A Day in the Life of a PA in Orthopaedic Surgery

June 5, 2014

By Kimberly Mackey, MPAS, PA-C

I enjoy being a physician assistant because my work is challenging, yet very rewarding. I am able to practice medicine within a multidisciplinary team where I consult with my supervising physicians daily.

I’ve been working as a PA in orthopaedic surgery for about a year. I chose orthopaedic surgery because of the variety it offers. In the same day, I assist in the operating room, perform joint injections, interpret X-rays and evaluate and treat orthopaedic problems in our clinic.

Here’s what a recent day was like for me.

Morning: operating room

There’s no place quite like the operating room.

There are procedures we do for every case. The surgical site is prepped, and the patient is draped to create a sterile field. Before the case starts, the surgeon calls a timeout to ensure everyone on the team is on the same page and to minimize potential errors.

This seems like it could become very routine. However, cases are never the same once the incision is made. There are factors such as the angle of the fracture or quality of the bone that requires real-time judgment calls. This type of thinking and acting in the moment keeps me highly focused.

Below is a snapshot of one of the morning cases.

Case 1: Open reduction and internal fixation to the ankle

The first case of the morning is a bimalleolar fracture (both bones in your ankle) to the right ankle with ligament damage.

During the case, we use an X-ray machine to position a metal plate to the fibula, the outer bone of the lower leg that forms the ankle joint. We use two screws to stabilize bone fragments to the distal tibia bone. After we secure the plate and close the incisions, we make a fiberglass ankle splint.

Afternoon: orthopaedic clinic

In our clinic, PAs are able to see patients and perform procedures with a high level of independence, which is what I like about the clinic setting. I see patients on my own schedule, but may always consult with one of my supervising physicians if I have any questions.

One of my favorite things is following a patient through the total joint replacement process. As a PA, I establish a relationship with a patient over a period of time as joint injections are performed. It’s remarkable to see a change in a person living with such an improved quality of life after joint replacement surgery.

Below are a few of the patients I saw in an afternoon clinic.

Case 2: Knee injection

The first patient is here for a joint injection of the knee with hyaluronic acid, which is known as viscosupplementation.

Hyaluronic acid injections are indicated for advanced osteoarthritis in the knee joint. Before a patient is eligible for a joint replacement, our practice follows a treatment algorithm that includes viscosupplementation.

Case 3: Ankle sprain

The next patient is a follow-up from the emergency room with a left ankle sprain. An X-ray was obtained and read as negative.

Upon examining the patient’s foot, I notice some point-tenderness. I order a left foot X-ray in clinic and identify a loose body at the lateral aspect of the left foot. I consult my physician on whether the patient needs to be referred to a foot and ankle specialist. My supervising physician agrees, and the patient is referred for further evaluation to determine if an ankle scope is recommended.

So that’s a little bit about me and what my typical day looks like. What do you like about being a PA? What is your favorite part of your job? Do you perform procedures? How do you and your supervising physician work as a team?

Kimberly Mackey, MPAS, PA-C, is a graduate of The University of Texas Medical Branch PA program. She practices in orthopaedic surgery in Houston. You can connect with her via Twitter @kimmackeyPA, LinkedIn, or email [email protected].