Q. Why did you choose to work at this location? How did you go about finding a job? How hard was it to find a job?
A. I knew that I wanted to work in the ER after my clerkship rotation. UHN was perfect as I would pioneer the role within their emergency department at Toronto Western & Toronto General hospitals. It is downtown, the commute is easy for me as I can take the subway. I found the position through the career start program.
Q. Has anything surprised you about being a PA since you started working?
A. Nothing has really surprised me to be honest. You know what you are getting into if you have been doing some reading around the Profession (both in Canada and the US). In Canada the major issues are surrounding Ontarios extremely slow acceptance of the profession. But so long as you advocate for yourself, and look for jobs – opportunities will arise.
Sahand works as part of University Health Network (UHN) in the Emergency Department. He’s pictured here with other PAs at UHN for an article on PA Day.
Q. How do you find working under the supervision of a physician in general? Do you feel that it limits you? How do you find the relationship with your supervising physician?
A. I can only speak with regards to the physicians that I work with (we have 72 in our ED at UHN) and I work with all of them so I think I have big enough sample size to say overall – no.
Each person is different with what they do/don’t do. As a PA another important quality is to recognize your role within the medical team. The beauty of the PA (at least to me) is the fact that you are never completely medico-legal responsible for the patient. As a result – there will be times that your SP may want to change your management plan – and you can’t let that affect you (some people take it personally). Ultimately – the major responsibility lies with the doc – so even if I don’t agree with the plan, I will state why and if they still want to do something differently, then it’s easy…I just listen (because it is their license on the line). Now this very RARELY happens. Often you and the SP will come up with a combined management plan that takes both of your opinions into account.
My general advice is – if you are someone that needs to be the be all/end all, and you can’t take a back seat for certain things, then being a PA will be frustrating. On the other hand, you have way less stress and know that you are always covered if things take a turn for the worst. Also- it is important to remember that even physicians don’t work independently. There are numerous situations where a physician will also ask for a second opinion (whether it is from a consultant or colleague)
Q. How well have PAs been integrating into the healthcare system? The PA profession is still relatively unknown by many people in the public. How do you personally deal with this challenge?
A. I think that I have already answered this question. In the US – it is much more well known and even in Canada word is slowly spreading. At the same time – there is always room for improvement and the more patients that we educate around our role – the better. The integration issue is more with regards to the government and funding. This is slowly being worked out as more privately funded jobs have been popping up around the province. Also – our association is working with the ministry of health regularly to help come up with a permanent funding model.
Q. Do patients respect you as a PA? Or would they rather see a physician? Do you feel that you get recognition from patients? From doctors? From other healthcare professionals?
A. To all of these questions I have to say: Yes.
The name PA is misleading but what people need to understand is that patients don’t care about titles. A lot of the time, even though I introduce myself as a Physician Assistant/Associate – they may not process exactly what I am and still end the interaction with “Thanks doc”. What I mean by this is: If you are confident and competent people will listen to you and respect your opinion. If you are not – then the opposite will occur. Regardless of whether you are a nurse, NP, PA or MD. If a patient sees a resident who is not confident with what they do they will ask to see the staff, if they see an attending who isn’t confident they will have bad reviews to give to the doc personally, the hospital and the royal college. It is also an issue that comes up with regards to patients wanting to see specialists, “Oh well you are just a family doctor, you aren’t an ophthalmologist so how would you know”. This occurs at all levels of the health care industry.
Q. What are your work hours like? How long are your shifts?
A. I work 16 shifts a month. This is a total of 6 – 10 hour shifts and 10 – 9 hour shifts. My shifts are all mid-day (as this works for me). So they are either between 11am – 8pm or 10am – 8pm. As I don’t have a family yet – I can sleep in, I miss traffic going downtown and I get home at a reasonable hour. I also try to work 2 weekends a month. Within the above constraints, I make my own schedule which is awesome as well, because I can just schedule around things without taking unnecessary vacation time.
Q. What procedures do you in the Emergency Department?
A. Procedures that I do in the ED include:
- casting, reducing fractures/dislocations
- lumbar puncture
- Incision and Drainage
- assisting during resuscitations
- We are starting to explore the option of getting certified for point of care ultrasound but we are not formally trained to utilize this yet (although we still use it to guide us for certain procedures).
Q. What is the rarest medical condition you have seen in the ER?
Giant Cell Arteritis, Image from Web MD
A. I have had one case of giant cell arteritis, the other day I had a case of a cranial nerve 3 palsy. The patient also complained of a thunderclap headache 3 weeks prior to her presenting to the ED. An MRA performed one week prior to her presentation to the ED was negative (which baffled all of us). We repeated a CTA in the ED which showed a 1cm PCOM aneurysm compressing her 3rd cranial nerve on the right. They think she probably had an intraneurysmal thrombus at the time of the MRA which is why they didn’t see it when she had the test one week prior.
Q. Do you find that you have work-life balance?
A. I find that I have a great work life balance. Given I have 3 days off/week, I have time to catch up on other things that I do on the side while I am off. I also teach part time at McMaster which is also a great opportunity.
Q. What learning opportunities do you have as a PA?
A. As a PA, the learning opportunities are infinite. Continuing medical education is necessary to maintain your certification with the Canadian Association of Physician Assistants, so you are constantly required to attend conferences and to take part in courses to advance your practice.
Sahand Ensafi presenting at the UHN Emergency Medicine Conference on Painless Loss of Vision.
Q. What is most rewarding part of your job?
A. This is a hard question and it depends on the day you ask. As a PA I have the ability to affect both the lives of the patients that I see and the Physicians with whom I work. This is a very unique aspect of my job that I enjoy. There is nothing more rewarding than treating a sick patient coming into hospital (who may have died otherwise) and seeing them make it to discharge 4 weeks later – all because of your initial diagnosis and management in the ER. The ER is an extremely high-stress area of medicine filled with chaos. We often take fore granted how much a correct (or incorrect) diagnosis can change someone’s life.
In terms of the Physicians – it is always nice coming onto a shift where the department is overwhelmed with high volumes and seeing your colleagues brighten up and say “thank god you’ve arrived!”. It makes you feel very appreciated.
Q. What are the benefits the ER has seen since implementing Physician Assistants?
A. Having the PAs in the ED has not only helped to improve flow and patient throughput but most importantly has allowed the PA/NP team to work collaboratively with one another in order to optimize our coverage of “advanced practice providers” in the ED during the busiest times of the week.
Also, by working with one another we can also reduce stress/burnout amongst our team as prior to this it was much more difficult to arrange for time off (as specific days required coverage with a PA or NP). I think this ultimately helps to improve physician workload but also improves patient care. Both the PAs and NPs in our department have the ability to take the time necessary to complete thorough assessments in order to provide thorough and exceptional care to the patients whom we assess (e.g. ensuring subtle abnormalities in labs/imaging as well as in the patients story are not overlooked etc). I think this is the ultimate advantage of having us as a part of the team – in order to not only improve wait times but to provide both timely and exceptional care to the patients whom we are responsible for.
Q. What is the most difficult part of your job?
A. Despite those life saving diagnoses that happen every once in a while, the ER is often a disappointing place for patients. Many come in with chronic problems that have been poorly managed for a long time – looking for answers/a quick fix. What they don’t understand is that the ER is a place for Emergencies – Heart Attacks, Strokes etc. And often, when you tell these patients that there is not much more that you can offer them – they can be quite disappointed.
Sahand taking an MPP’s blood pressure at the PA Awareness Reception at Queen’s Park. This event allowed PAs to speak with their MPPs about the PA Profession, and what PAs can do for Canadian health care.