I’m so excited to share the second installment of #PASpecialtySpotlight ! I really hope all y’all enjoy this look into Katie’s role in her specialty. I have several more great interviews lined up, but please send me an email if there is a specific specialty you are looking for, or if you are a PA-C who would like to participate!
What specialty do you practice in?
Critical care medicine. I work primarily in a neuroscience ICU and some in a medical/oncology ICU.
What is the setting of your specialty?
My specialty is 100% inpatient. I am an at academic learning center (meaning I work with residents)
What does your “average” day look like?
My typical day starts with receiving sign out from the provider on service the 12 hour shift prior. Afterwards, I “pre-round” on my patients. This includes reviewing labs, imaging, consult notes, progress notes, vitals overnight, orders, and visiting/examining the patient. We then have a interdisciplinary care meeting to discuss patients with the nursing staff, supportive care team, and care coordination team to review any barriers to their care. Afterwards, we round with the attending physician and discuss patient care plans at the bedside. The afternoons consist of admissions, planned procedures, family meetings, and teaching as time permits. Throughout the day, we run the list with the co-managing services (neurology/neurosurgery or oncology depending on which unit I’m in that day) and discuss specialty specific treatment plans and disposition.
What made you choose a job in this specialty?
I chose this specialty because of the unique role I get to play in a patient and their family’s life. While “healing” is largely physical, there is a large spiritual and emotional component. Though a big medical save is rewarding, so is a patient/family coming to terms with a patient’s prognosis and being able to enjoy time with them/honor their wishes and values. The academic rigor and procedural component is just a plus!
How did you stand out as an applicant? How did you land this job?
To stand out as an applicant, I did as many critical care rotations, conferences, and procedural workshops as I could as a student. A large reason I probably got this job because I rotated with the critical care team prior to working here.
What kind of training did you receive when starting?
My training was all on the job. As a new grad, I had 3 months of orientation alternating between days/nights paired with another APP (advanced practice provider). I prioritized working at an academic facility knowing that I would have to hit the ground running and wanted to be on a team that was geared towards teaching. While my approach was totally feasible, there were many times I wished I did a PA Fellowship.
In what role do you function? What are your responsibilities?
I split the patient’s on service that day with the other APP, resident, or fellow on service. My patients are my patients. I see them and assume primary care of them for the entire shift. This includes examining them, formulating treatment plans, doing family meetings, and performing bedside procedures. I admit new patients throughout the course of the day. Working at an academic center, there are often students on service that I share my patients with. My patient load varies anywhere from 5-26 patients depending on the patient census, number of providers on the team, and day/night shift. At night, I am the only provider physically on the unit, but there is always an attending physician on call to help out/come in if needed.
What resources do you love?
I live by uptodate. I also love Marino’s critical care medicine, the Neuro ICU book, Neurocritical Care (what do I do now), and “The Ventilator Book”. “Clinical neuroanatomy made ridiculously simple” is also a great starting reference. Emergency neurological life support (ENLS) is also a great course and I would recommend to anyone interested in NSICU or emergency medicine with some extra time on their hands.
How do you balance studying for your specialty with working?
I normally make a list of things I need to review throughout the course of the day. I review the topics either during down time throughout the day, when I get home, or on my next day off. I try to go to as many grand rounds and journal club presentations as I can. If I need an additional reference, my attendings are always a great resource and willing to teach.
What do you love about your job?
I do love my job! Critical care medicine can be emotionally and physically exhausting and burn out rates are high like many other inpatient specialties. Make sure to separate yourself from work and make time for you!
Is there anything you don’t enjoy about your job?
The biggest thing I don’t enjoy about my job is that sometimes there are too many opinions about patient’s’ treatment plans between the critical care APPs, critical care attendings, co-managing providers, consulting services, nursing staff, respiratory staff, etc. It can make the day a little chaotic, but it’s all in the patient’s best interest. Also flipping between day and night shift can be exhausting.
What specialty did you see yourself going in to when you started PA school? Why did that change?
I initially was interested in family medicine. Throughout first year of PA school, I realized inpatient medicine was a better fit. During my first rotation of clinical year, I was rotating through the TICU and after my first patient coded (yes, FIRST patient!) I saw a touching interacting between the patient and the APP on service and I was hooked. The role you have to advocate for your patient on a multitude of levels is unlike any other specialty of medicine.
Do you have any contract negotiation musts?
I’m not a contracted employee and unfortunately the salary/benefits were non-negotiable. Make sure to review your AAPA salary report and try to speak to PAs in similar positions in the area to make sure what you are getting is fair. Remember you can always ask to supplement your salary with more CME, time off, or paid call if they aren’t willing to budge on the number. Make sure to ask for details on malpractice insurance!
How did you know your position was the right fit for you?
I knew the system was a good fit for me through rotations. I actual didn’t rotate in the specific ICU I would be in until after I accepted the position. Luckily, it worked out for the best.
It’s a common suggestion that new grads go in to a “general” practice (family medicine, internal medicine, emergency medicine) before specializing later. What do you think of this?
I think working in a broad specialty is a great idea! I would highly recommend family medicine, emergency medicine, hospitalist medicine, or general critical care to anyone. It can be overwhelming at first, but personally I think it makes you a better provider in the long run. I always thought switching from a narrow specialty to something broad or outpatient to inpatient might be taxing.
Now for some ICU specific questions!
What are the biggest differences amongst the different ICUs (neuro, medical, oncology)?
The neuroscience ICU providers very specialized care to patients, where the medical/oncology ICU is much more similar to what you would expect to a typical medical ICU (acute respiratory failure, acute heart failure, sepsis, etc). The neuro ICU comanages patients with neurology and neurosurgery teams. This means that we work together with the neurologist/neurosurgeons to provide care regarding the neurologic/operative diagnosis and the critical care team personally creates treatment plans regarding the remainder of the patient’s treatment needs. We take care of patients that have had a variety of types of strokes, intracranial hemorrhages, movement disorders, status epilepticus, and post-operative brain/spine neurosurgery patients to name a few. The interesting part is that many of these patients have co-morbid medical problems, so many times the care can end up looking like that of the medical ICU. The medical/oncology ICU patients comprise patients with any critical illness with an underlying oncologic diagnosis that may or may not be contributing to their admission to the ICU.
What procedures do you complete in the ICU? How did you train for those?
In our group, the APPs do arterial lines, central lines, thoracentesis, paracentesis, lumbar puncture, and occasionally intubation. We also perform point-of-care ultrasound and are expected to be able to personally review CT/MRI/XR for basic findings. I was trained by other providers in our group. Additionally I attended simulation labs held by our group/institution. Perks of working at an academic center!
Do you think completing a residency would have been helpful?
While on the job training for critical care is certainly doable, I think doing a critical care fellowship would have been much more useful. Structured learning time is key! You can never be over educated.
What electives do you recommend PA students complete to help in the ICU?
I think rotations in emergency medicine, inpatient internal medicine, and internal medicine specialties (cardiology, pulmonology, nephrology) are the most useful aside from actual ICU rotations.
What is the salary like for an Intensive care unit PA-C?
Per the AAPA 2018 Salary Report, the average (50th percentile) salary of a Critical Care PA-C is $111,00 with a $6,750 bonus
New grads (0-1 years of experience) have an average salary of $104,000
These numbers also vary greatly by state.
I cannot emphasis how important it is for you to join the AAPA to get the complete copy of the salary report, as well as then having the ability to fill out the yearly salary survey. The more PAs who fill this out, the more accurate these averages are!
I really hope that all y’all enjoyed this little look into Katie’s life as an ICU PA-C, and that it gave you a better understanding of what an ICU PA-C can do. Keep in mind that even though PAs might work in the same specialty, their jobs might be drastically different!