Using Picmonic to Study in PA School

There’s always some excitement and jitters around back-to-school season, but it’s a bit different when going into a graduate-level program like physician assistant school. The pace is much quicker and the expectations are higher in PA school. Traditional study methods may not be as effective for digesting the amount of information presented. 

I personally experienced this during the first week of PA school when we started with anatomy. Hours of notetaking and rewriting information weren’t feasible. There just weren’t enough hours in the day! Instead of seeking other resources, asking for help, or changing how I studied, I blindly kept going and ended up with a C on my first exam. 

That was a serious wake-up call and shook my confidence. I knew something had to change quickly if I wanted to complete PA school successfully and I took a good look at my study methods. I needed something faster that targeted what I was learning in PA school specifically with the information I needed to know to care for patients one day. There are tons of resources out there, but one that I continually hear about from PA students and wish I had during PA school is Picmonic. Lucky for me, I can use it during my PANRE recertification! Let me tell you more about Picmonic so you can determine if it would be a good fit for your PA studies. 

Picmonic is a visual study aid. You know how you can recall that one episode of your favorite childhood cartoon, but trying to remember what your professor said yesterday is impossible? Picmonic makes what your PA school professor said into an animated graphic with mnemonic devices to make the information more interesting and memorable on test day. 

I found it very difficult to remember all of the necessary information strictly from text on a PowerPoint. Once I was on rotations, seeing patients in person, everything came together so much easier and I could recall the information much quicker. Picmonic is a happy medium by providing bite-sized videos that show and put all of the information together in a way that makes sense. 

So how should you use Picmonic? If I were in PA school, I would use Picmonic after I reviewed material from the lecture and books and felt I had at least some familiarity with the basics. I would view the associated Picmonic animation to help me connect the facts and concepts in a way I could understand and apply it to a test question. I would watch the Picmonic, review the facts, and then take the associated quiz. If there were any topics I struggled with, I would go back to my lecture material for review and then revisit the Picmonic. 

During PA school, I also liked to do last-minute quick overviews right before tests. Picmonic is perfect for that because you can make a playlist of the subjects you would like to review and the videos are short so it’s very efficient. You can even just watch on your phone to make it even more convenient whenever you have a few minutes of downtime. 

Here’s a sample study plan for how you could use Picmonic during a 2-week module in PA school. Start by looking over the blueprint for the section and find the accompanying topics in Picmonic. Create a playlist with the Picmonics you want to review. Set aside a dedicated time each day to Picmonic. If you have a commute or want to take a break, but still feel productive, these are great times to watch a few videos. As test day approaches, increase your dedicated time to allow for reviewing and taking the accompanying quizzes. Mark any videos you want to rewatch as refreshers right before the exam. 

To try Picmonic, use the code THEPAPLATFORM for 20% off. Picmonic also offers a great free trial where you can play and quiz on the 15 most popular topics for 5 days and then browse after that. This is a great opportunity to see how Picmonic fits into your schedule and if it’s a good solution for you. If you’ve used Picmonic, let me know your study plan and how it’s helped you in PA school! 

My Picmonic PANRE/PANCE Study Plan

Brought to you by Picmonic. Affiliate links are provided. 

Fun fact - to become a physician assistant (PA), you not only have to successfully complete both the didactic and clinical portions of the program, but you also have to pass an exam at the end called the PANCE - Physician Assistant National Certifying Exam. And yes, we pronounce it “pants.”

To continue to be a PA, every 10 years you must take a recertification exam called the PANRE, and although many PAs specialize, this is a general test. For PAs like myself who have only ever worked in a specialty, this is a bit daunting. Since I am in my 8th year as a PA, it’s time to start studying and brushing up on the other 96% of medicine I’ll be tested on outside of dermatology! That’s where Picmonic comes in to save the day.

When I was in PA school, I adopted a mindset early on during the didactic portion that I was studying for not only the end of subject test, but also boards, the entire time. Once I figured out the resources that worked best for me, I stuck to those throughout the program. I’m a note-taker by nature and need a way to put together the information I’m seeing and hearing to apply it to real-life situations. This happens on rotations, but how can you learn that same way before being thrown into the real world?

Visual tools that combine memory devices with application, like Picmonic, are great resources that weren’t available when I was in school. Now that I have to start over, I’m so grateful I can use Picmonic in my studying for the PANRE and I’ve seen how it would have been such a great supplement to the death by PowerPoints we sat through for 8 hours a day. Here’s my approach for studying using Picmonic.

The PANCE/PANRE is made up of 14 subject areas in the PANCE Blueprint that are each assigned a percentage. Dermatology is a whopping 5% compared to the cardiovascular system at 13%. 

Luckily, Picmonic is organized into the same categories with the main subjects broken down into digestible bite-size videos. From a broad perspective, Picmonic is an audiovisual learning system with unforgettable stories and characters to help you remember everything you need to know for school. The quick little anecdotes stick with you throughout clinical rotations and tests as a long-term memory retention tool. If you’re anything like me, finding little connections and different word similarities to remember quick facts helps so much with recall on test day.

Click here to sign up and be sure to use code THEPAPLATFORM!  

Planning Finances as a PA with PA the FI Way

Are ya'll enjoying our recent focus on finances? Do you know what "financial independence" is? Kat from @pathefiway is on The Pre-PA Club podcast today to tell us about her journey to establishing a financial education and helping other PAs meet their financial goals through her podcast - PA the FI Way. It was a really fun conversation, and I'm actually on her podcast as well talking about my student loans and creative outlet through The PA Platform.

Kat: So my name is Katarina, but I often go by Kat. I am a PA that lives in the upper Midwest. And I went to a PA school at Des Moines University. 

Savanna: Awesome and you're practicing now? 

Kat: Correct! Yep, I started in family medicine for about six and a half years. And I recently switched over to outpatient psychiatry back in January. I still do have a casual position with my previous employer as a walk-in/Urgent Care PA role too, so I like to keep that generalized medicine still going on too.

Savanna: Nice! Are you doing in-person psychiatry or mainly telemedicine? 

Kat: When I first started, because of the COVID pandemic, it was mainly telemedicine, but just recently we switched back over to seeing people in person again too. 

Savanna: Okay, interesting. Yeah, that's what a lot of my PA friends who work in Psych have been doing - a lot of telemedicine. It's a specialty that definitely translates well to that. I'm in dermatology, and it's a little hard to see things over Zoom, when trying to look at skin lesions. We've made it work, but it was a little difficult. So, let's take it back a little bit and what made you interested in becoming a PA?

Kat: So back when I was in high school, I felt as though I needed to figure out what to do with my life, as I'm sure many people felt the need to do back then. And I really enjoyed science, and I hadn't really thought about different types of careers in medicine. So back then in high school, a lot of people only think of doctors or nurses, although there are so many other types of careers out there in medicine as well. I highly encourage anybody interested in medicine to research about and consider other careers as well. But when I was in eighth grade, I tore my ACL my first and last time skiing, because I was not a good skier haha. And in the ER, the provider who saw me was a PA, and I didn't necessarily register it at the time as a teenager. But a few years later when I was thinking about what to do for school, my mom reminded me that that provider was a PA, and so we researched the profession together. I just really liked the fact that you get to have less student loan debt, and a little bit less time in school as well. I also really enjoyed the lateral mobility of the profession, obviously as I've utilized, so those were the factors that prompted me to pursue the PA profession.

Savanna: Nice! Yeah I feel like everyone comes to it in a different way but those personal medical experiences tend to be a common theme where you figure out, oh there are people who can take care of me who aren't necessarily doctors, which is nice and a good path to take. So I've actually never had a PA who works in psychiatry on the podcast surprisingly because I feel like there aren't that many of y'all. There's definitely a need and I know in the area I'm in in Georgia, we definitely need more psychiatry providers. What does a typical day at your job look like? What is your schedule like in that specialty?

 Kat: Definitely, you're correct that there are definitely few PAs in psychiatry. When I was looking into switching into a specialty, the research I found at the time was that probably less than 1% of PAs work in psychiatry, so I thought that was very interesting. During a typical day right now, I will see either intake patients, or follow up patients. Intakes are new visits, and they are either self-referred, like some people just want to see a psychiatry provider for some reason, or family medicine may refer them, or a lot of times, they are follow-up from a recent inpatient hospitalization for psychiatric purposes, and we are seeing them once they've been stabilized in the hospital. As I mentioned too, it’s both currently a little bit of Telehealth visits, a little bit of in-person visits, so it's a little bit of both going on. We also manage their mental health medications, and we have to monitor labs with that. It's very weird, I'm sure you can relate as a derm PA, but it's very weird not to use the stethoscope anymore day-to-day. But that was something to get used to, but I still feel as though I'm helping people, and it's definitely a very interesting specialty for sure. You see a lot of different things, lots of different mental health illnesses, but it's very rewarding to try to help others feel better and try to help stabilize their mental health symptoms, so that they can improve. 

Savanna: So are there any limitations in your specialty? Because I don't know about where you're at, but as far as with medications you're able to prescribe, just being in a specialty where you may be prescribing drugs that are on different schedules? 

Kat: Sure, so that's a great question! At my company, they are very much trained on the job. So, the medical director is the supervising physician that we work with. In my state, we don't technically need the true supervising physician role anymore because of legislation changes. But every company keeps that role differently, right? So he's a psychiatrist, and he works with the PAs and is very hands on. So we have a weekly meeting with him where we ask all of our questions; we can send him messages all the time; we can go down the hall if he's in clinic. He oversees the PAs at other clinics as well which is really cool. So he's very hands on. We prescribe and manage all mental health meds. There's even one of the big gun antipsychotics called Clozaril (clozapine), you have to take some online training and then we manage that and prescribe that as well. A lot of injectable medications and controlled substances too, but I do appreciate that our company has a pretty strict controlled substance agreement policy. So we don't mix any controlled substances. Or if patients are using drugs like medical marijuana, depending on the situation, we often don't use controlled substances as well. So I do appreciate that support too. 

Savanna: That's awesome. That sounds like a really great work environment and set up, which should be a goal for anyone who wants to be a PA. I want to pivot a little bit. So the reason we connected was through Instagram, and I started seeing your posts pop up on your account PA the FI Way, which we'll explain a little bit about. but so can you just explain what got you interested in financial topics and what inspired you to kind of create your account and podcast?

Kat: Yeah that's a great question. So, I guess for financial topics… I really wasn't that into finances. My husband used to manage all the bills, so I just thought that he manages the bills and I didn’t really have to learn much about finances. As a PA, I was just learning so much that I didn’t necessarily mind. I was definitely trying to pay off my student loans, but now aggressively. Unfortunately, I started off working with a financial advisor, who was not the best fit, because some things that he suggested aren't necessarily sound wisdom, so we got burned a little bit right out of PA school. How I got into the topic of financial independence was through travel rewards or travel hacking. We were on our way to a friend’s wedding, and one of my friend’s husbands asked, “hey do you like traveling? have you heard of travel hacking?” And he introduced me to the Choose FI Podcast. That is the podcast I started listening to, and that's how I got hooked on financial independence. I became kind of frustrated with our training - about how much we get into debt. We do earn a fair income out of PA school, but how do you balance that? So, it made me want to try to educate other current and future PAs out there about the concept of financial independence. 

Savanna: I'd say in the last couple of years, that is something I learned about because they don't really teach us in school about debt or loans or investing or any of that. So it's a lot of self learning. But this concept of financial independence was new to me. Can you explain what that means on kind of a basic level for somebody who's never heard of it?

Kat: Sure, so financial independence is a very broad topic, but I will definitely do my best to try to explain it simply to those who are just kind of getting started. So financial independence, the abbreviation is FI (that's where PA the FI Way came from). And that's the first part of the acronym FIRE, or Financial Independence, Retire Early. Retire Early is actually optional, so once someone reaches the point of financial independence, they don't have to retire early. They certainly can continue working as a PA for many, many years to come if they would like to, but reaching that point provides many doors throughout your life, like you could consider cutting back on work or things like that. So, FI is the point at which a person (or a couple) reaches where they have invested savings equal to 25 times their expected annual expenses. So a lot of financial calculators look at your current income, but it's not really what you make that matters for retirement, it's what you expect to spend in retirement. For example, if a couple expects to spend $80,000 per year once they stop working, then they will need to have invested $2 million, or investments plus savings money. Otherwise, if they are able to live very frugally on only $40,000 a year, they would only need $1 million. Some people are really frugal and live on less than that as well. So financial independence is based on something called the Trinity Study, and what that study shows is that if you reach financial independence, you have a very high probability that you'll be able to last for 30 years with your finances. So if you are thinking about retiring really young, you probably should have more than 25 times your expected annual expenses saved up. 

Savanna: Okay, that's what I was just thinking. So you're saying if I had $2 million in the bank, I could just retire - that doesn't seem like that would work hahaha. I mean investing is so complicated with compounding and all that. I'm sure there are lots of calculators online where people can plug stuff in and all of that. So when we talk about investing and saving and paying off debt and all of these things - when there are so many different techniques and terms, what stood out about this concept of financial independence? Do you plan on retiring early? When you found out about this, what steps did you decide, like okay I'm gonna do these things to make this a reality for myself. 

Kat: So the two very condensed ways of achieving financial independence is trying to cut back on costs and save a lot, but then also try to invest throughout your career too. So you're trying to invest as much as possible for your future. In regards to whether I'll retire earlier or not, probably. I really don't want to work until I'm in my mid 60s or potentially even 70s. I'm not exactly sure when we will for sure retire, but again as I had previously mentioned, reaching financial independence or being close to it allows you the ability to really cut back on your work if you really want to. My husband and I don't have kiddos yet, but once we do, then that can help with a balance in our life at that point. Both my and my husband’s fathers passed away at relatively young ages. My dad was in his early 60s. and his dad was in his 50s. You hear all the time about how somebody reaches retirement age, and they’re so excited to retire and unfortunately something awful happens where a spouse passes away, or they get an illness, and they can’t do the things they planned for their retirement, whether that's traveling or other hobbies or activities. So that's why we're trying to pursue financial independence. 

Savanna: Yeah, those are great, great reasons. And that's so true. I mean, there is so much variation in the PA profession between our specialties, jobs, locations, life, and debt and all that. Is this a concept that you feel like most PAs would be able to achieve and pursue, or do you think you need to be in a certain place already before you consider making actions towards setting yourself up for financial independence?

Kat: Sure, that's a great question. I think that every PA and their family can reach financial independence, and there's a few reasons why. One is that PAs do make a pretty decent and good salary. There are many school teachers that reach financial independence on a salary that's way less than us as PAs. Again, it’s about those expenses, so you don't have to cut back everything and live super frugally. But you need to find the balance of finding those things that you value in life. You don't have to be married to a high income earner as well. You can be the primary breadwinner, but if you have a PA salary, then you can certainly reach financial independence. 

Savanna: Are there any resources that you use? I know there is Physician on FIRE, who talks about this who is a physician. There is also White Coat Investor; I feel like everybody knows about. What resources have you found to be the most helpful in just learning about finances?

Kat: Yeah! I absolutely love the White Coat Investor and Physician on FIRE; they're both excellent resources for those of us who practice in healthcare. As I mentioned before, Choose FI Podcast is great as well. And there's another PA on Instagram, Kristin Burton (@strivewithkristin). I recently interviewed her for my podcast as well. So she has tons of good resources too. There's so many good books too! The Simple Path to Wealth is an excellent book to start with, or Quit Like a Millionaire. It really depends upon what type of modality you want to learn from. There are podcasts, YouTube channels, books. I do have my podcast as well, PA the FI Way. I tried to really teach about these financial independence concepts, break it down in understandable pieces for peers and make it applicable to them as well. 

Savanna: Nice, and I love that it’s specific to PAs! As a PA, you can understand the education and everything that goes into it, the job, and all those factors as well. Let’s talk about the different stages. We have pre-PA students, PA school students, new grad PAs, and other PAs. What are some things that people can start doing at these stages to kind of set themselves up for financial success later on?

Kat: Sure, yeah so this is a really deep question that you can go into many different branches, but I'm going to do my best to be concise here and try to give some actionable tips along each step here. In high school, try to keep your college costs low when planning for college. You can do that by taking AP or dual enrollment courses. I went to community college for my first two years of college too, so you can plan to apply to community college, and then start applying to tons of scholarships in high school. Then in college, you can also consider living at home that can keep your costs low, or you can become a resident assistant as well. You can use used textbooks and apply to more scholarships, and then try to obtain healthcare experience. You don't have to spend tons of money on your education to be able to start getting some of those healthcare experience hours. And then when you do apply to PA school, make sure that you are applying only to those programs that you have met all of those prereqs. Because as you know the cost of CASPA is pretty high. And if you aren't meeting all those prereq requirements, then it's probably not worth even applying to because you have to pay for every single PA program that you apply to. And then, in addition to applying for more scholarships, consider joining the military because you can get your debt paid back as a provider. The PA profession was founded in the military, so it's very fitting. In PA school, live below your means. So you're going to have your student loans that you're going to get, but it's really important to start budgeting. You need to start tracking, probably three to six months of every single dollar that you're spending. Keep your housing costs low, you don't need to spend money to buy fancy medical equipment. Just the simple medical equipment can do. Try to get rotations near your friends or family. 

As a new grad, try to live like a PA student for two to five years. So don't let your fancy new income as a PA cause you to have lifestyle creep, meaning that the more money you make, the more money you're spending. Then really try to plan out how you're going to pay back those student loans, you can consider programs like Public Service Loan Forgiveness (PSLF). You can consider refinancing loans, certainly after the current COVID federal student loan pause is over though, and then try to start investing ASAP. Many jobs will have a match for their 401k or retirement plan. So try to start investing even if you are paying off your debt because time is your friend when it comes to compound interest. Also try to track your net worth. It’s hard to know where you're going to be going, which number is your financial independence number, and then how far along you are in reaching that number if you don't know what your current net worth is. There's a tool called Personal Capital (https://www.personalcapital.com) that I really like to use, and that allows you to put in different types of accounts to see where you are at that moment in time.

Savanna: Yeah I use that too. That’s a really helpful way to visualize everything and see where you are at. Those are great tips! As you were saying those, it’s funny and it sounds bad, but I was thinking about people who stand out at every level, either myself or someone I know. Like there was someone in my class who ate out every single meal, and someone else who bought a new car when they graduated. I clearly did not do everything perfectly either!

Kat: Exactly, exactly. I definitely did not do things right out of PA school either. I only learned about financial independence five years out of PA school, and I've been practicing for seven years now, so I definitely made all of those mistakes as well. You bring up a good point with food and transportation. Food, transportation and housing combined comprise 61% of American budgets. So if you can really focus on cutting back in those three areas, then you'll be able to save more money and invest for your future.

Savanna: What advice would you give to somebody who wants to learn about this but is overwhelmed? Do you have a good episode that would be a good place to start? 

Kat: That's a great question Savanna! With my podcast, in those first couple of episodes, I talked about what the PA profession is if people aren't familiar with it, and then I do also talk about financial independence, and the different steps that I mentioned along the way there too. I also did recently create a free resource called PA the FI Way Beginners workbook that you can find on my website, http://pathefiway.com/, so you can you can sign up to get that resource to start. Otherwise, you can shoot me an email at Kat@pathefiway.com, and I'd be happy to send you a copy of that too. 

Savanna: Perfect, yes, that's awesome, and you're on social media as well. I've definitely seen your posts popping up. I see yours and Kristin’s posts a lot because it comes up on my Instagram all the time, which is great. I need the reminders! Oh, and I’ll put all that information in the description, so everybody can find everything. I definitely appreciate all of your insights and information, and hopefully this will be encouraging to some people to at least take a look at their finances and kind of see what changes they can make. 

Kat: Yeah, definitely. And I wanted to thank you so much Savanna for having me on. I’ve been following you for several years now. I think we graduated PA school right around the same time, so I think it's awesome what you've built over time since you've graduated from PA school! So thanks for all you do for current and future PAs too! 

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How to Create a Study Plan for PA School with Sketchy PA

Sponsored by Sketchy PA

The first thing people ask after receiving an acceptance to physician assistant school is - “What can I do to prepare myself?” With each program’s curriculum being so different, it’s difficult to get ahead, but one way to steady yourself for the difficulties of PA school is to develop a study plan. If you’re already in the thick of it and now understand what we mean by “drinking out of a fire hydrant,” you may be feeling overwhelmed by the amount of information being thrown at you every single day. It’s a lot! This blog post will help you determine your learning style, develop a study plan, and identify the most effective and efficient resources for the limited study time allotted during PA school.

What is Your Learning Style?

Many students float through high school and undergrad by adapting to each professor or class and depending on memorization. (Raising my own hand as I write this!) There isn’t a ton of focus on self reflection to determine your learning style, although doing so can make studying much easier, while also making the most of your time. I never took one of these tests until after PA school, but found I typically rank highest for Kinesthetic and Read/Write, but what does that mean?

There are tons of free quizzes online, like this one, that can quickly give you insights into how you learn best. The main identified learning methods in the VARK questionnaire are Visual, Audio, Read/Write, and Kinesthetic. In referring to the descriptions of these styles, Visual learners enjoy seeing information arranged in charts and graphs that show the information in a graphic manner versus writing, video, or photo. I love a good chart and definitely took advantage of the large whiteboards in the library during PA school. Auditory learning refers to students who best consume information through listening - podcasts, lectures, discussion, etc. Group studiers tend to fall in this category. Read/Write is somewhat self explanatory, but if you enjoy just reading the information in a textbook or on lecture notes, this may be your learning style. The last style is Kinesthetic, which is for students who like to see examples while learning to connect the subjects with experiences.

You may find yourself relating to multiple areas, and upon figuring out this information, it’s essential to recognize and adapt if a study method isn’t working for you or switch between styles when needed. PA school will be a rotating experience of different professors and testing styles, and you may need to adjust your study style along with them.

Once you have an idea of how you learn best, determine what type of other learners you study most effectively with. Group study isn’t necessarily just quizzing each other, but having a cohort of similarly minded students will help keep you on track and make studying a little bit more fun. While I personally don’t do well with “talking it out” or “teaching each other,” many students in my class preferred that method in their study groups. Being a more visual learner, I collaborated with 2-3 other students in the library, and while we mostly studied independently, we encouraged each other to keep going and asked questions when needed. We were also able to share helpful resources when the lecture notes weren’t sufficient. Moral of the story - Figure out what works for you, and stick with it unless it isn’t working anymore.

Developing a Study Plan

The majority of PA programs schedule lectures Monday through Friday from 8-5. So when are you supposed to study?? How can you take care of yourself in the process?? You’ll likely have an adjustment period while figuring this out, which is normal, but the sooner you set a schedule, the better. Most resources you use, like Sketchy PA, will give options for different lengths of use possibly ranging from 6-24 months to get you through PA school and help you plan your learning.

Take a look at your class schedule and determine if there are any pockets of time that you can use for studying. Are you a morning person or a night owl? I found studying early in the morning was much more effective for me when my mind was fresh before lecture. Look at your curriculum to see which topics and lectures are coming up and compare to the NCCPA Blueprint. Throughout all of your PA school education, remember that you are preparing for the PANCE! This brings us to the next point, which is finding the tools that will make your life easier. 

Identifying and Using Study Resources

Once you have a learning style and know what time you have available for studying, identifying the appropriate resources that will be most efficient for that allotted period. Realize early on that you will not be able to use every resource out there and what works for a classmate may not work for you. To illustrate the importance of finding a resource that will satisfy multiple learning styles, let’s take Sketchy PA as an example.

Unfortunately, these visual study aids were not prevalent when I was in PA school, but it seems to be a gold standard now. Why is that? Sketchy develops interactive learning with videos that help students remember material by connecting an image of a visual scene with the essential information, while showing the application of the material. We’re covering Kinesthetic, Visual and Audio learning, and if you take notes, you’ve got Read/Write done too! 

The videos created by Sketchy are specifically designed for PA students to highlight the information that is emphasized in the NCCPA Blueprint. To hear more about how this resource was developed, listen to this podcast episode with the PA Director at Sketchy, Prof. Moini. The image above shows a video with different symbols that are highlighted and explained in this story to help students retain information better and apply it. The videos are developed to supplement and support what you learn in the classroom, and kept to shorter lengths so you have digestible bite-size info for your small pockets of time. After solidifying the knowledge, use the review cards to make sure you understand the main points thoroughly. 

Most resources, like Sketchy, have a free trial so you can try it out and see if it will work for your learning style and study plan. Take some time to give it a shot, and I would love to hear your experience in the comments.

Take advantage of the Black Friday 2021 deal and use code PA20BF for 20% off all plans! If you miss out on that deal, SKETCHYSP will get you 10% off anytime.

What You Need to Know About Specializing as a PA

How do PAs specialize? While the physician assistant profession was designed to fill a need for primary care, there are many PAs who work in various specialties. A question that comes up a lot is how education works for PAs who choose to go into a specific area of medicine. Here's your answer:

Do PAs specialize during school?

Nope! PA school has specific subjects that are covered by all programs to provide a generalized education for a career in primary care. Even a program that is "surgery" focused will still cover those main areas that are required by the ARC-PA. There isn't required additional training to enter a speciality, although there post-graduate training programs for PAs available for extra education in certain specialties. The most common are ER, ICU, surgery, and psych.

What can I do during school if I want to work in a certain specialty?

Use your electives to get some experience and make connections. Networking is such an important part of finding a job. During rotations, I started off thinking I needed to tell all of my preceptors I wanted to do their specialty (even if I knew I didn't) to try to get job offers. It didn't work. Once I started sharing my interest for surgery and dermatology, I actually got calls about job openings in the area and my preceptors were essential in landing my first job.

Can PAs change specialties?

Yes! That's one of the benefits of the career. While PAs don't switch around as much as one might expect after they find their niche, it's reassuring to know it's an option. Before we get into that, here are some of my favorite specialty PA accounts:

@busybeingbridget - Plastic Surgery

@sammiesupageek - Surgery

@rectalrockstar - Anorectal Health

@itsgabythepa - Family Medicine

@strivewithkristin - Critical Care

@jamienicole_pa - ER

@thewholepa_ckage - Pain Management

Now let’s talk about changing specialties and working in multiple specialties — PAs can do it all!

One of the benefits of the PA profession is being trained as a generalist with the option of working in more specialized areas. A very non-exhaustive list includes dermatology (me), surgical positions (orthopedics, trauma, plastics, bariatric), endocrinology (my back up), OB/GYN, pediatric specialties, and even opthalmology. There are SO many options, and I think one of the coolest things about our profession is that even though we are all "PAs" the actual job description can look so different even if in the same specialty.

If a PA in one area, say dermatology, were to decide to change specialties or need to based on life circumstances, there isn't anything "official" that has to happen. It's as simple as getting a job in the new area, completing the necessary training, and likely brushing up on that section of PA school and learning more in-depth information. That's why having a supportive collaborating physician is so important! It took a good 6 months for me to feel somewhat comfortable in dermatology, and being 7 years out, there are still conditions I've never actually seen in practice or cases that surprise me. To make the switch to a new specialty at this point would take a lot of work, but I appreciate that the option is there.

As far as working in multiple specialties at the same time, it is possible, but probably not as common as you'd think. As you may already know, working in medicine can be exhausting, so trying to juggle multiple jobs and areas could be tough, but I know some PAs who do it well. One thing to remember about going into a specialty area is that the PANRE (recertification test PAs take every 10 years) is general and you'll be tested on all of the information from PA school again in the future, so that's a good reason to try to stay up to date with everything at least a little bit. I would love to hear more about the specialty you hope to work in or any experience you've had as a PA in different specialties! Let me know in the comments who your favorite PA is and what area they are in so others can find more PAs to follow along with.

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Staying Health in PA School

Today’s interview is with Ashley Turner. After graduating from UAB’s PA program, Ashley works as a full-time surgery PA with a background in nutrition. Ashley also does nutrition coaching through Faster Way to Fat Loss (which I did, and loved). We talk about our experiences in PA school, how to make good choices, and how to get back on track.

This episode also has a podcast which you can listen to here.

Ashley:  Hi everyone! I'm Ashley Turner. I'm a certified PA, and I work in Campbellsville, Kentucky, which is a small rural community where I grew up. I’ve been working in general surgery since graduating PA school. I live with my husband and 14 month old son, and all my family is here. I also do virtual health coaching with The FASTer Way to Fat Loss as well. So that's kind of me in a nutshell! 

 Savanna: How long have you been a PA? 

Ashley: I graduated in December of 2014.

 Savanna: We’re about the same because I graduated August of 2014! What was your background before PA school?

Ashley: I graduated from University of Kentucky with a Bachelor's of Science in Nutrition and Food Science. I wanted to go to PA school right after school, and I had my heart set on UAB. I always wanted to do surgery. So I applied only there following undergrad, and I did not get in. That was a huge blow to the ego! But that’s okay. I ended up taking a year off and I worked a lot of odd jobs. I worked as a nurse tech, doing triage at different clinics around Birmingham, Alabama. I actually moved there. I also cheered in college, so I became a cheerleading coach at UAB. And I also was a cheerleading coach in an all-star group down there as well. So I was working like three to four jobs during the entire year. Then I reapplied to UAB as well as another program in Nashville, Trevecca Nazarene University. I secured an interview at Trevecca, but did not get in. But at UAB, I got an interview and got accepted that second time, which I was really excited about! And it all worked out because I'm from Kentucky, and moving down there for a year and taking that leap of faith to reapply actually got me in-state tuition, which was helpful in the long run. 

 Savanna: That is a really big move! And I think a lot of people wouldn’t necessarily be willing to do that even if they really want to go to a particular school, and UAB is on the top of a lot of people’s list. 

Ashley: I really sing the praises of UAB; I had a really good experience. I think you can find faults in every PA program. You can really nit-pick any program. But you know, I really can't find many. The staff was just really great. All the educators were just really wonderful. Setting up our rotations were huge. And they had just a lot of great resources and a lot of great preceptors. So I have no qualms about UAB. It definitely does speak volumes when applying to jobs because people will interview me and ask me about my training at UAB. And I've had people specifically asked for “UAB-trained PAs”. It was just really great. So I love my program, and I'm glad I did take the leap of faith to move down there and work my tail off for a year. 

 Savanna: I also love surgery! I think if I did not do derm, then I would do surgery. Are you actually in the OR? What does your job look like on a daily basis? 

 Ashley: I'm currently not in the OR in this current job, as much as my previous jobs. So I don't know if this is a good or bad thing, but this is my fourth job right now. So in my first job, that was level II trauma center and acute care, my vascular and general surgery job, my priority is pretty much the OR. I did a lot of critical care. We really acted as first year residents. We had the pagers. We were first-call for any issues on the floor. We also rotated doing floor call, critical care call, and trauma call. So we responded to the trauma codes, and we would also be first assisting in the OR. That was really exciting. I got to do a lot of procedures - A-lines, central lines, chest tubes, thoracentesis, and I was learning therapeutic bronchoscopies towards the end. So it was really awesome! In my vascular and general surgery group, my first priority was the OR as well. We first assisted the majority of the time and rounded on patients. At my current job, I do a little bit of it all. I rotate in the hospital. I do a clinic for two weeks. And I do a little bit of OR. I round on patients and do consults in the hospital. 

 Savanna: Okay, cool. So what are your hours like?

Ashley: So there are 3 PAs in our service. We rotate two weeks stints in either the clinic with more hospital, or we have a float two weeks where you have a little bit of an easier schedule with some mornings off during the week if the load is light in the hospital. Coming off the hospital two weeks is a little gruesome because we are pretty much there 7am - 5pm Monday through Friday. Sometimes you can go home early, it just really depends on the workload, the patient load. You kind of have to be there in case consults come in because you are the first one to respond to consults. But in clinic, it's pretty much 8 am - 5 pm, and we have a half-day on Fridays. So it kind of rotates. It's been pretty nice. It's been nice for work life balance for me having a new child.

 Savanna: What is your level of autonomy and your relationship with your supervising physicians?

 Ashley: It has changed a bit. It’s gotten a little less autonomous as I’ve gone through my jobs. In my trauma job, they pretty much let you go. For chest tubes, I saw one, did one, and then went to the floor and did one by myself. The trauma surgeon looked at me and said, “You can do this, right?” And I was like, “Hmmm yep!” So I marched to the floor by myself with a student, and that was really the second time I put a chest tube in. That was quite terrifying, because my patient was awake on the floor in stable condition. So it was terrifying because they were very alert! So in my practice, if I ever needed them, they were a call away. They trained us very well. The other PA who trained us trained us very well, and they were there every step of the way. I saw a lot of chest tubes before I did that. They were just very good at feeling the situation and knowing when they needed to be there, and knowing when they felt confident in my ability with all the PAs. They did a wonderful job at maintaining the relationship between the supervising physician in the PA. 

Being in a small practice in a small town, it just makes it a little bit complicated, because everybody knows everyone. So you're pretty much seeing your patients at Church or at the Mexican restaurant in town and you don’t have that luxury because patients want to see the surgeon. They want to see your physician because that's who they're seeing out in the community. Midlevels are still a little bit new in a smaller, more rural community. So it's just a little bit different, but they still do a really good job of incorporating us into the practice.

 Savanna: Interesting! So what made you interested in nutrition? Like, why did you choose that as a major? And was it helpful for PA school?

 Ashley: Yes, I would say yes, to PA school, and also my career now. First of all, I was a biology major, but I hated coming out of the class and not really being able to apply it to my everyday life. And that really frustrated me that I spent all this hours learning things. And I was just like, “I want to just do something with this now. I want to learn something that I feel like I can apply to my life now.” And all through four years of college, I was a collegiate cheerleader. So being in shape, being at an appropriate size for our sport was very important. My sister was a nutrition major, and I would be kind of in the mix with her seeing what she was learning. I thought it was really awesome, what you’ve learned in class could apply to your life. You can build upon it and just continue on for the rest of your life! So I switched my degree to nutrition, and I ended up loving it. It helped me through my fitness level in college and where I needed to be and wanting to be. 

And as far as being a PA right now in our General Surgery Clinic, again, bring in a rural community, we do a lot of primary care through our clinic. So I think in a lot of larger communities, when patients come to your general surgery clinic, they pretty much already come with the diagnosis, and they come with a plan of action, what you're going to do. They have the appropriate studies ordered, and you pretty much know their problem and know your plan of action really before you see the patient, a lot of the times. But here, they come in a lot with vague symptoms and get shuttled to us to kind of figure out and decipher between their symptoms. And a lot of times, it's nutritional things. It’s IBS. It’s constipation. It’s diarrhea that is diet-related. It’s lactose intolerance. It’s gluten sensitivities. We coach people through that. We have a surgeon I work with Dr. Bahr, and he’s very sweet. People will come in with these complaints, and he’s like “She's the expert, please talk to her. Just listen to what she says.” So I’ll come in and counsel people through these things, even with people with diabetes who are so lost and clueless. So it's been really great. It's been really helpful in this environment! 

 Savanna: That’s an interesting way to think about it, because yeah, my biology degree was useless haha. Okay, so we’ve never really talked about this on the podcast at all -- staying healthy in PA school! I don't necessarily think I did a great job of this. It’s really hard in the thick of it, and you’re just trying to survive. You're not necessarily thinking about what you're eating, or if you're eating or if you're working out because school is such a big priority. So do you think you did a good job of taking care of yourself and your health during PA school?

 Ashley: I think I stayed active. I don't know if my diet was quite as tight as I would want it to be. But I think I've stayed fairly active, which was huge. My first year PA school, I was still coaching cheerleading, so I was able to work out with the cheerleaders and I even went to games with them and stayed active with them during my didactic year. So that was really easy, staying active and having an active stress relief from PA school, something to get my mind off PA school, my mind out of studying. So that was very therapeutic for me. And as far as overall health, I think that did wonders for me in my first year. 

I don’t think my diet did too well. You’re up at like 3 am trying to study for that test, and you’re just trying to stay awake. You’re going to Einstein Bagels, that was by our class. And sitting in class for six hours is mind-numbing, so at least you can enjoy that delicious cinnamon bagel. So I don’t know if I did my best with staying active. But I think staying active and finding that downtime and finding that stress relief when you think everything is kind of coming down on you -- I think I did fairly well. 

 Savanna: Yeah the only reason I worked out was that two of my friends in PA school would go to the gym and basically make me go. And they would run and I was like “I'm not running, I will walk with you guys around the track, but I'm not running.” They would always try to get me into mud runs and 5K races. And I would refuse! Haha I'm glad they were my friends and still my friends. I'm very thankful that they encouraged me to do that, because it was a good stress relief. 

Ashley: Yeah, and I think really managing your expectations on what healthy means to you at this point in time is important. Like having a raging six pack and a bikini body is probably not the best thing to think about in PA school. Maybe you don’t have the time to manage your diet and hit the gym like you are trying to compete in a bodybuilding competition or something. But really managing those expectations! Healthy means thriving in PA school, having the energy to study and having the energy to still maintain my relationships during this very stressful time in my life. So really digging deep, getting into your feelings, managing those expectations, what healthy means to you at the moment. I think that’s my number 1 tip is finding that stress relief and not allowing PA school to become all-consuming. Go out and have fun and find that stress relief. I think that could be the single most best thing you could do PA school.

 Savanna: Yeah! And make time for yourself. Even in the sense of checking in with yourself and doing things that take care of you like eating. I have said it before, but I love reading and I didn’t read a single book for fun during PA school. And when my parents would invite me to get dinner with them I would say no and ask them to bring me something back. And by the time they came home, I would usually be asleep because I just didn’t eat dinner. And that's not healthy. That's not making good choices for yourself. And again, looking back, I can see that. I don't know about your class, but my class had a snack closet. That was our fundraiser. So they would go to Costco and buy all the snacks for the closet. And then we could get a candy bar for like 25 cents. I mean, it was great! 

 Ashley: That’s definitely the number 1 question you should ask when you interview at PA schools. Do you have a snack closet? 

Savanna: I also remember that there were people in our class that would eat out every single meal. Like literally, they would bring Starbucks for breakfast. It was so expensive. They would go get something for lunch at the little cafe. And then they would all go out for dinner. And I was like how are you doing that? So expensive! 

So, how'd you get into nutrition coaching? One of the things I love is when PAs have interests outside of being a PA. 

 Ashley: Well, I never would have guessed in a million years that I would do something like this. Obviously I'll obviously always have been interested in nutrition. I have a degree in nutrition, I was a college athlete, where health and nutrition and fitness was really important. So it's always been an interest and always just finding ways to incorporate healthy things into your life. Because I knew from the very beginning, even as a nutrition major, that good health and preventative health starts with what you eat, period, We even learned that a PA school about being healthy for preventating disease -- 90% diet 10% exercise. I’ve always kind of had a passion for that, especially because people in my family have chronic illness. 

So during my post-partum period, I was lacking motivation. I was three months postpartum. I had a friend of mine, Lauren, who was a FASTer Way to Fat Loss. I had seen her posting, and kind of made fun of her. But I finally gave in because I was pretty much at a low point. I wasn’t making the best choices. Diet Coke was my best friend again. And basically every meal was refined sugar. I was like, “I’ve got to stop this. I felt miserable.” So I was overwhelmed at first, but after learning the strategies, it interested me even more. So I got onto PubMed and looked up articles on intermittent fasting. I was like, I think there is something to this. It was incredible. I was like, “whew, I think this is legit and this is real.” I mean, I wasn’t deprived. There wasn't a mean macro. There wasn't a macro that was eliminated or the “bad guy.” I felt like it was what I learned in nutrition. Everything in moderation. We have treats, we have carbs, we have fats. It was just a wonderful way to envelop everything people tell you into one system and one structure. So I loved it and eventually become a coach. And I’m a born teacher, a born coach. I love to do it; it’s my passion. So having nutrition, coaching, and preventative health all in one is a dream come true, honestly.

Savanna: We had an intermittent fasting lecture in PA school! I tried Whole 30, and that was awful. I tried it twice. The first time, I made it 15 days. The second time was when I was post-partum. I don’t know what was going on with my body, but it made me so sick. It was awful. I was waking up sick in the middle of the night. My husband was like “are you pregnant?” I wasn’t pregnant, like I didn’t know what was happening to me! I was doing it with my medical assistant at work. He's also one of my best friends. And I was like, “We're not doing this again. Not happening.” But I was like you, I was so desperate to not be squishy anymore, so I'm with you there because mine is 12 and a half months old.” 

So overall, what is FASTer Way to Fat Loss about? Give us the breakdown about that. 

Ashley: FASTer Way to Fat Loss is an online program that guides you through 6 pillars of the “FASTer Way”. The main one is intermittent fasting. Then you add in the others which makes it an awesome program altogether. But intermittent fasting, you have whole food nutrition, you have macros and macro tracking, carb cycling, strength training combined with HIIT, and then also accountability and community. You join an accountability group with me where I teach you and coach you through all the aspects. I teach you the metabolism of each macronutrient, why it is important to have them. I teach you why carb cycling is effective and what's happening metabolically in our bodies to show the results and the fat loss that we're having. We go over intermittent fasting, and what is happening inside our bodies and how intermittent fasting works with playing on our insulin levels and depleting our glycogen stores out of our liver, increasing apoptosis and cellular regeneration in our body. So I go through all of these things in the group, and I teach you how to put it together in cohesive flexible plan. It’s all online for 7 weeks and we have an accountability group. You have access to me daily with weekly trainings. 

Savanna: Okay, so I’ll say what I liked about it. I like that you as a coach - you have a degree in nutrition and you’re a PA. You’re not a random person who decided to coach people on nutrition, which I feel like I see sometimes. And I'm like, wait, why are you qualified to do this? So, that was great! Also, I tried intermittent fasting for a little bit. And I always thought it would be really hard. But once I got in the groove, it really only took a few days for me to adjust. Also through the teaching, I felt like I understood my body better and what it needed and why, which was very helpful. Also, I told you this, but I did not stick to the rules very well, like I pretty much ate what fit my macros, even if it was like dairy or whatever. But I didn't feel deprived of anything. I felt like I was eating a lot.

 Ashley: Yes, everyone says that! 

Savanna: I think one of my problems was that I didn’t feel like I could eat enough. But I was still seeing change and losing weight. So it was really cool. Really interesting how all that works. And if someone decides to do this, planning ahead was key for me. I learned that if I don't plan ahead, I'm going to choose the easiest option, which is usually the closest option - which for me is either McDonalds or Zaxby's. I learned a lot doing it! 

 Ashley: Yeah, I think it's such a great mindset shift for people, especially people who come from the 90s and are scared of fats. And then people who come from keto land, and are scared of carbs. And I preach all the time, I don't think there's a bad macro! I think you just have to find what fits for you, what makes you feel good. So you go through this program and you’re telling me how you feel through the whole thing. If I don't know the answer, I'll go find it for you. I'll research it for you. I'll find somebody else that knows the answer. And we really just brainstorm to find something that works and feels good for you. Because at the end of the day, if I just tell you rules to follow and they are not flexible and not personalized to you, you're not going to thrive and you're not going to survive in a lifestyle like that. And then it's going to be pointless. So that’s what I really like about it as well. I'm a huge proponent of understanding how and why we do something, so you just feel so much more empowered to do it. It’s a lot easier to kind of stay on track that way. It’s nice also depending on where you are in your journey. If you're at maintenance, if you want to change this, change more composition here, it just all depends on where you are in your journey. It can be flexible to meet that need! 

 Savanna: So tell us more about where we can find you and ask you all the questions!

Ashley: Sure! Here is a link that goes to my page as well FASTer Way to Fat Loss page, and you will see me as a coach. And we'll talk more about our pillars, what to expect, what rounds look like, and a lot more information. Also, I share a lot of tips and information on my Instagram. That's probably the main place that you want to follow me and see what's going on: https://www.instagram.com/ashleyphillipsturner or @ashleyphillipsturner. I keep you up to date on when my rounds start and when you can register. I like to drive into the science and why with my posts and stories. I try to keep you up to date on the latest research too! I kind of go over some stuff like that. 

Thank you so much for reading! I hope you found Ashley as endearing as I did. 

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When to Have Kids as a Physician Assistant

Even though you want to become a PA, you probably have other goals such as getting married and having kids. So we are diving into that topic today! This question comes from Jocelyn. Thanks for your question Jocelyn!

Jocelyn: My question is specific to females desiring to have kids. When is the right time to have kids as a PA, still fresh in the industry? To be specific, I'm 23 years old thinking that I will be done with PA school around 26 or so. My goal is to have maybe one kid by age 30. And I kind of feel this pressure where I would like to get in this upcoming cycle, if not the next. I just don't know if this is something that should be even thought about or just kind of pursue my dreams and see what happens. Thanks! 

This is a tough question. But I have some more recent experience with this since I have a three year old. So let's talk about what you should be thinking about if you're concerned about whether or not you can become a PA and still have the life you're envisioning as far as having kids. Now, I don't feel like this is a topic that is solely for females. If you are a guy, your wife may be thinking about kids more than you are or maybe you are too. It's okay to want to plan out your future. I tend to plan and really think about things in advance. So I'm with you if this is something that you are concerned about. Now, there's a few things to consider.

First of all, I think I learned this from personal experience; there's no good time to start a family and have kids. You can plan it and think about it, but things may not go the way you planned. Something’s always going to come up; it's going to be the next thing. For example, starting school, moving cities, getting a new job, getting a different job, someone’s wedding, vacation. There is always going to be an excuse, and there is always going to be something preventing you from starting a family. Eventually, you kind of just have to make the decision that now's the time. It's now or never. Just go for it!

Now, for a little background on me. If you've watched some of my videos or listened to some other podcasts, you've heard that I got married while I was in PA school. And that's not something that's typically recommended. But to me, it was important. My husband and I met in high school, went to the University of Georgia together, both biology majors. We got engaged right at the end of senior year. Then we both went to school. I went straight to PA school, and he went to medical school. For us, we didn’t want to wait so many years to get married until all of our training was done. We just had to make a decision, and that was to get married during school with a shorter honeymoon. It meant that it was a little bit stressful, and I wasn't quite as involved in the planning as I wanted to be (Thanks, Mom!). But for us, it made sense. 

When we had been married for five years, we started thinking about kids. I'm steady in my job. My husband had finished med school and was in residency. When's the best time? Do we wait until he's done with residency? But then is he going to do a fellowship? He's going to be starting a new job, is that a good time? I'm in my job, is that okay? I feel like I'm finally established - is okay for me to take a step back and take time off to be with a new baby? Essentially, we just decided that it probably was the right time, and it wouldn't be perfect. But that would be okay. So last year around this time, I had a baby. And I've learned a lot about the process. Pregnancy teaches you that you are not in control of anything. I mean, you can't predict if you're going to have an easy pregnancy or a difficult pregnancy. Thankfully, I had a pretty easy one, if anything, I was just a little bit tired. No real morning sickness or complications. But a lot of things can happen, and you kind of have to be willing to just let it go and trust that everything's going to be okay. I think for Type A personalities that tend to be PAs, that can be a little bit difficult. And I definitely struggled with that and had some anxiety about that throughout my pregnancy.

There is this pressure to get everything done right at once, and do it all. Sometimes, this isn’t always realistic, and that’s okay! You have to take things step by step and really decide to you what's important. 

Let’s break down your options:

1. Pre-PA: This is a great option. Like I said, pregnancy is unpredictable, so that may give you some more freedom with that unpredictability to adjust if necessary. Now that may push your timeline for becoming a PA, and this is where you have to weigh pros and cons with your priorities and what is important to you. You may be able to spend more time with them while they are so young because you aren’t in PA school yet.

2. PA School: PA school is hard, busy, and rigorous. If you talk to any new PA students, usually they they are completely overwhelmed. Personally, I can't imagine having kids while I was in PA School. I would’ve done it because then that would’ve been my new normal. But I don't know if it's something I would have actually chosen because it would definitely have been tough. During PA school, you would need a ton of support. This also depends on school set-up because some programs have very strict policies. For my school, you could not miss class unless you had a doctor's note. And even then, it was very, very looked down upon. That being said, I never missed a day of PA school. So with pregnancy, there are many appointments, and you may not feel good at times. With that unpredictability, that may cause you to miss some classes. Your school may ask you to take a leave of absence or extend your time in the program due to this.

Side note: If you go to the PA forums, there are some stories there. The PA Cafe is a blog specifically for PA moms and PA student moms. And we have an interview with the creator of that from a while back. But that's a good place to check to just to hear other stories from other people and see if you find something that you relate to. So in my class, nobody got pregnant and gave birth during school. A girl in the class above me got pregnant while on rotations. She was actually due the week after she took her PANCE. So she graduated, took the PANCE a week later, and then had her baby a week after that. I remember asking her about rotations, and she said the expectations for her were the same as any other student, despite being very pregnant. So for example, in surgery, you may be expected to stand for hours and hours, but that’s may be very difficult while you are pregnant. But that's something that you've got to just take into account and be ready for it. That's what happens. There are some Instagram accounts of PA students who have had babies, and it’s possible. You don't necessarily have to put that on hold! 

1. After PA school: This is what I did, and that's what most of my friends have done too. Right after PA school, we had just a bunch of weddings. And then a few years later, a bunch of PA babies were born! I wouldn't change anything about how I did things. Maybe if anything, I would have had her sooner because it seems like my baby has just been a part of our lives. And I can't imagine her not being here. So I love it! Actually, I was that person who's always like, “I'm going to be ready to go straight back to work. And I'm going to want to have such a short maternity leave.” That’s definitely not true now. I want to spend every single second with her, and even now when I get home, the first thing I want to do is give her a hug. You have to think also about finances and being financially stable. I don't think babies are quite as expensive as everyone makes it seem. There are definitely ways to save money! I have a true baby clothes addiction, so I'm probably not the best person to speak on that haha.

Keep in mind that the other thing about having a baby, either in PA school or as a working PA, is that you’ve got to have a plan in place for childcare and support. What are you going to do if your baby is sick, or if your sitter cancels? I work as a dermatology PA, and I have 35 patients on my schedule! That would be tough to move everyone. I would absolutely do it if I had to, but thankfully I have parent-in-laws who are willing to help out if something comes up. 

Whatever decision you make, it'll be the right one, and it'll be fine! And you'll have a sweet little baby who you love. And that's all that really matters. So you gotta decide what works best for you. I would love to hear your thoughts in the comments! And just shoot me a message on Instagram. Let me know your thoughts and what you did. If you have a story about how you became a parent before, during, or after PA school, please share it. I hope this was helpful and answered the question! Thank you for reading. 

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The Ideal First Job - Guest Post by Jordan Fisher, Co-Author of The PA Blueprint

We all want our first job to be perfect, but a dream job is hard to come by. Many new PAs will move on from their first job after one year (or even less), and there is nothing wrong with that. However, there are things you can look for in a potential job that will lead to longevity with your first position. So, what should you look for?

First of all, they should want you. Whether this is a potential job from a previous rotation, or through some connection with the practice, you should feel wanted. Though you are a new graduate, you still have the potential to generate a lot of revenue for the company. Make sure that throughout the whole interview process you feel welcomed and wanted, otherwise this may not be the correct fit. 

Though this is your first job, I am a firm believer that you should always try to negotiate. During contract negotiations your potential employer should be honest and transparent. You should have a firm understanding of what you are signing up for. Evaluate the contract and explain why you are worth a small percentage more as you negotiate (don't go crazy, this is still your first job). You likely won't get all you ask for, but the company will hopefully meet you in the middle. A practice that is willing to negotiate with you is a good sign. 

This is your first job, which can be terrifying. You are finally on your own with patients’ lives potentially in your hands. I have heard too many stories of new Physician Assistants being thrown to the wolves with no support. Do not allow yourself to be one of them. During the interview process you should gain a firm understanding of how you will be oriented. Will you be following a Physician or APP? Will you have some type of onboarding training? How many patients will you be expected to see and when? Make sure you know what you are getting into and that you are comfortable with it. 

To use myself as an example, when I started in emergency medicine, I had a four-week onboarding process where I followed seasoned PAs and NPs, with gradual increases in patient loads. This could extend to six weeks if I did not feel ready. This was exactly the assistance I needed, which left me feeling ready(-ish) to be on my own. An adequate onboarding process can make or break your first job. 

Ok, so you made it through onboarding, but is that it? What kind of ongoing support will you have? Any new PA will have a slew of daily questions because, well, medicine is hard! Will you have someone you can go to with these? A supervising or collaborating Physician? Another experienced APP or mentor? Make sure you have someone available onsite to help you with the inevitable difficult questions that will arise. At the Urgent Care I currently work at, I am much more comfortable on the days I have another provider here to discuss patients with, and that is still the case after four years of practice. Medicine is a team sport!

Besides your onboarding, what other training will you be receiving in your new position? See if your new practice has anything planned for you. Maybe there are a couple conferences they would like you to attend or an online bootcamp you can go through (I completed an online ED bootcamp). If there are other APPs in the practice, see what training they did. Do they have any PowerPoints you can go through? Training as a new PA is a continuous process and it is very helpful when your new employer has a plan in place for you to continue to improve your knowledge. 

On that note, has your new employer ever hired a new graduate? If so, do they still work there? There is no better sign than a practice that has trained and retained a new Physician Assistant. Make sure you speak in depth with the PA during the interview process as this can be a wonderful insight into a potential job. Plus, the practice will likely have a protocol in place to train you as a new PA. 

This is a lot to expect from a potential first job! No job will have everything, but just one or two of these traits, especially a job that has a previous new grad that is still there, are a good sign that you have found a suitable position. Do the best you can to make sure you will have the support you need, then go for it! And as I said before, if it isn't the right fit, there is no shame in moving on. Just try to stay for a year!

If you want more information on everything that is the PA career check out The PA Blueprint eBook at www.thepablueprint.com. This covers everything from how to navigate your work environment to student loans to retirement accounts. Follow us on Instagram @thepablueprint for all kinds of info related to the PA career. 

Thanks Savanna for the chance to share with your readers!

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Your Next Steps After Graduation

Once you graduate, all you have to do is pass the PANCE right? Everything else is self-explanatory, isn’t it? Unfortunately, it is not. The focus of your program has likely been on the PANCE and understandably so. Schools are ranked on their pass rates, so they are very invested in your success on this test. However, that is merely the start of your career. There are many more steps to come, much of which are not straight forward. By being aware of the next steps you can minimize the time it takes before you start your new career and get your first paycheck (here is an article on what to actually do with that paycheck). So, what are these next steps?

First off, make sure you have plenty of money saved.  The process from graduation to practice will add up, costing up to $2,000. I don’t have to tell you that nothing about becoming a PA is cheap. Be sure you save all your receipts so you can submit them for a potential refund from your new employer (this should be brought up in the negotiation process of your contract). Any money you saved that is not needed can be thrown at your student loans! Let the payback begin!

After you pass the PANCE (congratulations by the way!) you need to apply for your PA license in the state in which you will be practicing.  Each state has their own website and process for this, so be sure to look into your own state ahead of time. Do not wait until you have your PANCE results to prepare. Have a game plan so you can get you application in as quickly as possible. The timeline and cost for this will also vary state by state. My experience (the state of Colorado) was a cost of under $300 and a 3-week wait. Other states can be more expensive and have longer waits. Because of this, you want to ideally have your application submitted the same day you received your passing PANCE results. Save the celebrations for the evening (but then go HARD in the paint. You deserve it!)

Once you have your PA license you can apply for your DEA license (so you can prescribe controlled substances) and your NPI (National Provider Identifier). You can apply for these at the same time. The NPI application is free and has a very quick turnaround of a week or less. This is not the case with a DEA license.  This will cost you a whopping $731. This is one that is definitely worth getting your employer to refund you for. The process typically takes 1-2 weeks to get your approval and DEA number. Some employers may not initially require this, but I recommend everyone obtain a DEA as prescribing controlled substances is well within the scope of PA practice. Plus, not having this may be a negative for a potential new employer in the future. 

If you are in an office-based private practice, this may be the end of your licensing journey and you can finally start practicing as a full-fledged PA! If you have any involvement with a hospital, whether in the ER, specialist consultant, or as a surgical PA, you will need to get credentialed with any hospital you are going to work at. If you thought the previous steps were slow, you’re in for a surprise. The credentialing process with a hospital will often take around 3 months! This will entail copious amounts of paperwork and a lot of back and forth with the credentialing department. To help speed up the process there are a number of documents that you should have ready ahead of time.  These include:

• Your new PA license

• Resume or Curriculum Vitae

• Vaccinations included updated PPD

• Passport or Birth Certificate

• Undergrad and PA degrees

• Reference list- they may need to fill out a reference the hospital will send to them

Have these on hand to quickly provide if a hospital requests them. 

These various processes can be overwhelming, especially when all you want to do is start your new job. Stay organized and think ahead. The first few steps are all up to you, but once you get to credentialing, you will have additional guidance. You may be able to shadow in an office setting, but you will not be able to step foot in the hospital or OR until your credentialling is completed! 

We all just want a minute to relax after school is over, but don’t worry, you will have plenty of time for that. Stay on top of your game for another couple months and save yourself the hardship of delayed employment or running out of money as you wait to start your new job. Congratulations on all your achievements and welcome to the world of PA-C!

Thank you so much to Savanna and The PA Platform for this opportunity. If this article was helpful to you and you would like more guidance on things like job hunting, contracts, retirement accounts, or choosing a specialty, head over to www.panextsteps.com to get my guide on what to do after physician assistant school.  

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How are PAs Paid? Understanding the 3 Common Structures - Guest Post by Kasey D'Amato, PA-C

Thank you to Certified PA Consulting for sponsoring today’s post! Certified PA Consulting’s primary goal is to elevate Physician Assistants and Medical Professionals to new heights, and create a path toward a successful and fulfilling life and career. Be sure to tune into their FREE upcoming webinar on February 3rd to learn about salaries, negotiations, business and making 2021 your most successful year yet.

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“How to determine an appropriate PA salary?” This is a question that many PAs ask and many doctors ask when hiring a new PA, or when renegotiating their current PA’s contract. 

 The answer is: it depends.  

The salary range is wide, $60,000-over $200,000. 

The annual revenue collected is wide: $350,000-over $1,000,000.

There are a variety of factors that help determine an appropriate salary for a Physician Assistant.  Benefits such as health insurance, 401K, CME allowance, paid vacation, and malpractice insurance all represent a cost to the practice.  On the other hand, PA’s that attract their own patients, successfully market their practice, and contribute to practice management are often considered very valuable to their practice. So taking this all into consideration, how do you calculate a fair salary?  

The first thing to consider is that Physician Assistant salaries can be calculated utilizing a variety of different structures.  There is no published template or right or wrong way to perform these calculations and using “averages” can be dangerous because of the vast ranges listed above. The most successful physician/PA relationships occur when both parties feel that they are communicating well and working together towards the same professional goals both for themselves and the practice. 

There are 3 common salary structures for PAs to consider:

#1. The first structure, often for new grads or PA’s with minimal experience, is a trial period with a base salary only. The trial period is generally 6 months to 1 year, and a common base salary for full time (35-40 hour/week) PA with minimal experience could range from $70,000-$100,000 per year.  This PA needs to spend time shadowing and learning from their Supervising Physician (SP).  A new PA may receive some benefits including: paid time off, health insurance, malpractice insurance, CME allowance, or 401K.  After the 6 month-1 year trial period, the Physician Assistant should be very comfortable in the practice. This is when the PA can become more valuable to the practice because they can start to attract their own patient referrals and they have earned the trust of the support staff and community.  At this time, it is common to renegotiate the PA’s compensation to a salary + percentage based structure.

#2 .The base salary + percentage structure is the most common structure for PA’s with more clinical experience.  This formula can be structured in multiple ways. One example is a base salary of $80,000 + 15-20% of collections after the PA doubles their base salary in collected revenue. This system can be appealing for a SP because it allows the PA to “reimburse” the SP for their base salary, before rewarding the PA a commission for their increasing revenue.  Here is an example, assuming a PA generated $350,000 in collected revenue.

The PA would receive a base salary of $80,000 per year.  In addition, the PA would be paid 20% of their collected revenue, after deducting $160,000 (double their base salary) from the total collected revenue.  If their total collections are $350K, $350K - $160K = $190K.  20% of $190K is $38,000.  For that fiscal year, that PA would earn a salary of $118,000.00

Another variation of this structure is adding tiered incentive steps to the percentage formula,  where the PA's commission percentage would increase as his/her collections increase. This is mutually beneficial for both parties and is a common structure that rewards the PA as he/she grows in your practice.       

#3. Physician Assistants with over 3 years of experience often negotiate a salary based on straight percentage of collections.  At this stage of the PA’s career, he/she should be experiencing a full patient schedule and should be generating significant revenue for the practice (over $500,000/yr).  Experienced PA’s usually attract their own patient following and are able to practice without a lot of supervision from their SP which frees up time for the SP to see their own patients, perform more surgeries, etc.  The negotiated percentage can vary greatly, and is influenced by many factors. 

Straight percentage salaries usually range from 30% - 40% of the PA’s collected revenue depending on the benefit package.  The following list illustrates some of the factors that affect where a PA falls in the percentage range:

PA’s Expenses to the Practice (Lowers The Percentage Range)

• Paid Vacation

• Paid CME

• 401K

• Malpractice Insurance

• MA(s) dedicated solely to the  PA

PA’s Contributions to the Practice (Highers The Percentage Range)

• Independence

• Attracting own patients

• Taking Calls

• Marketing/Networking for the practice

• Office Managerial/Administrative duties

This list provides only a few of the many factors that are involved when determining a straight percentage salary. PA’s that receive percentage based salaries are generally paid monthly, and occasionally, quarterly.  It is important for a SP and a PA to have open communication when reviewing the PA’s monthly billing and collection patterns.  SPs and PAs can become great partners when they can openly discuss any concerns with each other, and the PA can learn from their SP how to bill the most effectively for the practice.  A PA that is knowledgeable about their collections can be a strong asset to a practice. It is in their best interest to maintain their patient load, generate more revenue, and bill efficiently in order to maximize their collections and salary percentage.
There is a wide range when it comes to dermatology PA salaries because there is a wide range of collections and practice settings that utilize a PA.  PA salaries will be higher if their collections are high. This should mirror the pattern of the physician community. A full time, experienced Physician Assistant can generate anywhere from $500,000-over $1M depending on the specialty.  It is very easy for the billing office to create a separate category to track a PA’s billing and collections (even though PA’s may or may not bill “incident-to” through their SP). 
Physician Assistants are increasing in numbers every year and can be a huge asset to any practice. The relationship between a PA and their SP is a unique partnership based on trust and mutual respect.  It is vital that the PA and the practice have the same goals for the role of the PA and are working towards the same long term professional goals and each supporting each other. The relationship is magical and leads to extreme job satisfaction when both parties feel respected and aligned and gain financial success together.

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Non-traditional Applicant using the GI Bill to Class President

This post is a transcription from an episode of The Pre-PA Club Podcast. Listen to the episode here: https://www.thepaplatform.com/podcast/gi-bill-for-pa-school

Travis: Hi everyone. My name is Travis Laverne. I’m a second year PA student at  Drexel University. I'm currently in clinical rotations; my 5th clinical rotation is in OB/GYN.  I'm also currently the class president for our class as well.  

Savanna: We'll definitely get to that because I have my personal thoughts on being an  officer in your class. But first what kind of brought you to the PA profession? Give us a  little bit about your background.  

Travis: Yeah, so it was pretty non-traditional. I was in the U.S. Air Force active duty for  13 years before I started PA school. I had always kind of had an interest in medicine. I  thought was really cool. I’ve always been attracted to the high-tempo type of careers, a  lot of responsibility. I do really well under pressure. That side of medicine always  interested me, but I just was kind of a knucklehead in high school and didn't have the  patience to kind of get through school. So I went the military route and I loved it. It was  really high speed; I traveled the world. I was exposed to a lot of PAs in the military,  because those are pretty much the main providers that we see in our clinics. So I was  kind of familiar with the career field, but I really didn't started investigating it until  probably about 10 years into the Air Force. My wife and I would sit down at night, and I  would watch those Untold Stories in the ER. I would just get so hooked, and I've  watched them religiously every night if I could have. I would always just try to figure out  what was going on with the patients. And she just kind of questioned me and was like,  “Why don't you ever get into medicine?” And that's kind of what kicked it off. Then I just  started doing more research, and the more research I did, the more the fire got lit. I  started reaching out to some PAs and some friends that I knew. I started doing some  shadowing, and the rest is history.  

Savanna: That's awesome! Okay, yeah so I would call that non-traditional.  

Travis: Before I had nothing to do with medicine. I operated the jet engine testing  facilities, so I was just straight maintenance type stuff. No medical background prior to  that. So it was a big jump.  

Savanna: So when you made the decision that this something you want to pursue,  practically what did that transition look like?  

Travis: I started doing a lot of research and trying to figure it out. I was carving  out a path as to what it would take. I had my bachelor's degree, and I was just about to 

finish my master's degree in management when I started. I had no prerequisites, core  science classes, or anything like that. So once I carved out that road map over the  course of probably 6-8 months in addition to shadowing and talking to PAs, I had a good  idea of what I needed to get done. School was my main focus, just getting the  prerequisites done. And then once I got closer, probably halfway through, I started  getting my shadowing hours. The more courses I took, I just started getting more and  more interested. I loved anatomy. I loved biology. I was like, “This is definitely my path.”  And then I started volunteering in the emergency room. And then I got a job scribing in  the evenings. That was kind of hard. I was active duty Air Force, so I had to work 8-5  morning job, and then I would come home and head to the emergency room for like a  10pm-2 or 3 am shift three days a week to try to get those hours and experience. All  while I was married with a baby.  

Savanna: Wow, that’s a lot!!  

Travis: Yeah, I did that for about three and a half years. I build up a decent amount of  hours to where I had to like make that decision, like was I going to apply to PA school  and separate from the Air Force? Another interesting component of it was I had to time  it right because when you're active in the military, you have a contract that you're  bounded by. With the Air Force, it was 4-6 years, so I had to time it right when my  contract was going to expire, and I could hit the application cycle. And I was short a  couple months, so I actually had to make the decision to leave the Air Force before  even applying to PA school. I was at 13 years in the military, and at 20 years, you can  retire. I would have been 37 years old with a pension, so that was a tough decision.  

Savanna: Oh gosh, that is tough. That’s like a leap of faith there! So you decided you  were going to go for it and apply. What did applying look like for you? What were you  looking in programs, and how did the cycle go?  

Travis: With the way that I had my life structured, I was married and we have a baby.  We really had to look for something that was going to support us, not only financially  with the GI Bill, but my wife’s family was in New Jersey. She's a high school teacher, so  she has a pretty good job. But we also need to be around family for like support. I knew  that PA school was very demanding, and we weren’t going to be able to do it alone.  Fortunately, in the New Jersey and Philadelphia area, there are a good amount of  programs compared to the rest of the nation, so it served us well. I found out that a  couple of the programs not only accepted the GI Bill but they offered the Yellow Ribbon  Program, which kind of adds to that. Drexel was a 100% Yellow Ribbon Program, so  that was definitely a top school. 

Let me go back a bit because before I was even able to apply, I got a job fortunately  through resources and asking friends and family at the hospital at University of  Pennsylvania as a clinical research coordinator in cardiac surgery. I think that is what  really propelled me to be able to get at least a couple looks at my application from  having such a non-traditional background. It really exposed me to a lot of really cool  medicine, and my letters of recommendation came from there. So I did that for a couple  months, and then I was able to put everything together.  

Savanna: Okay, so you had a wide variety of experiences on your application, which is  always a good thing. So how many schools did you apply to total?  

Travis: I applied to 5 schools total. I got interviews at all of them, but I only attended  Drexel's because that was the first one I got. With the Yellow Ribbon Program and GI  Bill, Drexel’s program pays for 100% of my tuition. So that was definitely a no-brainer  once I got the acceptance there.  

Savanna: Nice. Yeah my program has had the Yellow Ribbon Program, so we had a  couple of Veterans. Can you talk a little bit about like what that means, and who  qualifies for the GI Bill?  

Travis: Sure! I can speak from the active duty side. I’m not really too familiar with  the reserve and guard side. If you serve at least 3.5 years of active duty, you can benefit  from the GI Bill. You have to pay into it for at least a year, I think. When I did it, it was  like $100 a month out of your paycheck for a year. And then once you had those 3.5  years of secured active duty time, you had access to those GI Bill benefits. The cool  thing about the GI Bill benefits is that the GI Bill pays 100% of your in-state tuition up to  38 months. Unfortunately, a lot of the PA programs are at private universities, so it  would only pay up to a certain percentage. At the time when I looked, it was like  $19,000 or something like that, annually. But if that university had a Yellow Ribbon  Program, which is like the university acknowledging that they are veteran friendly, they  would match the GI Bill contribution, which was pretty significant. And it’s really  stipulated by like the different universities. Some universities will accept 5% of the  student population that are veterans and give them an allocated amount that varies. I  think some of the programs that I applied to would give me like $2,500 for the year or  $10,000 for the year. Drexel would make sure that 100% was covered the matter what.  At Drexel, if you're a veteran, you get it no matter what. It’s not even an application  process. You contact the VA department for the school, and they kind of do all the  paperwork for you. It’s a really easy process. You have to really contact the departments 

to see; it's very specific for the university. But yes, it's a phenomenal benefit and in  addition to the tuition, they pay you a housing allowance for the zip code of the college. I  think for Philadelphia, it is $2,500 a month on top of them paying your tuition. Definitely  worth taking advantage of!  

You gotta really understand how it works for you. Some people that I knew took  advantage of the GI Bill and the Yellow Ribbon Program for like their associate's  degree. That’s great, but in comparison, if I were to use it all up during my associate's  degree, that would have cost me probably $20,000-30,000. Whereas later in my career  for a graduate professional degree, it’s going a lot further. A lot of those VA reps at  colleges are very well versed in that, so if anybody has that benefit available to them, I  would highly suggest that they reach out to that department.  

Savanna: Yeah and at one point I was working with a PA at Duke, who is trying to really  advocate for veterans going into PA school. If anyone has questions, I can get you his  contact info. because he was working one-on-one with veterans to try to help them. All  right, so then you went to PA school! How’s that been? Good, bad, what you expected?  

Travis: My interview was one of the first groups of interviews. I waited a little  over a year before I started school. I continued to work at Penn. I was just kind of sitting  here, like alright I got it, now I just wait a year. So it was an interesting year.  

Savanna: Yeah! So you decide to run for class president.  

Travis: The way our class did it, I guess you could nominate yourself. I have no  intentions to do it because I'll be honest with you, like that first quarter… That’s when it  really hits you. Your eyes get really open, and you’re getting blasted. Anatomy and  everything was just crazy. And you're just kind of adapting, and I was commuting from  New Jersey to Philadelphia on the train, and that was all new to me. So I was like,  “There's no way I'm taking anything else on. You know I have a family at home. Like my  wife will kill me if I do this.” But I'm always seeking out the next greatest thing. I ended  up getting nominated by a couple of the members in my class. And I kind of sat on it, I  really didn't say anything and I started thinking that if somebody had went out of their way, seen something in me,  and nominated me, the least I could do was stand up in front of the class and make a  five minute speech. Next thing you know, I got elected. I took it on from there. I'm really  glad I did! Because that first quarter, I wasn't fully bought in because I had my wife and  kid at home. I was commuting. I was struggling, and I was tired. But then when I took on  a little bit extra responsibility as kind of a representative for the class, I just shifted gears. I was really brought in. And then everything started getting better. So, I think it  really saved that first quarter for sure!  

Savanna: Definitely, it helped you connect a bit better. How big is your class?  

Travis: I think Drexel has a reputation for a pretty high attrition rate due to the first  quarter of anatomy and stuff. I think we had 6 or 7 students from the previous year go  through anatomy again with us. And I think we are 82 to 84 students.  

Savanna: Oh wow that’s big! Yeah we were at 44. And I think I have said this before,  but I actually regret not running for president. In our class, it was a pretty important role.  I thought about it but didn’t end up doing it. There were times throughout the program  when I wished I had. But yeah it can definitely be a tough job.  

Travis: Yeah definitely, you can really do a lot of good in that position, especially for a  lot of students. I mean one thing is communication between like faculty and students.  When the students have issues, you really have an opportunity to like bring the class  together and really make it unique. As each class goes through, they create their own footprint. There are so many smart people in the class! That is one thing that's so great  about the profession -- it attracts these great minds. Just being able to steer that ship a  little bit, engage people, get good ideas from the class is great. I mean it’s a self-running  machine and our class is great because of that, but you are able to empower people.  When you empower the right people, cool things happen! So those positions are fun.  

Savanna: And you seem like someone is very easy to come to with any class issues  and is perceptive to class issues.  

Travis: Yeah! It takes a lot to like really like shake me up, just because you  deployments and stuff like that. So I learned to weather the storm.  

Savanna: You’re a natural fit there! All right, so you said you struggled a little bit  beginning PA school, which is normal. Everyone does. How long did it take you to find  your groove and what works best for you?  

Travis: To be honest, I think that whole first quarter was pretty messy for me. And that  was 10 weeks. I would say at week 6, I kind of had figured out. We had all these  recommendations from people, like what not to do, don't wait too long before you  change something, change right away, don't get stuck in your ways, and always ask for  help. And that's not something I did either because my GPA was really good. I had aced anatomy prior to this, and I thought I would be fine. And I wasn’t. It’s a lot and very  different. I remember my first exam, I literally failed badly. I was like, “Whoa, wake up!” I  was really upset. I was doing everything I could. I just wasn't retaining it, and you get  competitive with other people. You wonder why is nobody else failing like this? But they  really are, just nobody is really opening up about it, which is something else I found out.  But I think it probably took me that first quarter to get my confidence back up and get  into it. It was a little bit hard for me too because I had a lot of things going on back  home. It probably took me at least six to eight weeks to feel like I had this. Once that  second exam came back, things started getting better and I was improving. I knew I was  doing the right thing. I just had to do a little bit better.  

Savanna: Do have any tips on balancing? This is a question I get a lot, that I can't  speak to because I wasn't in this position of having a family established. I don't believe  in balance; I don't think everything will ever be completely balanced. But how have you  made that work with your family?  

Travis: I think you nailed it - it’s once you figure out that there will not be a balance.  Especially in my situation, it took me 3.5 years to get to this point. So we know what  was kind of coming. I mean, we thought we knew, right? Once you're in it, you're like,  “oh we have no idea what this was going to be like.” But we thought we knew what we  were getting into. But the best thing for me is that once I figured out how difficult this  was going to be, I sat down with my wife. We really went over how hard this was going  to be, and I showed her everything. No one will really ever understand it until they're in it  as much as you try, but I showed her all the assignments that were due and things that  we were expected to learn. We had a family calendar. As long as I was very on top of  that calendar in terms of showing my study time or if I needed to come home and lock  myself in the office, and she could visually see that, it made things better. As opposed to  me saying “I'm going upstairs to study” but she wanted to watch a movie or something.  But as long as I was a week or two ahead of her, I could put what I needed to get done  that week. Now it was still hard, very hard. And I kept promising her that it would get  better with clinicals, and it has. So she believed me and she hung in there!  

Savanna: Okay! Yeah it goes does go by quickly.  

Travis: Don't expect a balance and communicate as best as you can. There's gonna be  days where you're frustrated and stressed out, and they're frustrated and stressed out.  To be honest with you, there were days that I had to close my computer, and just say to  myself that I’m going to do my best. And that's all I can do, you know? I might not get an  A on this exam and just be okay with that because you have other things going on. I have two children. We ended up having a second son later on. I was upstairs in the  office, and he was calling my name. My oldest son goes, “Daddy doesn't live here  anymore.” Because he hadn't seen me. And that was it. Like I had to close the  computer and go downstairs. That broke my heart. And I was like never again. Once I  started learning what the exams were like, what’s expected of you, and how far you can  push yourself, I set a limit. I was never studying past 10 o'clock. I’d also maximize my  weekends; I didn't really study for my weekends. So I had my weekends with the family.  Yeah it wasn’t perfect, but we got through it.  

Savanna: No, that is hard, and I was living at home with my parents. And they were  great, but they also didn't quite understand. My fiance was in med school, so we would  see each other once a week for study date. That’s all we had. I remember one day I  was sitting at the dining room table. And there was a lot going on, a lot of tests, during  the first semester, I just broke down in tears. And my dad walked in, he was like, “What  is wrong with you?” I was like, “I'm fine. I just am having a moment.” And he went and  got my mom, and she was like, “She's good, just let her be. She’s good.” Because she  understood. Yeah, those things happen.  

Travis: Yeah I remember being in the library and seeing things carved in the desks like,  “We will get through this quarter - PA student 2018.” Yeah you know, everyone goes  through it. And yes it’s madness.  

Savanna: It's very interesting. But kudos to you for handling all that! You do it; you just  make it happen but like I can't imagine that.  

Travis: The quarters go by pretty quick.  

Savanna: Yeah, it really does. Alright so with clinicals - how have those been?  

Travis: They've been awesome! It’s a totally new world, totally cool. And I thought I was  going to thrive better in the clinical realm versus the didactic year. I did pretty well during  didactic, but I'm a people-type person. I like interacting and getting my hands-on experience. It's been everything that I thought it would be, maybe even more! So it's  been pretty awesome.  

Savanna: That’s great! And do you have any idea of where you want to end up? 

Travis: Yeah, I love surgery. I really would like to get back into it. The hours are really  long. And that’s what I'm working on right now with my wife, so we'll see. Emergency  medicine or surgery is definitely what I enjoy.  

Savanna: Derm has some surgery in it, just throwing it out there!  

Travis: What’s actually interesting is that my preceptor for my pediatrics rotation owned  a medical spa, and his brother is a plastic surgeon. He works in the office below. So I do peds during the day, and then in the late afternoons and evenings, I've worked  downstairs doing lips, Botox, and all sorts of stuff. So I don't know! Maybe there’s a little like pediatrics/derm/plastic surgery thing.  

Savanna: Yeah it’s not the same as an OR. I love the OR too. Well, thank you so much.  Is there anywhere where people can find you?  

Travis: They can check me out on Instagram (@ tjlaverne )! I'm a rookie at Instagram  right now. It's mainly just been kids and stuff that I've been posting. Or they can shoot  me an email too!

Savanna: Yeah definitely. They can reach out to me if they have questions and we'll get  you in touch. Awesome, thanks so much! 

2020 Gift Guide

It's that time of year again! When we get to celebrate our loved ones by getting them heartfelt gifts. We've compiled a list of our favorite choices for the pre-PA students, current PA students, and practicing physician assistants. It's been such a strange year with the pandemic and everything shutdown, so even if you can't see your loved ones in person, you can show them love this season through your "presents." (Feel free to forward this list to friends and family to give them some ideas. That is what I will be doing also.) This post does include some affiliate links, which doesn't increase the price for you, but gives us a small percentage of some purchases. Follow us on social media @thepaplatform on Instagram to be on the lookout for deals and sales.

Pre-PA Gift Ideas

For school: To make the pre-PA journey a little easier, here are some gifts to consider gifting to take some of the stress away.

Interview Package - Interview Guide and Course - When it's time to apply for PA school, the interview is one of the most important parts and it's never too soon to start preparing.

• PA School Interview Guide

• PA School Interview Course (p.s use code FUTUREPA for a discount!)

• Med Couture Scrubs - Getting patient care hours is required for almost every program, and many positions have a dress code of scrubs. These ones on the right are some of my favorite affordable one

• Picmonic - With a specific pre-health option, Picmonic offers a visual study aid that any pre-PA student will find helpful. - Click here for 20% off

For self care: When focused on becoming a PA, it can be easy to forget about taking care of yourself. Help your pre-PA student focus on themselves during the process.

• Big water bottle - One change I've made this year is increasing my water intake, and it's made me feel so much better. Highly recommend this half gallon water bottle.

• Workout clothes - Getting active and moving your body is a great energy booster. Here are some of my favorite Amazon Lululemon dupes.

• Sound machine and gentle alarm clock - Sleep is essential! This sound machine and gentle light/alarm clock duo is perfect for the anxious student.

PA Student Gift Ideas

For school:

To study - The study 24/7 lifestyle is just a part of PA school, but here are some things that can make it just a little bit easier.

• Smarty Pance - Studying for the PANCE starts on day 1 of PA school. Smarty Pance is a great option to study throughout school. - thepaplatform 10% off

• PANCE prep pearls - AKA the PA school Bible. I'm honored to call the author Dwayne a friend, and he is also a practicing PA, so he knows exactly what's needed to get through PA school.

• PANCE review book - For a quick review, this was my go-to during PA school, and a book that every student needs.

Tech - Since the majority of PA school consists of hours of lectures, pen and paper may not cut it anymore.

• iPad - In the Pre-PA Club group on Facebook, it's overwhelmingly recommended to have an iPad for taking notes during PA school.

• Apple pen. If your student already has the iPad covered, the apple pen is a great companion and you're saving trees!

• iPad case with keyboard - Personally speaking, it's the worst when an accidental drop wipes out a device. This case provides protection and a keyboard.

For rotations: Clinical rotations can be stressful with long hours, so being ready to take them on is essential.

• Medelita scrub jacket - My absolute favorite thing to wear at work 24/7.

• Crocs for work - Crocs have become my go-to work shoe. They're light, supportive, and comfortable. Don't knock them 'til you try them!

• Apple Watch - I got an apple watch last year from a family member, and I never thought I would love it as much as I do. Super convenient.

  • Having an extra band is always helpful, and I love this one. It's affordable and easy to clean.

For survival: Help your PA students in your life focus on some things outside of school and get through the tough weeks with some of these gifts.

• Keurig mini - Coffee. Because PA school.

• Kindle - My personal lifesaver. My kindle goes everywhere with me and is a great distraction. See below for favorite books.

• Cashflow Cornerstones online course - One thing we didn't really learn about in PA school is finances. This course created by a PA is a lifesaver for getting the basics down.

Physician Assistant Gift Ideas

For work: While the PA in your life may not specifically request something for work, here are some things they may not have invested in themselves yet.

• White coat - When it comes to white coats, Medelita has set the standard. The Rebecca is my absolute favorite and I recommend Sprite for thread color!

• New Balance Nergize - Good-looking comfy shoes are a must for working in medicine. These are some of my favorites. I might have 4 colors.

• Blue light glasses - Thanks to EMRs, we stare at computers and screens all day long and could use some eye relief.

• Scrubs - If you have any guy PAs in your life, my husband's favorite scrubs are Figs. Use this link for $20 off your first purchase.

For life: To separate from work life, here are some fun things that I've loved this year and think any PA (or person) would be happy to get.

Skin category: Being a dermatology PA, I have to give some skin recommendations of course.

• Babe Lash - Using a lash serum and not having to use mascara everyday has been a game changer. Use code SAVANNA for 20% off.

• Revision block - For an updated, but basic skincare routine, Revision skincare is my favorite cosmeceutical line. With these 3 products, you'll be set.

  • Brightening Wash - This vitamin C and glycolic acid based wash is a great first step.

  • Vitamin C - Dull skin? No problem! This topical vitamin C will brighten skin and lighten dark spots.

  • Retinol Complete - Retinols are the best for slowing down fine lines and wrinkles. This one is very tolerable.

• Dyson Airwrap - Ok. The price tag is high, but the time saving is so worth it. Wet to styled hair in 10 minutes.

To read: Book club is the highlight of my month, and here are some of the favorites from the past year.

• The Silent Patient - The biggest thriller and twist we read all year.

• One True Loves - Taylor Jenkins Reid is my new favorite author of 2020, and this is a nice, lighter romantic read.

• The Nightingale - A historical fiction set in WWII and one of our most favorites of all time.

Fun Category: Here are some fun stocking stuffers (kind of) that anyone should be thrilled to receive.

• Starbucks gift card - No one will ever turn down coffee! And those chocolate croissants aren't too bad either.

• Corksicle - Best cup ever. I got one of these for my birthday this year and now I"m obsessed.

• Loungewear - A fun robe has been my quarantine dress code this year.

• Peloton - Ok, I know. We hear about them all the time and there's a big price tag, but with the financing options, it's so worth it. Total fitness game changer. Use code UFSYCC for a free accessory package! If you get this for a significant other, brownie points forever.

For even more gift ideas (or to just see what I am eyeing and buying) check out our Amazon Storefront!

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How do Students Afford PA School? with Juno

Thanks to Juno for sponsoring this post!

One of the most common questions that comes up once you decide to pursue PA school is how do people pay for this? There are so many costs involved in attending a graduate program - tuition, fees, books, study resources, living expenses, etc. The majority of programs don’t allow students to work, and with the rigor of PA school, it would be extremely difficult to study and maintain a job. Most students end up needing to take out loans for all of these expenses, and then it gets confusing with all of the options available.

One of the most important things to look at when considering loans is the interest rate. The percentages you see may seem small, but when the money starts compounding on the first day of PA school classes, you will want it to be as low as possible! That’s where Juno comes in because they use group buying power to negotiate with lenders to get you the best interest rates available. It’s like buying in bulk to save money. Does it make more sense to buy one roll of toilet paper for $2 or 20 rolls for $10? You are basically getting a volume discount by combining your need for school funds with other students. I recently had the pleasure of speaking with Juno co-founder, Chris Abkarians, for my Youtube channel! I also encourage you to check out the Juno website yourself and see how up front they are with the process, but I’ll explain how it works. (And they have scholarships available that you should apply for right now!!) 

According to the 2019 PAEA report, the average cost of tuition at a private program was $95,058, with public programs coming in at an average of $52,585 for in-state students. Out of state students at public programs were just under the average of the private programs at $93,313. When you add in an average of $7,978 for fees plus living expenses that will vary based on location, that’s a huge chunk of change. Becoming a PA is definitely worth it, but those numbers can come with a shock value and the money has to come from somewhere. 

To see if Juno has a good option for you, the first step is joining the Juno student loan negotiation group for free and providing the typical information needed to obtain a loan. This allows Juno to put together a group of creditworthy students to present to lenders to compete for the best rate. The lenders will come back with options for flexible repayment terms and both fixed and variable rates or more limited terms. This is basically like sending your application out to multiple PA schools to see who is the best fit and has the best to offer you as a student. The story of how Juno began is really cool because the founders, Nikhil Agarwal and Chris Abkarians, actually did this process on a smaller scale while students at Harvard to save themselves and their classmates money just though negotiating directly with lenders. 

Juno looks at all of the offers and will evaluate what will be the best fit for the most members. Those factors include interest rate, fees, term and repayment options, customer service, eligibility criteria, and death and disability policy, as well as non-financial features. This holistic approach results in rates and terms that are better than anything available in the current market. 

After doing all of this work for you, Juno presents the negotiated deal for members to decide if the loan option is the best for them in comparison to other available loan offers. Juno will help you figure out the differences in what is being offered and also looks at the variation in the private and federal loan options. Both U.S. Citizens and U.S Permanent Residents can take advantage of this innovative approach to loan negotiations. 

If you decide the loan offer makes sense, you’ll have the opportunity to apply directly, but there’s no obligation to take the negotiated deals. You can pick a difference lender or decide not to get the loan at all. Juno will follow up and make sure everything went smoothly and all of your expectations are met through the lender that was chosen. 

I appreciate Juno’s transparency that you can see for yourself on the website. Many of the lenders offer a referral fee for using their services, but Juno will give that amount back to you when you use one of their deals. You’ll get at least 0.05% back in the form of a check when you take a negotiated loan through Juno. 

They also clearly state that you should consider federal student loans before any private loans, which some other private loan companies may not mention in the interest of getting business. 

Make sure to check out all of your options when looking into borrowing money. Compare the rates, ask questions, and look at the big picture to choose what’s best for your own situation, and including Juno in the process is a great idea. Click here to visit the Juno website and find out more! 

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How to Keep Up with Current Information as a Physician Assistant with POCN+

Sponsored by POCN+

It’s well known that physician assistants are lifelong learners. Our education is quick and rigorous, but the expectation to stay current with everything in healthcare continues far past graduation. I’m always looking for new resources and ways to make sure I’m current for my patients. In addition to the desire to learn, the CME requirements also encouraged continued learning, but the options can be expensive so I’m always on the lookout for free options, which is what I get to tell you about today! 

POCN is the largest and most informed NP/PA network with more than 400,000 members. Some of the resources they provide include news on curated topics covering the latest news and blogs across various therapeutic areas. With CE/CME offerings and video content from peers and case based learning, there is a ton of information to explore and digest. I’m excited to tell you about their newest resource specifically for physician assistants and nurse practitioners, and it includes free CME! 

POCN has recently launched POCN+, an application providing premium live and on-demand educational content for the PA & NP community. Think of POCN+ as the Netflix of PA education with the first over-the-top (OTT) streaming service for healthcare providers with peer-led content and education. You will be able to stream 24/7 content with free peer-led information through the one-stop resource to not only medical news, case studies, CDC COVID-19 updates, CME/CE videos and more, but also self-care resources to tackle mental health and burnout. You can find POCN+ on the Apple App Store or Google Play to access the service on your smart TV, computer, or mobile device. If you have an Apple TV, Amazon Firestick, or Chromecast, those will also work!

Since PAs must accrue 100 hours of continuing medical education (CME) every two years based on NCCPA requirements, we’re frequently looking for new sources and ways to find those hours. At least 50 of the hours have to be Category 1 CME credits, and that’s what POCN+ offers. The instructions for claiming CME from the videos is very straightforward and explained at the very beginning, making it super simple. 

There are multiple therapeutic areas covered through POCN+, including primary care, cardiology, women’s health, endocrinology, dermatology, neurology and more. The purpose of this new platform is to support patients, practice and career development. By utilizing the top expert PAs and NPs with videos from reputable partners, such as the CDC, Board Vitals, ReelDx, TCOYD and others, you’ll gain access to up to date information in an engaging format. 

So what type of content can you expect to find on POCN+? There’s a wide variety including weekly medical news highlights and interviews with health professionals on a variety of topics/therapeutic areas. To dive into details, case studies, an Expert Disease State series, and the Clinician’s Corner with discussions between NPs and PAs, provide clinical information for us to stay as up to date as possible. To make it even better, there are options for CME/CE videos to use for hours. A CDC COVID-19 series has been added to ensure PAs and NPs have the best access to the most current updates.

When you set up your account and sign in to POCN+, the information is presented in a very organized fashion. You can browse or search for any topic that may be interesting to you. I found some dermatology and skin related videos, but I’m more interested in the general updates outside of my specialty and news updates. On a computer, the top bar shows all of the options of different video types, including the CME options. Videos range from five minutes to an hour and a half, so there’s plenty of options to find something to fill your time. 

Another benefit is the possibility of surveys that match provider skills and interests to earn additional income, as well as the ability to connect with peers and colleagues across the country. This type of collaboration is exactly what our professions need to continue to grow and support each other. As a brand new offering, POCN+ will continue to grow and add new videos and resources moving forward. 

According to CEO Richard Zwickel, the purpose of POCN+ is to provide efficient, useful, and career-driving resources to the PA and NP community with the most comprehensive, one-stop resource that will be invaluable for the medical community to stay on top breakthrough medical news, learn from real case studies and get free CME credits.

It’s completely free to sign up! You’ll just need to fill out the form with your email, and you will need an NPI number to complete registration. Take advantage of the free CME and stay up to date with current medical developments for the benefit of your patients. Click this link to sign up for POCN+ now! I highly recommend checking it out and seeing how you can supplement your current learning style. Visit www.pocnplus.com for all of the info to start using this resource today!

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How to Survive the Night Shift - Guest post by Jamie

So you’re looking to survive night shift, huh? Maybe you’re a pre-PA student whose CNA position is overnight. Maybe you’re a PA student on a rotation that has stretches of night shifts. Maybe you’re a practicing PA in the ER, like me! Or maybe you stumbled upon this because you Googled, “I think I’m going to die working night shift, help!” Regardless of which category you fall in, this blog is for you.

Here’s a few general tips 

While at work:

• No caffeine past the first 2-3 hours of the shift (I know, you’re thinking, what? Are you crazy? But hear me out – if you crutch yourself with caffeine you’ll either have trouble sleeping later or crash around 4-5am).

• No liquids at all within 4 hours before you want to go to sleep for the day when you get home. (It’s important so you don’t have to wake up every hour to pee during the day).

• LOTS of water leading up to that 4 hours (I’m talking at least 60 oz). I use a large tumbler like this. 

• Snacks – healthy ones that will keep your energy up, like granola bars, oatmeal/overnight oats, fruits like bananas, berries, apples and peanut butter. If you like veggies, that’s great, too. I find I do better when I do nothing but snack all night rather than have an actual meal.

Once you’re home:

• Pee one more time before bed

• Shower if you need to (in a viral pandemic this is a good idea, advice may not apply if stumbling across this in 2025)

• Brush your teeth

• Read for 15-30 minutes – not on your phone! If you have blackout curtains, read with a lamp instead of sunlight. No electronic devices. If you’re going to take melatonin, do so now. When you get that wave of sleepiness, you need to sleep right then and there or it will pass and not work.

• Black out curtains or an eye mask to block the sun

• Ear plugs or a white noise machine to block out daytime noises, such as your husband talking on the phone while working from home, or your neighbor deciding 8am is a fab time to mow their lawn.

Schedule

If I have a stretch of 3-4 nights in a row, I treat that very differently than if I have one random night shift. Night shifts are any 8-12 hour shift that starts after 5pm. So this could be 5pm-3am, 6p-4am, 9p-7a, or a true 7p-7a. I consider the 5 & 6pm shifts “evening” and 7 & 9pm true graveyard shifts. If you have both available to you, it is of course easier to do a 6p first then a 9p to work yourself up to the 9p. You may not make your own schedule, though, so this is easier said than done.

Let’s say your stretch is 9pm for four days straight. This is how I typically tackle it:

Day 1

(Before your stretch, you do not work this night) – Go to bed when you usually would and you get a good, normal nights rest. This might mean you wake up at 8am or 11am. Let your body wake you up when you’ve had enough sleep, don’t force yourself to stay up late and try to sleep late. You’ll just rob yourself a good nights rest. I also would advise not drinking alcohol this night, as it will severely impact your sleep quality even if it’s just a glass or two of wine.

Day 2

(Your first night shift) – around 4 or 5pm, you’re going to try to take a nap. Ideally this is a 1.5 or 3 hour nap as a sleep cycle is about 90 minutes. If you have trouble sleeping (which I sometimes do, I’m not a great napper), then you’ll want to make this time restful. Read a book, color, watch TV. Don’t interact with anybody, don’t scroll your social media – just something mindless and quiet. Then eat a full meal around 7pm and head to work. If you are the type of person to work out, I usually do so around 2pm-ish.

Day 3

(Your second overnight shift) – you’re getting home around 8am. You’ll simmer down by showering, brushing your teeth, and reading in bed for a bit. Black out the room, turn on your white noise. Then you’re going to sleep as long as you can. If you’re me, that will be around 4 hours and then you’ll wake up starving. No problem! Get up, eat a meal (no caffeine yet), and now you work out, you watch TV, whatever it is you like to do. Now here’s the most important part: you nap again. Same as before, around 4-5pm, you take a 1.5-3 hour nap. Now you have successfully slept about 7 or 8 hours total.

Note: I know others who prefer to stay up in the morning when they get home, like you would do after a normal 8a-5p job. Eat a meal, hang out with their partner, exercise, walk the dog, whatever it may be, and then sleep around 11am-7pm. That’s fine, too, but I find the biphasic schedule works best for me because I am terrible at sleeping during the day.

Days 4-?

(However many more are in your stretch) – same as day 3. On your last day, to “flip back,” I typically wake up after that 4 hour mark and just stay up. I’ll go to bed around 12a that evening and feel hungover most of the day, but the following day I can wake up around 9am and feel much better rested and now can be a functional human going forward. Rinse and repeat indefinitely.

Alternative advice: never flip back and forth, embrace being a creature of the night and change your wardrobe to match your new vampire personality. Might I suggest something like this?

Sleep Aids

Let’s talk briefly about safe over-the counter medicated sleep aids.

First, a disclaimer, is that I typically do not use these because they make me feel like garbage. If I do, it is usually a melatonin on the day after my last night working so I can fall asleep around that 12am mark as desired. I don’t like the grogginess that many of these others bring.

Melatonin 1-3mg is sufficient. More melatonin =/= more sleep. To be taken about 1 hour before you want to fall asleep and when you feel sleepy you must let yourself fall asleep. If you fight it and keep reading or watching TV, it will pass and it won’t work. I have learned from poison control that it’s pretty much impossible to OD on melatonin, but again, you don’t really need a lot for it to be effective if you use it correctly. As a fun side effect, it can cause nightmares and exacerbate sleep paralysis.

Antihistamines  – medications traditionally used for allergies with a strongly sedating side effect. Unisom is used off-label for nausea in pregnancy, Dramamine for motion sickness. These will help you fall asleep, but frequently cause that “next day grogginess,” especially doxylamine due to its long half-life.

Dimenhydrinate – AKA Dramamine (shortest ½ life at 3-9 hrs)

Diphenhydramine – AKA Benadryl (moderate ½ life at 4-8 hrs)

Doxylamine – AKA Unisom (longest ½ life at 10-12 hrs)

Ask your doctor before taking if you are pregnant, have seizures, angle-closure glaucoma, enlargement of prostate gland, asthma, emphysema, or acute hepatic insufficiency.

And there you have it, folks. A comprehensive guide to how I survive night shift and flip-flop back and forth to do things during the day on my days off. This only works if you are able to have waves where you do 3-4 on and 3-4 off. If you have 1 on-1 off or other variations, you may have to try several schedules before you find the right thing for you. Hopefully you at least gleaned a few tips from this blog. If you have any other helpful tips, reach out – I’d love to hear ‘em!

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Follow Jaime on Instagram: https://www.instagram.com/jamienicole_pa/

If You Told Me This A Year Ago - Guest Post by Karlina Nguyen

A year ago, I was at my white coat ceremony. I remember walking across the stage as my mom coated me, still not believing that I made it through the toughest years in PA school. In my fourth year, my mom was diagnosed with Stage IV ovarian cancer. Every day was a battle of my mind questioning what the future would be like, and that uncertainty drove me insane. A year after, in my last year of PA school, my mom’s cancer metastasized to her brain, requiring brain surgery for tumor resection and adjuvant radiation therapy. I can still remember praying in the waiting area for my mom to make it through, and my biggest wish I kept saying was, “Please let her see me graduate.” And then here I was, walking across that stage with my mom coating me. God, that moment was and is everything to me. Everything I wanted was right in front of me — my mom, my degree, and my career. Everything seemed so perfect and right, and it felt like I was on top of the world.

“Nothing could go down from here.”

A year later, I am on the front lines of COVID-19 as a critical care PA working in an intensive care unit (ICU) in the middle of New York City. In a matter of my first five months of being a PA, I was hit with something that I never really thought I would have to be in — a pandemic. My hospital received the first COVID-19 case in NYC, and I still remember my anxiety flaring up as I woke up in the middle of the night with texts from my co-workers to check my e-mail. A week later, the numbers started to double and triple. In a matter of two weeks, NYC’s cases went up to hundreds. My hospital, which had a lot of vacancies in preparation to move from our current building to a newer hospital building, started to open up new units to try to match the surge of patients we were getting every day. We went from having one intensive care unit to three, and a new step-down unit for patients who met the criteria for critical respiratory conditions, but were not on the ventilators. Patients were intubated for a prolonged amount of time which resulted in many patients getting tracheostomies, requiring us to open another unit designated to weaning these patients. Soon enough, my hospital was filled with all COVID patients.

As these units kept opening, we started to become short-staffed. Our medicine residents were moved to the new intensive care units and medicine floors. My role expanded over the months, including training traveler advanced providers, surgical interns and PAs who were floated over to the ICU to help. With only half a year of experience in, I became one of the seniors in the ICU helping my fellow and attending run the unit. I went from the person who used to go to my seniors for help to being the person that others relied on due to them being out of their comfort zones. I mean, I was out of my comfort zone too.

My anxiety level worsened every day. Everyone was being worked past their limit, exhausted physically and emotionally. Passive aggressiveness was something that was in the air every day just from how stressful everything was. IV pumps beeping. Ventilators going off. Desaturations. Codes. Sometimes it would happen all at once with multiple patients. I started hearing all the alarms in the shower. I had nightmares of my patients crapping out on me, and I would wake up sweating and anxious the rest of the day.

Living in anxiety these months was just one thing. Coping with the number of deaths I’ve seen was another. School never prepared us in learning how to cope with grieving over our patients. They only taught us to not be too attached to our patients, but how do you do that when you are the only person that your patient has seen in these months? Family members were not able to visit unless the patient was actively dying and focusing on palliative/comfort care. Zoom became something we used, but how can that really suffice? I became attached to my patients. There were times where I had to put my phone in a specimen bag so I could call family members in the patients’ room. “Hold his hand for me please. He would not want to leave this world alone.” Behind the PPE, here I was, choking up in tears as I tried to keep it together. But how could I?

I came home almost every day exhausted. I found myself falling to the ground and just breaking down as I felt so helpless. I still remember telling everyone, “I can’t wait to change this world. I can’t wait to save lives and put a smile on my patients’ family’s faces.” And now, every day, I was calling family members delivering them bad news. I would walk into every night shift praying to God that I didn’t have to call someone at 2AM to deliver such horrible news. “Please tell me you’re lying. Tell me she’s still alive. This isn’t real.” What do you even say to those words?

Coming home from my shifts every day became harder and harder. I found myself breaking down in my car. I would pick up the phone to call my mom, but not be able to because I didn’t want to have her worry about me. In those moments, I just wanted to go home and see her, but I couldn’t. What if I am an asymptomatic carrier? What if I get her sick? I could never live with the guilt of that, and it became my worst nightmare of all. It was two months until I got to see my mom from afar, and three months and four days that I was able to finally hug her.

If you told me a year ago, that I would be battling a pandemic and my mental health failing me, I would tell you that you’re crazy. Six months out from this pandemic, I am still recuperating mentally. I am still dealing with the anxiety of, “What if this isn’t over yet? What if it comes back?” Every day, I am battling my mind with the fear of COVID-19 returning and trying to be present — to be appreciative that we made it this far. It’s still a working progress, but I know it will take time.

If I could tell myself a piece of advice to the person I was a year ago, it would be — It doesn’t stop once you graduate. It actually gets harder. You no longer have a program guiding you of what to do. You’re on your own from here out. You’re going in for one hell of a ride. Remind yourself of all the good intentions in your heart to heal everyone, but also know that you won’t be able to do so for everyone. You will have these battles you may not be prepared for. You’ll sink. You’ll float. But you will get through it at the end of it. They don’t teach you this in school, but life will.

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Listen to Karlina’s episode of The Pre-PA Club Podcast where she discusses what it is like to be a new grad working in the ICU in NY during the COVID-19 pandemic.

PANRE and Physician Assistant CME Review: Rosh Review

While many people are familiar with the resources Rosh Review offers for studying for the PANCE during PA school, Rosh Review also offers a PANRE Review Qbank with options for CME credits.

For a PA to maintain certification, there are certain national and state requirements. These guidelines are set in accordance with the National Commission on Certification of Physician Assistants (NCCPA) on a two year cycle. Every two years, PAs must accrue a total of 100 CME hours. There are two categories: Category 1 includes approved education and courses that reiterate the importance of knowledge and skills within the PA profession, while Category 2 consists of reading articles or journals and supervising students. At least 50 of the credits must be Category 1. PAs must take a recertification exam called the PANRE every 10 years.

This is where Rosh Review comes in to provide both CME credit and an extensive review of everything that’s pertinent for boards. When logging on to Rosh Review, you are given the option to set up personalized exams. You can choose the amount of questions for each exam, which topics to include, and whether you want it timed with the explanations immediately or following the test.

With 3,000 NCCPA-formatted questions, you’ll be busy for quite a while and get a feel for exactly what the PANCE or PANRE is like. For general studying, I prefer the “Tutor” mode with immediate explanations, but for hardcore board studying, I want it to be like the real thing and will set a one minute timer for each question and complete 60 questions at a time.

The questions written by Rosh Review are phrased in the same format as real PANRE questions. There are various difficulty levels, but the actual questions aren’t confusing. They include images of EKGs and rashes as well to help with clarifying exactly what they are looking for. In the exams, after you submit an answer, you’re given a thorough explanation on both why the correct answer is correct and also why the other answers are incorrect. There are also stats on how you shape up compared to how other test takers answered the question.

Rosh includes “One Step Further” questions that are quick tidbits to test your recall surrounding the topic of the question as well, and each explanation has a direct source at the bottom of the explanation to go look for more information if needed.

For CME credit, Rosh Review is worth 100 AMA PRA Category 1 credits, which takes care of the requirement for an entire year. It’s super simple. You have to complete at least 1,000 questions with a score greater than 70% and email Rosh Review directly to get the certificate. I love a good conference, but I can complete these questions from anywhere. In the comfort of my home on my laptop, or on the app on my phone when clinic is slow. This CME is $399, which will give you a 1 year subscription and time period to complete the CME. Compared to some conferences with far less variety and convenience that cost $850 for 25-30 credits, it’s very cost effective. If you have some CME funds left for the year, this is a great option to complete on your own timeline. 

To get more personal, here’s why Rosh Review works for me. I personally study best with a Q&A format. I figured that out while studying during PA school, and it hasn’t changed over the years. Having to apply my knowledge to an actual question or scenario challenges me to make sure I have a complete understanding of a topic instead of relying on instant recall. There was only one digital Qbank available when I was in PA school, and I didn’t like it. The questions felt like recycled USMLE questions and weren’t specific to the PANCE, which felt like a waste of very valuable study time. I relied on books for most of my studying, which weren’t very easy to tote around to all of my rotations or study on the fly when I had a few minutes of free time. Another limitation of using books is the difficulty of updating information in a timely manner in the way a website or software can be changed if there’s an error. There’s a feedback option on every question to submit if any information is inaccurate or just for clarification from a Rosh Content Education Expert. This is almost like a personal tutor who can help you to understand any tough concepts that aren’t coming across well through the Q&A format.

A couple of years ago, a student introduced me to Rosh Review while precepting. We would sit down and go through questions together in between patients, and I figured out very quickly how effective Rosh Review was for me. It was basically what I wish I had throughout all of PA school with the seamless exam formats and clear explanations. They also have an option of the Rosh Rapid Review books to accompany the questions with all of the extra study information included. You can click here to download a free chapter and get the books in either eBook or physical form.

While I am 3 years out from my PANRE, I realize the need for staying up to date with general medicine because the last 6 years have flown by. Working in specialty practice in dermatology, I’ve seen how quickly knowledge is lost without direct practice. Dermatology is only 5% of the exam content on boards. That’s not a great sign for me. Having Rosh Review as an option to continue testing my knowledge and providing explanations to why I (usually) get a question wrong has been invaluable. Since reviewing these questions, I’ve started to do this more regularly and I will continue to quiz myself regularly on the material. 

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*I was provided with a Qbank free of charge in exchange for this review, but all thoughts and opinions are my own. 

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Dermatology Physician Assistant Q&A

A few weeks ago, I posted a question box on my Instagram stories what questions you have about being a dermatology PA. I received well over 100 questions and I some of them in my Instagram Stories (check out my Derm PA Life highlight) and in a podcast episode over on The Pre-PA Club.

A little bit about me, I am a PA and I have been practicing for a little over 5 years now. I have only ever worked in dermatology but this is my second practice I have worked at. You can read more about my journey to becoming a PA here. I absolutely love my job.

How did you get into dermatology?

When I was in college, I was looking for shadowing hours because I knew I wanted to be a PA. The only place that I could get to call me back when I was in undergrad at UGA was a dermatology office. There was an amazing PA there who let me shadow here. I went in a few times a month for an afternoon to get my shadowing hours. My mindset at first was that shadowing was going to be a long and boring process. I was under the assumption that all dermatology was was acne and naked old people — (which there is a lot of!) but I found dermatology to be very interesting.
One thing I didn’t realize until I started working/shadowing in medicine is that dermatology is unique in the sense that you get to see visibly what is happening. you get to see the pathology rather than guessing from looking at numbers. There is a little bit of instant gratification when you can see someone getting better.

Do you ever get squeamish when with a patient?

The very first time I saw a punch biopsy (right above the knee) when I was shadowing I had to excuse myself from the room because I felt sick. I didn’t expect the skin to be as deep as it was. The way a punch biopsy works is you numb the area and then you take what looks like a cookie cutter and push it and spin it into the skin with a little bit of pressure. Once you pull it out, you can see all of the layers (the epidermis, the dermis, and the subcutaneous fat). It really freaked me out! The PA I was shadowing looked over at me and asked if I need to take a minute or sit down. Now I do punch biopsies all day and they no longer bother me. If you are squeamish, I definitely think it is something you can overcome during rotations.

What Does the Work Schedule Look Like? Is it like office hours?

i have always had a clinic schedule because i work in a private office. In September switch to part time so I only work Mondays and Tuesdays right now — I may add Fridays in the future. I get there around 8 and leave by 5. I always have a lunch break (unless I am running behind) where sometimes a drug rep will take us out or I will run to the store or even swing by the house. I try to plan surgeries or cosmetic procedures right before lunch incase I run over.

At my old job I worked 4 1/2 days with a rotating Fridays. I have heard of Derm offices that either open earlier or later or work on weekends, sometimes two.

How do you keep up with charting when you see so many patients in a day?

I want to preface this by saying that every PA and every office has a different procedure for charting. You will see this when you are shadowing.

The office I am at right now is very unique. They have found a way to have a hybrid paper chart and EMR system. They haven’t quite given up on the paper chart because it is really easy to file and find what you are looking for. At my old office, we had an EMR system and I would literally sit in front of a computer all day. Now I hardly ever touch a computer. It was a huge change but I don’t really mind it.

How charting works in my office is:

• The patient checks in and they bring us the chart

• The medical assistant will take the patient back and get their history and update the chart as needed

• They will let me know the patients ready when the chart is outside of the door

• I will go in and talk to the patient. I will do my physical exam and decide what I want to do

• The MA is taking notes in the chart during that time

• I come out and I try to dictate right away. I dictate with my phone and I essentially read my note

The nice part about dermatology is that a lot of stuff is pretty repetitive. I can speed through and add in any details that I need to. There are a few templates that I can use but I typically dictate, send off and then a few days later I will get the paper chart back where I can sign off on my notes and make sure everything is correct. It is kind of an interesting system but I never take my work home with me and I never leave anything for the next day.

How many patients do you see per day?

At my old office (when I was full-time), I was seeing around 35 patients per day. I saw a lot of those patients for several years. When I started at my new office, I am essentially building up my practice from scratch. Now I see about 25 patients per day which I expect for it to increase as time goes one.

What type of patients do you see?

I recently saw a patient who is 103! She was the oldest patient I have ever seen. I see patients of all ages — babies and infants all the way to elderly people — with all different kind of issues and conditions.

What types of procedures do you do?

At my new practice, I am getting to do my surgeries and procedures such as cosmetic fillers, botox and peels. I also get a lot of incisions and skin cancers. I do all of my diagnostic procedures as far as biopsies and shaves, punches, and freezing things.

Do you see most patients for routine skin checks or specific skin issues?

I see a huge variety. Definitely some skin checks, surveillance for skin cancer or weird spots and also a lot of triages and being the newest person I see a lot of new patients with acne, psoriasis, eczema and weird spots.

What is your favorite and least favorite part about working in dermatology?

My favorite - I love treating teenagers and acne. It is really rewarding to see them improve, get better and regain their confidence. Acne is fairly straightforward. There are only so many options and it is like a puzzle trying to put them all together. Sometimes teenagers can be a little reluctant to talk to their provider and give details but deep down, they are cool kids and I like getting to help them with their skin. Even as an adult and a derm PA, I still deal with breakouts and thinking back to high school, I wish someone would have validated the fact that it makes you self conscious when you break out.

My least favorite - draining cysts. i am not Dr. Pimple Popper — they smell.

Did you have a difficult time diagnosing when you first began?

Yes and no. In PA school, I had two weeks of dermatology. I got hired at my first job in April and graduated in August so I was able to set up my last two elective rotations in derm at my job in June and July. I’ll be honest, the first six months, when I would get home, I was exhausted from how much I was learning. It was difficult at the beginning and I just didn’t feel completely comfortable which has obviously changed as I have practiced more.

The first thing was psoriasis — it can be overwhelming and there are a lot of medicines plus it can look different for different patients. It took me a while to be comfortable with it.

Pediatrics is something that I would say I struggled more with because we don’t see babies and kids all of the time and their skin can be so different.

What you will find, though, in rotations and at your job is that you’re not going to know everything at the beginning and it will take a while to figure out what you do need to know. You will eventually feed comfortable. I think it took me about six months and I started to feel pretty confident.

What do you tell your patients if your unsure of the solution to the problem?

Going off the previous question, after working in derm for 5.5 years, I know what I don’t know. If there is ever a question, even if something doesn’t seem straightforward or if I have a little bit of doubt, I will ask for another opinion.

How much autonomy do you get?

This is also related to the previous question. I will say I get as much autonomy as I want. In my practice there is the physician and then another PA. The physician is usually there when I'm there. On Monday morning she goes to the prison and does clinic there but she's always reachable by phone if needed. We all consult each other. I have no shame and if I see something weird or that I am unsure of, I will ask my phsician to come in and take a look. She is more than happy to! She jokes that she loves the weird stuff and she never gets to see it which is so true because I am seeing all of the new patients and all the triage. A lot of times, I am pretty sure of what I want to do as far as a plan or diagnosis but I like to have that confirmation.

Working two days per week, I would say I only bring her in a few times per month. As a PA it is important to be confident in what you know but also know what you don’t know and be willing to ask for help.

What would you change about the Derm PA specialty if anything?

When you look at jobs or specialties, one thing to keep in mind is the type of lifestyle you want to have. There are two different types of work for PAs — clinical scheduled work and shift work.

As a dermatology PA, I can be fully booked 3-6 months out with patients so that can make it difficult to plan things. If you are full-time, working in a clinic Monday - Friday, you are probably going to have a limited about of vacation that you have to plan 6 months in advance. Things do come up but out of respect for patients and the office staff, you really have to be a planner. Trying to find a new spot for 35 patients is very difficult for the office staff.

Alternatively, is to work as like a hospitalist or shift work. My husband, for example is a hospitalist and his schedule is 7 days on and 7 days off which is nice because he always has these big breaks. If you are someone who likes to get up and go, being in a job like a hospitalist, in an emergency room or urgent care where you have shifts and not necessarily a schedule of patients expecting to see specifically you may be a better fit.

Not necessarily something I would change, just something to be aware of when looking for a job.

One thing that I wish I could change is that I wish patients understood their insurance more — I am sure every one in the medical field wishes this but especially in derm. A lot of times, patients come in and thing we can just cut off all of their moles or fix this spot because they hate it but it doesn’t work like that. Health insurance is there if something is harmful or malignant, not because you hate it. It can get a little old saying it over and over again to patients.

How do you manage being a PA while being a mom of a little one?

It's hard to be a PA, a mom, and a wife. What has really helped me is balancing and time blocking. When I am home I try really hard to be present. In the morning, we all hang out as a family and have breakfast together. My baby understands that I have to go to work but I live pretty close to my practice so I try to come home at lunch sometimes. When I get home from work, again I try to really be present and put my phone down. Once she goes to bed, I will work on emails, record podcast episodes and work on things for The PA Platform.

If you have any other questions, leave them in the comments below! If you liked this post let me know!!

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A Day in the Life of a Neurohospitalist PA - Guest Post by Brie Marks of @BetweenTwoStethoscopes

My name is Brie Marks and I’ve been a practicing PA for 5.5 years. I graduated from DeSales University in eastern Pennsylvania in 2014 and am currently loving my job in Inpatient Neurology/ Neurological Acute Care. As a Neurohospitalist PA, I work in the hospital only. I actually haven’t spent any time in an outpatient office since I was doing my clinical rotations! Our health network is comprised of multiple hospitals, so I spend some of my time at our main hub, which is an academic center, and some of my time in our community hospitals.  I’ve always been fascinated by the brain and neuroscience, and Neurology is a perfect fit for me because it is both very specialized (one body system) and also covers so many topics. Common illnesses and injuries that I see on the inpatient service include stroke, seizure, intracranial hemorrhages, spinal cord injuries, infections of the brain and spinal cord, auto immune diseases and neuro-degenerative diseases like Parkinson’s Disease and ALS.

A “typical” day for me is based on my location.

• If I’m at our main hospital, I meet with my team for rounds at 8am, where we discuss all of our patients for that day and divide them up between the Advanced Practitioners (PAs and NPs) and the Attending Physicians. 

• I then go see new consults and follows ups, trying to prioritize the sickest patients or who may be being discharged that day.  On our service, the Advanced Practitioner (AP) generally does all of the chart review, touches base with the primary team, looks at all of the imaging, performs the history and physical and comes up with a diagnosis and plan and then discusses or “staffs” that patient with the attending physician.  I truly have the most amazing team of APs and docs – its an incredibly supportive environment for learning and growth!

• If I’m at a community hospital, I “run the list” (decide which patients need to be seen) by myself, assess patients and either meet up with the attending physician later that day in person or speak with them over the phone. 

I work 40 hours a week, roughly 8am-4.  I take my turn working holidays and weekends, which is standard for an inpatient job. I finish my day at 4, though as with any inpatient job, there are occasional emergencies that need to be handled right away.  Some of my colleagues work 4 - 10 hour shifts and are scheduled until 5 pm, so I leave late fairly rarely.  I work 1-2 holidays a year, and when I work on a weekend, I get 1 weekday before and 1 weekday off after that weekend.  I do not take any “call” – meaning that once I leave the building, I am not contacted after hours or have to respond to emergencies.  I am a salaried employee, so I do not get paid extra for staying late, but there are times I leave early for an appointment or another obligation and it all generally evens out. 

A common question that I am asked is – how much autonomy do you have as a Neuro PA?

On my team, I am quite autonomous, but definitely feel that I have the support of my fellow APs and physicians.  We frequently meet as a team to discuss difficult cases, both as a brainstorming session as well as a learning opportunity. At our main hospital, the Attending Physician will generally speak to the patient after I have examined them, which gives the patient an opportunity to ask any questions that have come up in the meantime.  If there is an emergency or a stroke alert when I am at a community hospital, I respond to the emergency independently and then contact my attending with my assessment. As a PA on the Neuro service, I feel very heard and respected as a provider in my own right, but always have my team of docs to ask questions to and learn from.

Neurology is an incredible field.  I would encourage students not to be intimidated by the neuro exam or the complexity of the neuro material that’s covered in PA school. If someone is passionate about the topic, it is absolutely possible to master it while on the job. There are so many opportunities, including as a neurohospitalist, general outpatient neurology, or even to further subspecialize in areas like epilepsy, multiple sclerosis, movment disorders, headache, etc. 

Thank you to the PA Platform for allowing me to share some of my experiences as a Neuro PA. I feel so fortunate to have become a PA and would choose this career 100x over.  The struggle to get there is definitely worth it! Please feel free to reach out with any questions- I’m always happy to help. I can be found at Betweentwostethoscopes on Instagram, where I share insights into my life as a Neuro PA, as well as exam tips, neuro imaging and case studies.  

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2019 Ultimate Physician Assistant Gift Guide

The holiday season is just around the corner! We put together a gift guide of everything the PA Student in your life wants and needs for a successful year!

• Please note some of these links are affiliate links meaning that The PA Platform may earn a small commission if you purchase an item from this list. All opinions are my own. Thank you for your support!

Let’s get started!

1. Amazon Cleaning Service

   As I am sure you know, PAs spend their days serving and taking care of others. When they get home, the last thing they want to do is mop the floors, wipe down the windows and do the dishes. Treat the PA-C in your life with housekeeping services from Amazon! Learn more here.

2. At Home Manicure Set

   The perfect gift for PA moms who don’t have time to go get nails done and are scared of salons like me after being in derm. This handy set will keep their nails manicured and beautiful throughout the year! Buy one here.

3. Metal Insulated Wine Tumbler

   After a long day, the PA-C in your life could use a glass of wine… or two. I love this insluated tumbler because it keeps wine nice and cool and covered with a lid (no red wine spills on the couch!) Treat them to one here.

4. Roomba Vacuum

   Two words — life. changing. This vacuum takes the work out of cleaning and it’s so easy to use, your PA will have a sparkling house (or at least floors) all of the time! They can just set the vacuum to run throughout the house after everyone is in bed and wake up to a freshly cleaned house. Get one here.

5. Lily Pulitzer Lunch Box

   A cute lunch box is just the inspiration anyone needs to remember to bring a lunch from home. I love the Lily Pulitzer prints and this one really keeps food at the perfect temperature. Grab this cute lunch box here.

6. Essential Oil Diffuser

   Diffusers elevate mood and many use it to reduce anxiety and promote peace of the body and mind. It creates a calming effect in your PA’s home that is great for when they feeling burned out. Order one here.

7. Medelita White Coat and Scrubs (PLUS 20% off with code PAPLATFORM20 )

   If you have been following me for any time, you’ll know I love my Medelita white coat! You can read my review of the Ellody Lab Coat here. A white coat or new set of scrubs is just what any PA-C needs to start the new year fresh and stylish. Don’t forget to receive 20% off with code PAPLATFORM20.

8. Funny PA Coffee Cup

   This cup will brighten anyone’s Monday morning! This simple yet thoughtful gift will bring cheer when they open it up! Grab one here.