A Day in the Life of a Primary Care, Telemedicine PA: Desmond Watt, PA-C

I’m pleased to share this (long time coming) article for our A Day in the Life of a Physician Assistant (PA) series. It comes from a PA whom some of you may already know. Desmond Watt is a PA who is a huge (HUGE) advocate for PAs in virtual medicine and is the president and co-founder of an AAPA specialty interest group called PAs in Virtual Medicine and Telemedicine (PAVMT). We connected via social media and he has been kind enough to share with us what a typical day is for him. He has recognized a niche market that PAs are very equipped to fill and is yet another fantastic example of an “Empowered PA”. If you have an interest in primary care or in virtual medicine & telemedicine, keep reading!

Total side note: to clarify, the terms “virtual medicine” “telemedicine” and “telehealth” are interchangeable for this article.

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

Originally from the Chicago area, born and raised, and obtained an undergraduate degree at the University of Illinois, Urbana-Champaign. I was a former high school biology teacher with the “Teach For America” program in Oakland, California before going into healthcare. I received an MMS in PA Studies at Midwestern University, Downers Grove and graduated 2012.

I’ve been working in primary care since that time and currently work with an exceptional primary care group called “One Medical” over the last 5+ years. We have a large virtual care component to our practice, and I have practiced in this area over those 5 years as an office PCP and virtual medical director. In 2019, I moved to 100% virtual care as a virtual medical director supporting one of our San Francisco based markets.

Additionally, I am President and co-founder of an AAPA specialty interest group called PAs in Virtual Medicine and Telemedicine (PAVMT). We are intently focused on elevating the conversation about virtual care/telemedicine within our profession, advocating for PAs legislatively and generally to ensure they can practice fully and without barriers in this rapidly growing area of medical care. Most importantly, we want to help PAs get jobs in telemedicine!

In 2019, I moved to 100% virtual care as a virtual medical director supporting one of our San Francisco based markets. Additionally, I am President and co-founder of an AAPA specialty interest group called PAs in Virtual Medicine and Telemedicine (PAVMT). We are intently focused on elevating the conversation about virtual care/telemedicine within our profession, advocating for PAs legislatively and generally to ensure they can practice fully and without barriers in this rapidly growing area of medical care. Most importantly, we want to help PAs get jobs in telemedicine!

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

Primary care/internal medicine. Have always been in internal medicine. There’s something humbling about the role a primary care clinician can play in their patient’s lives. This person is bringing you intently into their lives, presumably for a long time, with an eye towards developing a deeply personal relationship that will bear their fears, flaws, aspirations, passions, etc. That engaging relationship dynamic has always drawn me to primary care.

Within my organization, I have split my time between office-based primary care and virtual care/telemedicine for 5 years. Since the beginning of 2019, I have been in a 100% virtual care role. This is less of a “front and center” primary care/continuity role, and one that fits more into an urgent/transactional care space. That said, the work is incredibly interesting, highly fulfilling, and you have the opportunity to have a meaningful impact on patient’s lives on a daily basis – all from the comfort of my home!

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

Outpatient primary care practice, though I work mostly from home in my virtual care role.

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

Monday-Friday, daytime hours. Occasional evenings, weekends, holidays, but these are infrequent.

Do you take call?

No

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?

A typical day is a short 20-foot commute to my home office. I log in to our EHR and get my IT items set up (computer-based phone, video connection, etc). Our virtual care is more on-demand and not scheduled. The day is highly dynamic/variable based on patient needs. We provide care across a number of channels – video, phone, messaging, etc, as well as handle a number of clinical tasks that support care continuity for patients – reporting on urgent lab/imaging results, handling out of office provider tasks for in-office providers on vacation/PTO, etc. A colleague referred to our care as the “interstitial fluid” within our organization. We support care in and around office-based encounters on a 24/7 basis.

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

Salaried given my clinical leadership role. Wage is highly competitive and I’m very happy given tenure and position.

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 or more specific to your situation?

As autonomous as I’m comfortable with. I have a collaborating physician in Illinois that I meet with routinely, who is also licensed in the markets I support (California). California also has chart co-signature requirements that we abide by, and this ensures a level of consistent interaction which is helpful in a virtual care space with more complex clinical encounters that I need an extra set of eyes on. I can’t speak to what’s typical in this situation as the type of care we provide is not happening broadly/extensively across the healthcare system.

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 am the virtual medical director for one of our San Francisco based markets, as well as our clinical product advisor for virtual care. I love what I do and enjoy being in a leadership position. I’m able to influence the conversation on virtual care direction within my organization, as well as support other clinicians to practice more effectively and have a greater impact on our patients. I have significant time seeing patients every week, and the two responsibilities can be difficult to balance at times, but it’s a great position otherwise.

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

PAs need to expand our presence in the virtual care space now. This is a rapidly expanding area of medical care, but one in which we are not yet behind the curve. Our various state-based practice laws will be significant barriers to accessing these roles as compared to other clinicians, as will be a lack of an interstate medical licensure compact (which is already in place for physicians in 26 states, and nurses similarly in many states, with NPs working towards this as well) to reduce challenges of obtaining and maintaining multi-state licenses. We need to advocate for ourselves legislatively to reduce these barriers so we don’t fall behind this important trend in virtual care. Simply put, if you plan to practice medicine beyond the next 5-10 years this type of care will impact your practice if it isn’t already. It’s not if, but when, and the inevitability of virtual care expansion is a critical component to addressing the huge health care questions we currently face around cost, access, provider shortages, etc. PAs are exceptionally trained to own a huge portion of this space, and we should aim to do exactly that.

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

Nothing specific. Mostly I want to demystify the concept of virtual care. There’s no magic here. Virtual medicine is medicine, it’s just practiced in a way that is somewhat different than what many clinicians might be familiar with. While you rely on a good history and thoughtful review of the medical chart, technology will increasingly support expansive capacities in diagnosis and treatment in this space.

Is there anything else you’d like to add?

• Join our Facebook group: PAVMT

• Check out our website: www.PAVMT.org

• Get active in the conversation! The virtual care medical revolution is happening now. Get involved. Talk about it. Ask questions. Create job opportunities for yourself where they don’t yet exist by encouraging your practice engages in telemedicine offerings.

• Here’s a recent article I co-authored with AAPA regarding important things to know about PAs and virtual care. Check it out: AAPA- The Top 7 Things Every PA Should Know About Virtual Medicine and Telemedicine

Thanks to Desmond for the work you’ve done while advocating for our profession. The field of virtual medicine and telemedicine is rapidly expanding and now is a great time for PAs to seek out those opportunities. We look forward to seeing your efforts grow!

-C