Episode #32: Aurthi, PA in Emergency Medicine & Orthopaedic Surgery
Getting Your 1st PA Job, Working in the ED, and Building Your Career in Canada
Aurthi is an emergency medicine PA and academic coordinator at the University of Toronto, returning to the podcast after her first appearance as a first-year PA student. In this conversation, she covers the full arc from clerkship to landing her first job during a pandemic, to building clinical confidence in a fast-paced ED alongside 50+ supervising physicians.
She breaks down exactly how a Canadian emergency department is structured, what procedures PAs own, and how scope of practice expands as trust is earned with supervising physicians. Her kinesiology background, procedural interests, and ability to communicate with Tamil-speaking patients all turned out to be bigger clinical assets than she anticipated.
Aurthi offers PA job-search advice, including how Ontario's Career Start grant works and why keeping your specialty options open early pays off later. Her take on the Canadian PA job market is encouraging, and her path proves that where you start doesn't have to be where you stay.
WHAT YOU’LL LEARNHow to navigate the post-graduation job search in Canada, including the Ontario Career Start Grant
What daily life as an emergency medicine PA actually looks like
How scope of practice evolves in practice, and the PA-MD supervisory relationship
What the Canadian PA job market looks like right now, and why new grads have more opportunity than any previous graduating class
GUEST BIOAurthi Muthu, BScPA, CCPA, MScCH is an Emergency Medicine and Orthopaedic Surgery PA at Scarborough Health Network, Academic Coordinator and IPE Lead at the University of Toronto PA Program, and faculty at CASTED. Before PA school, she completed an Honours BSc in Kinesiology and Medical Sciences at Western University and worked as a Kinesiologist at two physiotherapy clinics in the GTA.
She completed her BScPA at the University of Toronto in 2020, with clerkship rotations spanning emergency medicine in northern Ontario, general internal medicine, orthopaedic surgery, and pediatrics, finishing her final semester through a pandemic. She has since completed a Master of Science in Community Health (Health Practitioner Teacher Education) at U of T.
Today Aurthi works across two ED sites at Scarborough Health Network while leading a quality improvement project to centralize orthopaedic referrals between the ED and fracture clinic. She is one of the few Canadian PAs actively shaping both clinical practice and the next generation of PA students.
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From Pre-PA to Practicing: Aurthi's Journey
Aurthi[0:00] I'm grateful to be where I am. This is beyond what I had hoped for. 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 till now, we have more PAs joining the community and more people interested in pursuing it as a profession.
Aurthi[0:45] Hi everyone, I'm Aurthi. I'm an emergency medicine physician assistant trained in Canada at the University of Toronto Physician Assistant Program.
Anne[0:54] Since we last spoke — you had completed one semester in first year at U of T — so what have you been up to since then?
Aurthi[1:02] Lots have happened since then. I was starting my second semester during my last interview. After finishing didactic year and then semester three throughout the summer, I started clerkship. I started with a few rotations in the south and then went up north to do my emergency medicine rotation and a family medicine rotation, which also had a touch of internal medicine. We had a break because of the pandemic, then got back into rotations. I got the opportunity to do an elective rotation in orthopedic surgery and sports medicine, which really complemented my background in kinesiology. After completing clerkship year, I took a few months to work from home doing contact tracing, then started applying to jobs around the holiday season. I started working in January, about ten months ago, in emergency medicine. A few months in, I got offered the opportunity to be the Academic Coordinator for the University of Toronto Physician Assistant Program, which I thought was a great opportunity to give back to the program and provide student and course director support.
Landing Your First PA Job
Anne[2:38] Can you tell us a little more about what it was like to find a job after graduation?
Aurthi[2:47] It was a great learning experience. There are a lot of job opportunities outside of Career Start, which is the program the Ontario government provides to help new grads transition into a job. They cover half the salary for the first year for southern PAs, and for PAs working up north in underserved areas it can cover the first two years, with the employer covering the other half. There were external jobs posted and also Career Start grant positions. Everyone had a different approach. I tried to keep my options open in terms of specialty — I always knew I wanted to work in ortho, but I still applied to family medicine and emergency medicine. I found the interview process rewarding because you learn a lot about yourself and also learn how different supervising physicians understand the PA role. After a lot of self-reflection, I landed on emergency medicine, which is not a specialty I thought I would start in, but I'm very grateful for all the learning I've gotten.
Life as a PA in the Emergency Department
Anne[4:08] What drew you specifically to emergency medicine?
Aurthi[4:16] Working in general medicine fresh out of school helps consolidate learning from PA school. I really like the mix of procedural medicine — suturing, laceration repairs, fractures, and casting. Emergency medicine also gives you exposure to different physician preferences. I work with more than 50 doctors, and those are great opportunities to collaborate. They always say that working with PAs in the emerge means you have two great minds thinking about a patient case instead of one. As a new grad, I was able to learn from all these different MD colleagues and add to my toolbox in terms of patient care preferences.
Anne[5:23] How is the department of emergency medicine organized at your location?
Aurthi[5:31] We have four major areas. There's a resuscitation area for the most critical patients, then the acute area, the major area, and then the Rapid Assessment Zone, which is usually where PAs are situated. CTAS is how the triage nurse categorizes where patients go. In the resuscitation area you'll see CTAS 1 patients — heart attacks, anything needing immediate attention. In the acute and major area you'll see CTAS 2 and 3 — COPD exacerbations, query stroke. In the Rapid Assessment Zone you'll see CTAS 3 to 5 — something as simple as suture removal or a laceration requiring suturing, or a broken bone needing x-ray and casting. PAs are usually in the Rapid Assessment Zone, especially when doctors get pulled into the resuscitation or acute care areas.
The Impact of PAs on Patient Care
Anne[7:24] Can you expand on the impact of adding a PA to the emergency department?
Aurthi[7:32] Physicians are thankful for PAs being able to do procedures because they take time — whether it's a laceration repair or casting for a broken bone requiring reduction under sedation. Having a PA there to handle casting means the physician and PA can share that workload. Physicians can prioritize higher acuity cases while PAs see the quicker patient visits, with the doctor checking in before the patient is discharged. From the patient's side, we help reduce wait times because we're sharing the workload with the physician.
Common Conditions and Procedures in the Emergency Dept
Anne[8:41] Can you talk about some of the common conditions that present to the emergency department?
Aurthi[8:50] Taking a head-to-toe approach — we see a lot of headaches, sore throats, and upper respiratory infections, especially with COVID. Then chest pain, shortness of breath, abdominal pain, and musculoskeletal pain anywhere in the body. For chest pain, you want to rule out myocardial infarction, pulmonary embolism, and pneumothorax. For abdominal pain, common ones to rule out include cholecystitis, cholangitis, and appendicitis. In females of reproductive age, ectopic pregnancy is also on the differential. You want to rule out the serious ones, and if it's not that, reassure the patient and make sure they have proper follow-up.
Anne[10:17] What procedures are in your toolbox?
Aurthi[10:25] I really enjoy procedures in the emerge. Suturing is a big one — lacerations are very common and PAs really help with that aspect of patient care. Casting for fractures, whether ankle or wrist, sometimes under sedation if reduction is needed. Draining abscesses, ear irrigation — that one is probably the most rewarding because patients come in unable to hear and after you flush their ear they're incredibly thankful. Foreign body removal is common too — removing an earring backing from someone's earlobe, removing something from a foot after they stepped on it, or ingrown toenail removal. There's so much variety, and sometimes you just have to improvise to help the patient and ensure proper follow-up.
Anne[11:54] What kind of patients are you seeing in the emerge?
Aurthi[12:02] There's a lot of variety in terms of the patients we see. It could be pediatrics — a few months old — or geriatrics who can be even 100 years old. Another factor is cultural background. At the particular location I work at, speaking Tamil really helps with the patient population and addressing language barriers. You see this relief when the patient realizes I speak the same language — they're not as nervous and can really tell me what's going on, instead of having to call a family member. It saves that extra step and provides reassurance. So lots of variety in age, cultural background, and socioeconomic status, in addition to the variety of cases and presentations.
Anne[12:51] What can a patient expect if they're going to be seen by a PA?
Aurthi[13:00] A patient can expect two great minds working on their visit. When the PA walks in, takes the history, and does the appropriate physical exam, they go back and discuss the case with the supervising physician — the differentials to consider, investigations to order, and management options. It's a win-win: the PA shares the workload with the physician, and the patient sees the PA but also gets input from the supervising physician to ensure the best care possible.
Orientation of a new PA Grad hire
Anne[13:39] You were a new grad hired into the emergency department. What did your orientation look like?
Aurthi[13:48] I was very lucky to be joining a team of PAs who were already well established at the institution. I got about one month to orient into my role, which involved tagging along with one of the senior PAs and learning how things are done in the department, including their preferences. Everyone had one mentor. I really liked my mentor's teaching style — it was very much a "just do it and learn" approach, with feedback along the way, both from her and from the MDs I presented to. Other senior peers were very supportive and would ask about your comfort level. That team-based approach, with PA support and MDs understanding you're onboarding, was very helpful. We also had additional sessions — a casting workshop, a teaching workshop covering common presentations and how to approach them, and an ultrasound workshop, which I really enjoyed. Point-of-care ultrasound is commonly used at the bedside where I work, so that was something PAs got exposure to early on.
Anne[15:28] Did PA school prepare you for the job you're in now?
Aurthi[15:33] Yes, and it's something I take time to reflect on. Even though PA school is only two years, you learn a lot. Your first year in practice, especially in emergency medicine, is a steep learning curve — it's almost like drinking from a fire hose. PA school prepares you for that steep learning curve and for being an absorbing sponge as a new grad. Depending on where you did your rotations, you get exposure to specific patient populations and case types. Where I work now is a different patient population, and you're always adapting to your colleagues and your patients. Medicine is a lifelong learning process. PA school gave me the foundation, but you continue to learn on the job.
What Physicians Need to Know About Working with a PA
Anne[16:36] There are many physicians who have never had exposure to PAs and aren't sure what to expect. Some say it's like working with a resident who never leaves your rotation. Do you agree with that?
Aurthi[16:45] I think that's a good analogy. However, PAs extend physician services. One of my supervising physicians was actually asked if he was a PA, which shows how far PAs at this location have come — the way the doctor manages a patient case and the way a PA does has become almost synonymous in practice. That's not to say it's synonymous title-wise, but our scope of practice does reflect that of our supervising physicians. Whether it's being compared to a resident or a physician extender, PAs can serve that versatile role in filling different aspects of care.
Anne[17:49] Scope of practice is a term we hear a lot — what does that actually mean?
Aurthi[17:56] PA scope of practice mirrors that of the supervising physician. In the emergency department, depending on the doctor you work with and what's needed that day, a PA could be doing a lot of procedures or helping with histories and physical exams and getting patient visits started. I've had nights where from 6 PM to about 11 PM I'm seeing patients, reviewing cases, following up on investigations, and managing discharge. There was one day where I came back from my dinner break and spent most of my time in the Rapid Assessment Zone — I saw about nine lacerations while the doctor was in the resuscitation and acute care areas. Based on what's needed, your role and scope will vary. The beauty of emergency medicine is that your scope has the potential to keep broadening, and it's really up to you as the PA to find those opportunities to add to your toolbox.
Anne[19:15] What is the PA-MD relationship like when you're working with 50 different physicians?
Aurthi[19:24] It's great. The PAs who joined this location years ago really established the PA role well. When you start off, there's more guidance as you learn physician preferences and build trust. As time goes on and you show them your thought process and how you think through cases, you build more autonomy. That will vary based on the supervising physician and the nature of the case. For example, when I started, if I sutured a patient I would ask the physician to check it. As time went on and they were happy with my suturing, I'd provide discharge instructions independently. Eventually, when the supervising physician is in the resuscitation area, you get comfortable enough to start orders based on their known preferences, holding off on anything uncertain until they return. There are different levels of autonomy and it depends on both the physician and the nature of the case.
PA Procedures & Scope of Practice
Aurthi[21:02] There's this other side to it where you have to keep adapting based on physician preferences, and depending on who you're presenting to, tweaking what you would propose as next steps. But as you continue to grow and become an experienced PA, you start building your own preferences. My mentor told me about this when I was orienting — you'll learn the physician's preferences, but then you start figuring out your own. That actually sparks discussion. You say "this is why I think we should do this" and the physician asks why, and you have that conversation. That's a really valuable part of the learning process.
How PAs work in an Interprofessional Healthcare Team
Anne[21:42] Apart from the physicians and PAs in the department, what other healthcare providers are you interacting with and what is that like?
Aurthi[21:49] The beauty of the emerge is that we work collaboratively. The interprofessional healthcare team is very big in emergency medicine. I work with nurses, ward clerks, respiratory therapists, social workers, and different consultants — general surgeons, orthopedic surgeons, and the crisis team for psychiatry-related presentations. Because we're on the front line, we have the opportunity to refer and get opinions from different consultants, so there's the opportunity to work with multiple allied health professionals.
Starting a PA Career During a Pandemic
Anne[22:30] You started your PA career during a pandemic. What impact did that have on you and the department?
Aurthi[22:38] In my first few months, I didn't know what most of my colleagues looked like. I had to identify them by their eyes and maybe their scrub cap. We had to wear scrub caps, masks, N95s, face shields, and a lot of PPE, which took away that personal touch in terms of orienting to the team. Regardless, I was still able to bond with everyone and get to know their personalities. In terms of patient presentations, we saw a lot of sore throats, chest pain, and shortness of breath, making sure it wasn't COVID. After vaccinations started and cases began to drop, patients who had been holding off on coming in — sometimes with abdominal pain that had been going on for months — started presenting. The variety actually started broadening as COVID cases went down. It's still something we keep in our differential, but we're grateful for vaccination and for people being able to somewhat return to normal life, which also brings in more variety of cases to the emerge.
Advice for PA Students: Excelling on Rotation
Anne[24:09] For PA students, what tips do you have to excel on rotation?
Aurthi[24:16] Emergency medicine is probably one of the more intimidating rotations in clerkship. Go in with an open mind and always challenge yourself. You'll have a variety of patient cases to choose from — try not to always choose the case you're most comfortable with. Find the case that's going to challenge you and give you new exposure. Use the opportunity to learn from all your preceptors, whether that's your PA preceptor, your MD preceptor, or whoever else you're working with. Getting an idea of the nurse's scope of practice, the clerk's role, and how the team dynamic works will really help you understand how the PA role fits in. Lastly, read around your cases. If a patient case stands out, go home and read about the presentation, the differentials you should have considered, and what next steps to propose. If a similar case comes around next time, you'll know what to do — and that case might have its own twist, giving you something new to read around as well. Continuously reading around cases during clerkship will really help you down the line.
End of Rotation Exam Prep
Anne[25:43] How did you prepare for your end of rotation exam for emergency medicine?
Aurthi[25:52] I read around cases and made notes. I would review the blueprint for the end of rotation exams and if I encountered a patient case I'd make notes on it. If I hadn't seen a particular presentation, I'd read around it at home when I studied. I also did a lot of practice questions — clinical vignettes where you're given a situation and asked a follow-up question. That prepared me for the testing style of the end of rotation exams.
Resources for New PA Grads in Practice
Anne [26:23] What resources have you found helpful in your first year of practice to get oriented to emergency medicine?
Aurthi [26:31] UpToDate is one we use a lot in practice. When you're stumped, you look it up — the algorithms, patient education material, reading around cases. Talking to a colleague about a similar case they may have encountered is also incredibly valuable. EM:RAP — Emergency Medicine Reviews and Perspectives — is a great resource I use for CME credits, which we're expected to complete as working professionals. It also helps keep me up to date with evidence-based medicine guidelines in emergency medicine. And colleagues — colleagues are always great, especially very experienced supervising physicians who learned as they went through their years of practice and are willing to teach.
Advice for New Grads: Approaching the Job Search
Anne [27:36] What would your general advice be for approaching employment after PA school?
Aurthi [27:45] Lots of self-reflection — that's my key takeaway from that process. Reflect on where you see yourself down the line, what specialties interest you, what will give you a good foundation, and what type of environment you want to work in — whether that's a hospital or an outpatient clinic. Think about the number of team members you want to work with. In a clinic you'll have fewer docs but it's more niche. In a hospital it's broader, but it's also a big family and you all work together. Reflect on the team, the environment, the specialty, the geographic location, and what you want career-wise — all those factors will point you in the right direction.
One last tip: keep your options open. Don't limit yourself at an early stage when applying for jobs. I always knew ortho was on my list because of my kinesiology background, but I had this question in the back of my mind about whether I should consider general medicine first to build a strong foundation. I did apply to family medicine and emergency medicine, which wasn't something I had originally planned. Based on my reflection, I thought that keeping my options open and consolidating what I learned in PA school right after graduating would help me down the line, even if I eventually transition into specialty care.
The Canadian PA Job Market
Anne [29:37] What is the job market like for new grads? Are there opportunities for employment?
Aurthi [29:45] Reflecting on last year compared to this year, it's safe to say there are more jobs than there are PAs. Based on the opportunities I saw as a new grad applying last year compared to this year, more supervising physicians are aware of the PA role and want to hire. PAs made a huge impact during the pandemic, which really advocated for our role. As a result, more doctors want PAs on board to avoid burnout, share the workload, and take care of patient cases post-pandemic. One of the silver linings of the pandemic is that it helped advocate for the PA role. PAs have really proven their impact in patient care and in the Canadian healthcare system over the past couple of years.
I think the future is bright for PAs. Pre-PAs and PA students don't need to worry too much about employment opportunities. One of my supervising physicians said it well — if there isn't an opportunity, you can create one. PAs have made an impact in patient care, and if there's an opportunity to create a new job, we have trailblazers and mentors to reach out to to make that happen.
Are You Happy with Your Decision to Become a PA?
Anne [31:14] Are you happy with your decision to become a PA?
Aurthi [31:21] Most definitely. I'm grateful to be where I am — this is beyond what I had hoped for. When I found the PA profession I always said, this can't be real, this sounds too good to be true. But it really is a very rewarding career and it is too good to be true in the best way. 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 till now, the profession has grown, we have more PAs joining the community, and more people interested in pursuing it. That just shows there's a lot of potential, and I'm grateful to be a practicing PA just a few years after deciding on this career path.
Anne [32:08] What specific things do you find rewarding? What do you enjoy about being a PA?
Aurthi [32:16] What I find most rewarding is the opportunity to work collaboratively, which gives you the option of learning new skills and asking questions — whether from your MD colleagues or your PA colleagues — and continuously adding to your toolbox. The PA profession is very versatile and you can always find ways to contribute to streamlining patient flow and helping colleagues share the workload. The mix of things you get to do — procedures, seeing patients, hearing their stories — is something I genuinely love. A few days ago I was suturing a laceration on a senior patient and she was sharing the story of how she met her husband, who was there during the visit. Just hearing those stories while doing procedures, having that opportunity to connect with patients, and having a role in preventative medicine — which I was passionate about as a pre-PA and still try to incorporate through patient counselling — those are a few of the many things I find rewarding in the PA role.
Final Notes
Aurthi [33:30] Thank you Anne for this opportunity. It's always nice to reflect on your journey once in a while. Last time I was a PA student — this time I'm grateful to be a working PA. Thank you all for watching and listening to my journey so far. If you're interested in what my last two years were like and what my life as an emergency medicine PA looks like, feel free to follow me on Instagram at @aurthi.pa Thanks for watching.
