Dean Pennington began his career as a physician assistant (PA) in 1997. He works on a team with other PAs or with one or more physicians to provide care for patients. Pennington regularly sees, diagnoses and treats patients, along with his responsibilities of interpreting test results, aiding in procedures and assisting during surgeries. Pennington writes all of the postoperative orders for patients, and helps them and their families better understand procedures and treatments. He obtained his training from the University of Oklahoma College of Medicine and initially worked in occupational medicine and family medicine before moving on to orthopedic and trauma surgery, then spine surgery. Pennington blogs regularly at Scuba Instructor Training, which is dedicated to his other passion—scuba diving.

Why did you decide to pursue this career field?
That is an interesting question for me. I garnered a significant amount of information about PAs while I was in Desert Storm. I was a warrant officer and AH-64 Apache attack helicopter pilot. We had an aeromedical physician assistant and a flight surgeon assigned to our unit. I developed a deep friendship with both of them. They did a great job of educating me about their jobs, including their responsibilities and duties to the patient. I found that I enjoyed learning about this intriguing work so much so that I decided to pursue it. The U.S. Army did not have a pathway at that time to transition from pilot to physician assistant, so I exited the Army with the single goal of becoming a PA. This was a big change and a big risk, but I was committed. It is my thought that if you want to do something, you must commit to do it wholly. Just like joining the Army to fly, if I wasn't committed, I would not have completed the training. I knew that becoming a PA was what I wanted to do, so now I had to do it. I felt that I could help many people after becoming a PA, but I had to get there first.

What type of preparation did you do to get into this field?
Getting there is not easy. I had a degree in aeronautics, with a minor in aviation safety, but I didn't have the biological science prerequisites to enter physician assistant training. This meant I had to complete an entire year of classes at a local community college. It was interesting going back to school as an adult. I was driven because my future depended on two things: learning as much as possible and making excellent grades. These both were necessary for me to continue on to PA school.

In addition to this, I took a job at the local hospital as a nursing assistant. This could be one of the most difficult jobs I have ever held. It has given me great respect for people who do the daily grind of caring for another. It is not easy. I took the weekend position, the 7 a.m. to 3 p.m. shift every Saturday and Sunday. This entailed coming in for report at 6:30 a.m., vital signs every four hours, two meals served, baths, bed changes, enemas and all the heavy lifting. I felt like I could never catch up, but I did learn about being with and taking care of a patient and of a person. I knew this experience could only help me to get into school. I also shadowed two different PAs. I spent time in their practices, watching them take care of people. I applied to only one school, the University of Oklahoma Medical School in Oklahoma City. If I had known the statistics of entry into the program, I would have applied to more. You were required to submit transcripts of all colleges attended, any relevant work experience and an essay on "why I want to be a physician assistant."

The process is straightforward. The first cut was made on GPA alone, which halved the field. Next, the essays were read and face-to-face interviews made. I think my military experience was helpful, in that I had faced life and death situations, which not everyone does. Also in my favor was the fact that I made a 4.0 GPA in all the prerequisite course work. Classes pertaining to medicine were weighted slightly heavier than the others. I did not realize how fortunate I was when I was accepted into the program. Many of my classmates had applied one or two years in a row.

How did your education help you in your career?
The education I received at OU gave me the core information I needed to treat patients from a primary care prospective. It also provided me with the knowledge to pass our national certification exam with the NCCPA (National Commission on Certification of Physician Assistants). Being certified allows you to obtain a state license, which in turn allows you to practice medicine in that state. PAs take a recertification exam every six years. We are also required to obtain 50 hours of continuing medical education every year. Being a certified PA has told my colleagues and employers that they can be confident that I possess a broad minimum core knowledge in medicine.

What was your career path like in this field?
I have held three positions in the past 14 years. The first position was for only four months. It was a great job that I learned a lot from. Unfortunately, it was tied dramatically to the local economy, plus the fact I was required to do some additional training at OU made it short-lived. My second job was doing orthopedic surgery and trauma. I gained a significant amount of experience there. I did everything from total joints of the hip and knee, to shoulder injury repair, fracture repair of all sorts and even some spine surgery. I continued in this job for almost four years until the surgeon I was working with moved out of state. My third and current job is neurosurgery. I have been working with the same surgeon now for over nine years. We concentrate on the spine, doing fusions and decompressions of the cervical, thoracic and lumbar spine.

On and off, I moonlight in an ER or doing trauma orthopedics. I will continue doing neurosurgery until the surgeon I work with retires. I am a PA. We are the bread and butter of medical care for patients. I will always work with a physician as a team to provide care to patients. You can specialize in any field you like, and it is mostly on-the-job training. There are some residencies and advance training in certain fields if you want to learn more before going into that field. Many PAs become practice managers either through necessity or desire. Most states now allow a PA to own the practice. My path for now will be working with a surgeon to provide the best care that I am able to.

What types of skills is someone required to have to work in your position?
Tenacity, patience, empathy and care for others. Skills for surgery would be good hand-eye coordination, endurance (the surgeries can last from one hour to up to eight hours—they average for me about three to four hours). You must also have a good memory to remember patients, medications, treatments and the medical plan. Good organizational skills are also very important, as is familiarity with computers. Most practices are going to electronic medical records.

What do you do on a typical workday?
Monday, I will go to the hospital to be ready to start surgery at 7:30 a.m. Once the patient is in the OR, I go over their chart. I read aloud their diagnosis and the surgical plan. I review the imaging studies. Once they are asleep, I am in charge of positioning the patient on the OR table. I mark where the incision will be, then I will scrub and complete a sterile wash of my hands and arms, then get gowned and gloved. Once the surgeon arrives, I begin. This involves cutting the skin, then incising down to the lamina. From this point, I will assist the surgeon however he needs. This could be controlling bleeding, or retracting muscles or nerves. Once we are complete, I will either tie as the surgeon sews or I will sew and close the wound and put a dressing on myself. The patient is moved to the bed and taken to the recovery room. Once there, I write the operative note and postoperative orders. If we have patients in the hospital, I will go see them. This means I see how the patients are doing, if their pain is controlled, if they are getting up and moving, etc. I write a progress note and any orders to change medications if needed. Then, it is back to more surgery. We try to schedule it where we are done about 5 p.m. This is variable.

On Tuesdays and Thursdays, we have clinic. It starts around 8 to 8:30 a.m. I will make rounds before clinic. Then, I see all the new patients before the surgeon. I will do a physical exam on them. I dictate all the charts with a voice recognition system into a electronic medical record.

Do you plan to advance to another position within your career field?
No, I don't. That is kind of like asking a physician if he or she plans to advance to another position. I may go into another specialty in the future. I do have a special interest in diving and hyperbaric medicine. I have had extensive training in that field. I did this because I like it and it goes along with my other passion: scuba diving.

What type of person do you think is best suited for a job in your field?
I don't know for certain. I know many PAs and they are all different! There are a few common denominators: They are all smart, they all care about the patient, they have great verbal skills and they are as creative as possible at getting care for a patient even in difficult situations or circumstances. Most I know are quick to help but slow to accept accolades.

Do you have any advice for those who are looking to launch a career in your field?
Yes I do! If being a physician assistant is what you want to do as a career, you must:

• make good grades
• have good communication skills
• be committed
• learn as much as possible about PAs, which includes interviewing and shadowing them as they care for patients
• and lastly, don't give up. Many of my classmates got into school after one or two tries.

Being a PA is very rewarding. It allows you the satisfaction of knowing that you make a difference in people's lives. You work intimately with a physician to do this as a team. You will have the opportunity to laugh with patients and cry with them. In the end, if you are fortunate indeed, you will see that look or word that says so much. The one that says "Thank you for what you have done for me."