A Day in the Life of a Vascular and Thoracic Surgery PA: Elizabeth Dryden, PA-C

OH my PA friends, you are in for a treat. Today, my former PA school colleague, Elizabeth Dryden (formerly Diebert and for two years of her life thoughtfully referred to “Diebs”) has offered to answer questions for our Day in the Life of a PA article series! She is, frankly, hilarious, and I love seeing her share her life in words. She practices as a surgical PA in vascular and cardiothoracic surgery (swoon) and has so much to share!

Also, she has been INCREDIBLY patient with me! She sent me this post many (many) months ago and I’m just NOW getting to it.. #reallife.

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

Greetings from the beautiful state of North Carolina!

Born and raised in eastern NC, also known as God’s Country, I obtained my BS in Biology with minors in Chemistry and Forensics at the University of North Carolina at Wilmington. In undergrad, I was pre-med with intentions to go to medical school and become a pathologist and ultimately a medical examiner. But alas, a great friend of mine told me about the physician assistant profession my junior year, and due to multiple reasons, I switched tracks from studying for the MCAT to studying for the GRE. I took a year off between graduation and applying for PA school to obtain what most programs required of 2000 patient contact hours. I took that year and researched programs, took a few prerequisites that were not required for my BS and bought a book “How to get into the PA school of your choice” and read that thing FRONT. TO. BACK. Oh, for those that are curious, I was basically a medical assistant in Dermatology for that year of experience.

Then came time to apply to PA school and after researching how competitive most PA programs were, I applied to all schools between Georgetown to Barry University in Florida (I kept it southern east coast). In 2008 I interviewed at a few schools, one of them being the University of Florida. I knew at that time that was the program for me. I accepted their offer as soon as they extended and was in the graduating class of 2011 with 58 other individuals.

I have been practicing 8 years now, all in the state of NC. I have worked multiple jobs for most of those 8 years with recent backing down to one when I became pregnant with my second child.

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

Currently I am a Vascular and Thoracic Surgery PA- aka we do everything CV surgery does BUT hearts. And I love it.

Funny thing, I did not find my current position, it found ME. I was working General Surgery (took the position just before my first child was born) and became hooked on the OR. After about 2 years in General Surgery, which required coverage of the Wound Care Center for half my time, I was approached by the local vascular surgeons to join their practice. They made me an offer I couldn’t refuse (schedule people, its all about the schedule when you become a parent) and I joined them 2 years ago. Wound Care exposed me to many people with chronic vascular disease so I figured it wouldn’t be much different from what I was currently doing, just less bowel obstructions and choleys. I just know that surgery is where I am meant to be, it fits my personality, my practice, my need for excitement and instant gratification.

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

My office is a small, privately owned practice that is not owned by our hospital (which is a rarity these days). We have 3 vascular surgeons, 2 that are thoracic trained but one who routinely does thoracic cases. We have one NP and 2 PAs to assist the 3 surgeons.

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

The three of us APPs rotate through a schedule that includes 2 weeks in the office seeing patients and occasionally assisting in procedures as clinic schedule allows, and 1 week with hospital coverage which includes rounding, consults, and OR cases. None of us have call (call schedule is LIFE and NO call schedule is THE life), we do not work weekends or holidays. We do work late as our specialty does lend itself to urgencies and emergencies but this is not routine. Our emergencies are mostly acute bleeding/hemorrhage or cold leg. We work 4 days a week, 10 hour days and we rotate having either Monday, Wednesday or Friday off. I would estimate a safe average of working hours a week realistically is 44.

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?

For the 2 weeks we are in the office, we are seeing new patient consults (for which they see the surgeon every first visit), follow ups, post op follow ups, post procedure follow ups, scheduling surgery for patients and scheduling procedures (arteriograms, venograms, vein ablations, port a cath placements and removals, temporal artery biopsies, perm cath placements and removals). We are also the ones to direct admit the patients that require urgent or emergent interventions/ treatment. The APPs perform the following procedures independently: perm cath removals, provide wound care and compression therapy, and sclerotherapy injections. We assist in arteriograms as our schedule allows.

During our “hospital week” we meet with the surgeons in the morning, round on the patients, perform any consults that occurred overnight or throughout the day, manage the patients on the floor, follow up on imaging, labs, consultations to other providers etc. We are also responsible for the discharges. This is of course when we are not in the OR as first assist in surgeries scheduled for that week.

Are you an hourly or salaried employee?

We are all salaried employees who earn bonuses.

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 far as autonomy goes, in any surgical practice you are more tied to your SP/surgeon than any other office based practice as you do not carry your own patient load, but rather you are seeing/evaluating/caring for their patients. We typically are responsible for 90% of the clinic without having to be micromanaged, but we do consult them on any atypical presentations, persistent problems despite current management, and of course, they are involved with anyone who needs surgical intervention. Otherwise we care for the patients in clinic to free them up to be performing procedures and surgeries.

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?

As far as administrative or leadership roles…. I avoid those like a second year PA student avoids standing next to the attending on rounds. As Simon Cowell says “that’s a no from me”. Not that I am not a natural born leader, it just ends up being more work than this mom of 2 can handle at the moment.

What advice would you give to a PA who is considering working in your specialty? What is the one thing you wish PAs in other specialties knew before calling or referring to your practice? Is there anything else you’d like to add?

To any current PAs, PA students, or pre-PAs that are amenable to advice (because I’m about to give you some anyways)-

1. Do not ask questions of anyone until you have first had the opportunity to research the issue. Yes, questions are encouraged, but they should be well thought out ones or at least ones that lend to the idea that you did attempt to educate yourself first before asking someone else. There is something to be said about self-motivation and self-teaching which also makes your questions more educated, specific and lend toward more thorough answers.
2. Use your clinical year to find out what you have a penchant for or enjoy as a specialty, but keep an open mind. Prior to my surgery rotation, I tried my best to argue that I’d never go into this field. Nine years from my emergency general surgery rotation and I have been practicing in surgery for 4 years. Yes, joke is on me.
3. Your “needs” in a job/field will change throughout your career. When I started practicing, I was looking for income and flexibility as a newly married woman without children for which I worked 2 and 3 different jobs. In 2015 with my first child, all of a sudden SCHEDULE became most important to me- the ability to see my child everyday and make it home before bedtime. So don’t feel that you have to stay with one job forever if it is no longer fitting your home life or your goals.
4. Surgery as a whole can be a very rewarding field. It IS TOUGH. Do not go into surgery without thick skin and deaf ears. It is what it is, folks. My surgeons overall value me as a provider and are confident in my decision making and skills when it comes to their patients. But at the end of the day, they are still THEIR patients. Not mine. So I do not take it personally if they do not agree with every decision I made (and even if I’m told colorfully) because as a rule we can all be given the same patient and manage them slightly differently. Doesn’t mean anyone is wrong, it just is a difference in practice, training and experience. In this particular field and their different specialties you are more reliant on your SP’s preferences than any other specialty. Also, there tends to be more yelling (that’s where the deaf ears come in).
5. Surgery pearls for students: There is no crying in the OR. Do NOT touch ANYTHING. If you are assisting, attempt to hold the suction if you are not given instructions, it makes you look like you are doing something. If you can’t hold your suction, for the love of God, hold a DeBakey (forceps). If you are in the way, and you will be, home base is hands on the table or hands clutching your pearls (chest). Do not move them if not otherwise instructed. Do NOT touch the tech’s mayo stand. You ask for what you need in a clear and understandable voice. If you don’t know what you need, give the surgical scrub desperate eyes and they can usually give you what you don’t even know you need. I hope you practiced those one and two-handed ties, in your sleep, on break, in the bathroom. Sweat through the entire closure (if you are lucky enough to be able to perform) and take 2 months and 3 days. The CRNAs will love you for it. Get done and realize surgery is easily the BEST area of medicine as you saw a problem and were then able to assist in fixing the problem. Patient is (mostly) cured.

I’m so VERY grateful to Elizabeth for sharing her day to day with us! She’s an amazing and passionate PA and has so much to give to our profession! She is a hard-working PA and momma, and I hope a little glimpse into what it’s like to work in her world was as insightful for you as it was to me!

-C