Realistic Character Occupations: My Experience as a Physician Assistant

To win readers over we need to write characters so authentic they feel like real people. How do we do this? By brainstorming a character’s backstory, personality, needs, desires, and their day-to-day world. Lucky for us, one aspect of their daily life is a goldmine of characterization: the type of work they do. 

Think about it: a job can reveal personality, skills, beliefs, fears, desires, and more, which is why Becca Puglisi and Angela Ackerman created The Occupation Thesaurus, a writing guide that profiles 124 possible careers and the story-worthy information that goes with each. Because they couldn’t conceivably cover all possible occupations, I’m helping Angela & Becca supplement their project and sharing my experience as a PHYSICIAN ASSISTANT Maybe this career will be a perfect fit for one of your characters.

You can find the full list of Contributed Occupation Profiles and check out The Occupation Thesaurus: A Writer’s Guide to Jobs, Vocations, and Careers at Writers Helping Writers.

OCCUPATION: PHYSICIAN ASSISTANT


OVERVIEW

A physician assistant is a mid-level practitioner, someone who practices medicine under the legal oversight of a physician in the United States. PAs have very few restrictions on their practice, provided their supervising physician agrees to their activities. However, they may not act as primary surgeon, and eye surgery is restricted in some states. This flexibility means that PAs can act as an extension of any physician in any practice.   

NECESSARY TRAINING
Early PA programs were certificate, Associate’s, or Bachelor’s degrees. Modern PAs are required to have a Masters of Physician Assistant degree, which takes 2-3 years to complete following graduation from a 4-year undergraduate program. Training consists of an intense didactic year (“80% of medical school in half the time”), and then at least 12 months of clinical rotations in different practice locations: inpatient, ER, primary care clinic, rural clinics, specialty clinics, etc. Instructors are either PAs or physicians. On-the-job training with the supervising physician is expected when joining a new practice, and all medical records will be signed for at least several months. Continuing education (CE) in one’s practice area and general medication is required. Both state medical licensing boards and the national certifying board (NCCPA) require evidence of a set number of hours each year. Additionally, certifying nationally requires taking a comprehensive exam which is 6 hours long. This test is currently required to be taken again every 10 years to maintain certification, along with evidence of CE.     

USEFUL SKILLS, TALENTS, OR ABILITIES
A KNACK FOR LANGUAGES, A KNACK FOR MAKING MONEY, BASIC FIRST AID, BLENDING IN, CHARM, CREATIVITY, DETAIL-ORIENTED, DEXTERITY, EMPATHY, ENHANCED HEARING, ENHANCED SENSE OF SMELL, EQUANIMITY, EXCEPTIONAL MEMORY, GAINING THE TRUST OF OTHERS, GOOD LISTENING SKILLS, GOOD WITH NUMBERS, HOSPITALITY, INTUITION, LEADERSHIP, LIP-READING, MAKING FRIENDS, MAKING PEOPLE LAUGH, MECHANICALLY INCLINED, MULTITASKING, NETWORKING, ORGANIZATION, OUT-OF-THE-BOX THINKING, PEACEKEEPING, PERFORMING, PROMOTION, PUBLIC SPEAKING, READING PEOPLE, REPURPOSING, RESEARCH, SALES, SELF-DEFENSE, SEWING, STAMINA, STRATEGIC THINKING, STRONG BREATH CONTROL, SWIFT-FOOTEDNESS, TEACHING, VISION,WRESTLING, WRITING

SOURCES OF FRICTION
Differing opinions with one’s supervising physician on one’s capabilities or how to treat a patient
Having to defer to a physician who treats one with disrespect, or who leaves one all the unpleasant work in the practice (ER call, weekend call, documentation after seeing patients together, etc.)
Multiple practitioners in the same practice telling patients different things about the same illness
Patients who make unreasonable demands or requests (wanting antibiotics for a cold, unnecessary tests, narcotics, etc.)
Patients who lie about their symptoms, history, or past treatment
Patients who cannot recall their medications and don’t have a list (risking interactions with new prescriptions)
Patients who ignore/forget directions/recommendations, fail to improve, and return/call repeatedly
Nurses who can’t assist: swab, give injections, run tests, or fill out paperwork properly
Coworkers who talk about each other behind their backs
Someone calling in sick and having twice the work for the same shift
Having to work when one is sick because no one else can cover
Difficulty finding childcare due to the length of one’s shifts
Having to work overtime to finish charts
Never seeing the sunlight on the days one works
Difficulty paying back student loans
Exhaustion, back/neck/eye pain from being on one’s feet or charting on the computer all day
A complaint/accusation by a patient of poor care or malpractice
Suspecting abuse of a patient by caregiver, but being unable to prove it on report
Seeing patients in public and having them be uncomfortable because of what one knows about their medical history
Seeing patients in public who are confused when one pretends not to know them (HIPAA)
Seeing patients in public and being subjected to a loud report on their current health
Having friends and family send random, weird, or inappropriate messages or photos without asking 
Dealing with hostile, aggressive, or psychotic patients alone in a small room

WRITERS SHOULD KNOW…
PAs are not nurses, and they are not the same as APRNs, although both are mid-level practitioners. PAs are trained in general medicine whereas APRNs specialize early; APRNs also have a written, comprehensive, and specific set of rules about their legal range of practice. PAs are employed heavily in the US military in both medical and non-medical units to provide care to soldiers, but APRNs are used only in hospital units. 

Work and life balance is tricky. Burnout in healthcare is very high, and suicide rates as well. This is partly because of the psychological factors of dealing with the death of patients, or being unable to help relieve chronic issues, and the long hours and loss of personal life. Working holidays is common, and patient load often increases right before all holidays and school breaks. Additional stressors are the current healthcare system. Health insurance dictates an incredible amount of what is allowed for treatment, versus what is best for the patient. Health insurance also is weighted toward paying for tests and procedures rather than time spent face to face with a patient. 

Paperwork is neverending: documenting charts, setting up referrals, requesting prior authorization from insurance, submitting disability requests, writing job releases, applying for grants for rural or at-risk communities. 

Administrators often focus more on increasing reimbursement rates and keeping costs low than patient care. All practitioners are now monitored for productivity rates through electronic records systems, which means they are graded on how much income they have generated for the clinic or hospital versus how much time they spent on a patient. 

There is a general push to treat patients as customers, reinforcing quick fixes for the momentary needs rather than improving overall health and preventing disease. This also encourages patients to come in early for treatment of minor illnesses, most of which would resolve without intervention, and contributes to overuse of antibiotics and spread of superbugs as a result. 

Most PAs chose this job because they want to help people. Time spent with a patient—learning about the person, about the problem, examining, and then coordinating a plan for treatment—this is the best part of the job. Everything that gets in the way of this goal is what causes burnout. 

Angela & Becca’s note: a big thank you to Sara Blackman for generously sharing their experience in this job role!

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