking at the person as a whole.
Interviewer [6:31] What other treatment modalities can physiatry offer?
Maggie [6:34] In our clinic we do a lot of interventional medicine — all of our injections are guided. We do ultrasound-guided intra-articular injections, tendon fenestration, and other procedures to manage joint and musculoskeletal complaints non-operatively. We also make recommendations for physiotherapy, occupational therapy, and other rehab supports. We coordinate care with other specialists — we work closely with neurosurgery, orthopedic surgery, and neurology as a team.
Interviewer [7:18] What classes of medications are you generally prescribing or renewing in physiatry?
Maggie [7:25] In our practice we don't do a lot of overall pain management. We'll prescribe short-term analgesia — NSAIDs or Tylenol — but we do not prescribe opioids, mainly because it's difficult to follow up with patients over time. I'll often start a medication, give a two or three-week course, and then have them follow up with their family physician or a chronic pain program. We do prescribe gabapentin or pregabalin for neuropathic pain, and we manage spasticity with certain medications and Botox injections. The pattern is to start medications and then ask patients to follow up with their primary care provider for titration and ongoing management.
Interviewer [8:27] Can you describe the particular practice setting you're in?
Maggie [8:30] I work with one supervising physician. Our practice focuses on two main areas: a sports medicine patient population seeing high-performing athletes, and general musculoskeletal medicine. We focus heavily on hips — a lot of hip injections as well as extra-articular soft tissue hip diagnoses — and we also see shoulders, elbows, and ankles. We do some inpatient work on the spinal cord injury unit about three to four months of the year. We also run a spasticity clinic for patients with spinal cord injuries, cerebral palsy, and other neurodegenerative disorders, using Botox injections and allied health team management.
Interviewer [9:26] Can you describe what spasticity is?
Maggie [9:28] Spasticity comes from an upper motor neuron insult. It can occur in patients with cerebral palsy, spinal cord injuries, stroke, and neurodegenerative disorders. We see patients across the full spectrum — from completely dependent for care to highly functioning and ambulatory. Our job is to make recommendations that allow them to function better in their community or setting, whether that's helping their caregivers with dressing or bathing, or allowing them to ambulate and participate in sports more efficiently. We look at physiotherapy, occupational therapy, oral medications, and Botox injections.
Interviewer [10:25] Can you list a few common conditions you see in physiatry?
Maggie [10:30] We see a wide variety. On the musculoskeletal side: hip pathology including osteoarthritis, labral pathology, gluteal tendinopathy, bursitis. For shoulders: rotator cuff injuries and labral tears. Then tendinopathies of the knee, ankle, and elbow — really everything. In the sports population we do a lot of acute injury management and return-to-play. In the spasticity population we manage a number of different diagnoses with a broad approach to care. And we occasionally see rare conditions — things like genetic disorders causing muscle hypertrophy or neurodegenerative conditions like Friedreich's ataxia — which are great clinical challenges.
The Physician Assistant's Dynamic Role in Physiatry Practice
Interviewer [12:23] How would you describe your role as a PA in this practice?
Maggie [12:26] My role is quite dynamic. Depending on the day, I'm doing different things. For new consults, I review all imaging, do the physical exam, come up with an assessment and plan, and then review with my supervising physician so the patient gets to meet him and ask any further questions. For follow-ups, I tend to know the patients well — I see many follow-ups after interventions or diagnostic imaging, come up with a plan, and review with the team.
Maggie [13:15] I also do ultrasound-guided injections on dedicated injection days. I added that to my scope of practice after being trained by my supervising physician and others doing these procedures. Beyond that, I'm managing patient flow, liaising with the allied health team, and trying to provide comprehensive care. I get feedback that patients appreciate spending time with me — whether I'm showing them a model of the knee to explain their injury or writing down their plan to take home. I enjoy that part of the role.
Interviewer [14:16] How were you first oriented to the service?
Maggie [14:19] My onboarding was fairly quick because I had done an elective there. It was a seamless transition — I already knew how the hospital worked administratively and what clinic flow looked like. Day one was essentially up and running. After the first couple of months I settled into my role and figured out where I could be most beneficial. We continue to make changes, and every four to six months we meet to review what's going well, what still needs work, and what we want to accomplish with my role going forward.
Interviewer [15:07] What kind of mentoring and orientation have you received from your supervising physician, especially in the early days?
Maggie [15:12] It was a steep learning curve because physiatry is so specialized. I had a good base of knowledge coming in, but in the beginning we worked really hand-in-hand. I would sit in on his appointments with patients to understand his decision-making process. For the first six months, it was a lot of learning — we'd debrief after clinic, review questions I had, discuss new diagnoses we saw that day, and do formal teaching sessions on specific conditions.
Maggie [15:49] I also attend physiatry rounds when I'm able to, and I find physiatry conferences excellent for ongoing education. Working with the residents and students who come through the clinic is always a good way to continue broadening my scope and moving forward.
Interviewer [16:25] Which physiatry conferences have you attended?
Maggie [16:27] I've attended some specialty conferences — an ultrasound-guided spasticity management conference in Niagara with Dr. Khan, and I attend the OA Sport Med conference every year. I'm hoping to go to CAPM&R in PEI this year, as well as a physiatry review course — an intensive week of review across the board. I've also attended ultrasound-guided musculoskeletal conferences put on by the Rheumatology Society, and we're hoping to attend an ultrasound-guided MSK intervention course in the States as well. Always learning.
PA vs. Resident: Role Comparison and Value to the Practice
Interviewer [17:22] For those not familiar — how is working with a PA similar to or different from working with a resident?
Maggie [17:27] Describing us as permanent residents does have some truth to it in the early stages of your career. Like residents, we see patients alongside the physician, we review cases, and we're always engaged in education and learning. The key difference is that residents are there for a short time and then move on. Having a PA in your practice is like having that permanent resident — you can really cater to the clinic's specific needs.
Maggie [18:00] Having worked with one supervising physician for two years, I've molded my practice in ways that genuinely help the clinic — whether that's administration, seeing certain types of patients, or taking workload off the physician. We're learning, yes, but we're also providing that offload of work, taking on patient load and other tasks to allow the physician to provide more quality care to their patients and have a better work-life balance.
Interviewer [19:04] Any other benefits of adding a PA to a physiatry practice?
Maggie [19:08] In physiatry especially — because it's so specialized and busy — it's quite easy to integrate a PA into the clinic. I do procedural work, new consults, and follow-ups, all of which offloads pressure on my supervising physician. We work as a team, look at the day, and figure out what we can accomplish and how to make it efficient for both of us. A PA can really offer efficiency within the clinical role. We've changed how the clinic runs since I started — the length of appointments, the number and type of patients seen — to allow things to run more smoothly and allow my supervising physician to finish on time.
Interviewer [20:23] Do you handle dictation, medical documentation, medical-legal forms, and return-to-work forms? Can you describe the administrative side?
Maggie [20:31] Yes. I've essentially taken on all of those things. I liaise with patients, families, and allied health team members to get things like return-to-work and disability forms completed. That's often something I take on to take the burden off my supervising physician — forms are not anyone's favorite, but it is a meaningful way a PA can add value. Because I know the patients well, it's easy for me to fill out those forms or make the calls to figure out what's needed.
Interviewer [21:26] Do you work with medical directives?
Maggie [21:28] Yes. I implemented medical directives in my workplace. I pulled from existing directives in areas like the ICU and other outpatient locations to create my own. It was quite a process and took several months to implement, but now that they're in place it's very helpful — it's a written scope of practice to refer back to for documentation, ordering prescriptions, ordering diagnostic imaging, and so on. Everyone knows what I'm able to do, and it's all in that document.
Interviewer [22:10] It sounds like you work primarily in outpatient. Is it possible for PAs to work in inpatient or EMG clinics?
Maggie [22:20] I'm primarily outpatient-based, though we do short stints of inpatient management on the spinal cord injury ward. I think a PA would be very beneficial on an inpatient rehabilitation unit — whether that's spinal cord injury, brain injury, or amputees and prosthetics. A PA could function as that point person for the ward, similar to an internal medicine or orthopedic surgery PA, managing inpatients and liaising with the MRP. Our patients are medically stable but often quite complex, and they require a lot of work — managing comorbidities, following them through rehab, and getting them home safely. A PA would be very valuable in that role.
Insights, Challenges, and Training Comparisons
Interviewer [23:31] What do you love about physiatry?
Maggie [23:33] Everything, honestly. I really enjoy this patient population. I find it challenging, interesting, and ever-changing. Physiatry is still a relatively new and growing specialty with a lot of research and evidence-based medicine emerging around the conditions we see. That part is exciting — knowing I'll be involved in that going forward and continuing to grow and be excited about my work.
Interviewer [24:14] What do you find challenging?
Maggie [24:17] What I find most challenging is the patients we can't make a difference for. We often see complicated patients, and after exhausting many different treatment modalities, sometimes we have to have the conversation that we've done all we can. That's difficult because they're often coming to us as the specialist — as their last resort, last hope, last intervention. There's a lot of weight in that. I often leave feeling like I wish I could do more, and that just motivates me to keep learning and provide the best care I can.
Interviewer [25:10] Can you compare the training required to become a physiatrist versus training to be a PA in physiatry?
Maggie [25:20] When someone goes to medical school and gets into physiatry residency, that's a five-year residency. They're doing rotations across many specialties and get extensive training in rehab-specific medicine — oncology rehab, cardiac rehab, spinal cord injury, stroke rehab. It's a comprehensive five years.
Maggie [25:52] As a PA, you're trained as a generalist over two years — didactic in first year, clerkship in second year. In those first couple of years in practice, the scope is quite small, especially when entering a specialized field. Coming from my background in kinesiology and spinal cord injury, I had a very good base going into physiatry and was able to pull from that experience to engage meaningfully with our patient population right away. If you're coming from a more limited background, it's still doable — it really comes down to the support of your supervising physician and team.
Teaching, Research, and Future Direction
Interviewer [27:04] Are you involved in teaching or precepting PA students?
Maggie [27:08] Yes, and it's something I quite enjoy. I've had a number of longitudinal placement students come and observe. I always recommend physiatry as a placement — whether it's a half day or a full elective — to any PA student interested in family medicine, emergency medicine, orthopedics, or neurology, because we really do see it all. Musculoskeletal teaching in the PA and medical programs is quite limited, so getting that experience in a clinical setting — reviewing history-taking, differentials, physical exam — is very helpful for students. I enjoy having students and showing them how a PA can work in this type of clinic.
Interviewer [28:06] Are you involved in any research or quality improvement?
Maggie [28:10] Not currently, but it's something my supervising physician and I discuss often and that I'm looking to pursue. Specifically, I'd like to look at the implementation of a physician assistant in physiatry and how it has changed our practice — things like time to follow-up, time to consult, and number of patients seen. I've been gathering that information, and I'm looking forward to being involved in that research.
Interviewer [28:40] How do you see your practice changing over the next few years?
Maggie [28:44] That's a hard question to answer because the last two years has already been quite dynamic — we've been changing my role every four to six months, implementing new types of clinics and having me see new types of patients. I'll say that as a physician assistant, you're rarely stagnant, and you shouldn't be. You're always looking at improving the patient experience, improving clinic efficiency, and growing in your role. That's what I continue to focus on.
Interviewer [29:29] What resources do you use for on-the-job learning?
Maggie [29:31] A number of things — online resources, textbooks recommended by residents and physicians I've worked with, guidance on ultrasound-guided procedures from texts and online materials. Conferences and educational opportunities are great — you come out with a whole collection of new resources. I have a large library of references I use on a daily basis.
Career Reflections and Advice for Students
Interviewer [30:13] Are you happy with your decision to become a PA?
Maggie [30:16] Absolutely. I love my role as a physician assistant. I'm able to provide quality care to patients while also impacting the clinical experience and quality of life for my supervising physician. I get to be part of a larger team working together efficiently, and in the end, it's about patient-centred care. Having the ability to make a difference, to provide patient-centred care to such a diverse patient population — that has been very rewarding. I also love the many different roles I have in clinic and the question of where to go next.
Interviewer [31:13] Any tips for students struggling with the choice between PA and MD?
Maggie [31:18] I always say: if you truly want to be a practicing physician and that's your passion, then absolutely follow that goal. The PA program is not a stepping stone, and it's not an alternative to being a physician. It truly is a different profession and a different role in healthcare. You really have to explore what that means. I advise students to talk to practicing PAs, shadow them if possible, and understand what the role looks like in clinical practice — and that can vary a lot across specialties. The options are broad, but you really need to understand the difference and figure out what's right for you and what you want in your future.
Interviewer [32:26] Any tips for PA students hoping to pursue physiatry?
Maggie [32:31] Get as much exposure as you can — longitudinal placements, a clerkship elective, or even just speaking to PAs in the specialty or other healthcare providers working in physiatry. Really understand the different sub-specialties within physiatry and how you'd be integrated into that practice. The best thing for me was doing that elective and placement to understand what it was all about. I've also always had an interest in international medicine, so I spoke to a few PA students who had gone abroad in previous years, figured out if it was feasible financially and whether the program would allow it, and pursued that experience. I wanted to see what healthcare looks like elsewhere in the world and bring that back to benefit my practice in Canada.
