Tag Archives: PA

Vaccinating Our Children

So, my husband and I decided to vaccinate our seven-year-old boy.  We are both vaccinated ourselves and had no problems with the vaccine, other than some mild side effects like arm pain, a little bit of weakness, and fatigue. All which Covid caused as well, minus the arm pain. Even though I am a medical provider, I’m still a mom and had some hesitancy ‘s and concerns about vaccinating my son. Although I will say all my non-medical friends had their children vaccinated before I did. One day I was walking and having a phone conversation with my best friend of almost 30 years. She had placed her 7-year-old son in the Pfizer Covid vaccine trials. He did very well with both vaccinations. I said to her “Well I feel like our son is still growing and yeah I know vaccines are pretty safe nowadays and there have been studies on mRNA vaccines for over 10 years. Again, I just feel like he’s still growing, and it makes me a little nervous to give him a vaccine while he’s still growing.”  Do you know what she said to me? She said “Uh yeah, but they get like five vaccines at a time when they’re born. And they’ve had at least 20 vaccines before they’re the age of two.” You know, she was completely right, and this blew my mind even though I knew it already. Sometimes we all just need a little reminder of the things we already know. 

Our son got covid in August just after school began for the school year. It took both him and me down for about a week. Though we were on the 10 days of quarantine then. I can tell you that in Hindsight I am glad I had the 10 days. Going back to work, in the emergency room on 12-hospital shifts was rough. I had a hard time walking around for periods of time without being winded. The more energy I used, the harder I went down later.

Since we both had some natural immunity now, my husband and I agreed to wait on our boosters and on our sons first vaccination. We waited a total of 4 months, mostly because we didn’t want to feel crummy during the holidays. I got my Moderna booster, and my son received his first Pfizer vaccination in late December after Christmas. He had a little extra boost of energy and no negative side effects. Not even arm pain. Yesterday he received his 2nd Pfizer vaccination. He had an extra boost of energy again for a few hours, but this time he did experience some arm pain with mild swelling later in the evening. Today is the day after his vaccine. He is acting completely appropriate. He is tired but his energy seems to rise with Ibuprofen for his shoulder. . . and he is extra cuddly.

Gout

Gout on one foot with Tophi on the other. Make sure you know if you patient is an over or under secretor before you begin on maintenance medication. #pa_moments #gout pamoments.com

Gout. Most common to the first metatarsal but can occur in any joint. Note the erythema and edema. It is also exquisitely tender to even light touch.
Tophi noted (large bump appearance) to the first metatarsal joint. Tophi occurs from multiple previous gout attacks.

Covid 19 and its effect on Physician Assistant Education and future.

Elizabeth Massey, PA-C

Corona virus 19 first entered the US via social media and its effects on Wuhan, China. As an emergency Medical Provider and PA school educator I first thought, “Uh, Wow! That sucks.” Never did I think the virus would spread to the states. Then Covid-19 completely shut down China. There were news reports on how their citizens were coping with isolation and decrease in food supply and the fear of leaving their homes. This was startling and surreal to me even though I was not yet affected. The virus progressed to Italy with devastating effects. Now it is in the United states. Surely, we the smart people of the United states would learn from the other countries in the fight against this virus.

As a full time, Physician Assistant Educator and a part-time PA in the ER, I had colleagues at the CDC who related how BIG this was and knew the shutdown was coming soon in the US.

But did the US really shut down? No. It was left to local government with different opinions on the severity of the issue. I digress.

The PA school where I was busting my hump went virtual about a week and a half before finals. My world changed in more than one way – as I’m sure it did for many others. I was now a virtual educator full time.  I chose to furlough my part time position in the ER. My ER colleagues needed all the hours they could get to help support their families. The full time ED employee hours were shortened to 10 hours a month. Other facilities and companies were reducing the hourly or salary pay and cutting hours. I commend the ER staffing company I was and am working for with how well they treated all their employees during this hardship.

Meanwhile, I was learning new online platforms like zoom, and trying to figure out HOW we could test students while still maintaining test integrity. Special testing was required and still is – and this costs schools money that was not previously used on testing.

In a medical program it is important to learn physical skills. Skills like how to properly examine a patient, or how to perform certain procedures. This became exceedingly difficult and time consuming. As if working 50-60hrs a week in a medical program was not enough.  Now there was the extra time factor of staggering 8 students at a time in a lab (masked and gloved). Once the students left all the equipment and the room was disinfected.  Do not forget to add the wait time so the disinfectant could dry. Repeat for the next set of students. This was done for every class that required a lab. Labs that usually took 2 hours for a group of 40 students now took almost 2 days to complete.  This took one instructor out of the mix for 2 days’ worth of normal teaching and preparing. One might say it was a big change for schools and students. But this was only the didactic troubles medical programs were having.

The Clinical aspect of learning medicine was impacted the most by Covid 19. At first, only ER rotations were affected. Before long Clinical sites all around the country were cancelling their rotations, and some schools were pulling students out of their rotations. There were national meetings on how to keep the students in their sites or how the student could still get their required patient care hours, so graduation time was not altered. Rotations were shortened, flipped, changed, and postponed. The hardest hit rotations were the rotations that occurred in hospitals: Emergency Medicine, Surgery, OBGYN, or any Inpatient rotation. Then there were facilities that were just concerned for lawsuits should the student become Ill. There were very few rotations that allowed PA students to rotate and many of those required a N-95 mask. As the country is aware, there was a PPE shortage. Honestly, there is still – As I have ONE N-95 in a brown paper bag that I use when I am on shift. There were preceptors who simply didn’t feel comfortable with a student now. Some of the prior preceptors were furloughed or relieved of their duties entirely. Now there were fewer preceptors employed in general, and Many willing preceptors found themselves at facilities that were not.

There was a point when our program only had around 10 students on rotation while the other students were to study or do CME until a rotation became available. How would we decide which student would be allowed to graduate on time and which would not?

A few months later some facilities gradually began letting medical students back into certain rotations only. Hospital rotations were still a problem, but then Physician Assistant students began to have another problem. Select facilities would only allow Medical students or Medical students and Nurse Practitioner students, but not Physician Assistant students. Physician Assistant students are trained via the same model as Medical students and not the nursing model.  Thankfully, schools have learned ways around these difficulties, but many providers are burned out from Covid 19.  As Physician Assistants graduate, they will have a difficult time finding jobs as the market is saturated due to the layoffs of Physician Assistants and Nurse Practitioners. Now many of the positions available are Covid related–precisely what many facilities were preventing these very students from learning.  Some employers chose to only interview Nurse practitioners because of the autonomy level they have in some states – they do not need a physician to independently practice.  Now, 7 months later, some facilities are keeping Physician Assistants students out and will until spring of 2021.

What does this mean for the future of Physician Assistants? New graduates will have a difficult time finding employment and may not be as ready as they could have been due to reduced patient contact. Previously employed PA’s will have a difficult time finding employment with the pay they previously had. Nurse practitioners will continue to have a better lobby for themselves then PA’s will – which will make employment easier for them -thus driving PA pay down with it. Again, I digress. Physician Assistants around the country need to join together and help the students and schools still struggling to find meaningful rotations and Physician Assistants need to join together with their local Chapters to help fight for a better PA lobby for our profession. Don’t forget we can PIVOT in any direction- good or bad. Let’s pivot up!

PA skills and motherhood at it finest

Today, my son needed his bulbasaur (Pokémon) stuffy sewn. I’d rather use a sewing machine but I’ll take a few stabs at it by using my suturing skills. The simple running stitch was used in this superficial repair. And since I didn’t have my forceps I decided not do a non traditional knot tie by burying the thread underneath and going backwards.