A Day in the Life of a Family Medicine Physician Assistant

Family medicine was my second career specialty. I worked in emergency medicine for 3 years prior to changing specialties. Truthfully (and ignorantly), my idea of family medicine was this “happy place” where all the patients are on schedule and I was home by 5 every night and free on the weekends. 

While there was some truth to my vision, anyone who’s worked in family medicine knows how challenging it is. And after working in a family practice for 5 years, I can say it was honestly MORE challenging as a clinician than emergency medicine, at least for me. You really have to be familiar with ANY potential diagnosis or medical condition. The variety of things I saw in family medicine far outnumbered what I saw in the ER. You don’t always have STAT tests to help rule things in or out right away. You are the gatekeeper, the advocate, and the provider all in one. 

So, I thought I might give you a little run down of a day in the life of a family med PA, just in case you have any presumptions like I did. 

My day typically started at 7 and I would leave around 4:30-4:45. I did this 4 days a week. I was also given 4 hours of admin time, which combined equaled full-time status. Admin time is paid time to finish charts or any other non-clinical duties. Most providers in my area work 4.5 days a week and take an afternoon off from seeing patients for their admin time. I negotiated to work 4 long days and take one full day out of the office. I would work hard to be efficient so I didn’t have any administrative work to do on my day at home. I took Wednesday off, so I never worked more than 2 days in a row. I loved the schedule!

My appointment times were either 15 minutes or 30 minutes, with the 30 minute slots reserved for yearly physicals, procedures, and patients I knew required more time. Follow up and acute visits were 15 minutes. We usually had an hour blocked off from 12-1 for “lunch” (more on that later). 

On an average day, I would see around 20-25 patients. While I love doing procedures like skin lesion removals, joint injections, I&D’s, and others, those weren’t a big part of my schedule. I had a good mix of pediatric, adult, and some geriatric patients. 

My preference was for patients to have their labs completed before their office visit. During wellness exams, I reviewed lab results with my patients and tried my best to educate them on the basics of what these labs meant, even if they were normal. Of course anyone with chronic conditions like heart disease, hypertension, diabetes, etc, we would really spend some time looking at trends and talking about how they were managing their condition. We reviewed health maintenance and recommended guidelines based on the patient’s specific needs. 

I have a background in nutrition so I would almost always bring up wellness and offer tips for how to improve on nutrition and exercise or activity. While many providers stray away from this because they don’t have time or believe it makes patients uncomfortable, I found patients want to talk about their weight in a non-judgmental environment. So I always tried to offer this. 

Mornings consisted of three or 4 wellness exams, and a mix of follow up and acute visits. For any acute issues that required testing, I was fortunate to be in the same building with labs and imaging, and could easily send people to the hospital across the parking lot if needed.

I did not have a scribe. To be honest, I became very efficient at charting and using templates, and I’m still not convinced a scribe would save me time. Where I worked PAs didn’t have scribes so it didn’t matter. I would make every effort to begin charting in the room, and finish charts between patients.  

I had two major templates, one for wellness exams, and one for anything else. For common chronic diseases, I had smartphrases (or small templated paragraphs) outlining the highlights for those particular issues. Prior to going into the patient room, I would open a template. In the room, I would open the patient’s chart and just take a few notes while they answered questions. I would make every effort to be in front of them and not on the computer for most of the visit. I tried to place orders and fill prescriptions in the room with the patient, so I could make sure they were accurate and review them with the patient.

After finishing the encounter, I would run to my office and take a few minutes to finish the note. Many providers have 10 minute appointments, but spend their evenings catching up on charts. I made my appointments in 15 minutes and attempted to chart after each one. It didn’t always work out, but I generally had all of my charts completed by the end of the work day. 

Throughout the day, patients constantly send in questions and requests through their electronic record (we use EPIC and MyChart). Every few patients or so, I would also check on these messages and try to answer them. Some patients think you’re a personal friend with hours to sit and reply to them all day. While I want to be available for all of my patients, our time on MyChart isn’t billable nor accounted for in the schedule. I learned early on if it required more than one “back and forth,” I just needed to have the patient schedule an appointment. 

Examples of questions or request I would see are 

“My daughter was diagnosed with strep throat. My throat feels scratchy today, can I get an antibiotic?”

“I’m leaving on a mission trip to Africa, what should I do for malaria and vaccines?” 

“I’ve had x,y,z symptoms, should I schedule an appointment?”

If you have a good nurse, you can train them to use protocols and algorithms for many common questions, but I still spent quite a bit of time responding to patients. 

Any extra time between patients was also spent reviewing lab results, signing orders, authorizing prescription refills, and many other small tasks that take time. 

During “lunch” hour, I would catch up on any charting, messages, lab results, etc from the morning. I always tried to start the afternoon with a clean slate. If I was really efficient, I might have time to go outside for a quick walk and catch some fresh air, which was nice. Sometimes I ate, but usually in front of the computer. All with the goal of leaving as early as possible. 

The afternoon was much the same as the morning. 

My favorite aspect of family medicine is getting to know my patients and building a relationship with them. Of course some were easier to like than others. But for the most part, this is something I cherished and you don’t get it in many specialties. 

I liked seeing things through with my patients. In the ER, I may see a patient and never know what happens to them once they’re discharged. In family medicine, you can take the time you need working through your differential. It may take a few days or even weeks to figure things out one step at a time, and that’s ok. Not everything has to be figured out in the brief 15 minutes you see them. I also enjoy “managing” diseases, and seeing how they respond when you adjust a treatment or make a recommendation. 

The things I love about family medicine are the patient relationships, building a fun work culture, the schedule, and the variety of things I see. There are also things I don’t love. It’s a lot of paperwork. You spend a lot of time approving alternative medications, signing off on orders, dealing with insurance companies and prior authorizations, and other tedious tasks. You spend a LOT of time reviewing results and responding to messages, perhaps more time doing this than seeing patients. Patients often show up late and throw everything off schedule, which creates a domino effect. Patient’s think you don’t care about their time when really you have very little control over it. 

But at the end of the day, it’s one of the most rewarding specialties. It’s a specialty I never thought I’d end up in, but one I could see myself doing for a long time. 

Do you have any questions about working in family medicine as a PA? I’ll meet you in the comments. 

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