Payal Shah, PA-C, EMPA
Choosing A Specialty
Life as a certified emergency physician assistant takes dedication to our specialty, time to prepare for, and an exam to become certified. It was the best decision of my career. I knew after my emergency rotation that I wanted to practice emergency medicine. After I graduated I moved to Illinois to work at a small 13-bed rural community emergency department. There, I was fortunate enough to work with doctors and other midlevels who were willing to train me. While a culture shock and a completely different environment than what I was used to in South Florida, it was one of the best decisions I made for my career.
The staff I worked with taught me so much. I learned how to intubate with the respiratory therapists and attendings. Placing central lines was taught by surgeons and reducing wrists by the orthopedists. I always preferred hands-on learning. It was terrifying to be a thrown into emergency medicine. For me as a new grad, it was the best way for me to learn. There was a lot of good pressure. The follow-up limitations, and patient population itself were new challenges. Phone calls to transfer to higher level of care facilities were not something I knew how to do.
Learning The Role
While I was a student in the ED, I did not have to make those phone calls or call the consultants. As a practicing PA, my license was on the line. I wanted to prove to my doctors that I wanted and deserved to work with them. With tons of questions and help from my staff, I quickly learned the ways of the ED.
I eventually became more confident and more sure of my medical knowledge and my skills. Before I knew it I was managing DKA, strokes, acute STEMIs and non-STEMIs. Thankfully I had my attending there to give me help or answer my questions. I learned how to deroof burn blisters, drain peritonsillar abscesses and reduce dislocated joints. I became proficient in my technical skills, while also honing my medical skills.
After just over 2 years of experience in the rural community ED setting, I moved to a level 1 trauma I center. I currently practice there today. It is a completely different ballgame, especially with it also being a teaching hospital. It is still pretty much a constant surprise (but that comes with the territory of the ED).
Practice Make Perfect
Where I work, physician assistants are assigned the “fast track” side of the department. The “easier, more simpler” patients come to this area. The reason for the quotes is because in the emergency room, not everything is as simple as it seems. I have managed acute strokes, third degree heart blocks and ruptured ectopic pregnancies in this area. I also do laceration repairs, I&Ds of abscesses, and splinting simple fractures. All in the fast track.
Even though PAs are assigned to the fast track, we are encouraged to pick up shifts on the main side. This gives us exposure to more critical patients. It also makes us comfortable managing patients with higher acuity. Being new to the hospital, I started with one shift a month on the main side. Now that I have learned the protocols of the hospital, I work half of my shifts on the main side.
Taking the Leap
After about a year of working at my current hospital, I decided to pursue my CAQ (certificate of added qualifications) in Emergency Medicine. Studying for it was rough, especially while keeping up with my shifts, family obligations and not to mention the overall state of the country at the time with COVID 19. However, with all of its stress and time commitment, it was well worth getting the certification.
Once I passed my CAQ and became a certified emergency medicine physician assistant, there was a newfound confidence in me. I had always been confident in my clinical acumen, but with the certification, there was a new strive to prove to myself and to everyone around me that I was deserving of the certificate. I educated and pushed myself to pick up more main side shifts, while also pushing myself to learn more and become a better clinician and provider.
Being a Trusted PA
My attendings had trusted my judgement before I had my CAQ. After getting it, they were even more comfortable with my decisions and my methodology. I was more independent while seeing critical patients, and more sure of the decisions I was making. Studying for the CAQ had also refreshed my memory on the critical patients, and also on basic tips and tricks I had forgotten about while in practice.
In addition, now that I am certified in EM – I have increased job responsibilities, am more independent with my critical patients, and recognized for my skills by my accomplished attendings. In addition to all of the respect for getting my CAQ, there was also an increase in my compensation and bonus for achieving this milestone.
Validating the Decision to Become an Emergency Physician Assistant
I love being an emergency medicine physician assistant. I actually cannot imagine doing anything else. The fast paced environment, the flexibility, the difference I can actually make in a patient’s life- I personally would not trade it for anything. Life always stays interesting in the emergency department. Always be cautious, and don’t get tunnel vision. Never hesitate to ask questions. There truly is no such thing as a stupid question, and it is always better to err on the side of caution! The moment you think you know everything, is the day
you hurt yourself and your patient.
As a certified emergency physician assistant, I am more confident in the patients I see. There are still times I am completely dumbfounded and need help. I have no shame asking a myriad of questions because there is something I have never seen before. Don’t lose hope and believe in yourself!
Payal Shah, PA-C currently practices as an emergency medicine physician assistant in Washington, DC. She is a regular instructor of our clinical skills and procedure workshop, and has also reviewed the Emergency Medicine Board Review Series for the PA-CAQ exam.