October 20, 2021
Insights from PAs in Critical Care, Education, Primary Care, and Orthopaedics
December 4, 2020
PAs know that career flexibility is a built-in benefit of the profession. Whether you have a personal interest, a desire for professional growth, or changing family needs, transitioning into a new specialty can be a great way to reignite your passion for the PA profession and develop new skills and relationships. But it can be overwhelming to think about transitioning specialties. Do you have enough experience? What’s the best way to get your foot in the door?
AAPA’s recent “Ask Me” session gathered a panel of experts to answer PA and PA student questions on how to get started in popular PA specialties, or how to transition from one specialty to another.
Kris Pyles-Sweet, MS, PA-C, has been a PA for over 20 years. She is currently completing her doctorate of medical science at A.T. Still University, and has worked in a number of different primary care roles throughout her career.
Q: Should new grads work in primary care to galvanize all we have learned in PA school?
A: While it is a personal preference going into primary care right after graduation, I tend to agree with your assessment of its benefit: If you don’t use, you lose it. I turned down specialty offers after my own training for that very reason.
Q: How should you prepare for a job in primary care if your experience is in another specialty?
A: Transitioning from a specialty to primary care may not be as hard as one expects. First, PAs are educated in general medicine. The foundation we receive helps us pivot into different specialties, not the other way around. Second, having a specialty background could augment your primary practice. Acknowledge your specialty background and how it complements the general medical practice within a cover letter. Volunteering at a local free clinic permits a PA the ability to garner hands-on experience and builds the curriculum vitae. Finally, if a PA is planning to transition to primary care in the future, going on a mission trip is a great way to obtain experience.
Q: Some PAs may feel that they have to know everything in order to work in primary care, which is a misunderstanding. We do refer patients to specialists when needed. What can we do to help alleviate this anxiety that many have about practicing primary care?
A: One thing we should remember is PAs are trained in the generalist model. We have a base of knowledge on which one can rely. Brushing up on reading and completing CMEs in the most common illnesses and areas of concern is a good start. The Journal of American Academy of PAs (JAAPA) is an excellent resource for AAPA members. Also, no one practices in a vacuum. Help is only a phone call away if no one is in the clinic to ask a question. Medicine is an art and instinct on top of our education.
I remember walking in on a physician looking up answers in a book. He looked at my shocked expression and explained that no one knows all the answers. Since then, I live by the rules: Trust your training, research your questions, and never worry alone.
Q: Is there a way to work in primary care but to focus on a specialty area (i.e. infectious disease)?
A: In my experience, when working with other providers in an office, seemingly, there is always someone who is the go-to person. Usually, that person has experience or a particular interest in a specific specialty or topic. Choose to be knowledgeable in the subject you’re interested in by taking pointed CME, finding a mentor, becoming a member of an organization focusing on your interest area, and stay current in the latest trends, diseases, and treatments. Then be the go-to person in your practice.
Travis Randolph, PA-C, is a PA in the department of orthopaedic surgery and the clinical director of sports medicine at West Virginia University.
Q: How would you suggest a PA find a job in orthopaedics?
A: Finding an orthopaedic position can be challenging if limited to a specific city or state – so if you can, don’t limit your search area. Use AAPA’s PA JobSource to search for orthopaedic positions, or the job board on Physician Assistants in Orthopaedic Surgery (PAOS). If you aren’t currently practicing orthopaedics, it may also be helpful to brush up on your clinical evaluation skills and knowledge. AAPA and the American Academy of Orthopaedic Surgeons (AAOS) team up each year to offer the annual Musculoskeletal Galaxy Conference. The conference helps new graduates and PAs new to orthopaedics the opportunity to advance their orthopaedic knowledge. You can also look for programs that offer orthopaedic fellowships as well.
Q: Is previous orthopaedics experience a must when transitioning into the specialty? Would a new grad be favored over an experienced PA with experience in a totally different specialty?
A: As with most jobs, I would say that previous experience is preferred but not required. If a job is very competitive with several applicants to choose from, they might lean toward an applicant with more experience. However, in my current position, I have offered several positions to folks right out of PA school. Ideally, if choosing between either a new grad or a seasoned PA with no orthopaedics experience, I would be more interested in hiring an experienced PA without ortho experience over a new graduate. Experienced PAs have a lot to offer and typically are quick to pick up things while on the job. There are even some orthopaedic surgeons who would prefer candidates without prior ortho experience, so they can train their new PA to know all of the tendencies they prefer.
Emily Whitehorse, Ph.D., PA-C,is the founder and CEO of the Physician Assistant Faculty Development Academy™ and a PA educational consultant. She has worked in PA education for 25 years.
Q: What are some suggestions you might offer to PAs considering transitioning into PA education? Does teaching provide more flexibility than a clinical position, or is it more time consuming?
A: It has been my experience that many PAs think that you’ll have more flexibility by moving into an education position. While that is true to an extent, there is also some trade-off. Although it is generally easier for you to get release time from work to care for an ill child or family member, attend an event, and even take a sick day, the workload is different. In clinical practice, for the most part, you have a set schedule you work plus the time needed to complete your charts. But education is not a 9-to-5 job. Although you may have to be on campus from 9-to-5, the fact is most of us do our work in the evenings and during the weekends. This is because our days are filled with classroom time, program and university meetings, and student interactions. One of the most common challenges new faculty experience is how much work they had to do at home.
Q: What questions should a PA moving into academia ask their employer about the support for their transition?
A: Here are the questions I would ask: How will the program and university support me in becoming an educator? What services will be available to me? Are there funds available to attend educational conferences and workshops, and which ones do you recommend?
When it comes to workload, I’d make sure to know: What will my day to day responsibilities be? How many courses will I be responsible for? Is there a transition period to help me adjust to and learn my new roles and responsibilities? Can I observe and shadow current faculty? Will I be provided with a mentor? Who will I go to for guidance?
Can you share what the most common challenges are for new faculty, and how has the program helped new faculty to navigate them?
Q: When transitioning into PA education, what should the onboarding experience look like for making an optimal and positive transition?
A: In my experience, I have yet to see an onboarding process that addresses the common mismatch of expectations of what the applicant thinks being in PA education means and what it actually is. This includes fully illuminating the rewards and opportunities that being a teacher and educator brings and the challenges faced by and hard work required of new (and all) faculty. I believe they need to understand that they are making a career shift from medical practice to education, and that shift requires a different mindset and different knowledge and skills. In order to be successful, it will require their interest and willingness to learn about education and teaching. For the transition to be optimal, new faculty need ongoing support, mentorship and guidance, and the release time to learn about teaching and learning principles and practice.
Melissa Ricker, PA-C, practices critical care in Charlotte, North Carolina, and is the PA fellowship director for the APP Fellowship at Atrium Health.
Q: How do you get started working in critical care? Would it better, in your opinion, to work in primary care before transitioning into critical care?
A: After PA school, I elected to do a fellowship in critical care. Critical care is considered a high-acuity area of medicine, which often requires experience prior to interviewing. To be considered a competitive applicant for a job I would recommend prior experience or a fellowship. If are you looking for work experience, I would suggest urgent care, emergency medicine, or hospitalist jobs, gaining insight and experience with critical thinking, triage, rapid response, etc. Additionally, these jobs would expose you to pre- and post-ICU patients. If you are looking for a fellowship, you can check out APPAP (The Association of Postgraduate PA Programs) for more information.
Q: What is your best input on how to transition into looking into this career as a new grad with no experience?
A: First, I would recommend reaching out to the Society of Emergency Medicine PAs (SEMPA). This would be a great way to network with others, hear from employers what it is they are looking for in a new hire, scope out available EM-specific didactic and professional development resources like reduced-cost ultrasound training, procedure course, etc. Second, based on where you are interested in working, I would email the office managers, PAs, or department leadership to make yourself known, your interests, and your level of commitment. The more you can demonstrate confidence, competence, and eagerness to learn, the more likely an employer is to consider you for hire. Lastly, I would find ways to engage as a student in extra-professional opportunities (SEMPA, state advocacy organization, AAPA, etc.). These experiences will provide insight and practice that you can leverage, during an interview, to demonstrate engagement and a difference beyond the bedside. So many jobs are not just looking for PAs, they are looking for those interested in stepping up to chair committees, spearhead education, serve on advocacy boards, and more.