Category Archives: All Posts

What Specialty is Right For You?

Wow.  I feel like this is a huge one for me– and also will display a lot of how I have grown and developed as a person, student and now medical provider.  I am no where near the person I was in 2013– I am such a better version of myself and I grow, develop and learn everyday.

Before I went into PA school I was “strictly surgery…actual medicine is so boring and for weaklings”.  I also thought medicine was black and white (ha!) When asked at the beginning of PA school I was specifically strictly ortho or trauma surgery.  I actually did my elective rotation in trauma surgery. We were surveyed and when “orthopedics” was prompted I quickly raised my hand.  For anyone who knows me– you know I am enthusiastic and passionate about anything I do.

During didactic year we went through our system based modules and I was in for the surprise of my life. I slowly but surely became more interested in the art of medicine. When our module for women’s health came along, I never expected to love it.  I did.  Our teacher for this module is also the shit. Rosa is one of those people who has a gift to teach.  Everything clicked pretty well for me. I was hooked– like immediately.  I e-mailed our clinical coordinator that day and asked if I could please be placed with her on my OB/GYN rotation.  It was my 3rd rotation and hands down without a doubt my best rotation.  I struggled clinically A LOT on my rotations– my medical background was not strong and taking histories and putting the puzzle together simply took me a bit longer to grasp than others.  And that is OK– because I progressed. Anyways, I fell in love with women’s health here is how and why and how I have decided to pursue this career.

  1. Independent Practice

    Going through PA school and rotations helped me realize I wanted more collaboration as needed as opposed to supervision.  I also realized that the operating room just wasn’t for me (shout out to Dr. Opacic who called that shit first year of PA school– I get it now). I can’t describe it– I just simply don’t like the environment.  Plus I need frequent feeding and a sterile environment does NOT allow for that 🙂
    I wanted my own patient load.  I wanted to be responsible for treating and seeing my own patients– basically I desire to practice to the fullest extent of my license.

  2. Procedures

    I want to be able to do my own procedures, too.  IUD’s, Nexplanon, colopo’s, LEEPs– whatever I can get trained in and be competent in to do on my own.

  3. Some GYN’s also provide primary care

    I don’t want to lose my roots and ability to practice general medicine. PA’s are trained generally and I always want to try and keep a little bit of that flexibility whether it is in my every day practice or in a per diem job or volunteering at a clinic.

  4. The patient population

    Sometimes we need to figure out what we don’t want, in order to be certain of the things we do want.  I’ve decided this is true of everything in life from relationships to medical specialties.  I have spent almost 3 years practicing general medicine of varying acuity levels.  Medical consults, Hospitalist, Urgent Care and Family Practice.  Here’s what I know I DO NOT want to see everyday: really sick people, patients who have not “tried anything at home”, narcotics– I do NOT want to deal with pain management, children– especially babies (I swear I’m not that evil), people who have a runny nose who think it is an emergency (it’s not the person with the GSW to the head is), etc etc.
    Which leads me to well ok well why women’s health then? No one (ok 99% of people) do not show up for an invasive vaginal exam if there really isn’t something wrong. Most patients are able to provide you some semblance of a decent HPI because when something is wrong with your vagina you pay attention to it. They are typically somewhat on the healthier side.  The reason I say this is that if you have an awareness of “needing your annual exam” chances are you pay even just a little bit of attention to your health/wellness.

  5. Setting and work/life balance

    Are you looking to work in a hospital, ED, operating room or clinic?  What type of hours do you want to work? Do you want a set schedule, shift work, do you hate working nights, etc etc.
    I am NOT a night person. I worked nights and it was not easy for me.  I love being up at 4:30am. I love my workout before work and I want a job that allows me to do these things 🙂
    As I said before I do not want to be in a OR– or at least to this point in my career I have not found a position that has made me go “owe I wanna do that!”  Never say never, but I know right now it isn’t in my cards.
    12 hour shifts are also not up my alley.  To me it was like– ok I’ll do EVERYTHING that needs done in my life 7 days from now when I have a day off.  Simply not for me.  Some people love it.

    All things to consider!

Life as a Traveling PA

Recently I have had A LOT of questions about becoming a traveling or “locums” PA.  I decided to address everyone’s questions and tell everyone a little about my experiences to help out! Please leave additional question in the comments section and I will do my best to address them 🙂

FAQ:

1. Can I do this as a new grad?

You can.  However I imagine there would be pros and cons to this.  As a traveler/locum you are pretty much expected to go in somewhere, adjust to the EHR (electronic health record) if you have never used it before and roll like you’ve been there before.  So– there isn’t a lot of room for you to learn how to treat patients.
I tell most people that if you feel like you had great patient care experience, clinical experience and/or clinical rotations and if you can treat patients without feeling like you need to ask a lot of questions go for it.  I was a mental health therapist before being a PA and didn’t feel like I had strong rotations so it wouldn’t have been a great choice for me.
Second, expect to work in the “less desirable” areas or specialties.  I’m not trying to be rude or anything, but there aren’t a lot of people who wanna work in the middle of no where in North Dakota in psychiatry. BUT– if you take that job and get something on your resume it makes finding your next position a lot easier.  You have bargaining room.  Also, don’t expect the high-end of the pay spectrum (you would likely– most likely still be making more than anyone you graduated with).

2. What is the pay like?

It’s good.
I am unable to talk specifics, but it is definitely more than I was making as a new grad anywhere else.
You are paid hourly and always– ALWAYS high ball people.  The money is there.

3. What specialties can I work in?

It depends on what you are looking for.  As a new grad– see above. It also depends on what you have experience in.  You will always get more money in fields you have experience.  However, if you want to try something new and are ok with taking a little less money you might be able to try something new.

4. My friend/significant other and I want to travel together can we get an assignment in the same location?

Sometimes, yes.  Or it could be relatively close– or in between so you could share housing. But I would think with some positions this would be possible.

5. How do I find a company to work with?

NALTO is the National Association of Locum Tenens Organizations. This is basically the BBB for travelers/locum providers.  It is to protect you and the organization who is placing you from anyone getting treated like crap (for lack of better words)

6. Who finds your housing?

Your company has an entire department that is responsible for finding and paying for your housing.  And YES you can bring your dog =)  My nugget comes everywhere with me! I know some travel nurses who get a stipend and then find their housing– I haven’t heard or encountered this as a provider.

7. What about malpractice/licensing/credentialing?

Again, your company should have an entire department for this– if they don’t you’re with the wrong people.  I don’t lift a finger for any of this.  Make sure they cover “tail” insurance.

8. Can you pick your sites?

Yep.  I don’t go anywhere or do anything I don’t want to.  I’m an “independent contractor” which means I DO WHAT I WANT.  =) It also means I file taxes as an independent contractor— get a good CPA.

9. How long is each assignment?

It’s totally up to you.  I like to take assignments about 3-6 months long.  Then it is worth it for me to move all my stuff and be kind of settled, explore the area and peace if I want to!  If you’re good you’ll be offered extensions or permanent positions.  PRO TIP: a lot of companies have clauses about taking permanent positions out of a locum position.  As in how long you have to be gone from the position or there are also “locum to permanent” positions out there too.

10. What about benefits (medical, dental, vision, 401k)?

The only company I have come across that offers this is COMP HEALTH.  I didn’t take an assignment with them yet, but all of the recruiters I talked to were really nice and I would consider taking a job with them.  Their hourly pay is a little less compared to other companies, but you do get benefits.  PRO TIP: they have a 6% 401k match which is pretty good.
To give you an idea of benefits cost per year here is what I have been in for:
Health insurance: 260/month with a 4,500 deductible
Vision: eye exam was like 180$ and my contacts $120 for about a year
Dental: x rays and cleaning cost me $240.
I recommend a health savings account. I’m also increasing my disability insurance to better reflect my current earnings which will cost me about $150 per month.

11. Are you re-reimbursed for transportation and travel?

YES.  You should not drop a DIME.

12. What are the PROS and CONS?

PROS: 
The pay, no rent or utilities.
You get to travel and see the country on someone else’s dime. You aren’t subject to all the “office politics” because you are an independent contractor.
If you don’t like something about the job— it has an expiration date.
CONS: 
You move a lot.
You don’t have control over “the little things”– see below —

13. Are there positions outside the USA?

No idea.  Not that I have found yet.

14. How does retirement work?

I have my own retirement funds as of right now.  Comp Health (which is a locum company) does offer benefits to their employees.  6% 401k match.
I recommend a good financial adviser.  I love mine if anyone needs a rec.

15. Can you get hired on permanently?

This depends on the company you are currently contracting through and their rules.  Some have clauses in your contract that state “cannot work for x,y,z for one year after end of contract” others don’t care and some positions are also noted as “locum with opportunity to transition to permanent”

16. Are there any PA schools that incorporate study abroad?

Yes, my friend is applying to one but I cannot remember which.

17. How does state licensing work?

Literally your company should do EVERYTHING for you.  You should not lift a finger. Or pay a dime.  And don’t let anyone ever tell you that you cannot work for another company because “they paid for your license” that is complete bullshit and a rep just trying to bully you into staying with them.  I highly recommend not working for someone who tells you this as they definitely don’t have your best interest at heart.

18. Do you get a living stipend?

No.  My costs are literally all covered.  I don’t pay rent or utilities.

19. What is the best way to prepare for this type of position before/during/after PA school?

Before: Get experience as a CNA, in a hospital, work as a nurse– some type of position that prepares you to be immersed in health care and you don’t feel like a fish out of water as you graduate.
During: Really really really focus on the plan of care.  Know what you would do for the patient.  Also know what you would do if something went wrong.
After: Apply? And be willing to take a job somewhere not ideally located or not in the perfect specialty

20. How competitive is being a locum?

There is a HUGE need.  This also is variable based on specialty.  I have done all hospital, family or urgent care med.

21. Can you change specialties?

Sure. It helps if you have prior experience in these specialties.

22. TAX DEDUCTIONS

So– you can turn A LOT of things in to tax deductions.
Flights
Food
Coffee
Health Insurance
Dental work
Vision
Hotels
Cell phone
Electronic purchases
Amazon Prime
Kindle
iPad
Anything that “is a cost of operating business”

23. Are certain areas in higher demand.

Yes Rural areas.

24. How does salary/payment work?

You are an hourly employee
If you don’t work you don’t get paid– but you are paid well and honestly it doesn’t matter.
You are paid through your company.

25. Is salary competitive?

Yes.  More than competitive. And again– always, always HIGH BALL on your offer for what you want compensation wise.

26. If you live in a state that NCCPA exempts you from taking PANRE and you travel to a state that requires it, do you have to take the PANRE before you go?

So, as a traveler I would no recommend going without NCCPA cert. Most locations want or require it.

27. Are you given additional training?

I have not been.  You need to be ready to step in to someones shoes for the most part.  But– I do think there are jobs out there that are longer contracts that may be willing to train if you took less pay or something.

Tid-Bits:

  • Keep copies of everything.  Especially the malpractice insurance you have with each company/position.  You will need this with each new position you apply for
  • Make a folder for each company/position you work in your e-mail.  Keep everything.
  • As for copies of proof of wherever you are living.  I recently lost my housing (which wasn’t my company’s fault but a total pain in the ass) Ask for every damn thing in writing.
  • If people are interested in how I cook/eat/count macros while living in a hotel let me know.  I’ll write a post all about that
  • Yes, your dog can come.
  • Get a file folder for all of your “business related” receipts

Things you don’t have control over that you probably haven’t thought about:

  • Your shower pressure
  • closet space
  • washer/dryer
  • neighbors
  • dishwasher
  • how long does the hot water last?
  • sometimes contracts fall out.  I swear all of the “this never ever happens” have happened to me.
  • Fridge space
  • THE MATTRESS.  I swear if any performance mattress companies out there want to sponsor me I AM IN.  My last 2 places had shitty soft mattresses and I have honestly thought about having one sent to me.
  • Concealed carry license.  I’m not trying to be political at all but if you have a concealed carry license for a weapon it will be a pain in the ass to transfer it so you can actually use it.
  • If you like your position and they want to hire you depending on your contract they might not be able to
  • Auto insurance.  As long as you are only in a location for 6 months you can use whatever permanent location you want.

Stuff you wouldn’t think of but need to know:

License plates.

Yea totally didn’t think about this.  There are a couple routes you can go.  You can sell your car or park your car somewhere and have your company rent you one.  Or you can say “eff it” and figure it out as you go– which is what I did because I LOVE LOVE LOVE my Nissan Rogue!!!!  My plates actually expire this month.  I am using a co-workers address in a county in California that doesn’t require smog inspection. What is tricky is that in order to change your drivers license address you normally need a lease, mortgage or utility bills to “PROVE” you live there.
Well I have none of those. So, what do you do?
The DMV also accepts bank statements.  So, I changed my investments and my bank statements to that address and I explain my situation and bring those documents.  That has worked with me in the past and hopefully when I go for my license plates and address update they change it for me!

Driving Insurance

I left my insurance under the town I lived in for my first travel assignment in Danville, PA because the rate is dirt cheap. You are “LEGAL” as long as you are only staying somewhere for 6 months. You don’t necessarily have to change your location.

Health Insurance

So, I haven’t had to deal with cross states yet.  I’m also for national health insurance (bring on competition and drive down rates hahahaha).  However, my guess is that moving to a different state would be a “qualifying event”

Voting

See my debacle regarding license plates!

Banking

I recently switched all of my regular banking with USAA (my dad was in Vietnam so I automatically qualify to have accounts with them).  I HIGHLY HIGHLY recommend them.  They are so kind and always willing to help and EVERYTHING– EVERYTHING can be done on the internet or phone.

Reflections and a New Year

Someone recently brought a great podcast titled “Increase Your Impact”to my attention. As PA’s, PA students and Pre-PA’s I think a lot of us are cast from the same mold of goal and success seeking.  In today’s society sometimes it can be difficult to stop and realize that we have in fact come a long way in 365 days, because we continue to pursue more success.  

I am going to answer the questions below because I believe it is a great exercise for your mind and soul, my hope is that it prompts some of you to do the same!  

Part of what I want to do in the upcoming year (I refuse to say “new years resolutions” because I believe change and reflection can happen anytime) is to share more of my personal life, aspirations, accomplishments and little life hacks I believe have made me a well rounded and successful individual. And generally some stuff other people might really dig 😉 

  1. What are you grateful for?

    My health, first and foremost.  I know this appears “cliche”; however, I have witnessed a great deal of illness and death in my life and I am thankful everyday that my body works as it should.  I don’t need a permanent catheter, I’m not bed bound and I am able to physically push my body to the limit lifting and crossfitting.  Second, I traveled more than I ever have in 2016 and 2017 is already shaping up for the same.  Seeing the world is one of the most important things to me and I am finally able to do just that!

  2. What struggles did you overcome?

    A lot of you may or may not have read about my financial struggles coming out of PA school.  I had what seemed like a insurmountable amount of private student loan debt that went in to collection.  I did something about it.  I left everything I was comfortable with to decrease my cost of living, increase my income and pay off debt.  In 12 months I’ve paid off about 30k in debt. I talk about this because I hope that someone out there who is struggling will know that it is doable. 

  3. What did you learn?

    A lot of medicine.  Tomorrow I will celebrate 2 years of being a certified physician assistant.  They (whoever “they” are) say that your learning curve is the steepest during your first two years of practice.  I hope to continue to learn just as much for the rest of my career, but my god I learned a lot this year!

  4. Who positively impacted your life?

    A great number of people.  Less likely to be thanked by most people include my financial advisor– dude put my shit together.  And all of the usual suspects in my life who have always positively impacted me–Debbie, Stacey, Melanie, Katie, Cass and Doug.

  5. How am I different from the person I was in January?

    I am more patient.  I am more kind to myself, organized and directed.

  6. What relationship do I need to strengthen in 2017?

    I would say my friend Katie.  We don’t talk as often as I like and I want to make a better effort!

  7. What do I need to stop doing?

    Wasting time on social media.  There I SAID IT.  I have so much I want to get done this year, everyday and every week.  I’m going to significantly decrease the amount of mindless scrolling I do and replace that behavior with working on the project goals I have for 2017.  Also– give Piper increased walking (don’t worry she isn’t deprived we go for a 2 mile walk 4-5 days per week).

    Order less shit from Amazon and split that money between vacation and loan payoff!

  8. What do I need to start doing?

    Not being so hard on other people.  Attempt to employ the concept that everyone is doing their best.  No, I didn’t coin this concept– Brene Brown did.  I have a tendency to be very critical of other people (as much as myself).    In full disclosure, in 2016 I became better and being more kind to myself as opposed to others.  

  9. What do I need to keep doing?

    Following my training and nutrition programs.  I’ve really dialed in on my health and wellness the past year and I’m really proud of that!

    Follow through with the projects I have planned for 2017 and make progress every day.  

    Keep reading for enjoyment and making selections that enrich my life and make me a better person. 

    Striving to learn at least one new thing each day about medicine.  

America Has No Idea What They’re Eating.

I recently started working 1:1 with a nutrition coach.  I’ve always been a healthy eater.  Recently,  I’ve cut out sugar and focused more on healthy foods and timing of nutrition.  When I felt I had done all I could on my own I hired a coach for a few months.

Now I’ve weighed some foods before and eyeballed even more.  Let me tell you the first time you weigh or measure peanut butter or almond butter you question everything you ever thought you knew.  And then you cry just a little inside and out.

I look at the portion sizes people take in and scream and die on the inside.  People literally have no idea what they are eating.  In turn, their kids also are not learning what they are eating.

One of the women on the facebook page for the nutrition program I follow (Working Against Gravity) posed a question if other Moms in the group worried about what their kids though about them weighing and measuring their food.

At first I was like eeehhh good point.  Then I thought a bit deeper.  I thought to myself “This is a great teaching opportunity!”

Kids take in so much from their parents. Food, eating habits, nutrition and wellness are no different. I figure it this way, parents who weigh and measure their food can potentially cause the same harm or good as the parents who quadruple the dosing for their children.  It is all about the perspective.

The way I look at it is for parents who are healthy and weigh and measure food, they can teach their children about what is necessary in order to properly fuel their bodies and grow up healthy. Teach them what veggies, healthy protein and carbohydrates are and what they do for their bodies and mind.

Not teaching children about healthy portion sizes and food can have just as much if not more a detriment than showing them that it matter.  It results in kids growing up not being able to identify what broccoli or cauliflower is, or eating 16oz of pasta when a serving is 1/2 to one cup, eating 10oz of steak or chicken when 2oz gives you 15 grams of protein.  10oz of meat= 75g protein.  CRAZY!  My daily requirement on any day whether it is a rest day or I’m in the gym being active for 2-3 hours is 120g.

Like I said, people have NO idea what they are eating. As long as we as adults have no idea what we are eating– we pass that same message on to the next generation.  I guess my final statement is that we shouldn’t shy away from teaching kids about healthy eating.  If they don’t learn to form healthy habits, it will likely result in unhealthy habits and behaviors.

Healthcare Culture: Everything Hurts and I’m Dying

There are a lot of issues being discussed in healthcare today.  One point I don’t hear a lot about, but see everyday comes directly from our patients mouths.  They come in to clinic with the mindset of “everything hurts and I’m dying”.  What this means is that if they have a headache they think and know that they have a brain bleed and they need and MRI.  If their child has a cough they definitely need an antibiotic.  They woke up sick this morning or have an ache in their shoulder x1 day: everything hurts and I’m dying.  

The undertone of this statement that they don’t directly say: And you BETTER do something– better yet– what I think you need to do. 

Now, let me be clear it isn’t that I’m not empathic to patients who are feeling ill or in pain.  However, there is this culture out there that extreme measures, investigations and treatments need to be taken if you have a headache.  Are there the small percent of people who do need these measures? ABSOLUTELY.  That is why we do history and physical exams to weed these people out and send them for these tests.  

Why does this matter? What is this causing in medicine? Cost. Waiting room lines. The emergency department being used for non-emergencies (sorry people this was not created for you to get a pregnancy test free or score some morphine for back pain– it was meant for people with asthma exacerbation, CHF, PNA amongst so many others). 

How does this effect providers? We also have to act like someone who thinks they are dying are dying.  If we don’t they’re not satisfied. Re-assuring patients has become the most difficulty part of my job.  We all know when we have this person in front of us.  I always make sure to do a full physical exam.  I talk them through it saying “your ears are clear–no infections, airway is patent– tonsils are not enlarged, no lymph node enlargement, lungs sound great, your neurological exam is completely normal, vital signs completely within normal limits—– etc etc”.  But for some people they just aren’t satisfied.   

What else are we to do?  Patients who push for further intervention, I tell them I cannot treat an infection that is not there or worry about signs or symptoms that you do not have.  I tell them this is good news.  

My question is where are we going wrong? It seems like more and more people are lacking basic concepts about colds, headaches and belly aches.  I do my best to educate my patients.  Viral bronchitis is a BIG one.  I tell them 98% of bronchitis is caused by a virus. The cough can last 3-4 weeks even after you begin feeling better.  I state “Scary symptoms that you DO need to be concerned about are persistent fever or coughing up blood streaked sputum.” I ask them EVERY TIME “do you have any questions”.  I usually ask this twice. Yet somehow there are still people who come back a week later cause they have a dry lingering cough?  

Would love to hear thoughts from students on rotation and practicing providers with how you best handle these situations.  As well as suggestions.  May this serve as a reminder to always educate your patients as much as possible!

Breaking Down PA School Interview Questions XII

This week also features two questions.  Thanks to Abigail for e-mailing me!!  I love when you guys send me writing topics and questions you are asked at interviews, so keep it up!

Q:What patient population do you least like working with gathering your patient care hours?

What are they looking for

  • That you aren’t going to bash anyone.
  • Bias 
  • Compassion (that you have it, duh!)

What to avoid saying

  • Anything negative.
  • A statement that is going to cluster or segregate a group of people.  (Disclaimer: the statements below are not things that I would say and in no way represent how I feel.  They are simply a way to give examples.)
  • For Example:
    • “Working with pain patients was the worst, constantly ringing the bell to ask for more pain medications and complaining”
    • “Diabetics who are non-compliant.”
    • “Psych patients, it’s not even like they have a REAL problem.  Just suck it up”

What to say

  • You really enjoyed the diversity (of whatever population(s) you worked with)
  • Mention that the diversity of medicine you were exposed to really makes you look forward to clinical rotations and learning more about all areas of medicine. 
  • Every patient is a person first and that their disease does not define them.
  •  Certain qualites can present challenges such as non-compliance, but it is all part of working in medicine and that you look forward to growing as a person and future provider.

Q: What specialty would you least like to work with as a PA?

What are they looking for

  • To see if you’ve made up your mind about what area you think you want to work in
  • If you are open-minded about learning
  • If they are a program focused on underserved populations/family care if you have interest in that area

What to avoid saying

  • You are “certain” you want to work in a specific area.
  • Saying anything negative about a particular area of medicine.

What to say

  • Mention what you liked while shadowing, but DO NOT commit 
    • For example: ” I really liked the role and responsibilities of Emergency Department and Cardio Thoracic Surgery PA’s; however, I know there is a lot for me to learn and many areas of medicine to gain knowledge and exposure. 
  • You cannot be certain because you worked in a small subset of medicine (wherever it might have been) and that you look forward to figuring out what specialty you want to begin your journey in medicine. 

Breaking Down PA School Interview Questions XI

Focus on social media and internet self diagnosis!

Q: Would you accept a Facebook friend request from a patient?

What are they looking for?

  • Understanding of ethics and patient interaction
  • HIPPA
  • Professionalism.  My program was HUGE on this, it was a percentage of every class grade. 

What to avoid saying

  • “Sure, I have drinks every friday with patients from the clinic I volunteer at”
  • “Yes” without any thought consideration.
  • In my opinion saying “yes” at all.

What to say

  • The best and most effective patient-provider relationships are those that do not encompass dual relationships
  • Even with clear cut “simple issues” such as a UTI, you can never predict what issues may develop with a patient or a family. 

How you might be pressed 

  • What about in a small town where everyone knows everyone?
    • The good thing about being a PA is that there is likely a collaborating MD/DO who shares time in the clinic.  
    • State that you understand that you may know a number of your patients from other community groups (gym, church, etc) and that as frequently as humanly possible you would have patients with whom you have close personal relationships see your supervising physician to provide the best, most unbiased care. 

Q: How do you feel the internet and sites such as WebMD are contributing to healthcare?

What are they looking for?

  • Respect and consideration for your patient.  Simply that you can show you will listen to them. 

What to avoid saying

  • “Its destroying healthcare and making providers jobs more difficult”
  • “Your google search does not trump my medical degree” (even if you think it sometimes!)

What to say

  • There is a lot of information available on the internet.  If patients are able to find reliable information (CDC, Medscape) I think it can be helpful for patient education and awareness.
  • I don’t see much harm in it, at least it shows patients taking an investment in their health or illness and can provoke insightful questions and/or helpful information

How you might be pressed

  • What do you do when patients try and undermine your medical opinion? For example telling you they KNOW they need antibiotics.
    • Re-state their symptoms and tell them what was re-assuring about their exam.  A lot of the time when I get that “feeling” interviewing a patient that they won’t be happy unless they get an antibiotic as I go through their exam I make statements like “your ears look perfect, nice and clear” “lungs sound great to signs of infection” yada yada. 
    • If that isn’t effective I say “I understand your concern and if you would like I’d be happy to get one of my colleagues or collaborating physician for a second opinion” (this usually works)

 

The Hierarchy of Medicine & Minding The Gap

Medical careers have always had somewhat of a tough, rough and tumble appeal.  It’s difficult to get accepted, get through school, residency, fellowships, boards, etc etc. We’re all these type A, rise-and-grind people. Whatever your particular career may hold, whether you are a nurse, doctor, PA, NP, Pharmacist.  The culture of medicine is BRUTAL and our jobs are difficult enough, so I pose the question: why are we making it more difficult on each other?

Who remembers being a PA/RN/Medical Student and being terrified of Residents or Attendings?  Allow me to raise my hand first. I cannot help but think how backwards this is.  Think about it, we are in a field that most people would say they enter to “help people”.  That is what we write in our personal statements and tell admissions committees I guarantee it. So, if we are truly in the business of helping people and “working as a team” why am I getting yelled at for calling an on call Fellow Physician at 2am? Why do I hear providers yelling at nurses? Confession: I’ve done this. Second confession/further information: Don’t page me “Pt has a fever.  Please advise” when they already have Tylenol ordered. (If I had a dollar…)

Ok, anyways I’m getting off track. When did medicine become a culture of “I’m higher up than you so I can yell at you/treat you like crap?” Back to that 2am call to a Fellow Physician: If you do not want to be woken up, don’t be a GI doctor– it will require call. Second, since when did I have to apologize for waking someone up because I have a patient that truly needs you to get your ass up and come in and do something?  You chose this, you wanted to pursue this career and help patients.  Get up. Put on your shoes and get your ass to the hospital. No, I didn’t say this– but I thought about it.

Perhaps the greater question is: Does this behavior and interactions harms patient care?  Especially in a hospital setting at teaching institutions where environments can be quite cut throat and hostile.  Residents fighting for cases, PA’s trying not to get their ass chewed out by fellows and attendings, providers getting pissed at nurses, nurses getting pissed at CNA’s. etc etc.

Like I said, have I been guilty of being an asshole when I’m dead tired and can’t handle another trivial request? Yep, sure have. Am I proud of this? No.

Listen, the reality about medicine is that you deal with people all day and it gets rough and sometimes you lose your shit.  (I hope I’m not alone here) Have I let this realization alter me for the better?  Sure have.

I’ve been reading a lot of Brene Brown’s work lately.  In one of her books (I think it was “Daring Greatly”) she talks about how you are not who you say you are or who you want to be.  You are only what you do.  The difference between this, she refers to as “minding the gap”. The space between who you are/what you actually do and who you want to be/what you actually do. 

Everyday I look at my fridge where I have a dry erase board that says “Mind The Gap”. And I think about the person I want to be in the present and how I want to become better every day.  Am I perfect? Hell no.  Am I trying? Hell yes.

 

Breaking Down PA School Interview Questions X

The PA career is incredibly competitive to enter.  Despite the number of programs out there and more popping up every year, your chances of acceptance are 1-2%.  For example the year I applied to Pitt there were well over 1,000 applicants and 40 seats.  THAT IS CRAZY TO ME! It makes me so thankful that I was able to earn acceptance, participate in such an amazing career and now help and interact with some really great Pre-PA students!

Q: Why should we choose you over other applicants?

What are they looking for?

  • You can demonstrate that you are confident and have earned the right to be in their program.  
  • Confidence
  • Assertiveness
  • You can clearly and concisely state why you are an excellent candidate
  • You’ve prepared  

What to avoid

  • Not having an answer.  
  • Being tentative. If you hesitate this demonstrates that you haven’t thought about this question or even worse that you don’t know how to answer it.  
    • A candidate who sits that and hims-and-haughs like “well….”, “ummmm”, or “I think….maybe…” Cut the crap say why you’ve earned this! Someone who hesitates or looks like they can’t give an answer isn’t someone an admissions committee correlates with a successful PA student.

What to say

  • I was not asked this questions; but, I did prepare for it.  My answers would have been as follows:
    • My tenacity.  By and far my first quality that sets me apart.  I risked a lot to take this course.  I also worked at times 4 different jobs to make ends meet and build experience and boost my application.  I did whatever possible to be successful in meeting this goal and I will demonstrate the same traits as a PA student and practicing professional.
    • My energy. I bring a great amount of energy into every situation I’m in and will put that energy towards becoming the best provider possible.  
  • Other great answers may include:
    • Perseverance
    • Diverse background
    • Maturity
    • Focus on wellness
    • Lots of time spent with underserved population
    • Substantial amount of clinical experience
    • Master’s Degree

I Don’t Have Time VS. It’s Not a Priority.

I cannot emphasize how much “I don’t have time” correlates to “It’s not a priority.”  I challenge everyone to take the phrase “I don’t have time” and replace it with “It’s not a priority”.  I guarantee you that it will be eye-opening.    

Quite frequently I have individuals who talk to me about my workout regimen and my food prep and I’m amazed at their ability to find reasons as to why I am able to do the things I am able to do for my health and how those reasons correlate to why they absolutely cannot.  
The most recent incident occurred as someone proceeded to tell me that I have time to workout because “I’m not responsible for other people”. Translation: I don’t have a husband or children.  First, I believe this is an excuse.  Do individuals who have families have a time management and priority challenge: yes. Do individuals like me have a priority challenge?  YES. Everyone’s time management challenges are unique to them.  I feel as though others have attempted to make me feel that because I don’t have a family, my priorities and check lists of things to complete are somehow easier to accomplish or not as important as those with families/husbands/wives.  I proceeded to tell this person that I work full-time. I run a side business and a website.  I have a dog that is a priority and I make sure she has food prepared and gets a walk 6 days a week. I spend a lot of time on the website/blog and other projects I’m working on collaborating with other professionals.  I also spend a decent amount of time reading about medicine and investing into my career. 
Everyday I wake up at 4:45am. I go to the gym participate in group crossfit class 5-6 days per week and 3 days a week I do extra individualized programming.  I’m either out of the gym by 6:30 or 7:30am on days that I work depending on my programming.  I go home walk my pup and listen to my HIPPO education RAP, shower/get ready/pack lunch(already prepped for week)/eat breakfast. Any extra time is dedicated to editing statements or working on the website OR a special project I’m working on with National Physician Assistant Eduction (its secret for now 😉  I arrive at work at 9am.  9am.  By the time I get to work I’ve done more with my day than most people do with 12 hours.  Currently I work in an urgent care.  This morning in 3 hours and 15 minutes I have seen 11 patients and written most of this blog.  Any down time at work I spend editing, reading medicine or responding to emails. 
We all have priority challenges.  We filter massive amounts of information, people and tasks daily and we decide consciously and unconsciously what we prioritize.  You are what you do, not who you say you are or what you say you will do. 
We all have the same 24 hours in the day, it’s all about finding ways to maximize every minute and hour afforded to you. 
I challenge everyone who reads this article– for ONE WEEK: Replace “I don’t have time” with “It’s not a priority” and I guarantee you will learn a great deal about yourself.