Tag Archives: Medicine

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!

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!

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

Breaking Down PA School Interview Questions VII

Q: What questions do you have for us?

What are they looking for?

  • Ability to be insightful, that you’ve done you research on their program
  • To see that you are genuinely interested! A lot of applicants will just sit back and let the time pass. 
  • Pay attention to what other people ask! (If the Q&A is within a group)
  • When someone speaks turn and look at them when they address a question.  This shows respect and that you are interested in learning about what you might be able to learn from others.

What to avoid

  • #1:ASKING QUESTIONS YOU CAN FIND ON THEIR WEBSITE
    • HUGE, MASSIVE NO-NO.  Ok, but really know the information available on the website inside and out.  
  • Asking questions that have already been answered by staff or that someone else have already asked 
  • Not asking any questions at all

What to ask

  • One of the questions I asked was “What can you tell me about what your program has to offer that I can’t find online?”
  • The role of the PA is shifting, we work in more settings and sub specialties than ever before.  Think about asking how the program is adjusting to teach the students to meet the demands for jobs upon graduation. 
  • If you are one-on-one with faculty ask them about their job, what area of medicine do they practice, what do they enjoy about it?
  • What is the best advice you have for students to succeed and gain the most out of their education at <insert name of school>?
  • Ask questions that build on information already available on the website or that you’ve learned through your visit
    • ie: I saw on your website your PANCE pass rate is 98%, what steps does the program take in order to ensure students are well prepared”

Breaking Down PA School Interview Questions IV

Q: What do you feel is one of the biggest issues currently facing our health care system?

What are they looking for?

  • Understanding of what is happening in our health care system.  This shows the panel that you are interested in medicine and what is going on in the field you want to enter (in a lay persons answer: you know what’s up)
  • Perhaps you have a member ship to AAPA and read PA professional or JAAPA, mentioning these or others  as your source of information demonstrates a few things: dedication to the profession, extra effort to obtain information, self motivated behavior

What to avoid

  • This is tricky here, because you need to mention what is happening in health care without associating your personal opinion to the matter which can be difficult (to some degree you have to give an opinion because they are asking you what you think–just be careful!)

What to say

  • There are so many issues facing health care right now, below are a list of issues I feel are at the forefront of medicine and affecting providers:
    • Opiate abuse and dependence, both prescription and street heroin use
      • I would say 2/3 patients I admit or see have a prescription for a narcotic pain medication.  It’s a very intense issue in our country and is complex and multi-factorial.
        •  Patients who are given prescriptions after surgery and continue to have pain therefore continue to have a prescription for pain medication.
        • Lack of conservative measures or patients failing conservative measures such as physical therapy, weight loss.  I see a lot of patients on narcotic pain medication for arthritis, much of which joint destruction is caused by obesity (not ALL of the time but pressure on joints can really destroy them)
        • Pressure for patient satisfaction.  Docs, PA’s and NPs are being scored and reimbursed based on how patients feel they are treated.  As part of that crisis I don’t doubt that some providers view part of that satisfaction as controlling patients pain control.  I’m not stating all providers do this by any means, but I know I can say I saw it on rotations and I have treated patients in the hospital who have not seen their provider in 6 months and they continue to provide scripts for family members to pick up for them (by the way this is not ok and I’m fairly certain is some type of violation of a DEA license because patients need to be seen at regular intervals for a continued narcotic script to be valid)
        • Street use I hope is an obvious one that I’m not going to breakdown here
        • Serious implications for health, especially with heroin use–infections, overdose, etc.
    • Shortage of providers/Rural Medicine/Access to treatment
      • This issue is real.  As a traveling PA I can tell you that both of my assignments now will be in areas that desperately need providers.  
      • This is also a great way to talk about how PA’s help bridge the gap (Mind the GAP!— London anyone?) 
    • Cost of health care
      • This issue is also all too real.  Listen I pay 193$ a month and I’m a completely health individual.  I barely use my health care.  That is just the BEGINNING of this issue.  High monthly payments, high deductibles (my deductible is $2,700 and just for some perspective my financial advisor thought this plan was best for me), cost of medications, lab work, imaging.  I could go on.
      • IMO patients not being able to afford their medications creates a number of issues. 
        • First, they can’t get basic control of their chronic medical problems–say diabetes
        • Second, if patients can’t control their basic medical problems they end up with complications in the hospital and then they can’t afford their hospitalizations.  This is a problem not only on a personal level for the patient but also health care at large–driving up costs like crazy. 
        • The bottom line is that patients are more concerned with paying for healthcare than their own wellness which is is just bad all around
    • The specialization of medicine
      • We have become a society that continually self-refers to specialists.  Ankle pain? See ortho.  Diabetes? See endo. Both on an inpatient and outpatient basis–heres the issue:
        • PCP’s have less time with patients and more issues to cover–which creates more referrals and also patients to self refer because they can’t get appointments (which goes back to both cost and access)
        • Less continuity of care.  As best as we try for communication between offices it doesn’t always happen the best. 
        • Devaluing general medicine
          • Ok, this is my bias–but I believe that a medical home is really important.  Having a provider that knows you well and a “first line of defense” when you have a problem.  We are driving providers away from family practice and internal medicine for many reasons (less pay being one of them) and it seems to create the persona that this is not important and it is! 
          • Despite my bias/opinions make sure that if you discuss this you do so in a positive light.  Again, reinforcing the importance of family medicine and giving as many people as possible access to quality care.

Breaking Down PA School Interview Questions IV

This weeks question was submitted via e-mail and its a two-for-one! If you have a question you want broken down be sure to e-mail me at: all.things.pac@gmail.com

Q: What is your greatest strength?

What are they looking for?

  • This is pretty straight forward.  What do you do well?  What characteristic do you possess that makes you an excellent candidate and will make you a great PA?
  • Try to wrap the quality into a story to show that you have demonstrated that behavior in the past.  Behavioral interviewing is a large part of PA schools.  Admissions committees believe the old saying “history repeats itself”. Show them in addition to telling them with a story.

What not to say:

  • I’m a great student, I graduated with a 4.0 (they will have all these stats and likely on your resume).
  • Anything really vague or that they can get from your resume. Remember anything open-ended you are asked in your interview is your chance to tell them anything about yourself and why you are the top 1-4% of applications they received.
  • Don’t brag too much.  There is confidence and there is cocky. Be confident, not cocky. 

What to say:

  • I was not asked this on my interview.  Had I been asked I would have said perseverance.  I had a long, pre-determined and daunting road to the point of applying to PA school.  I saw something I wanted and went after it with my heart and soul. I had arrived at this point and would use the same perseverance to make my way through PA school and throughout my career.
  • Be genuine. People can sense when you give them a bunch of bologna.
  • This is a very individual answer. In my opinion appropriate answers include: compassion, team player, adaptability, thriving under stress and being able to work effectively with many different individuals (there are many more but these are just examples to get you started).

Q: What is your greatest weakness?

What are they looking for?

  • Also quite straight forward, but a little more messy than your strength.
  • You always want the weakness to be something you turn in to a strength, but not be overwhelming.
  • Demonstrate that you understand what you need to work on and how you can better yourself

What not to say:

  • Anything that can be misconstrued as a quality that would make you difficult to work with your impede your work as a PA or PA student
  • Stay away from politics, religion or anything that can be construed as racism–all very very bad things.  Anything that can be emotionally charged should always be avoided in interviews (I hope all of these things are obvious and not qualities anyone posesses but just as a friendly reminder).

What to say:

  • I was not asked this question for my PA school interview either that I remember.  However, I have been asked this at many interviews prior to PA school.  My answer has always been “Low tolerance for a poor work ethic” aka I can’t stand laziness.  I further state that I tend to take on responsibilities of others and it can take away from the quality for which I perform my own job.  I’ve since learned to better stay within my means by still being a team player.
  • What do you need to improve on? Are you too hard on yourself/you own worst enemy? Do you have a tendency to be an over-achiever and not know when to take breaks and relax? Do you take on too much responsibility in a group setting? Trouble stepping back and following because you’re a natural leader? All of these are good examples
  • Remember: BE GENUINE!  I cannot stress this enough, it’s so easy to see when someone is insincere.

 

 

Medical Musing of the Week: Behcet Disease

Overview

  • Disease marked by recurrent eye and genital lesions as well as ocular involvement.  Autoimmune/autoinflammatory disease with a hereditary component.

Etiology/Pathogenesis

  • Perivasculitis and early neutrophil infiltration w/ endothelial swelling
  • Association with HLA-B*51
  • Mediterranean descent/region, middle east and far east

Clinical Manifestations

  • Recurrent oral and genital ulcers
    • Painful with yellow necrotic base
    • Can occur alone or in clusters
    • Subside in 1-2 weeks w/o scarring
  • Integumentary Involvement
    • 80% of patients also have skin lesions
    • Folliculitis, Erythema Nodosum, Vasculitis (infrequent), sweet syndrome and pyoderma gangrenosum
  • Ocular Involvement
    • 50% of patients experience ocular symptoms
    • iritis, uveitis, retinal vain occlusions, optic neuritis
  • MSK
    • 50% have arthritis or arthralgia
    • Knees and ankles most common locations
image
                                               Clinical Manifestations of Behcet’s Disease

Diagnosis

  • Clinical
  • Pathergy Test
    • Introducing a needle under the skin resulting in an abnormal healing and development of ulcers and raised erythematous area demonstrating irregular healing
Positive Pathergy Test.  Increase in inflammation and erythema represents impaired healing
Positive Pathergy Test. Increase in inflammation and erythema represents impaired healing

Treatment

  • Methylprednisilone 
    • 1 g administered intravenously for one to five days,  for progressive, severe, organ or life-threatening disease.
  • Colchicine
    • Effective for mucocutaneous involvement
    • Also associated with decrease in joint involvement for men and women and genital lesions and erythema nodosum in women
  • Azathioprine
    • Patients treatment with steroids and AZA demonstrated less vision deficits and blindness
  • Cyclophosphamide
    • 1 to 2.5 mg/kg per day, orally
    • 1 g or 0.75 to 1 g/m2 by monthly infusion IV
    • Effective for neurologic and vasculitis associated with Behcet’s

Complications

  • 30% develop DVT and PE is a rare complications
  • Blindness may ensue from Panuvitis
  • CNS Behcets: IL-6 is persistently raised in cerebrospinal fluid of these patients

 

 

 

 

My Journey

I’ve gotten a lot of questions recently about what my journey was like up until the point of getting my acceptance letter to PA school.  I also realized that I ask my clients (and patients) a lot of probing questions and there are a lot of things they don’t know about me!  Not because I’m unwilling to share; but, mostly because I focus on other people in my work.  Ok, enough chit-chat I’ll get down to it.

A brief background: I was pretty aimless academically in high school.  I was not your traditional straight A valedictorian type.  I worked hard and did above average; but, I don’t think anyone ever saw me as “smart”.  My mind had other areas of foci.  Mostly I was always an athlete first.  My mom was super sick with cancer most of my childhood and I think it probably took more of my mind then I realized or would ever be willing to admit.  I based college on where I would play softball and had no idea what in the hell I was doing when I went to college.  All I knew was that I was getting away from home and that made me happy.  Also that going to college was what everyone was supposed to do, so I did it.

If I had to do it over again, everything would be different.  Maybe not high school, but college for sure.  I would go to community college get whatever credits I could as cheap as possible.  I would have vacated the mid-west ASAP. I wouldn’t have majored in psychology and I wouldn’t have gotten a master’s degree around the same concentration.  WHAT WAS I THINKING. I was pretty hopeless and I think I suffered anywhere from a 4-7 year quarter life crisis. 

So, there I go proceeding with about 120k in student debt and a lot of people in my life cocking their heads at me wondering what the hell I was doing.  I didn’t know what the hell I was doing for the record. I was 24 years old working as a personal trainer and bartender.  I knew about half way through my Master’s it wasn’t right for me, but decided to finish. What the hell was I doing?

When I was working as a personal trainer a worked with a lot of medical professionals.  I talked to them a lot about what kind of work they did.  It interested me, medicine always interested me. As cliche as it sounds I was obsessed with all the typical medical shows–ER and Grey’s Anatomy (by the way as truthful as it is don’t put this in your personal statement 🙂 One day, a friend of mine who I was training brought in a brochure about Chatham’s Physician Assistant program.  I was like this is it.  I want to do this.  I sat down made a list of all the crap you guys know needs done to have a complete PA application, made a time line and never looked back.

I decided to stay in Pittsburgh if I could to avoid out of state tuition. Yea, I know good time to start worrying about that.  I also wasn’t interested in up rooting my life at this point.  So, I compiled a list of 5 schools wrote down all the classes, GRE, supplemental apps, letters of rec, etc that I needed–sent in my application to CASPA beginning of June, visited all the programs I was applying to, got an interview at Pitt, got accepted and the rest is history.

I realized not a lot of people agreed with my choice.  Of course no one vocalized anything. But you can always tell when people think you’re bat shit crazy. People did.  I didn’t particularly care.  As for why I didn’t really have much academic confidence when I was younger I’m not really sure.  The older I got and the more purpose I had in the science courses I was taking the better my performance became.

If you have a purpose you have a path.  Don’t let barriers stop you or others disapproval–or seeming disapproval.  Just bite the bullet and jump. I had a lot of reasons why I might not get an interview or get accepted.  I’ve also talked to a lot of people who focus on this detail.  Don’t let the don’ts come into your house and set up camp in your brain.  Don’t go down the don’t rabbit hole.  Remember you are unique and if you’re reading this you probably have your shit enough together to see how other people did it and that makes you a step ahead of a lot of people.  Always give yourself credit.  Smile. Be confident.  I’m convinced anything can be accomplished with these simple statements.  Good luck everyone!!  

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