Day in the Life of a Physician Assistant
Three PAs wrote down everything they did on one ordinary workday. No interviews, no prompts. Just the day as it happened.
These characters are composites, built from dozens of real accounts, interviews, and community threads. The people aren't real. The experiences are.
What you'll learn
- A specific day in three PAs' working lives, broken down hour by hour
- The clinical decisions that don't appear in the job description but happen every 15 minutes
- What the job feels like from the inside on a normal, unremarkable day
Maeve's Tuesday
Alarm goes off. I sleep in scrubs on OR days because it eliminates one decision. Coffee from the machine in the kitchen, black, two cups in a thermos. My cat Walter watches me from the counter with the expression of someone who thinks 5:40 AM is unreasonable. He's right.
Arrive at the hospital. Badge through the surgical services entrance. The pre-op area is already busy. Our first case is a 71-year-old woman named Mrs. Kendrick who is getting a total knee replacement, left side. I reviewed her chart last night at home. She has a history of atrial fibrillation and is on warfarin, which we bridged to Lovenox five days ago. Her INR this morning is 1.3, which is acceptable for surgery. I check in with the pre-op nurse, a woman named Angie who has been doing pre-op for 12 years, and she tells me Mrs. Kendrick is anxious. I go talk to her.
Mrs. Kendrick is sitting in the pre-op bay with her husband. She's wearing the hospital gown and she looks small in it. She's nervous about the anesthesia, not the surgery. Her sister had a bad reaction to propofol 15 years ago and she's been worried about it since. I explain that the anesthesiologist will review her history, that we have her sister's records flagged, and that Dr. Calloway, who is our anesthesiologist today, is meticulous about drug allergies. She relaxes slightly. I mark the surgical site with a purple marker on her left knee, per protocol. The site marking is one of those things that seems basic but prevents the kind of catastrophic error that makes the news. I've never seen a wrong-site surgery. The marking is why.
In the OR. Mrs. Kendrick is positioned, prepped, and draped. The surgeon is Dr. Navarro, who I've worked with for three years. The scrub tech is Jay, who keeps a playlist of 80s rock on a Bluetooth speaker in the corner that Dr. Navarro tolerates and I secretly enjoy. The first cut is at 7:12. I'm standing across from Navarro, retracting the patellar tendon so he can access the joint. The saw comes out for the femoral cut. The smell of bone being cut is something you never get used to. It smells like a hot hair straightener, almost chemical. Jay once said it smells like burning toenails. That's closer.
The femoral and tibial components are in. Trial reduction looks good. Range of motion is 0 to 120 degrees, which is excellent. Navarro says "nice" and places the polyethylene insert. I irrigate the joint with about 3 liters of saline, which is the pulsatile lavage to clear debris. Then we close. I suture the arthrotomy, which is the deep layer, while Navarro closes the capsule. Total case time: 72 minutes. Mrs. Kendrick goes to recovery. I write the post-op orders on my phone while walking to the break room: weight-bearing as tolerated, Lovenox to resume tonight, PT consult in the morning, pain management per the multimodal protocol we use for all knees.
Second case. A 54-year-old man, ACL reconstruction using a patellar tendon autograft. This is a more complex surgery than the knee replacement in some ways because the graft harvest and tunnel placement require precision down to the millimeter. I'm retracting and irrigating for most of it, but I also harvest the bone-patellar tendon-bone graft, which is my favorite part of any case because it requires delicate saw work on live tissue and you can feel the moment the graft frees from the patella. Dr. Navarro lets me do the graft harvest on all ACL cases now. He didn't for the first year. That trust was earned over about 40 cases where he watched me do it while standing close enough to intervene. He doesn't stand close anymore.
Case done. I scarf a protein bar and half a banana in the locker room. The third case is at 11, a rotator cuff repair, which is arthroscopic and therefore less physically demanding for me because I'm managing the camera and instruments through small portals instead of holding retractors in an open incision. My shoulders thank me on scope days.
Rotator cuff repair. Straightforward. Two anchors placed in the greater tuberosity, suture passing went cleanly. Dr. Navarro commented that the tissue quality was better than expected for a 62-year-old, which is his version of being optimistic. Total case time: 94 minutes.
Lunch. Actual sit-down lunch in the physician lounge, which is a room with a microwave and a table that's slightly nicer than the break room. I eat leftover pasta and check my afternoon schedule. No more OR cases. Afternoon is clinic: six post-op follow-ups.
Clinic. Six patients. Two post-op knees at two weeks: both doing well, remove staples, check range of motion, clear for outpatient PT. One post-op shoulder at six weeks: good healing, start strengthening phase. One patient with a meniscus tear who needs to schedule surgery. I explain the procedure, the recovery timeline, answer his questions. He asks if Dr. Navarro is good. I say yes. He asks how many of these Navarro has done. I say roughly 300. He looks relieved. One patient with lateral epicondylitis who I've been managing conservatively with a counterforce brace and PT. Not improving. I discuss a cortisone injection. She's nervous about needles. I tell her I'll numb the area first and it takes about 10 seconds. She agrees. I do the injection. She says "that's it?" That's always what they say. Last patient cancels.
Charting. I have six clinic notes and three operative reports to finalize. The operative reports are templated, so it's mostly confirming the details and adding specifics: component sizes, blood loss, any deviations from plan. Mrs. Kendrick's op report takes 12 minutes. The ACL takes 15 because the graft measurements need to be exact. I'm done by 5:45. Drive home. Call my mom. She asks how surgery went. I say "three for three, all clean." She says "I still can't believe you do that for a living." Neither can I, some days. In the good way.
Bennett's Thursday
Get to the clinic. Small building, used to be a dentist's office. Three exam rooms, a front desk staffed by Kelly, and a lab area where our medical assistant Phoebe draws blood and runs the point-of-care tests. The physician I collaborate with, Dr. Underwood, is at the main campus 20 minutes away. She's here Tuesdays and Thursdays for half the day. Today is one of her days, which means I can consult in person for the morning at least.
Review my schedule. Twenty-two patients. Eight are chronic disease follow-ups: diabetes, hypertension, COPD, thyroid. Six are acute visits: two sore throats, a back pain, a possible UTI, a rash, and a "just doesn't feel right" which is my favorite chief complaint because it could be anything from dehydration to lymphoma. Four are well-child checks. Two are annual physicals. One is a pre-op clearance for a patient getting a hernia repair next week. One is a medication management visit for a patient on three psychiatric meds.
First patient. A 58-year-old man named Donald with Type 2 diabetes. His A1C came back at 8.1, which is above target. He's on metformin 1000mg twice daily. I added a GLP-1 agonist, Ozempic, three months ago but he stopped taking it after two weeks because the nausea was too much. I ask if he's willing to try again at a lower dose. He says he'd rather try a pill. I switch him to Jardiance 10mg and explain what it does, how to take it, what side effects to watch for. I also refill his lisinopril and his atorvastatin and order a lipid panel and metabolic panel for three months. Total visit: 18 minutes. I'm already 3 minutes over but Donald always goes over because he talks about his grandkids for the last 4 minutes and I let him because his wife died two years ago and this is the conversation he used to have with her.
Nine more patients. The "just doesn't feel right" turns out to be a 44-year-old woman who's been fatigued for three weeks, has lost 6 pounds without trying, and has night sweats. Those three symptoms together get my attention. I order a CBC, CMP, TSH, ESR, and a chest X-ray. I also palpate her lymph nodes and find a 2-centimeter node in her left axilla that's firm and non-tender. I refer her to the oncologist in Bend, which is a 4-week wait, and I flag the referral as urgent. Dr. Underwood walks by and I grab her. I describe the findings. She agrees with the workup and the referral and suggests adding an LDH to the labs. I add it. I tell the patient I don't want to alarm her but I want to be thorough, and that the specialist will take a closer look. She asks me if I think it's cancer. I say I don't know yet, and that's the honest answer, and the honest answer is the hardest one to give because it leaves the uncertainty with the patient.
Lunch. Eat a turkey sandwich at my desk while signing off on lab results from yesterday. Twelve results to review. Ten are normal, I message the patients through the portal. One is a thyroid panel that's slightly off, TSH of 5.8, which is subclinical hypothyroidism in a patient I've been monitoring. I'll discuss at her next visit. One is a hemoglobin A1C of 6.0 on a patient who was at 7.2 six months ago, which is a win. I type "Great job, whatever you're doing keep doing it" in the portal message. That message will take 15 seconds to type and will make her week. I know this because I've been her provider for five years and she screenshots my positive messages and sends them to her daughter.
Eleven more patients. The well-child checks are efficient: growth chart, developmental milestones, vaccines, anticipatory guidance. I can do a well-child in 14 minutes if the kid cooperates. The two-year-old did not cooperate. The pre-op clearance is routine: review the patient's medical history, check an EKG, clear him for general anesthesia. The psych med management visit takes 25 minutes because the patient is on lamotrigine, sertraline, and hydroxyzine and wants to taper off the hydroxyzine. I discuss the taper schedule and the risks of reducing an anxiolytic while keeping the other medications steady. I ask Dr. Underwood about the interaction. She's already left for the main campus. I call her. She agrees with the taper plan. Total phone call: 90 seconds.
Last patient cancelled. I use the 15 minutes to catch up on charting. I have four notes still open from the afternoon. The charting is the part of this job that follows me home. Each note takes 5 to 8 minutes if I'm focused. That's 30 minutes of charting I'm doing right now, plus the notes from this morning that I did between patients. I'll have maybe two notes left to finish tonight at home, which I'll do on the couch with my laptop while my partner Cass watches something on TV. She's used to it. She calls it "pajama charting."
Lock up the clinic. Phoebe already left. Kelly is closing out the schedule for tomorrow. Drive home. The road from the clinic to our house is 12 minutes through farmland and I don't turn on the radio because my brain needs the quiet. I think about the woman with the axillary node. I think about whether I should have ordered the chest X-ray stat instead of routine. I decide routine was right because she's stable and stat would have alarmed her more than necessary. Then I think about it again. Then I stop thinking about it because Cass is making dinner and the house smells like garlic and I'm done for today. Mostly.
Colette's Saturday Overnight
Wake up. I slept from 9 AM to 6:30 PM. Blackout curtains, white noise machine, phone on silent. My roommate Janae, who works a normal 9-to-5 at FedEx corporate, leaves a note on the counter that says "there's chili in the fridge, good luck tonight." I eat the chili standing up in the kitchen while reviewing the ER census on my phone through the hospital app. Board looks manageable: 18 patients, none critical.
Arrive at the ER. Badge in through the ambulance bay entrance because the main entrance takes longer. Get sign-out from the day-shift PA, a guy named Fletcher who's been here four years. He hands me three pending patients: a 72-year-old with a UTI waiting on urine culture sensitivity to guide the antibiotic, a 19-year-old with a laceration that needs suturing, and a 45-year-old woman with an asthma exacerbation who's been on a neb and is improving. Fletcher looks tired. He says "average day" which in the ER means nobody died on his watch. He leaves.
Suture the laceration. The 19-year-old cut his hand on a broken bottle at a barbecue. It's a 4-centimeter laceration on the thenar eminence, deep enough to see the muscle belly but no tendon involvement. I anesthetize with 1% lidocaine, irrigate with saline, and close with 5-0 nylon. Seven interrupted sutures. He asks if it'll scar. I say yes, a little. He says "cool." He's 19.
Check on the asthma patient. Peak flow is up to 320 from 180 on arrival. She's comfortable, breathing easily. I discharge her with a prednisone taper, a follow-up appointment with her PCP, and instructions to use her rescue inhaler before exercise. The UTI patient's sensitivity comes back showing the E. coli is susceptible to nitrofurantoin, which is what I would have prescribed anyway. I discharge her with a 5-day course and instruct her to follow up if symptoms don't improve in 48 hours.
The board fills up. Saturday night in Memphis. Three walk-ins and two ambulances in the next hour. Walk-in one: a 6-year-old with a fever of 103.2 and ear pain. I look in the ear. Bulging tympanic membrane, erythematous. Classic acute otitis media. Amoxicillin, ibuprofen, follow up with pediatrician in 3 days. Walk-in two: a 30-year-old with a twisted ankle from a pickup basketball game. X-ray shows no fracture. Air cast, ice, follow up with ortho if not improving. Walk-in three: a 52-year-old man with epigastric pain that started after dinner. His vitals are stable. I order a troponin because epigastric pain in a 52-year-old male is cardiac until proven otherwise. I also order a lipase to check for pancreatitis. He tells me he had "a lot of barbecue." I tell him the tests will help us figure it out.
Ambulance brings a 34-year-old woman, motorcycle accident. She was a passenger, low-speed, wearing a helmet. Complaint is right wrist pain and right knee pain. She's alert, oriented, vitals stable. No loss of consciousness. I order X-rays of the wrist and knee. The wrist shows a non-displaced distal radius fracture. The knee is clean. I splint the wrist with a sugar-tong splint, give her a sling, prescribe ibuprofen 600 every 6 hours, and refer her to orthopedics within the week for a cast. She asks if she'll need surgery. I say probably not for a non-displaced fracture, but the orthopedist will confirm. She seems relieved. Her boyfriend, who followed the ambulance in his car, is in the waiting room looking worse than she does.
The 52-year-old's troponin comes back normal. Lipase is 340, which is elevated. Normal is under 60. That's pancreatitis. I start IV fluids, order a CT of the abdomen to check for gallstones or complications, and admit him to the hospitalist service. He's disappointed because he thought he was going home. I explain that pancreatitis requires monitoring and IV hydration and that the CT will tell us more. He asks if it's serious. I say it can be, which is true, but most cases of mild pancreatitis resolve with supportive care. He asks if it was the barbecue. I say possibly, alcohol and high-fat food are common triggers. He says he had three beers and a full rack of ribs. I don't editorialize.
A lull. The board is at 12 patients, all dispositioned or waiting on results. I chart. ER charting is fast because templates exist for everything: laceration repair, fracture management, chest pain workup. I can complete a chart in 6 to 8 minutes if nothing complicated happened. The complicated ones take 15. I eat a granola bar from the vending machine and drink water from a bottle I refill at the fountain because staying hydrated on a 12-hour shift is a discipline, not a choice.
Ambulance. A 68-year-old man found unresponsive by his wife. Paramedics intubated in the field. GCS of 5 on arrival. The attending, Dr. Torres, takes this one. I assist. We stabilize, CT head shows a large hemorrhagic stroke in the right basal ganglia. Neurosurgery is consulted. The neurosurgeon reviews the images remotely and says the bleed is not operable. The patient goes to the ICU. Dr. Torres and I talk to the wife in the family room. She asks if he's going to be OK. Dr. Torres says the next 24 to 48 hours will tell us more. She nods like she already knows. I get her water and a warm blanket because the family room is always cold and because there's nothing else I can do for her right now.
The rest of the shift is a mix: a dental abscess (I prescribe antibiotics and pain management, refer to a dentist), a 20-year-old with a panic attack who thought she was having a heart attack (EKG normal, troponin normal, I spend 15 minutes explaining what a panic attack is and why it feels exactly like a cardiac event, she's embarrassed, I tell her she made the right call coming in), and two more walk-ins that are minor and dischargeable.
Day shift arrives. I give sign-out to the incoming PA. Three patients pending: the stroke patient in the ICU, one patient waiting on a CT read, one waiting for a ride home. I walk to the parking garage. The sunrise is happening and Memphis looks almost pretty in that light. I drive home with the windows down because the cold air keeps me alert. Janae left for work already. I eat cereal, brush my teeth, close the blackout curtains. Walter, my cat, is somehow at my roommate's place and I don't have a cat. That was a different PA. I don't have a cat. I have a quiet apartment and a bed and 9 hours before I do this again. I'm asleep by 8:15.
Frequently Asked Questions
What does a PA do all day?
It depends on the specialty. Surgical PAs split time between the OR and post-op clinic visits. Primary care PAs see 18 to 24 patients for a mix of chronic disease, acute visits, and well-checks. ER PAs evaluate and treat patients across the acuity spectrum, from lacerations to cardiac emergencies. The common thread is independent clinical decision-making with physician oversight.
How many hours do PAs work?
Most PAs work 36 to 50 hours per week. Primary care is typically 40 to 45 hours, Monday through Friday. Surgical PAs work 45 to 55 hours including OR time and call coverage. ER PAs work 12-hour shifts, usually 12 to 14 per month, with documentation time extending beyond the scheduled shift.