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Medscape
16-07-2025
- Health
- Medscape
Essential Insights for PAs Navigating Their Critical First Year
While some healthcare professions have seen their numbers rise significantly in recent years, few jobs have experienced growth like physician assistants (PAs), or as they are now called in many states — physician associates. The National Commission on Certification of Physician Assistants (NCCPA) reported that between 2013 and 2022, the number of PAs in the US climbed from 95,583 to 168,318. At the end of 2024, those numbers had increased to over 189,900 PAs, according to the NCCPA. To join their ranks, you need to complete a PA program — usually for 27 months or 3 academic years — which grants you a Master of Science degree. After that, you need to pass the Physician Assistant National Certifying Examination. Once on the job, PAs do everything from taking medical histories and conducting physical exams to diagnosing and treating illnesses, ordering and interpreting tests, prescribing medications, and assisting in locations ranging from operating rooms to research labs. The first year as a PA can be filled with challenges, rewards, and lessons that can't be learned in the classroom. Alec Williams, an orthopedic trauma surgery PA at Stamford Hospital in Stamford, Connecticut, shared some revelations and insights from his first year after graduating from Quinnipiac University, Hamden, Connecticut. On-the-job Education Williams acknowledged that the 'drinking from a firehose' metaphor for PA school is an apt one, as students are expected to learn a vast array of skills and medical information in a short time. He said PAs are able to come out of school as 'medical generalists,' equipped with tools to care for patient's health in a variety of clinical specialties. 'This being said, with only 27 months to master the art of medicine, the intricacies of various subspecialties are often neglected in some programs, while other programs take the time to focus on some and dismiss others,' Williams said. 'For example, in our orthopedic curriculum, we are taught about the many common orthopedic conditions related to overuse or acute injury, which may present in an office setting. Yet, that is only [one third] of the orthopedic world.' Countless variables involved in diagnosis, treatment, and recovery add to the challenges faced by PAs in all types of specialties, Williams said. More Than Patient Care In addition to realizing how much there is to learn, Williams said a second major revelation was the amount of time that is needed for obligations beyond the actual practice of medicine. 'As PA students, we are bounced around every 4-8 weeks between a multitude of clinical practice environments, from large urban hospitals to rural outpatient mobile clinics and everything in between — including even some foreign countries,' Williams said. 'With this, we are exposed to a small sample size of various PAs' scope of practices. We rarely have the opportunity to fully appreciate the nuances of the extra-clinical responsibilities that PAs must be accountable for on a daily basis, like clinical documentation, administrative work, billing, leadership or committee work, and much more.' Because many of these extra-clinical duties play such a large part in the care provided to patients, it is important that early-career PAs become proficient in many of these soft skills, Williams said. Ask the Right Questions Williams said it's important to understand that medicine is not black and white, but rather, it's full of gray. 'In PA school, we learn clinical guidelines and textbook presentations,' he said. 'But in practice, we quickly realize that no disease reads those same textbooks. Patients rarely present the way PowerPoints have said they will; so instead, we must master the ability to weigh competing priorities, make decisions with incomplete information, and adapt to the unique context of each patient.' He recalled a young patient he encountered just a few months into his career. The patient was recovering from an ankle fracture but was experiencing posterior calf and knee pain. An obvious response — a textbook response — would be to order a venous duplex ultrasound to rule out deep venous thrombosis. But that consideration opened a host of new questions. Williams wondered, 'Would removing the splint for the ultrasound compromise the fracture reduction? Could we worsen the patient's pain or soft tissue injury by manipulating the leg? Could this be a Baker's cyst or referred pain instead? Will this impact the patient's surgery scheduled for today?' Williams said he's learned that clinical reasoning becomes more conceptual and individualized the longer you practice. 'You stop searching for the 'right answer' and begin asking better questions,' he explained. 'Simply put, you look beyond just what the diagnosis is to see how that diagnosis will change management of the patient in front of you. To provide effective, patient-centered care, I would advise early career PAs, like me, to actively make the effort of moving beyond the student mindset and start thinking like a clinician.' Williams suggested recent PA grads be 'relentlessly inquisitive' and ask questions — even if they think they should already know the answer. 'Clinical learning accelerates when you prioritize patient care over your own ego,' he said. 'Also, you have to communicate often with your team. Learn to rely on your fellow PAs, attendings, nurses, residents, and the many other healthcare professionals around you.' One other piece of advice to PAs starting out: Give yourself grace, Williams said. 'Like any new graduate — whether an accountant, lawyer, or mechanic — you're going to make mistakes early in your career,' he said. 'That's part of learning. What matters is how you respond: take accountability, reflect, and lean on your team to grow from each experience. You'll feel behind at times, but with consistent effort, your clinical judgment and confidence will grow faster than you think.' Making a Difference Williams said his first year on the job reminded him not only of the responsibilities that come with being a PA but also of the opportunity to make a difference in people's lives. 'Never take for granted the deeply humbling privilege we've been given as direct medical care providers,' he said. 'Patients place an unequivocal amount of blind trust in us, despite being at their most vulnerable moments. The beauty of this profession lies in our ability to empower our patients to find strength and peace, even when the outcome isn't perfect. If that is your 'why,' hold onto it tightly.' Along the way, PAs should also remember to prioritize their own health and strength. 'Your stamina and clarity will depend just as much on what you do outside of work: sleep, boundaries, hobbies, and a strong support system,' Williams said. 'Many of us became PAs because of the balance we will have, both in the workplace and in our personal lives. Protect that balance and be mindful of it always.'
Sky News
11-07-2025
- Health
- Sky News
TV doctor and IVF pioneer quits British Medical Association over 'damaging' planned strikes
One of the UK's best-known doctors says he has resigned from the British Medical Association (BMA) because it has "effectively encouraged young doctors to strike". Professor Robert Winston, a TV doctor and IVF pioneer, also said a planned five-day walkout by resident doctors, formerly junior doctors, in England at the end of July could lead to the death of a patient. The Labour peer's decision to leave the BMA on Thursday was first reported by The Times. Asked about his decision on Sky News Breakfast on Friday morning, Professor Winston, 84, said: "I've got very serious concerns about the way the British Medical Association is behaving and the way it's run... they have effectively encouraged young doctors to strike." Turnout for the vote was 55%, which means just under half of eligible doctors voted for strike action. Professor Winston, who had been a member of the BMA for 60 years, continued: "It's hardly a democratic decision, but in any case, it's thoroughly damaging. "It's damaging to the doctors. It's damaging to the profession. Most importantly, it's damaging to patients and the risk of taking one's work out means, inevitably, that somebody, at least somebody, will die." Professor Winston, 84, agreed with resident doctors that their working conditions had become worse over the years - saying many have to share a bed with someone else who is on call and that sometimes they don't get a "decent meal" at the end of their shift. However, he said: "The government have done their very best to meet the doctors and what I have to say is that it's very clear that most of us entered medicine because of the altruism involved. "Threats of strike action have been there ever since I came in 60 years ago as a member of the BMA. But actually, like most doctors, I've never been on strike and would not countenance it because I do not think it's in the best interests of anybody." 2:27 Professor Winston, who became a household name through his documentaries on child development, told The Times the "highly dangerous" walkout could harm people's trust in the profession. Earlier this week, the BMA announced that resident doctors would walk out for five consecutive days from 7am on Friday 25 July until 7am on Wednesday 30 July. Doctors in England and Wales were awarded a 5.4% pay increase by the government, but the BMA threatened strike action following the announcement, claiming the increases did not account for historical pay freezes. The BMA is calling for a salary increase of 29.2% to bring salaries back to "full pay restoration". The union argues this is the level at which pay has declined in real terms since 2008, when adjusting for inflation. Health Secretary Wes Streeting called for resident doctors to "abandon their unreasonable rush to strike" and said that NHS recovery is "fragile". Mr Streeting told the Commons on Thursday: "We have put the NHS on the road to recovery, but we all know that the NHS is still hanging by a thread, and that the BMA is threatening to pull it." Sky News has contacted the BMA for comment. Professor Winston is based at Imperial College London and is known for pioneering treatments to improve in vitro fertilisation (IVF) - where eggs are fertilised by sperm in a laboratory setting. His work involving IVF includes the development of pre-implantation diagnosis - which allows embryos to be screened for genetic diseases and means parents carrying faulty genes can potentially have children free of illnesses such as cystic fibrosis.
The Independent
11-07-2025
- Health
- The Independent
TV doctor's warning over ‘dangerous' strike
Professor Robert Winston, a prominent TV doctor and IVF pioneer, has resigned from the British Medical Association (BMA). His resignation was prompted by his strong disapproval of the planned five-day strike by resident doctors in England, set to commence on 25 July. Mr Winston, an 84-year-old Labour peer, said that the "highly dangerous" walkout, triggered by a dispute over pay, could erode public trust in the medical profession. He said that strike action disregards patient vulnerability and urged the BMA to reconsider, warning of potential "long-term damage" to faith in doctors. Health Secretary Wes Streeting also appealed to resident doctors to abandon their "unreasonable rush to strike", cautioning that the NHS recovery remains "fragile".
BBC News
04-07-2025
- Entertainment
- BBC News
Di man wey wake up for future: Tori of doctor wey forget 12 years of im life after accident put am for coma
Dr Pierdante Piccioni na unwilling time traveller. Twelve years of im life dey completely wiped from im memory afta in suffer brain damage for one motor accident for 2013. Wen im wake up for hospital di next day, im bin tink say na 2001 and no fit recognise im wife or im now adult sons. Di whole tin shock am, and now, im no fit practice medicine again, Pierdante - wey pipo close to am sabi as Pier - dey try find the man wey im bin be before. Searching through thousands of emails im discover say im get dark side. Im experience dey so exceptional, so tey e jinja dem to do one Italian TV show about one young doctor wey dem shoot and – similar to Pier - wey lose 12 years of im memory. On 31 May 2013, Pier regain consciousness. Im bin dey lie down for di hospital emergency ward wey im bin dey manage before for Italian city of Lodi. "Di first tin I bin see na white light - and na di light of di emergency room wia my colleagues put me afta di accident. I remain for coma [for] about six hours and wen I wake up, I see only di eyes of my colleagues. "Wen dem ask, 'Wetin be di date today?' I tink [for] five, six seconds, and I ansa, 'Today na 25th of October 2001." Den im see im colleague dey type inside iPad. Dis na wetin bin dey exist back in 2001, wen di only tin wey phone fit do na just to make calls, send text messages and receive basic news updates. But di biggest revelation neva still happun dat time. "Dem ask me, 'You wan see your wife?'" "Of course: 'I wan 'see my wife', I reply. "And for my mind, I expect my wife [to enter di room], but 12 years younger. But di woman wey enta di room no resemble my wife, but] someone like her. She get plenty wrinkles." Pier also get to come to terms wit im children growing up and turning into adults. "I ask dem, who you be? Wia my children? Becos I no believe say [dem be] my sons." Dem, im wife break di shocking news to am: im "mama", wey bin dey very healthy for im own mind, bin die three years ago. "Wen I bin wake up, I bin feel say I dey 53 years old. During di day, I discover and realise say I dey 65." Dark prince Digging through evidence of wetin bin hapun during di twelve years wey delete from im memory, Pier shock to find out say im bin no always be nice man during dat period. "I ask my friends, my colleagues, my wife, which kain man I bin be. Good man or bad? "My colleagues tell me say, wen I become chief (head) of my emergency department and I get about 230 [wey dey work] below me." Dem get one disturbing way wey dem take dey refer to am. "My nickname be di Prince of Bastards." Pier - wey dem also sabi as Doc at work - say e dey impossible to believe dis, becos im no ever tink of imsef as bad pesin before. "Dem tell me, 'You dey very, very dark. You dey very strong... but too hard wit oda pipo.'" Pier missing years: Discovering im true self As Pier learn about how di world take move on during im missing years, im go look for im true sef to dey revealed inside im correspondence - letters. "I read all di emails - [dem bin dey] more dan 76,000 - to try understand who I bin be... For some emails, I get to [acknowledge] say e get one bad man, one bad chief, one serious pesin. Im say im find out say wetin im colleagues bin tok na true: "I bin dey very, very sad wen I read those emails." So, Pier decide to become nicer person. "I start to write diary every day. I write wetin I feel - important or [boring] tins of my day or my life. "I be wrong man in wrong time. Dat no be my time. "I bin dey like foreign pesin for world wey I no understand. I feel say I dey alone. [I feel like say] nobody bin understand me." Pier enta dark place. "I bin feel [alone] for a long time. Becos my mama don die, [e bin feel like] my children die. "So why continue to live? I tink of suicide during those moments, becos dis [bin no feel like] my world." But Pier find way to lift imsef from im negative tinking. 'Fall in love again' Pier bin dey work 15 to 16 hours a day before di car accident wey cost am 12 years of im memory. Im wife say afta im become head of emergency department, im bin dey hardly ever come home. "She tell me, 'I no really know if you get girlfriend or [maybe] more dan one... becos you [be] workaholic'." Pier decide to rekindle im position as husband afta im realise say im don fall for im wife all over again as soon as im wake up from im short coma. "Wen my wife turn to [waka comot from di room] I look her [from behind]. I bin feel in love. E bin dey, wow, nice." Im say, to am, she bin no feel like di same pesin wey im remember. "I tink I be di only man wey fit say: 'I don betray my wife wit my wife'. Becos she bin be like anoda pesin and I fall in love [wit her all over] again." Pier say im new reality dey bright and full of hope. "I dey proud not only for my personal [journey], but... to make new, beautiful memories all over di world. "Dis na my mantra."
The Guardian
14-06-2025
- Health
- The Guardian
‘Tennis repairs you': the 101-year-old fuelled by iced coffee who still plays competitively
Henry Young doesn't mind being asked about his secret to a long, active life – it comes with the territory when you're a 101-year-old competitive tennis player. It has its perks, like getting to play on centre court during the Australian Open, but what he does mind is that it's considered so remarkable that he is playing at all. That he is seen as extraordinary and there must be some magic trick that keeps him going. 'What bugs me is that people give up their tennis when they have some kind of injury,' Young says. 'I'm a monument to the medical profession because I've had so many injuries and I just persevere, and then tennis repairs you.' Just as a sore calf doesn't have to mean the end of the road for a runner, or a pulled hamstring signal the end of a football career, Young wishes the prospect of injury didn't deter older people from playing sport. But staring down the barrel of a long rehabilitation process can be daunting, and returning to sport and exercise after injury undeniably gets harder as you age, so an ever-increasing amount of determination is required each time. This is not something Young is lacking. 'Two new knees, a new hip, pacemaker for my heart, hearing aids in one ear and a cochlear implant in the other and two broken noses,' he says. 'You just can't keep a good man down.' Young's doggedness is key to playing for so long – he just can't stop, it's not in his nature. Tennis has featured in Young's life since school, along with rugby and then squash during his time as a fighter pilot in the New Zealand navy. But when he returned to work on the land in South Australia after the second world war, he could only pick up a racket a few times a year. It wasn't until Young was 70 and retired that tennis became such a big part of his life. Winding around War Memorial Drive in Adelaide 30 years ago, he passed the tennis club with a billboard out front saying 'good tennis players wanted' and thought he'd have a crack. 'They said, 'you have to get tennis lessons unless you belong to a tennis club,' and I didn't want to take lessons,' Young says. So he made up a club. 'I said that I belonged to the Inglewood Tennis Club. [Inglewood] was the name of a neighbouring property where we used to play tennis. And they took it.' As Young had suspected, he played well enough to satisfy the recruiters at Memorial Drive so no lessons were required. 'That's when it started,' he says. 'And I'm competitive so I started really playing, and making it my sport, which it still is.' Now a centenarian with three decades of competitive tennis under his belt, Young is preparing for the ITF Masters Championships in Croatia in October. He plays three to four times a week, often with his friend and sometimes doubles partner Gerry Prideaux, and spends a little time in the gym at his retirement complex. That training regime is about to diversify further. 'I've bought myself a rowing machine,' Young says. 'I've set it up next to the window … so every morning I'm going to do 20 minutes rowing in the Adelaide hills.' Young made history in 2023 as the first 100-year-old to play in the World Masters Individual Championships. 'It's only recently that they've started to make it a bit easier for me,' he says. 'I used to have to play down in the 80-year-olds [age category]. But then they made it 85, now they've got the 90s, and some of the countries are even going to 95.' He's sure it won't be long before there are enough players over 100 to have their own age group too. 'I'm doing my little bit to persuade people to keep on trying, because we're all living longer these days.' Sign up to Australia Sport Get a daily roundup of the latest sports news, features and comment from our Australian sports desk after newsletter promotion Young is happy to share his advice for staying healthy as you age and swears by 'wholesome thoughts' and a balanced diet with a twist. 'I watch my diet, and part of my diet is that I drink three two-litre [cartons] of Farmers Union iced coffee every week,' he says. His attachment to iced coffee is so strong that he's always itching to get back home to it when he travels interstate. The coffee is the outlier in an otherwise fairly standard menu. 'I like everything, I like my meat and my fish and vegetables … I make sure that I get that full variety,' he says. 'I snack on nuts during the day and I've got my iced coffee, and that really keeps me fit.' However, Young's number one tip for people of any age is no secret at all. 'I would encourage everybody to play tennis,' he says, claiming the medical profession supports his view that it's the best ball sport for you. 'In tennis, win or lose, you gain something. It's very nice to be able to say to the man at the other end of the tennis court, 'it was a good win, but you had to work for it,' and you both laugh. They're the ones that you remember, the games that you really had to fight for, and that's competition … it's good for you.'
