The PA/Physician Relationship

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PMY 470: The PA/Physician Relationship

Session 470

Today, we are hitting replay on a special eShadowing session hosted by Dr. Thomas Maxey, a pediatric cardiac surgeon, and a PA, Abby Young, where they discuss the roles they have and the roles they share.

If you’re interested in eShadowing, it happens every Monday 8 pm Eastern as well as PA eShadowing on Monday’s 7 pm Eastern. And yes, you can put this in your applications.

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Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:22] The MCAT Minute

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[03:38] The Future of Healthcare

Thomas says while he was in training, there were already PAs but not to the level of what it is today where they’re working well together as colleagues. It has now become the future of healthcare.

“The PA profession is new, but it’s refreshing and hopeful.”Click To Tweet

Right after PA school, Abby did a fellowship for PAs at Texas Children’s Hospital in pediatric surgery. Like med students, PAs do different rotations throughout their schooling. She spent time in pediatric neurosurgery, pediatric ENT, and pediatric heart surgery.

After fellowship, Abby took on a pediatric orthopedic job since it was the only one available. But she used that time to develop her surgical skills, patient care, and work one-on-one with the surgeon. Eventually, she changed positions and coveted the role of a PA for pediatric cardiac surgery.

[06:30] The Role of the PA in Pediatric Surgery

“Most operations today need an assistant and that role of an assistant is far beyond just holding strings or holding a hook.”Click To Tweet

Thomas says working with a PA is like a dance and so both have to learn how to dance together. And their working relationship helps their operations go smoother.

Abby says the biggest thing they need to look for is that relationship in the operating room. They should be able to roll off each other and understand what each other needs. Hence, a PA can be handy in an operating room, understanding what their next move is before even a surgeon knows their next move.

That being said, it takes a lot of technical training with a surgeon for the PA to do this. Abby advises looking for a surgeon or physician who’s willing to teach you.

Thomas adds being a PA is a skill set that he thinks Abby makes a better PA than he would. Her view from the other side of the table is different but she sees what he sees. It’s an acquired skill set that some people just don’t have. It’s an innate ability to see things in reverse so she can see what he also can’t see and show it a little bit better in order to make the operation smoother. And as a pediatric heart surgeon, there’s a timer in everything they do; hence, efficiency is key.

[10:28] The Challenge of Delegating Things

Thomas says he holds himself to a very high standard as well as Abby to a very high standard. There’s a level of clarity in the communication because the life of their patient is on the line. A big part of that is the trust element that’s built over time. And that comes with a training period so they can deliver what’s expected of them in pediatric heart surgery.

'As a PA, you really have to be able to find that physician who’s going to go up to eight flights of stairs with you to look at a kid and see how they're doing.'Click To Tweet

Abby concurs with Thomas and praises him for letting her make decisions by herself, which she finds encouraging and empowering. At the same time, she makes sure she updates him on every patient. And if there are any changes that need to happen, they do it together.

[14:33] Partnership, Not Competition

Thomas explains that the world of pediatric heart surgery is unique because if you go into family practice or even a pediatric practice, those roles can probably be more even.

'We're partners. I have my role, she has her role. They're very well defined. And that's why we work well together.'Click To Tweet

Abby has also seen a couple of groups of PAs in North Carolina and talked about whether PAs can be the manager of their own practice without needing a supervising physician. But like Thomas said, in their role as PAs in their setting, that is never going to happen because they need a physician and a PA or nurse practitioner.

Moreover, PAs don’t see physicians as competition because they respect all the training physicians have had to go through, which is a lot more than they have. They get a lot of on-the-job training, and they rely on their physicians to teach them. They learn what these physicians are learning in medical school in two years or less. So PAs rely on them.

[17:10] Handling Patients Who Only Want to Talk to Doctors

Abby says she has heard patients multiple times asking for the doctor. And so, she just explains to them that she’s the right-hand person and the extension of the physician.

Having followed Thomas around so much, she knows his lingo and what Thomas wants the parents to hear. She’s basically saying what he would be saying at the same time so Abby just tries to explain to the family that she has followed Thomas for a long time.

At the end of the day, these parents are having their child go through heart surgery, and the surgeon is the one responsible for it. As a PA, Abby explains everything to the patients what Thomas would be talking about including the anatomy, surgery, and any post-operative expectations. So they go over everything to ease their mind. She also assures the patients that the surgeon will meet with them at some point.

Another point Abby wants to make is the importance of watching the assistant surgeon and she tries to watch every surgery as much as she can over and over again. 

Thomas acknowledges the role of the PA in talking with families because they lay the groundwork with the family so they know what to expect from surgery in general.  They explain how the surgery is going to work, or that they’re going to meet the anesthesiologist, or maybe they need to come in for a pre-op appointment on this day. Then he can swoop in at the end and talk about the surgery.

'I have to go through the risk, I need those words to come out of my mouth to the family's ears. Even if they've said it 10 times, they're going to hear it for me one more time.'Click To Tweet

Unfortunately, Thomas is the one who has to talk about the risks. This is the mandatory vocabulary that he needs to deliver at that time. Thomas is going to be holding the child’s heart in his hand, so they need to hear the risk right from the person doing it. Because if one of those risks occurs, he takes comfort in knowing that he was able to speak to them about it before the operation.

Abby adds that when you’re speaking with families, everyone is on an equal playing field. It doesn’t matter where you come from.

[25:53] Did Abby Ever Think About Being a Doctor?

Abby says she has never considered going to medical school. She clarifies that people who go to medical school and those who go to PA school have different mindsets. They have the same goal of taking care of a person but what they want to achieve is different.

'People who want to go to medical school and people who want to go to PA school are two different mindsets.'Click To Tweet

When she was 15 years old, Abby was playing soccer and got hurt. She saw a PA that night and it changed her life drastically. That same PA is her mentor she invited to her wedding last Fall. She saw him as a model and so she wanted to be just like him. So at 15, she already knew she was going to PA school and that it’s what she was going to do for the rest of her life.

[27:45] The Malleability of a PA Career

Thomas explains that the good thing about being a PA is your malleability because you have the ability to move around. You can do heart surgery for five years or 10 years and then go be a dermatology PA. The downside though is the turnover. Whereas when you’re a specialist, you can’t be a heart surgeon when you’re an orthopedic surgeon.

As Thomas went through med school, there was a medicine track that led to cardiology as well as other subspecialties. Then there are surgeons, cardiac surgeons, thoracic surgeons, vascular surgeons, and pediatric heart surgeons.

That being said, the trend in heart surgery has changed over the last 10 years to where the boundary between cardiologists and heart surgeons is a little more blurred. 

They now have teams for the structural heart. There are cardiologists and heart surgeons that talk about a patient’s mitral valve disease and the best way to treat it. And so, the boundaries of those siloed things are now a little more blurred. The role of the cardiologist he knew 25 years ago is different today.

[33:41] The Shift Towards Graduate Medical Education System

Abby explains that when the PA profession first started, it was really for the PA to be a family practice provider. The small town has one doctor, and then they need some help.

Now, a PA can specialize in anything. Their training is so broad and every 10 years, they have to take a broad test. 

When she graduated six years ago, there were very few fellowships that existed. But now, PAs are becoming more specialized. And so, she thinks fellowships are going to become more of the norm. They’re going to be more needed in the operating room of different fields.

[35:35] Delivering Bad News to Patients

Thomas explains that while pediatric heart surgery has advanced greatly over the last three decades, their mortality is very low, but it is not zero.

The mortality is about 2.5% which turns out to be about six or eight kids a year that don’t survive when you’re treating 400 kids. That’s why Thomas makes it a point to go over the risk with the families because it’s part of his job that he has been doing for 20 years.

Thomas has been doing this for 20 years, but it doesn’t get any easier. And he believes that the day it does get easier is probably the time for him to hang it up. 

'I'm a human more than I am a doctor.'Click To Tweet

But 99% of the time, he is convinced he has the best job in the world, and 1% of the time, they’ve got the worst job in the world. And if it were much more than that, it’d be hard to do.

At the end of the day, it’s all about humanity. It’s not written in a book nor is it on the MCAT. Humanity is not something you practice, but it will come out if you’re a good human and care for people. That’s why you’re going into healthcare via PA school or med school and you’re going into this for altruistic reasons.

Thomas’ advice to our future doctors and PAs is to be human and care about the patients that you take care of. Thomas says this is natural, otherwise, don’t get in the game. If you have to fake it and study and learn how to do this, he recommends getting into another field for you.

[41:00] Final Words of Wisdom

Thomas is glad he and Abby are able to do this together. It’s a snapshot of healthcare and what it’s going to be in our world. Regardless of what specialty or career you choose, if you enjoy your colleagues that much, you’re lucky. Pursue it with passion.

'The relationship between the physician and the physician assistant is vital to success.'Click To Tweet


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