Interview with a Rural Medicine PA-C

Here's an interview with a PA who practices Rural Medicine in North Texas.

1) Why did you become a PA?

 I spent quite a bit of time in my undergraduate career trying to decide between medical school and physician assistant school.  I had the opportunity to work as a medical assistant at a Christian family practice office where I feel like I was introduced to excellent medicine and a great example of a physician/PA team. One of the physician assistants I met there had trained at Duke during the first few years of that start up PA program in the 1960's, so coming to know him and hear his stories of training was truly a dose of PA history! The other physician assistant at the practice was a new graduate and offered a fresh perspective on the process of applying to PA school, and the up and coming advances in the PA profession. It was through coming to know these excellent physician assistants that I realized the value of the profession and began to learn more and more about PA's and their patient centered focus.

2) How did you pick UNT HSC? What was your time like there? What strategies helped you?

I picked UNTHSC because of the warm welcome I received during my interview period.  I had taken a few days to talk candidly with students at several of the Texas PA schools, and the UNT students were honest about the difficulty of PA school but spoke highly of their program, and felt like they had the support of their faculty and student peers.  I also knew I wanted a longer PA program, so the length of UNT's program was very attractive to me.

I had an excellent time at UNTHSC.  Looking back, it was very challenging, but also a time of great personal and academic growth.  Our class of PA students operated like a family, we all worked together to take complete notes, and shared study materials; the fact that competition between classmates was not a hindrance was something that helped all of us navigate the three years of PA school.  Taking one day or part of a day off from studying, a "day of rest" if you will, was another vital part of maintaining a balance in school.  There is a "buddy system" in place where you will be assigned an upper class PA student to help you with tips and strategies during the first few weeks of school, and I would recommend taking full advantage of their experience and knowledge.  

3) How did you get into Rural Medicine? Did you do a rural rotation in school?

I did not complete a rural medicine rotation, and would not have initially seen myself practicing in a rural setting.  I knew I wanted to gain experience in primary care with my first job after graduation. To be quite honest, when I interviewed for my current position, I didn't fully realize how rural a setting it was until I arrived at the job interview!  Once I met my supervising physician, and saw the practice setting, I was intrigued  and impressed; I decided I was up for a challenge and an adventure in rural medicine, and I have not regretted that decision.

4) How has your perception changed about Rural medicine since you started practicing?

My perception has changed in several ways.  My perception of the PA/physician team started off as something fairly standardized, but now I realize that that relationship is unique to the individual physician and physician assistant, as well as variable by practice setting.  The scope of practice of rural family physicians and by extension, that of rural physician assistants, is still fairly extensive.  

My perception of work/life balance has changed quite a bit; in the rural setting, your job and involvement in the community doesn't end at 5:00 pm.  You become an integral part of the community, and people come to know you as a leader, and will ask you to commit to various voluntary or appointed positions.   I've had patients call me in the middle of the night, with a health emergency or question.  You see people at the local meat market or grocery store and they will ask you their medical questions with bold (and sometimes amusing) honesty; they will often introduce you to family and friends and say "This is my PA, they take care of me".  

Finally, my perception of the medical community overall has changed since I began working in a more rural area.  We do have limited specialist coverage, and all of the family physicians rotate call for any patients that are admitted to the hospital.  There is a spirit of teamwork between the family doctors, their physician assistants, and the specialists we have covering our local hospital which I have not witnessed anywhere else in my training, and this is something I will always remember about rural medicine.  The medical staff here truly do rely on each other for personal and professional support, and everyone collaborates very well to help patients receive the treatment they need, even if it means staying late or taking on an patient consult. For example, I frequently contact our orthopedic surgeon and cardiologist on call for our area hospital on their personal cell phones when I need advice on a patient I have in the office.  

5)  What kind of patients do you see?

I see a range of patients in the family clinic, infants to geriatrics, for anything from preventive exams to chronic disease management, to walk in visits for sick patients and minor injuries.  My supervising physician and I also see patients at the local nursing home, so I round on those patients at least one per month. I am the provider on call for the nursing home, so take 24 hour telephone call for any situation that may come up with our patients there.  After building my skills in the clinic and nursing home my first year in practice, I have had the opportunity to gain some experience with inpatient medicine; I essentially pre-round on any patients my physician or I admit to the local community hospital, and work closely with my supervising physician to coordinate hospital orders and discharge planning.

What does a typical week look like for you?

My days start at around 06:30 when I call up to the local hospital to check on any admitted patients.  If we have patients in the hospital (usually anywhere from 1-5) I head up to the hospital around 07:00 and start rounds and progress notes.  My supervising physician usually meets me on the inpatient side and we wrap up discharge planning or further hospital orders together.  Clinic starts at 8:00, so I head to the office after hospital rounds, and see patients from 8-5.  If anything comes up for our nursing home patients during the day, or if I received an overnight call for any problem, I will drive by the local nursing home during lunch of after office hours to make a nursing home visit for any sick patients. I don't typically take call at the hospital or round on patients over the weekend, although I am still on call by telephone for the nursing home;  If our nursing home patients get sick over the weekend and I am in town I usually will pay a weekend visit to them.  The providers at our office number seven (three physicians and four physician assistants) and we alternate shorter weekend clinic hours, so we each work one out of every seven weekends.

6) What is your favorite part of your practice?

My favorite part of my practice is the long term relationships I have had the opportunity to form with patients.  It is common to build relationships and take care of several generations of a family.  It is rewarding to see patients back for follow-up over an extended period of time and mark their progress.

7) Any advice for future PAs?

I think my advice would be to remain open to career changing opportunities, but don't be a afraid to take that first job in primary care, for those who are so inclined. I believe it has been a really valuable experience, and I think that physician assistant scope of practice can really be utilized to its full extend in that setting.  Second, I would say to make sure to try and maintain a work/life balance that will help you stay grounded and prevent burnout, especially during the first few years of practice.