Balancing Teaching and Clinical Practice

But being a physician assistant wasn’t always his career path. Junsay received his bachelor’s of science in animal physiology and Neuroscience from the University of California, San Diego in 1998. However, he soon grew unsatisfied with the direction of his life and his job working in a laboratory and followed the lead of some friends who were applying to PA school. "After learning about PA school and the profession I realized that is what I wanted to do. It embodied all things I was interested in—education, science, biology, working with people. It was also a new profession that I felt if I could learn, I could help promote."

Junsay received his master’s of science in physician assistant studies in 2003 from Western University of Health Sciences. Of his current jobs, teaching for his alma mater has proven to be the most rewarding. "I started working at Western University of Health Sciences in September 2005," he states. "As an alumni, I frequently returned to help out with various workshops and help proctor physical assessment checklists. I have always been interested in teaching on some level and after the [PA surgical] residency wanted to have a hand in preparing future PAs for rotational and clinical experience. Once an opening was available, I interviewed and was fortunate to get the job. I am an instructor currently teaching emergency medicine and clinical skills curriculum."

As an instructor, Junsay’s responsibilities range from preparing lectures to researching and developing curriculum for the various classes he teaches. He also plays a key role on numerous committees and keeps office hours for any students who want to stop in and voice their concerns or ask him questions regarding their education or career choice. At the West Covina Medical Clinic—General Surgery Department, his main duties are performing minor procedures such as skin tag removals, skin biopsies, wart treatments, toenail removals and other "lumps & bumps" procedures.

As for his work at Arrowhead Regional Medical Center, he enjoys working for such a large, county hospital. Arrowhead is a 500-bed facility located in Colton, California. "It is a Level 2 trauma center associated with Western University and Loma Linda University," Junsay notes. "Students from these schools, as well as other medical and nursing schools, do rotations and internships there. In addition, it has medical residencies in many specialties as well as PA postgraduate residencies in general surgery, orthopedics and obstetrics and gynecology. There is a dialysis center, cardiac cath lab, respiratory lab, wound care clinic, burn clinic and physical therapy clinic to name a few of their services."

Junsay started at Arrowhead in 2003 when he was a part of the first PA general surgery residency program class there. He worked there for a year and left for San Diego before coming back to help out with SICU/Burn call occasionally. "At Arrowhead," he says, "I take overnight call for the surgical intensive care unit and burn unit. I perform inpatient management of these patients. The majority of these patients are trauma victims with injuries requiring ICU status and are on some sort of ventilator or life support. I also write admission orders as well as diagnostic or pharmaceutical orders. Occasionally, I have the opportunity to perform various procedures from IV placement, chest tube insertion or removal, arterial lines or wound management. Often, I am in the position to communicate to family members of the condition and status of their loved one—a specialized skill in itself."

Junsay often finds himself drifting back and forth between the pros and cons of his two lines of work. On the one hand, he loves the challenge and the influence he has as an instructor. "I was very happy and proud that Money magazine and salary.com [listed] PAs and college professors in their "Top 5 Best Jobs in the United States." As a teacher, I like the freedom I have to shape my class. I especially treasure the relationships with my students and the staff. The most satisfying thing is [to help] a student do well on clinical rotations and pass their boards and find a job. There is value to being a little part of that person’s accomplishments."

On the flipside, he states, "A dislike of the teaching is sometimes you feel like there isn’t enough time to prepare. It could be a personal thing. Maybe I’m not preparing enough or efficiently. But with the increasing duties of the job, the balance between learning new skills and information to become a better teacher with the preparation time needed for a class and understanding how to bring these two together, I feel sometimes I could be a better teacher if I had more time. Another aspect that frustrates me is that sometimes students have not accepted the expectations required of a graduate program, and it feels like I have to be a parent as well as a teacher. It can be frustrating, but at the same time when you are able to make that individual improve and change, it makes it all worth the extra work."

The pluses and minuses are equally prevalent in the clinical setting, he concedes. For him and others like him, being a PA is as much a calling as a job. "In the ICU," he remarks, "I like the fact that managing these patients forces me to understand the physiology and process of their injuries or disease process. It is a high acuity and stressful job, but it keeps me on my toes, many times making quick decisions with limited information. It’s a stimulating job both intellectually and emotionally and always a very challenging occupation being an intensivist. Most of all, I enjoy working with the patients and family especially when I sense a feeling of comfort and understanding and appreciation from the instruction, updates and management I provide for the patient. Things I dislike are not sleeping in my own bed and the hours overnight. It’s the job and the care that makes it worth it, though."

Being in both worlds definitely has helped him in relating to his students the demands of the working world. He comments, "The challenge is balancing teaching my students the difference between learning things academically and what they are going to see clinically. As a PA, you work with different physicians. Each one, especially on rotations, will have their philosophy. It’s not necessarily the ones that we teach or that are in the book. They all have their own ways of treating certain conditions and approaching patients that are different from what the book says. So, we can tell them, ‘Here’s what you will need to know for your tests . . . but when you go out and practice, you’ll see that it is done this way also.’"

And every once in a while, having such a full plate pays off in extremely rewarding ways. This past April, for instance, he went with 13 of his students to China as part of a partnership with the University of Beijing. They spent three weeks overseas and were given demonstrations of traditional Chinese medicine that provided those making the trip with first-hand comparisons to Western medicine.

This was Junsay’s first trip to China, but almost certainly not his last. "Hopefully," he says, "we can continue this as an annual opportunity for our students. A lot of people are looking into alternative therapies. This experience not only gave our students experience with a wholly different culture and society, they also got to learn medicine from a total, 180-degree perspecti
ve. We got to actually practice a lot of the traditional Chinese treatments, like acupuncture and moxibustion [a medicine therapy, popular in Asia, that uses mugwort herb to stimulate circulation and induce a smoother flow of blood]. We got to see patients being treated and actually examine some patients. It was very beneficial for everybody."

Such explorations are all part of Junsay’s continuing quest to stay ahead of the advances in the medical world. In the future, he hopes to work for either a second master’s or even a doctorate in education. "I just want to continually improve my knowledge of medicine and the profession to instruct my students effectively," he states. "The greatest challenge is to stay informed with the current advances and their applications. For a pure educational standpoint, it’s important to let the students be aware of new technology, treatments and themes in medicine that their supervising physicians may employ that aren’t in the textbooks. It’s difficult enough to teach the avalanche of information that’s currently standard. It is always a challenge to find how to implement new information."

He adds, "One of the greatest concerns is maintaining and increasing the public awareness of our role in the healthcare system and the services we provide. I feel many problems encountered are due to misinformation. The more we can prove to individuals that we are competent healthcare providers, the more likely they or people they know will not avoid seeing a PA for a physician. Another, and I feel just as important, issue is our importance in specialties. Currently, there are discussions about post-grad specialty programs and other qualifications PAs should have in certain specialties. Also, discussion is generated about certifying exams due to the increased specialization of PAs. I’m worried that if there is any requirement for special certification or tests to work in a specialty, it would limit our horizontal mobility that is unique and an advantage for our profession."

Junsay is certainly out there on the front lines promoting the PA profession to any who are interested. His enthusiasm for the work can only be labeled as infectious. He beams, "People who are drawn to the profession at an early age tend to be highly motivated, and they want to do something for society. They really want to help people and be a part of people’s lives in terms of seeing someone go from sickness to health, from sad and distressed to happy and well. The students that we see have that drive to do a better good. There is nothing like being in our position where we can make an active or passive positive influence on our patients and their families. Keep educating your patients and family and friends about our profession. We need to ease the fears some patients have when we introduce ourselves as PAs and help create more confidence in the patients when a PA sees them. As we are gaining more exposure and more physicians are realizing our potential and value, we have been increasing our influence in the specialties and hospital settings. With the residency cutbacks, more PAs are finding opportunities in hospitals. As the understanding of our capabilities improves, the easier it will be for us to broaden the areas we can be employed."

And to those young in the profession, Junsay stresses getting involved with professional associations as a way to further career connections and personal knowledge. He, himself, is a member of the California Academy of Physician Assistants, the American Academy of Physician Assistants and the American Academy of Surgical Physician Assistants. "It’s a lot of acronyms," he chuckles. "But from a continuing medical education standpoint, you get articles and literature that increase your medical knowledge base. [Associations] enable you to stay on the cutting edge of medical care. You don’t want to fall too far behind technology and advancements in treating patients. With the Internet these days, patients will come in with more information than you’ve been exposed to. So, you have to be on your toes and up to date."

Ryan Junsay, PA-C, MSPA, is an instructor at California’s Western University of Health Sciences and is on staff at West Covina Medical Clinic and Arrowhead Regional Medical Center in San Bernardino County. He received his master’s of science in physician assistant studies in 2003 from Western University of Health Sciences.