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physician assistant

I’m a Physician Assistant and I Play One on TV

Posted on Mon, Mar 06, 2017
I’m a Physician Assistant and I Play One on TV

By Kenneth Szwak, MHS, PA-C
I’ve never considered myself “normal,” whatever that means. Certainly not typical in the realm of medical professionals. I pursue creative endeavors equally as much as professional and athletic ones. I play guitar, have been in many performing bands, love heavy metal music, and have had more hair styles and colors than I can remember (which some my colleagues over the last 20  years would like to forget). While I don’t buy into astrology, I would seem to be the Gemini that my birthday indicates, and I cherish it, feeding both my professional and creative personalities. So, when I saw the advertisement in ACEP Now that “Untold Stories of the ER” was looking for new stories, I knew I had to apply.
Story Submission 

After I took the step of emailing the production company, several weeks passed before I received a reply, asking me to submit multiple stories for them to consider. I already had several cases in mind and racked the corners of my mind for more. In the end, I submitted 10 stories with about three that I thought were “can’t miss” cases that I was sure they would pick.
Several weeks later I received word that they wanted to work with me. You can imagine my surprise when I learned that they not only didn’t pick the cases that I thought were a “sure thing” but they chose the one I liked the least. In short, the case was regarding a patient who had hiccups for three days, which turned out to be a small bowel obstruction.
The next step was a Skype conference call to go over the details of the case with two of the show’s producers. From that, a script was produced, which was edited back and forth over the next few months. I wanted to ensure that the script held true to the medicine of the case, and the writers wanted to make certain changes to protect the confidentiality of the patient and add more flair to the story. In the end, the patient was written to be a young female circus performer in the ER with her boyfriend.
The Commute 

Filming each segment takes two days, and I was only able to get four days off, providing for what would be a whirlwind trip. I was flown into Vancouver along with my girlfriend. As I was technically working in Canada, I was presented with very specific documents I had to present at customs. The Canadian customs officer was quite unimpressed with what I was sure at the time to be the start of a promising career in TV. Once through, we had just enough time to get dinner and catch a Canucks game before heading to sleep for an early start.
Filming Day 1 

I had to be up around 5 a.m. on the first day of filming to meet my driver. No surprise there, of course they would send me a limo… or in this case, a minivan to carpool with one of the production assistants and several others to the set. The set itself was actually an old mental health asylum that was converted into TV and movie sets. I realized several months later the same location was used in the conclusion of one of the new X-Files episodes. Imagine that, me sharing the same location as David Duchovny and Gillian Anderson, albeit not at the same time. Surely TV stardom was just around the corner.
In all seriousness, I was blown away when I realized I had my own production assistant getting me coffee and a breakfast sandwich. I thought to myself, “Better enjoy this now, because it won’t happen when I get back to the ER.” The first day was spent doing a table read of the script with the actress who played the ER nurse and the actress who played the patient along with one of the producers and director. Table reads are actually great fun, and are exactly like they sound: A group sitting around a table, reading through the script, seeing what works, what doesn't work and making edits. It was a lot of laughs and brought me back to when I dabbled in drama in high school and college. I was delighted to be in the company of people who got my obscure references to old TV shows and movies like “The Prisoner” and “The Great Race.” I also found out that while this was my first time in TV, this was the first time the show worked with a physician assistant. After that, I filmed the scenes where I talked to the camera and worked with the art department to make sure that the X-ray and CT images looked correct. We wrapped up around 1 p.m. Afterwards, my girlfriend and I enjoyed a little of Vancouver, a very modern, progressive city with a great local restaurant scene – especially the oysters.
Filming Day 2 

The second day of filming is typically a long day and I was advised to plan on being there at least 12 hours. When I arrived, I again found my production assistant eager to grab me breakfast. I changed into my scrubs, and took a seat in the makeup chair. They needed a lot of makeup to make me camera friendly!
Actually filming scenes are even more fun than the table read. Edits are continuously being made to the script as you find some things aren’t working when you start filming. There are mistakes, goofs and laughter. There is a lot of collaboration to find out what works, and the director, Alan Harmon, was great to work with. I’m sure not all directors are the same, but Alan was easygoing and took my and other actors’ opinions into consideration. For example, they were concerned with the opening scene, where the nurse hits me with the chart and makes fun of my last name. They felt it was inconsiderate and wanted to change it. I said, “No, keep it! They make fun of my name all of the time in the ER. That’s just how we are.”
My other favorite moment was when the director pulled me aside to discuss how I was going to deliver a particular line. He said, “I want you to say this with some gravitas. I want you to think Pacino.” I burst out laughing and said, “Alan, there’s like three Pacinos. Do you want ‘Panic in Needle Park,’ ‘Revolution’ or ‘Scent of a Woman’?” After some thought, I knew which Pacino to try to emulate.
Through this experience, I learned how things are filmed: different filming angles, how to keep and how to film a person vomiting. The day ended earlier than expected after about eleven and half hours. I could tell the crew was happy we finished ahead of schedule, and I took that as an indication I learned my lines and came prepared.
Coming Home 

By the time we got back to the hotel, there wasn’t much time left in the day. My girlfriend and I again took to the city, enjoying fantastic food and libations at several places. We returned to our hotel at around 3 a.m., took an hour-long nap, packed our bags, and took off for the airport, leaving The Great White North behind us.
Epilogue: The Episode Premier 

I had been given a rough estimate of when my show would premier, but it changed a few times. The episode, “Hiccup Circus,” aired on TLC and Discovery Life 13 months after I filmed it. Watching with some friends over my house and again with colleagues at work, it was surreal to see myself on TV. I was amazed that I remembered so much from filming that I could pick out which scenes they kept, which ones they didn’t and which takes they preferred over others. I also learned that I don’t like the sound of my recorded voice. I had a good laugh when one of my colleagues texted me, saying a patient called the ER to ask if that was me on TV.
I more than enjoyed the experience, and hope to do it again someday. Until then, I’m still waiting for Hollywood to call me. I probably shouldn’t hold my breath?
Kenneth Szwak, MHS, PA-C, is the lead emergency department physician assistant and EMS co-director at Our Lady of Lourdes Medical Center, Camden, N.J. He is a graduate of Rutgers University and received his medical training from Drexel University. Szwak is a board-certified physician assistant and a fellow of the American Academy of Physician Assistants (AAPA) and Society of Emergency Medicine Physician Assistants (SEMPA). He services on the New Jersey State Society of PA’s Government Affairs Committee and Political Action Committee. Szwak has lectured to medical interns and residents, physician assistant programs, EMS programs, and has authored several peer-reviewed journal articles.


The Emerging Role of Advanced Practice Providers Requires Comprehensive Training

Posted on Mon, Oct 10, 2016
The Emerging Role of Advanced Practice Providers Requires Comprehensive Training

As the population ages and consumer demands grow, the need for physicians is increasing faster than the supply. Simultaneously, the industry is experiencing profound changes in major healthcare reimbursement methods.

There’s no simple solution, but adjustments to how we approach healthcare delivery are being made at practice sites across the country - each with a mission of supporting quality, value and both fiscal and clinical accountability.

One change that seems to be highly effective at helping alleviate the impact of reductions in reimbursement and overtaxed physician resources is the use of advanced practice providers (APPs).

APPs are advanced, certified or registered professional caregivers, including nurse practitioners (NPs) and physician assistants (PAs), who are licensed to evaluate and treat patients under the general (if not immediate) supervision of an onsite physician. PAs, NPs or advanced registered nurse practitioners (ARNPs) have advanced medical training to conduct examinations and diagnose and treat patients under the general direction of a physician. APPs are largely seen as analytical, efficient problem-solvers who are detail-oriented and patient-focused.

According to the American Association of Nurse Practitioners, more than 205,000 nurse practitioners (NPs) are licensed in the U.S., with 44.8 percent holding hospital privileges. The National Commission on Certification of Physician Assistants reports more than 95,000 physician assistants in the U.S. All signs point to increasing demand and growth in job creation in these fields.

Licensure requirements, which often determine the level and scope at which APPs may practice, can vary significantly state to state. More importantly, there exists a great deal of variability in education, clinical training and experience among APPs, which impacts both the roles they can serve and the degree of acceptance they may receive by physicians and other healthcare workers.1

APP Academy Provides Training Continuity

Training and experience is crucial, and unfortunately for most APPs, this can only occur on the job as part of their clinical practice. To reduce variability among providers and improve overall training and clinical expertise, EmCare developed an innovative APP Training Academy. Developed by Andy Mulvey, MD, FACEP, and Richele Wright, MSN, FNP, the academy began training APPs at Community Hospital South in Indianapolis. More than 25 providers have completed the academy.

The program has prepared participants for improved interactions with patients and staff, including emergency physicians and medical staff. Documentation improvements along with more efficient patient flow have been additional benefits of the program. And, perhaps most importantly, patient satisfaction scores have improved.

Lead APPs from EmCare’s North Division have participated in monthly calls to share best practices, disseminate organizational updates, learn from guest speakers and get updates on recruiting, enrollment, human resources issues and quality. By nurturing the APPs and APP leaders, both patients and the healthcare industry are benefitting from well-equipped practitioners who are helping to close the gaps in access to care and the physician shortage.

“This has been such a rewarding experience for everyone involved,” explained Wright. “The additional training allows both the APPs and physicians to practice at the full extent of their licenses and education. Word is spreading about our approach to emergency medicine, and we now have a waiting list for the academy.”

Implications for Emergency Medicine and Hospital Medicine

While there are still barriers and resistance in some areas, APPs are forging ahead with new roles and responsibilities in the fields of emergency medicine as well as hospital medicine.

APPs in the emergency medicine field help physicians achieve goals for providing efficient, quality patient care. These highly trained professionals conduct an evaluation, order tests, diagnose and provide urgent treatments for minor to support improved access to care.

Some of the benefits that APPs can provide in the E.D. include:

  • Fast evaluation and treatment of acute conditions
  • Communication to patients and families about diagnoses and treatment
  • Communication with patients’ other physicians
  • Stabilization and monitoring of acute conditions

In hospital medicine, APPs become an important part of the hospital team through:
  • Careful ongoing monitoring of the patient condition, progress and treatment through rounding
  • Coordinating the services patients need within and outside of the hospital
  • Answering questions presented by patients and families
  • Providing ongoing communication with patients’ other physicians
  • Timely discharge and planning to ensure continued treatment after discharge
  • Sending records to patient’s other physician

The roles and responsibilities of advanced practice providers are likely to grow as the healthcare industry evolves to support consumer demands and better manage costs. Finding ways to help provide quality patient care will be essential to building a better healthcare system.

For more information about APP jobs at EmCare, visit our Clinical Careers page.

1 Kleinpell, R., Scanlon, A., Hibbert, D., Ganz, F., East, L., Fraser, D., Wong, F., Beauchesne, M., (May 31, 2014) "Addressing Issues Impacting Advanced Nursing Practice Worldwide" OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript 5.


Featured Recruiter: Tara Gorombey

Posted on Mon, Sep 28, 2015
Featured Recruiter: Tara Gorombey

Each month, we will feature a Q&A with one of our recruiters.

Name:  Tara Gorombey
Position:  Advanced Practice Provider Recruiter
Division: EmCare Partners Group
Location: Parsippany, N.J.

Education:  Bachelor of Science

Years with EmCare:  I've been with EmCare for 6 months, but I've been with Emergency Medical Associates (EMA) for 2 years (EMA was acquired by EmCare in February 2015).

Years in the recruiting field? 13 years.

Why did you decide to become a recruiter? My first job was working as an administrative assistant for a staffing agency. I was promoted and began sourcing and doing junior recruiting.

How does your experience enable you to connect candidates with the right positions? After recruiting for several years, I’m able to read people. I now can tell which candidates and interested in a position and which ones are passive and less committed.

Describe one of your greatest professional accomplishments. I worked full-time while going to school at night for three years.

Describe your ideal candidate. I look for a candidate who’s clinically strong but has a personality that will fit with the ED team they will be working with.

How important is the “relationship” between recruiter and candidate? It’s very important. You both need to understand each other and communicate well.

What do you enjoy outside of work? I like to go to concerts with my son.  I also collect vintage mid-century modern items.

What’s your favorite inspirational quote? “Don’t walk behind me I may not lead, don’t walk in front to me I may not follow.  Walk beside me and be my friend.”

What qualities make a successful recruiter? A successful recruiter should have emotional intelligence and be able to relate to his or her candidates. You also need to understand the industry you’re recruiting for.

Can you give an example of something a candidate has done that really impressed you during the recruiting process?  I’ve had a few candidates that turned the tables on me during the interview and asked questions about me and the company.  I find that candidates who have a lot of questions seem to be a lot more career-focused than those who only ask one or two questions.

What are a few of your go-to questions during an interview?

  • How did you hear about us?
  • Why did you want to become an APP?
  • Why did you choose emergency medicine?

How should a candidate follow up after an interview with you? Always send a thank you email.

Where do you look for candidates, both in-person and online? Do you use social media? I use LinkedIn, Indeed, DocCafe and HealtheCareers.

How would your co-workers describe you? Hardworking and funny.

If you could have dinner with anyone, living or historical, who would you choose and why? Morgan Freeman because I respect him as a person and as an actor.  

What’s the most interesting place that you’ve been? At a concert standing next to David Bowie!

What was the last book you read? “American Gods” by Neil Gaiman

What personal accomplishment are you most proud of? Being an awesome mother!