A Day in the Life: as a Vascular Surgery PA

An inside scoop of what a day in the life as a vascular surgery physician assistant and recent graduate looks like…

It’s been 9 weeks since I began practicing as a provider. 9 weeks learning the in’s and out’s of how this surgical subspecialty operates and treats patients. 

 A little background for those who don’t know…
I am primarily working as a surgical PA providing a first assist in cases for the 4 surgeons in our practice. 1 day of the week I see patients in the clinic, and the other 4 I’m in the operating room. For the past 8 weeks I have been training with each of the surgeons separately on 2 week rotations - overall these rotations have been helpful to get to know each surgeon personally, develop an understanding on how they approach their day, learn their specific preferences in the OR, and how they prefer to round and document. Although I love the group I work with, I would be lying if I said it’s not overwhelming getting a grasp on the entirety of it all at times.

As the #1 requested blog topic on the site right now, let’s dive in to what most days look like:
6:30am: Arrive at the hospital to round on and write progress notes for any post-op patients in house
7:00am: I make my way down to our Pre-Op holding area and help sign off on patients scheduled for procedures. 
-      This can include getting a new history and physical to make sure there haven’t been any changes since they were last seen, checking labs and medications to make sure they’re stable and safe for the operation, and confirming/marking correct sites on the patient for the operation.
7:30am-6:00pm: Consists of time in the OR. 
-      We usually find time for coffee & lunch if it’s not too busy
-      Since there are 3 surgical PA’s, including myself, we typically split ourselves up between the surgeons in the OR’s depending on the type of procedures they’re performing. 
-      Since the OR is quite hard to predict when cases finish for the day or if any emergency surgeries are added, each day finishes at a different time. 

What my personal schedule looks like:
Mon-Friday: 7:00-6:00pm 
Call: 7:00pm-7:00am every 3rd night (or 10 nights/month)
Weekend Call: Every 3rd weekend- this consists of morning rounds with inpatients Saturday and Sunday + taking call Fri/Sat/Sunday until 7am Monday morning.

So, you might be wondering what a ‘call shift’ looks like for me?
This was something I wasn’t familiar with in detail prior to starting aside from thinking “okay so I get a call when it’s a night or weekend, what else”? In all honestly, being “on call” means something different for everyone which varies from each practice- but for us it means getting phone calls from the hospital and potentially going in for emergent operations. 
As the PA on-call we are the first to receive any pages via text/calls that pertain to vascular surgery, covering multiple hospitals in the central Florida region. These pages can vary from routine requests to adjust medications/place orders to a STAT page regarding a patient in need of intervention. These pages are typically labeled as either: routine, STAT, calls from the transfer centers to coordinate whether a patient needs to be transferred to our facility to be seen by our group, or doctor-to-doctor calls. 
Once I receive a page and communicate with the physician or nurse placing the page out to our call service, I must decide if it is something that needs to be relayed to the surgeon on-call ASAP or if it can wait until the morning to assess. This can be quite difficult to discern at times as no two cases are the same in vascular surgery, and especially as a new provider with no prior call experience. Thankfully, I’ve been given helpful guidance (and patience) from the rest of my team as I go through the process of learning how to essentially ‘triage’ and navigate my way through determining which calls are urgent enough to inform the surgeon about and which calls can wait until waking hours. 
TLDR;Call shifts are quite frankly a shot in the dark when trying to determine whether it’ll be a busy night/wknd or not. Weekday night call (7pm-7am) can range from 1 routine call to 15 calls and a midnight emergency that you have to report to the hospital for. 

 Common cases we book in our OR
AV Fistula / Graft creations and revisions, Carotid Endarterectomy, Carotid stent insertions (aka Trans Carotid Artery Revascularization), Endovascular AAA repair, Open abdominal aortic aneurysm repairs, Angiograms, Renal artery stent placement, Temporal artery biopsy, Below/Above knee amputations, Lower extremity revascularizations (whether that requires a thrombectomy or bypass), Peritoneal dialysis catheter insertions, and Tunneled hemodialysis catheter (PermCath) insertions. 

Vascular Surgery is a difficult specialty to sum up into one post and here’s why:
Considering that we operate on any region of the body (with exclusion to the brain/face), we must know the anatomy of all arteries, veins, and nerves of the body. Our patient population isn’t always the *most* compliant, and adding the addition of kidneys failure for 90% of patients we see- does not make for a straightforward surgical case or plan. As I previously mentioned, none of our cases are the same- just as every patients’ arterial/venous anatomy and history is different. Vascular surgery is an intricate specialty that requires a A LOT of work-- this combined with the severe conditions our patients present with makes it one of the less elegant surgical subspecialties out there… 

So why vascular surgery?
When considering a specialty I was interested in I had no idea Vascular Surgery would be a top pick, in fact I can’t really say I even considered it prior to graduation. I would say this wasn’t even on my radar primarily because I didn’t quite understand the scope of the specialty, I had no exposure to it before my first interview with my group. All I knew (even after clinical rotations) was that I wanted to work with my hands and make an impact in the lives of my patients. I asked to shadow the providers in our group on a variety of cases after my first interview to get a better understanding prior to making any decisions moving forward. From doing this, vascular seemed like the perfect balance of intensity and variety that I was looking for. 
This surgical subspecialty without a doubt provides a verybroad spectrum to its scope of practice- which means there’s a wide variety incorporated in our day to day cases in the OR. Though the learning curve may be steep because of this, it never gets boring- which was a huge factor to me. 
Needless to say, I work A LOT more hours than most of my PA school cohorts.  Naturally, vascular demands working many hours and presents with complexities that aren’t necessarily taught in school. Due to the heavy workload and high volume of exposure, I’m learning at a faster pace than I would with less hours/less expectations. In my opinion, this will only make me a stronger PA in the end. 

That’s a Wrap:
Keep in mind, every PA (even other PA’s in vascular surgery) is going to have different hours, responsibilities, and experiences that make up their everyday life. Going into the workforce from school will vary in experience, mine in particular has been harder than all of my clinical rotations combined (not a surprise) whereas my friends in primary care were able to jump in with complete autonomy and knowledge prepped from PA school. However, it should be stated that regardless of the specialty and regardless if you’re brand new or not- the expectation to perform at the level of any given practitioner with confidence is there. There are no longer multiple choice answers to choose from at the end of your patient encounters, or a memorized decision tree to follow for the next steps in care – the responsibility to do what’s best for the patient is now in your hands.