This article appears on the Journal of the American Academy of Physician Assistants’ blog, Musings.
After attending AAPA Conference in San Francisco, I was struck by the spectrum of work performed by PAs across the country (and even throughout the world). As someone who has always worked in family medicine and who has spent the last nine years in frontier (aka “very rural”) medicine, sometimes I can’t even comprehend what my PA colleagues who work in the ICU or cardiovascular surgery do on a day-to-day basis. In case some of you are likewise wondering what it is like to be a PA practicing in rural medicine, I would like to share a few insights into my practice.
You might be a rural medicine PA if …
• In the span of a single conversation you may play the role of clinician, friend, nurse, confidant and social worker.
• You still make house calls; sometimes arriving at the patient’s home by foot, car or snowmobile (depending on the weather).
• You are asked to examine canine patients with such regularity that you keep a special box of vet supplies easily accessible. You also may have a cache of dental and orthodontic tools.
• You learn more from seeing your patients’ carts at the local grocery store than you do from the answers to the social history questions you ask in the exam room.
• You have the privilege of working with extremely dedicated, volunteer EMTs and firefighters who are willing to drop whatever they are doing to respond to an emergency.
• Patients bring you gifts … fresh vegetables, homemade jam, potholders, down jackets.
• It’s totally acceptable to hug your patients.
• Patients look forward to annual physicals with you because you have time to “catch up.”
• Right next to your drawer of vet supplies, you have a tool drawer (or two) for when you need to fix generators, toilets, leaky faucets and/or refrigerators.
• You take vital signs, perform phlebotomy and give vaccines because there is no one else to do it for you.
• You must be well-versed in the details of PPO, HAS and HMO; Parts A, B; and Tiers 1−3 because it directly affects how your patients access and afford healthcare (and you will hear about it if they have to pay for an expensive prescription or see an out-of-network provider).
• You find it easy to talk with your patients about end-of-life care because you know them outside of the clinic, and therefore, have greater insight into their desires (or not) for the continuum of life-sustaining treatment.
Amy Klingler practices at the Salmon River Clinic in Stanley, Idaho.