Whether you’re just looking into a career as a physician assistant, or you’re already in PA school, it’s never too early to start thinking about a specialty. But what about the biggest specialty of all – Primary Care? Primary Care has had a bit of a public relations problem for decades, but today we’re going to talk about why Primary Care is worth a second look. It’s actually a group of specialties: Family Practice, General Internal Medicine, Pediatrics, and Obstetrics and Gynecology (OB/GYN). These are broad areas. And to be a primary care provider you need to know at least a little (and often a lot) about a lot of things.
If you wrote Primary Care off as not for you, you might want to take a second look. There are some great reasons to go into this field – reasons that you might never have considered.
As a primary care PA, you will always have a job. Plastic Surgery PAs can’t say that – when the economy dips they can get laid off. But there is a huge shortage of primary care providers, and if you become one you will be seen as a little bit of a hero to your patients. People naturally appreciate others who do what needs doing most. And for it, your patients will go to great lengths to appreciate you; they will make sure you know that your work makes a difference.
Get bored easily? No problem. Every day in Primary Care is different. Not only will you serve all types of people, you will be called on to weigh in on all types of problems. Illness, injuries, psychiatric problems, family planning, diet, exercise, medications, imaging, and advocacy for your patients will all be within your province. You will get to do many different things.
We’ve all heard of flight attendants asking for medical assistance on planes. This really happens, and it is rewarding and fun to be there when it does. If you’re a dermatology or hand surgery PA, you won’t get called on very often to save the day when you’re out in public. But as a Primary Care PA you can confidently step forward to help if ever there is a need. If you are a hand surgery PA (and it isn’t about someone’s hand), believe me: you’re gonna want to hide in the lavatory.
Primary Care — because of its broad scope — requires you to use your intuition. Often you will need to treat patients before you have a lot of data, such as when you have a patient with abdominal pain, or a child with a fever. You will need to use instinct and “feel out” what you think is happening. Is this patient BIG sick, or LITTLE sick? Are they suffering from an infectious process, or an inflammatory one, or something else? Can treatment wait, or is it urgent? These questions require a provider who is comfortable making educated guesses and acting on them. By contrast, surgical specialists collect as much data as possible, then try to go in with a plan, hoping to avoid surprises like the plague.
If you value your professional independence, Primary Care has a pleasant surprise in store for you. As with all PA specialties you will work under the supervision of a physician. But it pays to investigate just how closely. Here you will mostly be flying solo, which is very important to some. You will have your own patients, and you will be expected to make the decisions. You may sometimes consult with your supervising physician, but you will usually be the one who decides when. This is different from surgery, where as a PA you will have much clinical responsibility, but more of what you do will be with or at the direction of your supervising physician.
Particularly if you’re younger, this tends to get overlooked. Do you want to get to know your patients? Do you want to know them better each time you see them? If so, Primary Care is the way to go. It’s not uncommon for Primary Care PAs to work with the same patients for decades. You may even treat one of your original patients’ children someday. For some, this relationship building is stressful, uncomfortable, or unimportant. These folks should probably consider something else. But if you see the relationships with your patients as another nice perk of your job, your patients will love you, and you will have another reason to love what you do.
Besides treatment, in primary care you will be tasked with teaching your patients about their health. In narrower specialties such as neurology or endocrinology this is harder and less realistic. In primary care it’s not only possible — it’s essential. Helping diabetics understand how to maintain their blood sugar and helping depressed people to understand the importance of remaining socially engaged are just two examples. Patients love to have things explained to them, and if you do it, they will love you for it.
In primary care you will find out if what you did worked. If there’s uncertainty, you will eventually find out what was “really going on,” and what happened in the end — because you will follow your patients. By contrast, Emergency Room PAs often treat patients and never see them again. This makes for many unfinished stories, and can leave you wondering how well you are helping your patients in the long run. If you always want to know how things turn out, then you’re in luck in Primary Care.
Primary care is by its nature a social specialty. There’s lots to do, so you will have more office staff than most. You will also have different patients than most, and consult with more specialists than most. Much of what you do will require teamwork, and you will be one of the team leaders, if not the team leader. Some specialties that differ here? Psychiatry — where privacy is so important — will have you interacting with fewer people, and Internal Medicine subspecialties like hepatology tend to be so narrow that you don’t need much staff and you see fewer patients in a day.
Because Primary Care is in such demand, it’s the best place to find someone to help you pay off your student loan debt. It’s not uncommon for Family Practice and OB/GYN clinics to hire you with an agreement to pay off a chunk of your PA school debt for staying for a predetermined length of time. They do this to attract applicants, and it should attract you. Once those loans are paid off, you have more options for your career than ever.
At first glance, Primary Care can seem “ordinary,” because it doesn’t have a high magnification focus on any one area. But that means you will enjoy variety, challenge, and great responsibility in this specialty. So take a closer look – the payoff could be a long and satisfying career.