Tag Archives: Physician Assistant

Second time applicants, this one’s for you!

I get a TON of e-mails contacting me about what to do differently as a second time PA school applicant.

My not so great answer is: It depends on where you were and what you showed the admissions committee last year. 

But, for those of you looking for some more specifics (probably everyone) I’ll do my best here. 

Also first, let me ease some anxiety.  I can tell you that I was fortunate enough to be accepted on my first try (looking back I’m not sure how!) But I would say approximately 1/2 of my class were second time applicants and two people in particular who I thought were two of the smartest (and still do) in my class were both second time applicants. 

DO NOT allow a detour to inhibit you from finding a path ❤

OK.  Now down to the good stuff! 

The Quick and Dirty Version….

  1. Increase shadowing hours
  2. Shadow in new specialties
  3. Re-take courses
  4. Re-take the GRE (this is low on my priority list)
  5. Get a new certification 
  6. Volunteer
  7. Some people pursue additional Master’s degrees (THIS IS EXPENSIVE).  But a lot of people are doing it to set them apart
  8. Medical mission trip
  9. Demonstrate continuity by keeping your present job(s)/shadowing experiences/PCE/HCE
  10. Do something that makes you a stand out!  I had a lot of fitness certifications on my application.  PA schools aren’t looking for the same cookie cutter anything.  I’m partially convinced that my number of different experiences made me “different” and was a big contributor to me getting an interview. Dare to be YOU and different! 🙂

A Little More Detail + Questions to Ask Yourself

How did you improve? 

So, a year has passed. What changed?  How have you improved your application?  Did you re-take course work, get more exposure to the PA profession by additional shadowing, get any certificates (CNA, plebotomy, etc).  If you did–highlight that in your application and personal statement and/or interview!

“Nothing changes if you don’t change anything”

If you haven’t actively taken steps to demonstrate your continued dedication to the PA profession and strengthening yourself as an applicant– GO NOW and do it! 🙂

Who wrote your letters of recommendation (LOR)?

If you were lucky enough to read your LOR and weren’t blown away by them– ditch them.  Ask someone else.  This is another frequent question I get.  WHO SHOULD WRITE MY LOR?  This is based on what programs you are applying to and what they are requesting.  Make that a priority.  A good rule of thumb is as follows:

Professor: To attest to your past academic success and likely success in a arduous graduate studies program

Supervisor: Attesting to you being a quality employee, work ethic, team work– you know all that good stuff!

PA: Where this may seem obvious I did NOT even think of it!  But, a lot of schools want to see that you formed a good relationship with a PA who will attest to them wanting you to join the profession.

If you cannot get one of the above other great sources are RN, NP, MD/DO who can attest to your ability to work within the healthcare system as a team member and who will thrive specifically as a PA based on their observation of you and knowledge of a PA’s role and responsibilities

What did you learn from your unsuccessful CASPA cycle?

There is some new and emerging documentation stating that competitive graduate programs are actually seeking out applicants who have either experienced hardship or “failure” (I don’t actually believe in real failure– we either win or we learn) to see how they have responded to circumstances.  Show them you knew that not being accepted was not a final destination– but a detour and a learning experience. 

Either in your statement or interview talk about how you grew from the experience. 

How strong is your personal statement?

I get this question A LOT “should I re-write my personal statement?”

While there is no hard and fast yes or no to this my GUT responds to people with “Are you the same person you were a year ago?  Hopefully the answer is “no”.  Hopefully you’ve added to your application and grown as a person and professional in ways that will contribute to your experience as a PA-S, your classmates development as well as when you become a practicing professional. 

Lack of nutritional education in PA curriculum

Why aren’t we taught about nutrition?

I was talking to my boyfriend last night who told his doctor about what his diet consists of based on macronutrient (proteins, fats, carbs) amount per day.  His healthcare provider had nothing to say or add.  They were clearly not well versed on the topic.  And I can’t blame them.  It isn’t something we are taught (at least in PA school– I cannot speak for medical school)
BUT WHY are we not taught about the one singular thing that sustains us to live? (well that and hydration) on a very basic level.  Yet, we are teaching medical providers absolutely nothing about it (that I know of at least–someone correct me if I am wrong :).  
What do we learn as first line treatment for EVERYTHING? “diet and lifestyle changes”.  Right?!
Yet, America overall is so very sick. What is causing this and how do we on a small individual level begin taking steps to mitigate this issue? 

1. Set a positive example

I think that a portion of lack of nutritional and lifestyle counseling comes from either lack of personal knowledge or providers who do not follow the advice they would like to provide their patients. 
I’m not suggesting this is always the case or that the majority of health care providers are overweight and know nothing about nutrition. I’m simply suggesting there is a gap. Between what most providers need to know and what knowledge they have.
 
We need to set an example of responsibility for health and wellness in our own lifestyles so that we are comfortable discussing nutrition and exercise with patients. The best boss I have ever had led by example, and it made me want to work harder and be more of a team player.  I know it isn’t exactly the same, but hopefully the concept is appreciated. 

2. Put the patient in control

When anyone is approaching change, they determine where they are ready to begin.  Meet your patient wherever they are in the change process.  Frequently as helpers we seek to “fix” and tell patients how they need to be “fixed”. 
 
I am SO guilty of this!  “do this not that” “avoid this and do this”. 
 
Recently, I have taken on some different language.  
 
“What changes are you willing to make to achieve a healthier lifestyle/weight/etc?”
 
“What are your reasons that are meaningful for you to seek out these changes?
 
“What goals do you have for your health?” 
 
WHAT IS YOUR “WHY”?
 
Talking to a patient about exercising 5 days per week when they do none or maybe they don’t WANT to do that is going to only lead to frustration. 
 
Baby steps.  I love the quote “slow is smooth and smooth is fast”.  Once they are able to make 1 or 2 things they want to make habit and a lifestyle, start suggesting additional small changes.  Small things ADD UP!

3. Seek out knowledge

There is an ABUNDANCE of educational materials and courses on nutrition available out there.  As providers, maybe we have a responsibility to learn some basics (I know don’t we go through enough school).  I am not suggesting we attempt to take on the roll of a clinical dietician or nutritionist. 
 

What is the purpose/function of each macronutrient (protein, fat, carb)? How does each one serve our body and needs in a different way.  We need protein, fats AND CARBS (yes you need those) on a CELLULAR LEVEL. Our cell walls are comprised of all three. Our cells make up our tissues, tissues make up our organs and our organ systems make up our WHOLE BODY.  NOTE: There are variations of needs for each individual based on coexisting disease, goals, desires and basically how you FEEL.  Some people do great eating vegan: good for you.  Some people count macronutrients: good for you.  Not every way of feeding and honoring our bodies works for each person.
 

Learn the basics of some of the major types of nutrition programs (macros, paleo, keto, vegan, vegetarian).  I am definitely victim to pigeon holing myself into IIFYM (if it fits your macros)– because it is what works for me (disclaimer: this does not mean one eats only donuts because “it fits my macros”).  Admittedly, I’ve had a judgemental approach in the past towards other nutritional approaches.  Until I realized we are all not the same round peg going into the same round hole. And as long as your nutrition supports your body and wellness, I’m taking the approach of “good for you!” 
 
Personally, the nutritional approach I follow is IIFYM (if it fits your macros).  Precision nutrition is the certification that my nutrition coach attained and most of the coaches who work for the company.
Excuse my fine dinnerware 😉 
 
PLUG/RECOMMENDATION: if you are interested in learning more about the IIFYM approach visit http://www.workingagainstgravity.com or feel free to message me!  (I love to talk nutrition).  As an active mover– weight lifter, orange theory, crossfit, hiker, runner, etc etc and health care professional I FULLY endorse their approach and coaching.  Their blog also has so much information available for FREE!  Definitely check them out (I get nothing for recommending them!)
DISCLAIMER: I am definitely biased towards this approach because it has worked for me. 🙂
There is also a great deal of information available on podcasts which I have branched out to, and they are FREE!  I encourage you to listen to  nutrition based podcasts and also listen to the ones you may not necessarily agree with. This not only helps gain perspective of a patient or future patient, but also simply because you don’t agree with the entire basis of the program doesn’t mean you can’t take bits and pieces and make them useful 🙂
 
A simple quote that we can ALL live by no matter what nutritional approach you follow is the following:
 
“Eat real food, mostly plants, not too much” -Ben Bergeron
 
I am not advocating veganism or vegetarianism with this concept.
 
Eat real food. 
 
What does this mean? If it is on a shelf or has an expiration date > 2 weeks– its not real food. 
 
Mostly Plants.
 
Micronutrients are SO important and vital to maintaining health and wellness.  There are micro’s that you can only get from a diet that is rich in veggies! Magnesium, zinc, vitamins, etc etc.  Don’t get me wrong I love my steak once in a while, dairy and ALL sources of protein (if you don’t, that is ok, too!)
 
Not too much.
 
This means something different for everyone.  For most of our patients this can be simplified to prevent being overwhelmed:
 
1/2 your plate is veggies
1/4 lean protein
1/4 starch/carbohydrate
1-2 thumb size of healthy fat (nut butter, avocado, egg yolk, etc). 
 
I think if we can all follow those 3 principles and relay them to our patients we might instill some wellness! 
Example of what I bring to work to eat during a day 🙂

4. Encourage wellness instead of treating illness 

I listen to a podcast called “Pursuing Health” By crossfit games athlete and now medical doctor, Julie Foucher.  On one episode, she discussed where medicine is heading and I LOVE that she said that we are gearing more towards KEEPING PATIENTS WELL instead of treating illness. Instead of incentives for how many patients we see it will be based on quality and wellness. 
 
The problem with this: you can give patients all the information and tools, but if they don’t do the work– will we be getting “dinged” for their illness?  
 
I see both sides. I want to promote wellness, but we cannot FORCE people. I’m interested to see where this is going.  Also, definitely check out Julie’s podcast!  She was the first CF athlete I cheered for and love seeing what she is doing!

5. Advocate change

This is more of a MACRO (as in large) concept.  I would love to hear if people actually THINK nutrition needs to be incorporated and on what level into PA (and/or medical) school curriculum.  Are there people out there who encountered nutrition as part of their pre-req’s or in PA/Med school?  I’d love to hear experience and/or opinions about this!  (Especially because I know I tend to be really biased about wellness/nutrition/exercise 🙂

Top 5 Personal Statement Mistakes

I’ve been helping pre-pa students for the past 2 years with their personal statements.  During that time I’ve noticed some patterns that almost every statement I look at for the first time encompasses.  

  1. Lengthy personal stories

    Personal stories can be really great to use in your statement. As long as they contribute to why you want to be a PA, will be a good student or professional. Also, keep them concise.  I have read statements where their entire 5,0000 characters are simply a story.  And I find myself thinking “ok that is nice but why do they want to be a PA?  What will make them a successful student? If there is no purpose behind the story, it is simply only a story. 

  2. Abrasive/Abrupt transitions 

    Sometimes when I am reading a statement I’m reading about a patient care interaction and then its like BAM something totally different and I have no idea why the direction changed so quickly . Even between paragraphs– your statement should have an organization and flow to it.  It is different for everyone, but the order should make sense!

     

  3. Not writing to your audience

    I ask all of my clients the same question: who is reading your statement?  The answer: An admissions committee. When you write your statement, if the words do not serve a purpose to the admissions committee they need to go— its just “fluff”.  Do not lose direction or purpose at any point in your statement.

  4. Not focusing on THE purpose 

    If you take nothing else from this article the most important point I attempt to get across to my clients is: the purpose of the personal statement.  They are as follows:

    1. Why do you want to be a PA.
      I mean SPECIFICALLY a PA.  To be blunt no one cares that you are interested in medicine, want to help people or any other blanket/generic statementWhy do you want to be a PA as opposed to ANY OTHER MEDICAL PROFESSION?  
    2. Why will you be a successful PA student?
      Most schools receive approximately 1,000-1,500 applicants per CASPA cycle. Some more some less.  However, statistics demonstrate that attaining acceptance to PA school is more difficult by the numbers than medical school at an estimated 1-2%. What makes you unique? What previous behaviors have you demonstrated that positively predict your ability to succeed in an arduous post-secondary program!? 
    3. What will make you a successful professional?
      Demonstrate examples of your past that you will carry forward to your career that will make you successful.  Was there a situation in the past that you went above and beyond for a patient? How do you show empathy? Did you encounter challenges that required you to persevere and overcome obstacles? Draw connections to your previous experience and how it will apply to your success as a PA-C.

  5. Lack of assertiveness

    Listen, I am on board with bragging about yourself is difficult–unless you are a narcissist of course. I promise you other applicants are putting it out there.  DO NOT use passive language such as “I think I will….” Instead say “When I am a physician assistant student….” “When I reach this goal….” etc etc.  If you show the admissions committee that YOU are confident YOU will attain this goal– they are more likely to believe it too! Get rid of  the words: if, when, just, maybe, think and replace them with: can, will, know, certainty, etc etc.  
     

On the Obesity Epidemic and What People Don’t Want to Hear.

No one is going to like me for this article. Physicians, PA’s, NP’s, patients… basically all of America is going to hate me.
But, sometimes we need to hear things we don’t like. 
I’d like to start by saying that in America we are constantly bombarded with all types of consumption and choices.  Society at large has us set up to fail– to over consume in terms of nutrition and finances– and pretty much anything else. 
We are not set up to succeed in our health or wellness, which continues to spiral out of control through generations.  I read a statistic (several times) stating 80% of America is either obese or overweight.  I can’t remember the source; but, I started to pay attention to my patients and the general population at large and I mean– it seems pretty accurate.
Fast food, advertisements, portion sizes… hell even the size of our utensils are grossly enlarged to skew our perception of what we “SHOULD” (trigger word) be consuming and how much of it.
The number of subconscious decisions we make in a day regarding the food we choose to consume and what we spend our money on is basically innumerable.
We live in a society that values quantity and quickness over quality and mindfulness.  My response to this is: THIS NEEDS TO CHANGE.  It is not something that is going to change on a macro level.  It starts with each individual and spreads.
Now, here is the part no one is going to like.  We are all responsible for this. 
HOW?
Will power and responsibility is a thing.  We are all individually responsible for how we treat our bodies, minds and souls.  The nutrition and lifestyle we choose fits into all of these categories. Simply because society does not set us up to succeed does not give us an out to be obese, lazy and victims of our circumstance. 
We all have the power to make better choices.  Do it.
Health care providers: QUIT skipping the difficult conversations.  Patients need to hear that they are obese and what they are doing to their bodies by not honoring them with healthy choices. I’m not suggesting we start bombarding people with “hey you know how overweight you are? do something”. What I am suggesting is that we start having difficult conversations and lead by example. 
Is it difficult to sit in front of someone and tell them “you need to lose weight” and have that conversation?  Yes.  I do it 5-10 times per day.  No joke.
If you are skipping over the conversation you are part of the problem and not the solution. 
Modern western medicine teaches us in school to treat illness.  What I have learned in my time on earth and three years as a medical provider is that you have to learn to teach you patients to honor wellness.  That well-being is not a pill, it is not an overnight solution or a crash diet or diet pills (I simply tell people “no” when they ask for them).
Teach your patients wellness.  If you don’t know what this means I encourage you to learn. Learn and practice what it means to live a life of mindfulness and wellness.  Develop an understanding of proper nutrition– unfortunately we are NOT taught this in school and it is something I have learned through nutrition coaching.
SHAMLESS PLUG: If you are interested in a life overhaul that starts with honoring your body with nutrition visit Working Against Gravity at: https://www.workingagainstgravity.com/

DISCLAIMER: I do not receive financial incentives or anything by promoting them.  But by being a part of their group I did develop mindfulness and a nutritional habit that honors my body and wellness. My life changed because of the choice I made to work with WAG (working against gravity). 

I encourage all of my colleagues, future colleagues, physicians, nurses— or whoever you are— start with yourself.  If you transform yourself and learn, you have the capacity to help and transform another.  This change will not occur overnight;  but, I encourage everyone to be a part of change on a small scale so that changes at large can occur in the future ❤

If you want to see a physician, I want you to see a physician.

“When will I see the doctor?”

For those of us who are practicing PA’s, there is no shortage of this statement. Up and coming PA’s: get used to it.

I know for me, I expected to hear it.  I have ZERO ego about someone who makes this statement to me.  If you do, consider a different career.

I had a patient today who was fairly rude about the fact that I was not an MD/DO.
“Well when are you finishing school?”, “Did you go to Stanford?” (so random), etc etc.

I told this couple that there wasn’t a physician on site.  We never have a physician on site.  I further told them that I am licensed to do everything in a family practice setting that a MD/DO can do.

They still weren’t satisfied.

At which time I said “If you prefer to see a physician I suggest you contact your health insurance company for a provider in your network”.

Why did I let this go so easily?

Establishing a relationship and actually getting a patient like this to value your words is worse than slim to nil. They’re wasting their time, I’m wasting mine and honestly I probably open myself to a law suit HEAVEN FORBID the slightest thing goes wrong.

Dear patients, if you want to see the physician–I want you to as well.

But not before I educate you about how capable PA’s are 🙂

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.  

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.