What are some of your dreams? Do you dream of working in a certain speciality? Do you dream of living in a specific state? Do you dream of having incredible work-life integration? Listen to today’s episode to hear how Rachael Anstine, PA-C made her dreams a reality.
Rachael is a PA working in colorectal surgery in rural Montana. Rachael had always dreamed of living in Montana, but didn’t know if it would ever truly happen. Rachael shares how she and her husband went from dreaming of theoretically living in Montana to the logistics of actually making it a reality. She talks about everything from PA licensing in a new state to making new friends.
We also talk about how to improve your charting to be more efficient so that you can leave work at work instead of bringing it home. I loved chatting with Rachael about how she created an ideal work-life integration. Tune in to hear this Unicorn PA’s story and how you, too, can make your dreams a reality.
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Rachael Anstine is a PA working in colorectal surgery in Montana who made her dream a reality. She graduated from Chatham University in 2020 and started working in private practice orthopedics for one year. After that, a colorectal practice reached out to her, and she took to the job because it offered better benefits, better pay, and better hours. Rachael fell in love with colorectal surgery after that.
Last spring, Rachael and her husband talked about actually making their dream of moving from Pittsburgh, PA to Montana a reality. Rachel started looking for jobs in Montana and reaching out to recruiters. While she loved colorectal surgery, she was open to jobs in general surgery, colorectal surgery, and orthopedics. She found a colorectal practice that was creating a new PA position and now works with that practice in Montana.
What is a Day in Your Unicorn Job?
Rachael says this is the first time her supervising physician (SP) has had a PA. She has been in this job for five months and is still working on finding the best way she can support the practice and her SP.
Currently, Rachael is focused on seeing clinic patients 3 days per week. Her SP is only 1 of 2 colorectal surgeons in the entire state of Montana. Rachael sees the clinic patients so that her SP can spend more time in the OR. Racheal also helps in the OR when she is available. In addition, Rachael also helps a bariatric surgeon connected to their practice in the OR.
What is the Role of a PA?
Rachael feels that the role of a PA is to fill in gaps. These gaps can occur anywhere in the office or hospital setting and in the patient experience. Rachael helps wherever she is needed – with her SP, the nursing staff, or the OR staff. Rachael will help finish the case and then assist with moving the patient to PACU.
A good question every PA should ask themselves is, “What can make everyone’s lives easier?” PAs can help fill in gaps so patients can be seen and get the care they need as soon as possible.
While other staff can also help fill in gaps, PAs have experience and knowledge that medical assistants and nurses do not. This can help patients get the correct care more quickly.
Rachael says she has always been interested in Montana. She has never liked crowds, cities, or places being built up. She is drawn to Montana because it seemed more open and spacious than the east coast.
Chatham University has an association with a hospital in Montana, so Rachael was able to do a rotation there in PA school. The hospital was located in rural Montana and only had 5 inpatient beds. During this rotation, Rachael was able to ski every weekend. Her husband also came out to visit and spend time exploring the area. They both loved it.
After PA school, Rachael and her husband took a ski trip to Montana. They both had a dream to one day move there. While they enjoyed visiting western Montana, they went back for another trip to see if it was a place where they could really live full time. They fell in love with Missoula and decided to make the move.
Logistics of Moving and Changing PA Jobs
After Rachael and her husband decided to officially make their dream a reality and move to Montana, Rachael started looking for jobs. Most PA jobs in Montana are primary care and ER. Rachael also reached out to recruiters when job hunting, and one recruiter told her they had a new position in colorectal surgery that was just being created. This job offered a pay raise and better benefits than Rachael’s current job in colorectal surgery.
Rachel explains that she got her job offer first, then started working on her Montana licensing that same week. In Montana, there is only one person who works on PA licenses, which can be good and bad. This person is also Rachael’s practice manager’s dad. While they said it could take several weeks for her license to be processed, it only took two weeks.
According to Rachael, the process was very straightforward. There was a step by step process of forms she needed to submit. She received an email of additional paperwork that was needed, which she easily sent in. Then she became a licensed PA in Montana.
From Pennsylvania to Montana
There is a big difference between dreaming and life in theory versus the reality and logistics of moving. When Rachael and her husband first arrived in Montana, the moving company hadn’t delivered any of their belongings yet. Rachael and her husband bought lawn chairs to sit in in their new home. They also didn’t have any internet for a few days. It made for a somewhat uncomfortable start.
Missoula’s population is about 100,000 people. Rachael explains that most people in Missoula are transplants, so they don’t have family or friends locally. This makes it easy to meet people, make connections, and make new friends. Missoula has a small town feel, but it’s easy to get to places you need.
Rachael describes the area as very laid back. People don’t dress up. Time is considered differently; there is no rushing. Rachael is encouraged to leave the office when her work is done to hike, spend time with family, etc. She doesn’t need to stay until a certain time “just because.” People embrace the ethic of “work to live, don’t live to work.”
How People Reacted to the Move
Rachael says her family was concerned about them being farther away and the difficulty in traveling to Montana. Her family was worried about not seeing each other as often and having less physical time to be together. However, their friends were very encouraging and supportive of their move to Montana.
Sometimes it can be good when family lives farther away – then you need to plan time and activities together. This can actually increase the amount of quality time you have together. You may have more quality time with those who live farther away than those who live close by because you’re more intentional with people visiting from farther away.
How to Chart More Efficiently
There is a delicate balance of working with your EMR system to optimize time. Having presets and smart phrases are very helpful, but you need to be careful that all your notes don’t look the same.
Rachel recommends working with your office staff and being clear about what they can do to optimize your time so you’re not doing double work. Can your staff put information in the after visit summary while you’re examining the patient or writing prescriptions?
In Rachael’s office, new patient paperwork is laid out in the same format as chart notes. This makes it easy to fill in since everything is in the same order. Make the note do your chart review for you – pull in vitals, imaging, etc. Can you click less? The less you need to click or move, the more efficient you can be.
Rachael also suggests to re-evaluate your notes and charting system after a few months to determine if it still works for you. What are you using? What is worth your time? Then, you can adjust your smart phrases as needed.
It can also be beneficial to ask other providers what they do and what templates they use. You don’t need to recreate the wheel. Ask another provider if you can use their template or how they set it up. You can also ask your IT team if they can help set up your notes how you want them – they can be much quicker than you would be creating it yourself.