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Ophthalmology: a ‘rare find for PAs’ by Heather Woolwine Public Relations Employment of physician’s assistants (PA) is expected to grow much faster than average for all occupations through the year 2014, according to the Bureau of Labor Statistics (BLS), U.S. Department of Labor. Anticipated expansion in the health care industry and an emphasis on cost-efficiency fuels the recent data.   Charleston native and MUSC Storm Eye Institute PA Malissa Sandhu understands that her profession is growing, and is excited that more people are beginning to utilize and understand PAs and their contributions.   Though her larger profession is becoming well-known, Sandhu’s specialty, ophthalmology, is still a rare find for PAs.   “I’m the only ophthalmology PA that I know of, and part of that has to do with the presence of really fantastic ophthalmology techs that do a great job working in most eye clinics around the area,” Sandhu said. “It’s been six years since I graduated and, more and more, I’m seeing physicians and other health care team members realize how PAs function. They have come to realize that we’re trained to be an extension of the physician. We’re not here to compete. We’re trained to be a part of the team.”   Employing PAs is becoming more common in the United States and South Carolina as evidence supporting their cost-effectiveness and productivity surfaces. In addition, the South Carolina Board of Medical Examiners is expected to approve recent state legislation that allows PAs to write prescriptions for narcotics. Unlike many other states, South Carolina did not allow PAs to write narcotics prescriptions, which caused confusion for PAs taking jobs across state lines. Birth of a trend PAs emerged in the 1960s when an undersupply of physicians and rising health care costs contributed to the recruitment of returning medical corpsmen from Vietnam. They were well trained and highly experienced, but found no place in the health care system to use their unique set of competencies. Ultimately the marriage of circumstances in the health care system and the war veteran health care workers led to the formation of the PA profession. Now, PAs practice in a variety or roles and settings, but always under physician supervision.   In the beginning, PA’s were resigned to rural areas and used primarily to fill gaps in the system. Today, they are moving beyond the traditional office setting and can be found in hospitals, academic medical centers, public clinics, and prisons.   “Oftentimes, patients are confused about the difference between PAs, nurses or nurse practitioners,” Sandhu said. “A PA is totally different from nursing, and vice versa. There are things that nurses do that I know I couldn’t do. We really are supposed to work as a direct extension of the physician. With that being the case, a PA should take on the model of the physician they work for and really do their best to become another arm, basically. I work for Dr. [Gene] Howard and he was great about asking me what I wanted to do and gave me a real hand in writing my job description. It’s important to love working with the physician that you choose to practice with so that you can work together to provide the best care possible for your patients.”   According to BLS, “physician assistants perform many time-consuming tasks normally done by doctors. They interview patients, take medical histories, give physical examinations, order laboratory tests, make diagnoses, and prescribe appropriate treatment. They perform routine therapeutic procedures, such as giving injections and immunizations, cleaning and stitching minor wounds, applying splints, and removing casts. Routine laboratory procedures may include drawing and examining blood, taking cultures, and performing and reading skin tests. By doing these tasks for the doctor, PAs allow physicians more time to treat more seriously ill patients.”   Sandhu’s duties also include post and preoperative procedures in ophthalmology surgery due to her unique position with the Storm Eye Institute.   After her physician cousin prompted her to look into becoming a PA, Sandhu shadowed a local PA while still pursuing her undergraduate degree in biology at the College of Charleston. “I loved it, so I was accepted and enrolled in the MUSC PA program. PAs are trained primarily in family medicine so if you want to specialize, you factor that into the type of physician you choose to work with. Many specialties like ophthalmology are a part of the grand scheme, but for instance, I didn’t know how to use a slit lamp until I began working in ophthalmology- now I’m showing PA students how to use it. When you specialize, you really do become that extension.”   After she graduated from the PA program in 2000, Sandhu worked in a neurology office in Orangeburg. From there, her interest grew into neuro-ophthamology and a position at her alma mater. While working in neuro-ophthamology at MUSC, she began to assist with oculoplastic surgery from time to time, and when a full-time position became open in that area, she seized the opportunity. “[Oculoplastic surgery] really drew me in and I like it so much more,” she said. “With plastics, I feel like I’m a part of fixing things and the patients are always so happy with how they look. I also get to do some of the really fun cosmetics stuff in addition to assisting in the OR.”   In addition to assisting Howard with blepharoplasties, eyelid reconstructions, and other surgical procedures, Sandhu provides chemical peels, Botox, and permanent make-up services to patients. “Permanent make-up is a great option for people with tearing problems, low vision issues, or just because they prefer it to applying makeup everyday or because of the toll of the aging process, like losing the hairs that make-up your eyebrows,” she said.   Reiterating how much she enjoys her profession, Sandhu added, “when you decide to do this it should be a life commitment. It’s about providing great patient care, not because it’s the next best profession, because you can make money or because it looks ‘cool.’”   For information or to schedule an appointment, call 792-8100. Friday, June 16, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publication at 849-1778, ext. 201.