A Day in the Life of a Neurology PA: Brie Marks, PA-C

There are many specialties a physician assistant can work in, and today we are highlighting the field of inpatient neurology! Brie Marks, PA-C, has been kind enough to tell us what her daily life as an inpatient neurology physician assistant is like for our “Day in the Life of a PA” article series. If you love learning about the brain, have ever been interested in the field of neuroscience or had an interest in caring for patients with acute neurological diseases, read on!

#*Update 8/27/19: Brie kindly shared her awesomeness and now we have a BONUS “Brie’s Guide to Brain Imaging” at the end of this post!

Tell us a little about yourself, which Physician Assistant program you graduated from and when you graduated.

My name is Brie Marks and I’ve been a practicing PA for 5 years. I graduated from DeSales University in eastern Pennsylvania in 2014.

What is your current specialty? Why did you choose this specialty?

I currently am loving my job in Inpatient Neurology/ Neurological Acute care. I’ve always been fascinated by the brain and neuroscience, and have only ever wanted to work in the inpatient world.  Neurology is a perfect fit for me because it is both very specialized (one body system) and so very broad! I like to think that Neurology is the “Internal Medicine” of a subspeciality!

What type of environment do you work in (hospital, clinic, administration, or a mix)?

Hospital only. I actually haven’t spent any time in an outpatient office since I was doing my clinical rotations! Our health network is comprised of multiple hospitals, so I spend some of my time at our main hub, which is an academic center, and some of my time in our community hospitals.

What is your schedule like? Do you work Monday through Friday, weekends, holidays, night shifts?

I work 40 hours a week, roughly 8am-4.  I take my turn working holidays and weekends, which is very standard for an inpatient job.  I only work 1-2 holidays a year, and when I work on a weekend, I get 2 weekdays off, which can be great for making appointments, etc.

Do you take call?

Nope! No call.

Describe a typical day like for you? Do you start in a clinic or hospital setting, do you stay there for the entire day? What time do you start and finish?

If I’m at our main hospital, I meet with my team for rounds at 8 am, where we discuss all of our patients for that day and divide them up between the Advanced Practitioners and the Docs.  I then go see new consults and follows ups, trying to prioritize who is the sickest or who may be being discharged that day. 

On our service, the Advanced Practitioner generally does all of the chart reviews, touches base with the primary team, looks at all of the imaging, performs the history and physical and comes up with a diagnosis and plan and then staffs that patient with the attending physician.  I truly have the most amazing team of APs and docs – its an incredibly supportive environment for learning and growth!

I finish my day at 4, though with any inpatient job, there are occasional emergencies that need to be handled right away.  Some of my colleagues work four 10 hour shifts and are scheduled until 5 pm, so it happens fairly rarely. If I’m at a community hospital, I “run the list” (see which patients need to be seen) by myself, go see patients and either meet up with the attending physician later that day in person or speak with them over the phone.

Are you an hourly or salaried employee? Do you think your wage is comparable to your specialty in your location?

Salaried.  Yes, we recently had a market adjustment, I think it’s very fair and comparable.

How autonomous are you, what types of things do you involve your supervising physician for and what do you do on your own? Is this typical for your specialty as a neurology PA or more specific to your situation?

I am quite autonomous, but definitely part of a team.  If there is an emergency or a stroke alert when I am at a community hospital, I respond to the emergency independently and then contact my attending with my assessment. I feel very heard and respected as a provider in my own right, but always have my team of docs to ask questions to and learn from.

Do you currently participate in any administrative tasks or have a leadership position, formal or informal? Do you think this augments or hinders your other responsibilities?

I coordinate our PA students and shadowing opportunities for our department along with our lead PA. I don’t find it really affects my other responsibilities.

What advice would you give to a PA who is considering working in your specialty?

DO IT! Neurology is an amazing field. Don’t be intimidated by the neuro exam or if you feel you don’t understand the material when you’re in school. If you’re passionate about it, you will learn on the job. There are so many opportunities, and you can choose to be a neurohospitalist like I am, work in general outpatient neurology or further subspecialize in areas like epilepsy, multiple sclerosis, movement disorders, etc.

What is the one thing you wish Physician Assistants in other specialties knew before calling or referring to your practice?

Did you read the migraine protocol before calling? Does the person have a clear infectious etiology for their encephalopathy? Ha, honestly, we’re happy to help. If you’re questioning if you need a consult, maybe try a curbside first though?

Is there anything else you’d like to add?

I absolutely adore being a PA and would choose this career 100x over.  The struggle to get there is so worth it!! I’m passionate about mentoring students that are 1^st generation college students as well as English-as-a-second-language learners! Please reach out –happy to help!

Where can interested PAs follow you?

Betweentwostethoscopes on instagram and facebook. I share insights into my life as a Neuro PA, as well as video interviews from the medical community and exam tips and tricks!

Thanks again to Brie for her insight into her daily life as a neurology physician assistant! Neurology physician assistants work in a variety of settings, and it was great to hear how she functions in her role as an inpatient neurology PA.

Brie is such an excellent example of an Empowered PA! She is very active on social media and if you’ve ever considered working in the field of neurology, or if you are looking for neurologic exam tips check her out on her Instagram and Facebook handles! And if you haven’t already, follow Empowered PAs on IG and Facebook for more great articles like this!

BONUS! Brie’s Guide to Brain Imaging:

Your patient needs a scan, but which one?? Here’s the quick and dirty guide to help you choose!

CT without contrast

• Used for: Blood, Bone, Bullets (metal), looking for edema
• Pros: Quick (30ish seconds), well-tolerated, relatively cheap 
• Cons: Not as good as MRI to look at tissue, obtains images via X-ray (radiation exposure)

CT with contrast

• Used for: Tumors, infection 
• Pros: Quick, well-tolerated
• Cons: Nephrotoxic (uses contrast dye), Not as good as MRI to look at tissue

CT Angiogram (CTA)

• Used for: Assessing intracranial and extracranial vasculature
• Pros: 2nd best test to look at vessels of head and neck
• Cons: Nephrotoxic

MRI without contrast

• Used for: Any time you need to see brain tissue but don’t have a suspicion that you’ll need contrast (stroke, encephalopathy of unknown cause)
• Pros: Best test to look at brain tissue, no X-ray, images based on electron arrangement via an extremely strong magnet 
• Cons: Takes a long time (at least 30 mins), Pts have to lie flat, closed in space so many people get claustrophobic, expensive, cannot use with metal in the body or with some pacemakers/ICDs

MRI with contrast

• Used for: tumors, demylenating disease (ex. MS), infection 
• Pros: Best test to look at brain tissue, less nephrotoxic (uses Gadolinium) 
• Cons: Same as above, can’t use in End Stage Renal Disease (risk of Nephrogenic Systemic Fibrosis) .

MR Angiogram (MRA)

• Used for: Assessing intracranial and extracranial vasculature
• Pros: Less nephrotoxic, may obtain without using gadolinium if necessary due to End Stage Renal Disease 
• Cons: Flow-based study, poor/ slow flow makes the vessels look worse than they are 

Conventional Angiography

• Used for: Vasculitis, aneurysms 
• Pros: Best study (Gold standard) for vascular imaging 
• Cons: Invasive procedure, risk of groin hematoma, have to stop blood thinners for the procedure, risk of causing embolization of plaque

CT Venogram/ MR Venogram (CTV/ MRV)

• Used for: Assessing intracranial venous system, looking for outflow obstruction (usually tumors, arteriovenous malformations (AVMs), venous sinus thrombosis (clot)
• Pros/ Cons: as above for CTA/ CTV