Carol James

Physician assistant Carol James keeps 7-year-old Emily Randall occupied while removing her stitches.

In the jungles of Vietnam, military medics knew their mission. But without medical degrees, their role in civilian society wasn't as clear. So in 1965, a surgeon at Duke set up a program to turn ex-medics into physician extenders, creating a new niche in American medicine.

Today, physician assistants can train in more than 100 programs throughout the country. Armed with 75 percent of the skills of a fully trained doctor, they are a critical and compassionate link between overstretched physicians and worried patients and their families. Most have a background in basic science, several years of health care experience and an advanced P.A. degree.

At Hopkins, physician assistants can be found in nearly all the surgical specialties and in areas as diverse as pediatric oncology, emergency medicine and the AIDS group. With National Physician Assistant Day coming up on Oct. 6, we asked Carol James, lead physician assistant in pediatric neurosurgery, about the job that has kept her fascinated for two decades.


Q: What drew you to this profession?

A: I got here the hard way. I came to Hopkins in 1967 as a medical secretary, working on my B.A. in life sciences at night and eventually becoming a transplant coordinator. I observed many P.A.'s during those eight years. Just before I left in 1979 to start a two-year P.A. program at Yale, my father was diagnosed with glioblastoma, the most malignant form of brain tumor. He only lived six months, but during that time I could see many instances where a P.A. could have filled the gaps and made a huge difference. I knew then I was doing the right thing.

Q: What does your job entail?

A: My first two years here as a P.A. were spent entirely in the operating room learning neurosurgical procedures. I began working directly with Ben Carson in the mid-'80s. As residents' responsibilities have changed and the practice has grown, we've hired three more P.A.'s [Dana Foer, Judy Gates and Anne Biser-Rohrbaugh] and rewritten my job description at least four times. I still see pediatric patients in the clinic and the OR, but mostly I handle trigeminal neuralgia [TN], an excruciating face pain that affects the elderly. I work patients up [medical history and physical] every day and still scrub most of the craniofacial cases with Dr. Carson. If it's just the two of us, I first-assist. If there's a resident, I'll step back to second-assist so he or she can learn.

Q: What gets you up in the morning?

A: I love neurosurgery. The technology is exploding-robots, intraoperative CAT scans-to the point where we're not doing anything the way we did it even three years ago. The field changes and I'm right there with it.

Q: What about the downside?

A: It's a never-ending job. My days are typically 12 or even 14 hours. My voice mail is full by the time I get here in the morning. I spend a lot of time returning calls and e-mails from patients and families, because children with brain tumors, hydrocephalus and spina bifida have ongoing needs. I have kids I started following in infancy who are now in college and still our patients.

Q: How do those long hours affect your family life?

A: Luckily I'm married to a man who's used to entertaining himself, although he does worry about me. We don't have children, but I'm godmother to Dr. Carson's. If I had my own children, I couldn't keep my job because you can't do either one halfway. At Hopkins I can affect the futures of so many children. I have no business being on this earth if I don't contribute something.

- LR