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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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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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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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 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.

My Decision to be a Part-Time PA, Full Time Mom

As you may have heard, I recently made the decision to go part time at work and I wanted with  you how and why I decided to go part time, what life looks like now and how I’ve been transitioning this week into this new role. 

My Background

Before I start, I want to back track and share a little bit about my experience. After graduation, I went straight to working in dermatology. My husband was in medical school at the time, so he didn’t get any time off. I couldn’t take a vacation or anything I just had to get out there and start making money. I went straight into my dream job and I loved it. I started off working four days per week, Monday - Thursday, which was awesome. It was a pretty good schedule and I was either home or leaving the office by 5pm. They eventually asked me to start coming in on Fridays also which worked out because I figure, if I’m not making money, I was probably out spending it plus my husband was so busy with med school and wasn’t home a lot. I started working Friday mornings and it was great. I did that for a while and as you may know, dermatology is a very busy speciality. A lot of times, I would be seeing 30-35 patients all day long which I was fine with. I like working hard and staying busy -- I’d rather be busy than bored. 

Then Comes Baby

Everything changed once I had my daughter last year. I always knew that when I would be pregnant and have a baby, I would go back to work and not cut down on hours. I have friends who are PAs, who work in other jobs and who are stay-at-home moms so I have seen all sides of it. I always thought that stay-at-home moms had it so easy and I just knew I would never be able to stay at home all day but then I had my baby. Once I had her, it’s hard to explain unless you have had a child, just how much everything changes. I know that everyone says it, and yes it is cliche, but it’s so true. I took 11 weeks of maternity leave, which I highly recommend to use as much as you can. I had some postpartum complications and had to go back to the hospital for a week. By the time I got over all of that, I really only had about 9 weeks with her. 

Time to go Back to Work

When the time came for me to go back, I felt like we were finally getting our groove. I was breastfeeding which is NOT easy! No one teaches you how to do that so it was hard and now (TMI) I had to pump at work. A lot of transitions at once. At this point, my husband is in residency and his schedule is all over the place. I did ask to go back to four days a week while I was pregnant. My work and I came up with a compromise and I worked one Friday per month which then made things complicated with child care. 

It’s very difficult to find someone to trust with your child, if you’ve never done that before. Luckily, I had my mother-in-law helping. We found a great nanny who was with her two days a week as well. When it came time for me to go back to work, I was a mess. I was crying and losing my mind. The day I was supposed to go back, I just remember I stood at the door sobbing and begging my husband not to make me go, to not leave her. This feeling was so strange to me because that is not who I thought I would be. I thought that after four weeks, I would be like, get me back to work, I’m bored, I don’t want to sit around this house all day . Now, I literally wanted to sit on the couch with my baby on me. 

Adjustment Period

I went back to work and everyone told me that I would adjust and get used to it but for the first six months, I was balancing a lot. I was working full time trying to figure out this mom thing, and still doing PA Platform stuff, it sometimes kind of felt like being a single parent with my husband in residency. We had a lot of conversations usually with me crying about just how overwhelmed I was. I read a bunch of books, a really great one, Stretched Too Thin, was really helpful. I talked to my working mom friends who have had kids, my stay-at-home mom friends and my family and they all knew that I was struggling with balance. 

We hear a lot about the flexibility of the PA profession and the great work life balance but I found that there is no balance. You’re never going to have everything equal. If you’re trying to equalize it, there’s always going to be something that is pulling more of your energy or attention. You have to decide what if a priority or not. So it became going to work, coming home, being exhausted and not being able to give my family the energy that I needed. Also, if you have ever had a kid, there is this thing called the witching hour and it happens right around 5pm. I just wasn’t getting the best time with my baby. In the morning, I would get up, get her ready, get her food going, leave, come home, and then she is exhausted, tired, angry and crying which makes me want to cry. It wasn’t a good system that we had. It did get better. After about six months in, I was having these weekly anxiety driven fits but my husband was like, I don’t know how else to help you but something has to change.

Turning Point

We started talking about if we could make it work if I went part time, which was a long discussion. It wasn’t something that happened immediately. We had to look at finances, childcare, his schedule, my schedule...what would this actually look like? Would I be okay if I was home more? Ultimately what it came down to was my happiness. I don’t have a lot of hobbies outside of The PA Platform and shopping. At the time, I found the most joy and happiness when I am hanging out with my family, whether that was my husband or my baby or preferably both. That’s when I am happiest and when I came to this decision, I knew in no way could I see myself ever regretting spending more time with them. I could see myself regretting working more if I didn’t have to. 

It was just exhausting me to the point where I would get home on Thursdays couldn't get off the couch. Friday was a day to just recover, Saturday I'm actually trying to get stuff done and by Sunday is time to start over. It's just this constant grind, which I know everyone does and I admire everyone who does all this because it is not easy and I've learned that. 

We looked at it and decided it was probably possible. I was going to try to wait till the end of 2019 because my work was going through some changes and transitions which I wanted to try to help them through that. In June, my nanny quit.  She ended up being a full time job somewhere else which I totally understand because benefits and all of that. She gave us a month's notice and by then my husband finished residency, which his schedule as a hospitalist is seven on seven off. So when you look at that on a calendar with my schedule, if I'm working five days a week and he's not home until late, we really would only have like two to three days together every other week and that's not what I signed up for. That's not what works for my life, what works for me, when it comes to marriage, I want to see my husband and spend time with him. 

Telling My Employer

I went to them at work, which was not an easy conversation. I think leaving a job is kind of like a divorce and my situation was a little different because this is my only job I've ever had it been there for five years. There wasn't anything wrong, really and if there was it would have been a different situation. If you know you're feeling like you've been abused or used by a job and you're ready to leave. This wasn't that this was I wanted to stay but ultimately the job that they needed for a PA was a full time job. We tried to talk through some compromises, but it just wasn't working. Ultimately, I had to put in my resignation letter and that was really hard. I was really emotional about it even leaving, just because I had a great relationship with my supervising physician -- she was an amazing teacher, we had great communication, a great flow, and to leave that is hard. 

No Regrets

But like I said, I can never see myself regretting being home more with my baby. Another thing that I kind of told them is I could see the difference in her when I was with her more. If I had a longer break of four or five days, me and my baby had a much better relationship than when I, running out the door and running in the door to do bath time and dinner. She is a very strong willed one year old and likes to kind of push back and bump heads with me and she does it the most with me instead of anyone else. When we actually have more quality time, she tends to be a lot more sweet towards me. I felt like it was important for me to be there. I don't want to miss anything in her life --  I don't want to miss her events and I just as much as I can be there. This is not who I thought I would be, yet here we are. 

Finding a Part-Time Job

I had working parents growing up my parents were teachers. I think they were great examples for me and I don't ever see myself not working completely. I will always be a PA and I think I'll always practice clinically. What ended up happening was I turned in my resignation, and before I even turned it in, they had four resumes. I started pulling out some feelers with some drug reps and other PAs about jobs and within 24 hours, I had a new job in derm with the opportunity to make my own schedule, however I want it. That does show you the flexibility and the work and the desirability of a PA especially with experience. 

I'm very, very excited about my new job I started this week, I've only been one day. But next week I start seeing patients and it's different, they do things differently which isn’t necessarily a bad thing. I think getting to see different ways of how offices work will just make me a better provider overall. Overall, it's been a good transition, we'll see how it continues to go. 

Are You Considering Going Part-Time?

I would encourage you, if you think you might want to be part time, at least explore it. I mean, put numbers on paper, look at it. Go to your work, see what their thoughts are on you going part time. Also, always be looking for jobs -- that's something that I heard once at a conference, I think it's great advice, like never stopped looking for jobs, because you don't know what's out there. Another thing is, I was very surprised by how supportive my patients were. They were all very excited for me, even though I was leaving, and I couldn't tell them where I was going. I would tell them, But I mean, “next time, you're going to see someone else because I am leaving. I’m going part time to stay home with my baby more” They were all so supportive and told me how excited they were for me -- that was really sweet. I did feel you know that I'm abandoning them to some degree, but they were all very understanding of why I was making the change, and very supportive of it. 

Are you thinking about whether you should go part time or what that looks like? Feel free to send questions my way, because it was not an easy couple months going through that transition. I am very, very glad that I made that decision. I'm working two or two and a half days every week. I have a really great supportive practice who is very family oriented. So I'm really, really excited about that opportunity. Thank you so much for following along on this journey!

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Informational Interview with Stephanie Howard OB/GYN PA

Stephanie (S): My name is Stephanie Howard and I am a physician assistant. I live in Knoxville, Tennessee and I’ve been practicing obstetrics and gynecology since I graduated in 2010.

Savanna | The PA Platform (TPP): Has that been your only job?

S: Yes, I actually did a rotation with this physician, my supervising physician now, and I always knew I wanted to do women’s health. In undergrad I followed around an OB/GYN and so I kind of knew that’s what I wanted to do. I did my elective in women’s health also and I went back and did my elective with her and she offered me a job. So I’ve been with her, I guess, really since 2009 because I did 12 weeks of rotations with her.

TPP: Okay, cool. So I actually did something similar where I actually got hired before I did my electives. I was hired and then got to do 8 weeks of basically training before I jumped in my job so we kind of did the same thing there. 

S: Well I think that that’s awesome and I felt like I’ve recently picked up a lot of clinical year students. I try to tell all of them, “treat every rotation like a job” because you don’t know if people are going to have openings where you’re at, you don’t know who they know, and if you do a really good job like you could be offered a job. I think I was offered like five, I was offered 5 jobs during clinicals. Of course now you know in Knoxville where I’m at, its kind of a saturated area for PAs, but at the time when I did it wasn’t and so I always try to tell everybody like if there’s something that you like or want to do women’s health, like see if you can set up your own rotation or your own elective somewhere you may want to be and like prove to them and show them why they should hire you and how they could benefit from having a PA. 

TPP: That’s really good advice and something I wish someone had told me. (Let’s backtrack in a minute. I went into rotations with the mindset that I should tell everywhere I was working that that’s what I wanted to do. For example, let’s say I’m on family medicine, they would say “well what do you see yourself doing? What do you want to do?”, I would respond by saying “ oh, family medicine”. Even though, in reality, I knew I liked derm.  I knew I liked procedures, and when it came to rotations I actually really liked everything except for psych. It wasn’t until I actually about halfway through the year I started telling people when they asked. It was actually my surgery preceptor I first told, “You know I really think I’m interested in either surgery or maybe dermatology.” 

Once I started being honest about it and told him and my emergency medicine preceptor, that’s when people actually started seeking me out and saying like “I heard about this job, send your resume” and getting calls so it’s interesting that you give out that advice of “go into it thinking of it like a job interview because you don’t know who those people know”. It was my surgery preceptor that got me my job because he had that connection and he was able to make a phone call and say “you need to interview her and I think it would be a good fit” and so I was very appreciative of that.

S: They are more likely to take advice from a colleague who they respect and has been with somebody than like something that comes across on Indeed or an ad in the newspaper.

TPP: Exactly, I agree and that’s what I tell people with shadowing. Use all of your connections and when it comes to clinical I had a couple of preceptors who would tell me like “you seem like you want to be here and you are really participating” which I found to be a very strange comment. I felt as though all students should be like that, but apparently not.

S: I experience that also. If you ask the majority of people about their women’s health rotation there are so many mixed feelings -- you either want to do women’s health or have absolutely nothing to do with women’s health. It’s one of those things that I tell everybody, even if you don’t enjoy the rotation be interested and participate. We are trained as generalists, this is our only time in pre-PA to make the most out of our education and be the best most well-rounded PA that we can be. We really need to be all hands in and try. A lot of people have been on my rotation and they say “ooo I don’t really want to do this” and I think to myself, “well you’re here so you’re going to do pap smears until you’re comfortable with it”. A lot of people don’t and your preceptor can pick up if you don’t want to be there or not and it all goes back to how likely am I to refer somebody for a job or write a recommendation. It’s important to try and be present because they’re taking the time out of their day to teach you and obviously they enjoy their job or they wouldn’t have students and they wouldn’t be doing their job. 

TPP: That’s so true. I’ve seen the same thing shadowing. If somebody’s letting you shadow you need to act like you want to be there and pay attention. On clinicals that may very well be your only exposure to that area. You need to soak up as much as possible -- especially if you know you want to do something else because like I’ve found in derm, there are certain things that affect women in areas that would crossover with OB/GYN. I definitely see things and treat things that you guys see and treat. I get referrals from OBGYN offices so it’s important to have as much knowledge as you can even of other areas if possible.

S: Patients never understand, you know obviously there are different specialists but, they think that you know what their derm knows or what their internal medicine doctor knows so they’re going to talk to you about it so at least being familiar, and saying “well I don’t do that every day, but I do remember this from my rotation and this sounds familiar” because they’re going to ask you about stuff.

TPP: Let’s backtrack a little bit -- why did you decide to become a PA?

S: I think that I was kind of fortunate because my aunt and uncle are both PAs. I grew up knowing what a PA was. I was in high school and I was exposed to what PAs were and at that time it wasn’t as popular.  I’m not super old I graduated high school in 2003. When I went into undergrad I knew that I wanted to do something in the medical field and being a PA was always an option for me. I did that whole biology in undergrad and basically had to do the premed route because I would say “I want to be a PA” and people would say what’s a PA? Now they have pre-PA tracks that you can go through in school, but at that time, I graduated undergrad in 2007, nobody I knew, knew what a PA was. I got to shadow PAs, went around and I realized that that was something that I wanted to do as a female. I wanted to do something in medicine but I also wanted to be able to have a family and to be able to have a life. The balance of what the PA profession gives you, to have a life and a family and to be able to be a practitioner, it was just something that worked out really well for me. 

TPP: What did that look like? I graduated high school in 2008 and college in 2012 and I feel like there wasn’t much information out there and the same thing, I would go to my advisor and “you want to do what? What’s a PA?” so I can imagine you ran into that even more. What was your application process like? Did you get in your first time? How many schools did you apply to?

S: I don’t know when CASPA started or not but I had to apply through that. I applied to 4 schools. I’m from Alabama and I applied to two of them in Alabama and I applied to one in Arkansas, and then the one in Knoxville. I was a student in undergrad and knew what I wanted to do that right when I got out of school. My biggest challenge was really my patient care hours and trying to find something that I could get in without having tons of patient care hours was challenging.  I applied to those and got interviews at three places, was waitlisted at one, and then accepted into South here in Knoxville. The program was nice because it started in the fall and a lot of the other programs were starting in winter and so those things that just really lined up for me. 

TPP: Once you got to PA school was it what you were expecting? What was the most difficult part for you?

S: I remember our first day they told us the amount of information you’re going to get is like drinking water through a fire hose. I’m sure everybody tells you that analogy and so I knew that there would be a lot of studying going on and a lot of information. Honestly the hardest part really has to do with kind of like the fear of missing out. Not that you’re missing out on things, but people don’t understand how much time you spend studying and how your priorities have to change when you’re in school. I remember having friends and  I missed their weddings. It’s not so much in clinical but in didactic you were studying all the time. I remember I had some friends who came to Knoxville for the weekend because we had a wedding and I had like a peds test, an OSCE and like a pharm test on Monday and on Saturday they were inviting me to the pool and to have cocktails together and I had to tell them I had to go to the library. They just didn’t understand. I had to explain that I was basiclaly studying my life away and to go have fun without me.. 

TPP: I felt the same way. You have to make those decisions. I was living at home and my parents, I always felt so bad until I learned how to study. They would ask me to go to dinner and I would have to say “I can’t, I need that 30 minutes or that hour to study” which was a little bit dramatic, but you have to eat. 

S: You have to learn how to study and learn what’s important and what’s not important. Of course you’re not going to know everything but you have to get those basic concepts. At South, we had quarters so probably the first 2 quarters to try to like get in the groove and figure out studying.  It can be done, I got married the second quarter of PA school so it can definitely be done. More so time management and knowing that you’re not going to get to go out every night and there are some things that you’re going to have to miss, but it’s a small, small amount of time.

TPP: Plus, it goes by so quickly.  I felt as though it flew by -- small sacrifices. Once you got to the end of PA school you knew you wanted to do OB/GYN and you got lined up and did your electives. Did you interview for any other job or was that your only “this is the job I want”? 

S: Once she offered me that job, I knew that was what I wanted to do. During my rotations I had been offered other jobs and they were one of those things that they were getting in touch with me and it was more so if this falls through I’ll get in touch with you, but I knew that’s what I wanted to do and I really clicked with my supervising physician. She has taught me everything that I know about women’s health and has really trained me to do things the way that she wants them done. We have a great relationship and she values PAs in their role in medicine. She’s a very big supporter -- that’s so important as the PA to know that, who you’re working for really understands what you can do you and uses you to your full potential. 

TPP: What does a day at your job look like?

S: It differs from day to day. I do a lot of annual exams, birth control consulting, irregular periods, etc... I see everybody from adolescents to teenagers, pregnant women and menopausal women. I work up a lot of things such as dysfunctional uterine bleeding and pelvic pain. I deal with ovarian cysts, fibroids -- all of those things. We even do weight-loss counseling in our office, so there’s a lot of stuff. I am procedure-oriented, I love to do procedures so I do biopsies, such as endometrial biopsies. I manage abnormal pap smears, and do follow-ups with colposcopies. I do lots of ultrasound procedures like sonohistograms and hysterosalpingograms to look at the lining of the uterus and to make sure the tubes are open. We do a lot of bladder installations in our office for interstitial cystitis, and put birth control in and take birth control out. There’s a lot you can do in women’s health besides just pap smears all day long.

TPP: One question that I get a lot about specifically PAs working in OB/GYN is what can you do as far as pregnancy and delivering babies? Which I don’t know, I feel as though some of this varies by state maybe. What are your thoughts or role in that way? 

S: Yes -- I work with pregnant patients all day from conception -- trying to conceive and helping people conceive with Clomid and different medications -- to managing them throughout their pregnancy. Our hospital, or the hospital that I work at, currently doesn’t have any PAs, midwives or nurse practitioners that deliver. So I think really that it’s hospital-oriented and what the hospital wants you to do. I have delivered babies before with my supervising physician. You know it all kind of came down to what did I want to do? What lifestyle? And delivering babies is awesome, but babies do not wait on anybody and so if you get into the delivering thing you’re going to be on call on the weekends, you’re going to have to be getting up at 3 in the morning and go deliver a baby and that can be a rough lifestyle. For me, I don’t personally want to do that. I love managing my pregnant patients, I love managing gestational diabetes and hypertension and helping them throughout their pregnancies. When it’s time for babies to be delivered generally, my supervising physician, leaves the clinic and when she leaves the clinic it’s mine to run. I see her patients and I make sure that they are being taken care of so she can go do that. When she comes back she doesn’t have 15 patients still waiting on her before she can leave. I think it’s really a personal preference. I know that there are two residency programs now for post graduate OB/GYN and they do a lot of vaginal deliveries. I think more than anything it depends on hospitals systems because if the hospital is not going to let you deliver, it doesn’t matter where you’ve trained or what you can do. 

TPP: I remember in school we had a dermatology PA come in to do a talk and she had done one of those OB/GYN residencies I think in California. She said when she was out there she delivered about 300 babies and when she moved back to Georgia she could not get approved by the medical board to deliver babies. They just said no and even with the support of her supervising physician and proof that she had done all of these deliveries, in Georgia it’s just not considered part of a PA’s scope of practice. We do have a lot of midwives who deliver so I think that’s something for somebody who wants to deliver babies you have to look at that if you’re thinking about becoming a PA look at your state and figure out if that something you can do or not. 

S: Exactly because there’s definitely not a reason that we can’t deliver babies. We are trained adequately and obviously if you do post-residency it shouldn’t be an issue. A lot of states, unfortunately, have that rule and a lot of it could be that that’s a midwife thing in midwifery. A lot of times you have different organizations that maybe you don’t want PAs to get in there because that takes away job security as well.

TPP: Yeah I think that’s definitely part of it of why that kind of separation is there. How many patients do you typically seen in a day?

S: I see about 25 patients a day. Sometimes I can see more depending on if my supervising physician has to go do a delivery or what’s going on in the office. I have  slots in there too to work in but generally it’s about 25. 

TPP: Okay, and do you work full time?

S: I do. Full-time for us is four days a week. I have Tuesdays off which is nice so I can I spend time with my kids at home or kind of have a me-day. I always tell everybody working in medicine I love it and I would not trade it for anything, but especially woman’s health. We see a lot of psych stuff so there’s a lot of anxiety, there’s a lot of depression. I think because it’s such an intimate job, people are more likely to talk to me about things and tell me things that they should tell their primary care. Emotionally, it can be really exhausting some of the things that I hear so it’s nice to just have a me day to kind of decompress.

TPP: It is important to not take too much work home with you. Let’s talk a little bit about your Instagram account and now podcast. We first connected on Instagram in the little PA community that is there. What made you start now what was Teenage Female Health and is now the thegyn_pa? 

S: I see so many teenagers in my clinic and you know it’s just so crazy because half of the stuff that I hear from them is they’re not very well educated when it comes to the female body and I think a lot of that has to do with the fact that we grew up and we are told “girls have vaginas boys have penises those are very private things we don’t talk about them”. Then in fifth grade someone takes us in a room and they’re like you’re going to have a period. We watch a video and you’re like “what in the world is happening?” and so then parents are like  “well, she learned about it in school and we rely on the school system”, but living in the Bible Belt especially living where we are is an abstinence only education system, there’s a lot of misinformation out there and there’s a lot of information that these girls aren’t getting. I wanted to create a program where they could get information that’s correct because you can look up anything on the internet and you can make it say exactly what you want it to say. I wanted to like be a source of information that was correct for these young women and I actually have an online sex-ed and comprehensive health program for girls from seventh to twelfth grade. It’s online so I started my Instagram because I quickly found out that Facebook isn’t cool anymore.

TPP: Facebook is confusing.

S: Everybody has Instagram so I quickly noticed that my audience becoming a lot of PAs, so pre-PAs, adolescent girls, young women in their 20-somethings and then also nurse practitioners and different healthcare providers. I felt as though naming it teenage female health isn’t very inclusive so I think a lot of people felt like “this page isn’t for me because I’m not a teenager” so that’s why I changed it to thegyn_pa. 

TPP: Okay cool. You started your podcast which I love the name by the way, you want to tell us about that?

S: Yeah, so the podcast is called Britt and Steph At Your Cervix! Britt was one of my students and we went and got pedicures a few months ago before she moved to Texas to start her job in OB/GYN and she mentioned that we need to do a podcast. I thought. “I have no idea how we would even do that!”  We talked about it and she is a huge podcaster she was like “there’s just not like anything out there for women’s health to listen to. I think there maybe something but it’s kind of like dry”. Our personalities are very like laid-back and we both value education and think knowledge is power so we wanted to get material and present it to future healthcare providers and current practitioners in a way that just kind of seemed like having a glass of wine with your friend and make it easy to understand.

TPP: Well I listen to the first episode and I can say that you guys nailed it. I listen to it while I was taking my baby for a walk and it was a great refresher and as you said, it’s really easy to listen to. The concepts are really simple to understand, nothing crazy or conceptual. It was great. I’m excited to see where you guys take it. I’m sure there are plenty of topics to cover. I’m sure you will get lots of  questions. 

S: Oh yes, so we already have 42 topics planned.

TPP: That’s almost a whole year! I think we covered everything. Any other advice or tips that you’d like to throw out there? 

S: I think that you know definitely one thing is that if you were interested in women’s health don’t be scared. For some reason people have this misconception that women’s health you know isn’t for PAs. My question is why? We are trained as generalists, we have just as much training in women’s health as we do in general surgery and pediatrics. Most people are like “PAs are just not in women’s health” and that’s true. There’s less than 1% of us, but it doesn’t have to be that way and we shouldn’t have to be discouraged. I would just have to say that if women’s health is something that you want to do, it’s definitely an attainable goal. It’s a great career -- go at it and find your rotation and let people know that that’s what you want to do. Don’t be scared to do women’s health. Just like we mentioned earlier, if you want to do vaginal deliveries then look at the states and know where you can do that or hospitals that will allow you to do that. 

TPP: Just before you jump in, get all the details. Stephanie will help you answer any of the questions that she can about her job and it’s kind of nice to have the social media to get kind of more awareness about our role in different areas. I think you’re doing a great, great job.

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My Everyday Essentials as a Dermatology PA, Mom, and Blogger

This post has been sponsored by Zebra Pen. All thoughts and opinions are my own.

Working as a dermatology physician assistant for the past five years, I know what works and how to make my day more efficient. As a busy PA, blogger, wife and mom, people constantly ask, “How do you do it all?” It’s time for me to share what my days look like and what makes my life easier.

I’m a pen and paper kind of girl, but I’m very picky about my pens. Luckily, I recently found a favorite with the Sarasa® Grand Gel Retractable Pen from Zebra Pen. It’s got a good weight to it with a metal barrel, dries quickly, and even looks stylish. As an added bonus, no one in the office can steal my pen since they know it’s my trademark. I need a to-do list to keep my life organized. I’ve experimented with apps, but if I physically write something down, I’m much more likely to remember it. If you’re a pen junkie like me and on the lookout for a new go-to pen, check out more information here to see how you can Choose Different!

My planner goes everywhere with me so I can stay on top of deadlines and tasks. Each week, I take some time to review everything I need to get done for the week, as well as the things I would like to start working on. Goal planning is important, and breaking down bigger goals into small steps makes them seem more achievable.

For making a new podcast episode or video, I have to plan out a topic, title, talking points, images, and links. It seems like a lot until I take it one step at a time. I also like to look at my list daily and write down anything I need to do or put on my shopping list as soon as I think of it.

Once I get to work, there are a few tasks I do everyday. The first thing is my pathology reports. Since I do a lot of biopsies in dermatology, once the results are faxed over, I decide on a treatment and mark it on the report. I also have to check the schedule from the previous day and send letters to patients who missed their appointments.

Once I start clinic, it’s really busy and I see on average 30 patients each day. They range from acne and eczema to skin checks and biopsies. If you are ever involved in doing biopsies, make sure to get consent from the patient, and mark a skin map so we can find the lesion again in the future.

I think it’s funny when I have patients sign consent and they ask to keep my Sarasa® Grand Gel Retractable Pen. Having nice pens like this one from Zebra Pen is actually something my patients notice, and I view it as an accessory. They like the way it writes, but also that it dries fast without smudging. 

After I’m done seeing patients in clinic, I finally head home to see my baby girl, but I always keep my planner and pens in hand. You have to find systems and tools that work for you and stick to them!

Should the Title “Physician Assistant” Be Changed? Research Points to Maybe.

While at the 2019 AAPA conference in Denver, CO this week, I sat in a session titled “Title Change Investigation Update.” The hour-long presentation came from WPP, the research firm behind the exploration of whether the name of the PA profession should be changed. AAPA has released an article with an update as well, but I want to help you understand the information that was shared during the session and how it was received. This presentation was not made available after the session (so far), but my seven pages of notes will suffice. If you want the summarized version and don’t care about the logistics, scroll to the end.

For a little background, the title change investigation comes from a resolution that was passed in the 2018 House of Delegates that resulted in a vote of starting a further investigation on whether the physician assistant title should be changed, whether it was feasible, and what were potential alternatives. Over the past year, this has been a topic of much discussion of PAs, but in the spring a 45-minute survey was sent out to begin this investigation. This survey received some backlash for length and lack of seemingly relevant questions, which was (somewhat) addressed in the presentation.

Upon arrival, we were urged to shift to the center of rows to make room for more attendees as it was expected to be packed, but as the presentation started I found myself one of only 3 PAs sitting in my row. I’m not sure if the unexpectedly lower attendance was due to the session timing at the end of the day or a reflection of PAs having other priorities, such as learning about information they can apply to their daily jobs with patients.

The presentation started with Pandora, the project lead from WPP. She was joined by Rich Durante, the research and analytics lead, and Jasmine Tansy, the title lead.I have to admit, at this point I almost felt as if I was sitting in an Apple keynote between the very well-rehearsed talk and fancy PowerPoint. The goal of the talk was shared - review and give clarification of project to date, share and inform on the research, and share conclusions and next steps moving forward. This would be followed by addressing questions from the PA community.

They also addressed what would not be covered - full quantitative findings report (meaning we only saw two solid data points from the study), presentation of brand strategy and title options (there were no mentions of contending alternative titles), and financial outcomes. There is a legal team that is also on board, but was not in attendance, responsible for researching the legal and financial ramifications of a potential title change. They will review laws and regulation to avoid confusion in the marketplace and advise on legal and legislative steps with a goal of bringing outcomes to fruition and avoid changes in billing, scope, and responsibility. 

As the presentation began, it was noted that the PA profession would be referred to only as “physician assistant” throughout the talk, with no use of acronyms. Pandora made a point to address that the use of this title “may be difficult to hear” for some of the audience members. Personally, I found this bizarre as I attended physician assistant school and I am fine with being referred to as such. I will be using the PA acronym for the remainder of this article.

WPP made a point to recognize that PAs play a role, and will continue to play a role, in delivering high quality health care. Their stated goal with this project is to “position PAs to compete in an ever-changing healthcare marketplace, and increase relevance with state groups and patients now, and in the future.” There was no discussion of how WPP was chosen for this task, but the resources allotted to the project (thus far) were a million dollars to put the vast cost of this type of project into perspective. WPP stated the challenges they found for determining an appropriate title include the variety of PAs in scope and specialty, competition for space in patient’s minds from other providers, and a lack of a good understanding of what PA stands for. Pandora presented two key questions to address:

• Is there a need to evolve the PA brand based on objective well-informed data and analysis driven view?

• If so, how do we redefine how the PA profession is positioned in healthcare today and in the future?

The set up of the research process was discussed as a 5 phase process including discover and design, research and analytics, insights and strategy, title development, and validation. At this point, phase 1 and 2 have been completed, and we are in phase 3 with an estimated timeline of May to December 2019. 

Phase 1 - Discover and Design

The purpose of this phase was to set the foundation for learning by reviewing research for relevant industry trends, publications, and regulations to see how PAs operate today. To begin this process, WPP met with a council of 12 volunteers that all represent PAs, including members from influencing organizations like NCCPA and ARC-PA. It was decided at this point that there was not enough “data” available to indicate that a name change should be investigated further, leading to phase 2 and the survey portion.

Phase 2 - Research and Analytics

This “world class research” has a stated purpose to “inform understanding of how PAs are perceived as part of healthcare and understand what drives perceptions,” as well as how PAs are linked to broader perceptions of healthcare value. This survey will serve as the “backbone of strategy and title recommendation.” In addressing why this particular survey design in the quantitative portion, specifically length and format, Rich stated there had to be “trade-offs” for comprehensiveness and length of survey. Based on WPP’s experience, they have a good sense of number and types of questions that can be asked before causing people to drop out or compromise data quality. Rich informed the audience that the survey questions were pre-tested with PAs to get feedback from individuals, which influenced adjustments to “flow and length.”

This process began with qualitative research of discussions with 55 individuals, including PAs, PA students, NPs, physicians, patients, employers, “think tanks,” professional societies, medical boards, government agencies, and legislators across 20 states. One of the main findings across all constituents in the qualitative portion is that overall, PAs are well regarded. According to patients, PAs are trusted with good communication skills, but sometimes they don’t know what the PA roles and responsibilities are. With other healthcare providers, PAs are “capable allies” who help manage patient care, are trusted, and sought for counsel. Employers appreciate the financial access and patient care benefits of PAs. All of this indicates a “clear value in today’s healthcare system with access and improved economics.” Some of the stated benefits of PAs include:

• Increased access with extending quality care to more patients by allowing quicker appointment scheduling, as well as less appointments with more time than physician colleagues leading to greater patient communication

• From an economic standpoint, PAs are hired at “significant discount” to help healthcare facilities see more patients, offering more revenue at a lower cost expenditure

• Value will grow in the future, due to an aging population leading to more demand for healthcare

Based on these benefits, WPP would like to highlight the opportunity for PAs to add value to the healthcare system by further extending access to care, particularly in rural areas in an economical way. 

Despite these benefits, it was found that there is a significant difference in the “perceived role” of PAs. Patients feel that PAs have more capabilities than NPs, stemming from the word “physician” in the title, which provides a “halo,” while NPs are viewed as “nurses with a lower order” from a patient perceived hierarchy. In contrast, other healthcare providers see PAs and NPs as the same in responsibilities and capabilities, with differences in how they are trained, while employers feel that PAs are more focused on procedures and surgical support, but NPs are more focused on preventative care and patient education.

From these results, it appears that perceptions are driven by the amount of direct contact PAs have with their constituencies. If a health care provider or employer has worked with PAs, they knew exactly what they did, but without that contact, they did not have a strong understanding of the capabilities. Patient understanding varies based on factors, such as exposure and age. Overall, PAs have a high degree of satisfaction and enjoy the role and its benefits, including direct patient contact, less debt, earlier start than medical school, flexibility, fewer “non-patient care” headaches, and are overall collaborative, not competitive, with physicians. 

The tension surrounding the profession stems from a lack of autonomy being an issue with many PAs, and while they feel physicians are mentors, many PAs feel micro-managed and that they spend too much time in non-patient care duties. The research then looked at the AAPA’s definition of PAs to determine how this description is perceived. 

“PAs are medical providers who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider. With thousands of hours of medical training, PAs are versatile and collaborative. PAs practice in every state and in every medical setting and specialty, improving healthcare access and quality.”

Respondents familiar with PAs found this to be very accurate, and in general felt positively motivated to work with PAs after sharing this description. PAs find this definition aspirational, while other healthcare providers view it as accurate and reflective of reality, and employers view the versatility and collaboration as true benefits. Individuals with less familiarity were surprised by the description “in a positive way” because they were unaware PAs could prescribe or serve as a principal health care provider.

From a patient perspective, there were two barriers that seem to lessen patient interest in “seeking out a PA.” The first is the title, which is not seen as a good fit with PA role and responsibilities, and most find it demeaning to the capabilities to see the word “assistant” in the title. Patients, other healthcare professionals, and employers all agreed and felt that it was confusing and sent the wrong signals. From an emotional perspective, PAs don’t want to be looked at as “assistants,” but respected as peers.

The second barrier is a general lack of education and awareness about what a PA does as it is a relatively young profession and many non-healthcare providers have limited exposure and understanding of a PA’s capabilities. According to WPP’s presentation, a patient in the qualitative portion stated that the name “does a disservice to the knowledge of a PA, while providing a boost to the physician’s ego.” Personally, I can’t think of a patient in my practice who would be familiar enough to share these eloquent sentiments. 

For employers, the barriers have a different focus. Institutions find that PAs have a “lack of experience when new” compared to “NPs with several years of clinical experience as a nurse,” and feel that PAs require more time and supervision when new. Employers do recognize there are some driving factors that are beneficial in hiring PAs including extending access, great bedside manner, helping to improve efficiency, as well as being economically viable.

To summarize the qualitative portion of the survey, the results indicate that PAs are valued in the healthcare system and offer true benefits to health care providers, patients, and employers. We all knew this right? The study finds these benefits to include extended access, particularly to rural areas, increased system efficiency, lower cost to employers, and a growing contribution to the increase in an aging population with fewer physicians and a growing cost of healthcare.

So what issues limit this PA potential? A lack of a universal understanding of the PA role, a title that creates confusing with limited awareness and connotes less responsibility than PAs believe leading to tension within the profession, and employers perceiving that PAs need significant training out of school and laws requiring extra administrative time for supervision of PAs.

Moving on the the survey. For the quantitative portion, the survey was sent out to a list provided by the AAPA, and completed by 6,845 PAs and 1,357 PA students. This is a response rate of 6%, which sounds low, but AAPA states is in line with most research studies and provides a “good sample size and is robust for analysis.” The purpose of this part was stated as developing a deeper understanding of PA roles in clinical practice and determining the impact of PAs and other providers in delivery of healthcare. Basically, the goal was to figure out what are the perceptions of PAs and what drives value.

In order to do this, WPP explored the following themes:

• How important is education awareness in increasing understanding of PAs roles and capacities

• Demographic facts influencing knowledge of the PA role

• Misalignment of fit between the PA title and role 

• Tension between PA autonomy and connection to physicians

• How employer perceptions impact hiring

• Gauge differences in perceptions of what PAs are capable of and legally able to do

Only two data points were shared during the presentation. The first one was regarding the AAPA definition stated previously. Most PAs found that the definition fits with the roles and responsibilities, but the title “physician assistant” does not. This is the main point addressed in the AAPA’s article. Basically, we’re okay with the definition of what we do. If you ask if the name “physician assistant” describes that definition, it’s not a match.

Main conclusion - “Based on research and analysis findings, it is strongly suggested that an exploration of an alternative title should be pursued, and quantitative findings from physician assistants alone warrant this exploration.”

What’s Next?

Phase 3 - Insights and Strategy - This portion will begin in the August-September timeframe to leverage research to develop a strategic foundation to position and PA brand and inform title development.

Phase 4 - Title Development - WPP will try to leverage insights and strategy to explore new title opportunities. For title strategy, it’s essential to define intent to figure out what title should communicate and then figure out what’s available by looking into validating information and seeking legal counsel. (More on this at the end.)

Phase 5 - Variation and Implications - WPP will use field quantitative survey results to validate a new title option, and assess legal and financial ramifications.

The timeline for delivery is early 2020 with a brand position and title recommendation to be presented for HOD consideration with full quantitative findings beyond the data points that were presented at this year’s conference, as well as an evaluation of related business and legislative cost estimates. And with that, it was time for questions.

PA Concerns

So why didn’t the survey ask about what titles we recommend? While the survey was active, one of the main complaints among PAs was the 45 minutes it took to complete, as well as the lack of questions directly addressing a new title. At this point, WPP clarified that not only are they looking at the title issues, but the PA profession as a brand, and how these perceptions align with the ideal role of a PA to determine what it will take to move the profession in that direction. After those determinations, they will try to pick a potential title. If you were wondering during the survey why you had to rank various professions, the goal was to understand how PAs, physicians, and NPs are perceived along the same dimensions. Not to assert that one provider is more valuable than another, but to determine what makes PAs unique. This 360 degree perspective is meant to highlight PA strengths and the aspects of the role considered most important in providing care, pinpoint what differentiates PAs, and attempt to transcend the title for a “holistic brand strategy.” 

A researcher from Duke was first at the microphone, and questioned why the available peer-reviewed literature regarding the title change wasn’t used to come to the same conclusions without using significant resources, and WPP responded that their literature review didn’t provide the spectrum of what they needed to investigate since it did not link the perceptions of value to healthcare. She offered to point them in the right direction to resources.

Evelyn, a Pacific University PA student, asked about the brand positioning strategy and if that was something WPP would be assisting with, which they responded they would be happy to do, but had not been asked to stay on at this point to develop any advertising strategy beyond the foundation of strategy. This will be up to the HOD, which is why it’s important to make sure your delegates have your best interests in mind.

Someone asked if they included PAs outside of the United States, and they did not.

Betty, a PA from Arizona, questioned why they were waiting to look at legal ramifications until after making these decisions. As something that is in thousands of policies and regulations at many different levels, what is going to happen? WPP deferred to the Foley law firm that was not present, and Donna from AAPA stepped in to state that the first step was coming to the conclusion that there needed to be an investigation to look into titles first, and now the necessary steps are being outlined if a name change were to move forward. The name must be identified before looking at trademarks, and the path is starting so those discussions will unfold at what would happen at a state and federal level.

Another PA asked if the WPP firm had experienced a similar title change in another profession that was launched successfully. The response - “We have done extensive work in the healthcare field and title change is uncommon and not frequent because the decision has already been made so an outside group isn’t needed. We have hundreds of credentials across the globe with naming credentials and experts in titles and how people perceive language to gain clarity and get preference.” Short answer - No. 

The last PA to speak stated she wasn’t worried about the sample size or response rate, but the length of the study. In her opinion, a 45-minute study in the PA world will get a response bias because the only people who will answer are the ones who are biased. (This gained an applause from the audience.) She admits that people know it is a “lousy title,” but questions if the cost is worth it to change it at this point. She also stated that she feels the survey lost some credibility with the types of questions because PAs didn’t understand why they were being asked about things that didn’t seem related. WPP stated that not all data was shared and that the purpose of the survey wasn’t just to see if a title change was needed, and Rich felt that individuals who take the longer study will be more motivated, but won’t just be PAs in favor of the change.

The summary given by WPP is obviously going to be politically correct and not give too much direction, but the main takeaway is that according to PAs, other healthcare professionals, and patients, the “physician assistant” title doesn’t particularly fit with the definition, while most PAs do agree that the description in appropriate. Whether or not that should lead to an official title change is the next step.

I agreed with Betty’s concerns of why the legal and financial ramifications are not being looked at until resources are being poured into this study. A name change will not bring in more revenue, for AAPA, employers, or PAs, and may be detrimental as the study showed one of the desirable qualities of a PA includes the economic benefit. Will this cause our AAPA dues to increase? How much of the budget will this consume, while we continue to lag behind legislative financial support in comparison to other professions, including NPs? At the end of the day, this is a business decision, not an ego issue, and the questions of how this will have a financial benefit should be considered. Personally, I don’t believe a different title will result in a higher salary for myself, and will likely cost my practice money (that I hope they don’t take from me). While it may change patient perceptions over a long period of time, PAs may be inflicted with the burden of the cost. This should not be an emotional response or decision, similar to giving results to a patient, it should be based on well-thought out research and what makes sense from a legal and economical standpoint.

So if it is determined to be a feasible option, what should the “physician assistant” title be changed to? This research indicates that the term “physician” should remain as part of the name, which would rule out suggestions such as “medical practitioner.” I guess we’ll all wait on the edge of our seats until the next survey to see what our options are, but I would love to hear your suggestions in the comments.

#healthyinmedicine - Staying Healthy as a Physician Assistant

With the rigorous process of becoming a PA, it can be way too easy to lose sight of our own health when caring for others. This is something I’ve definitely struggled with, but continue to work on. We should be encouraging each other to be #healthyinmedicine instead of just focusing on our patient’s health. Here are some of the practices I’ve found to be helpful. I would love to hear about your habits and tricks for self-care in the comments or on social media. Make your own #healthyinmedicine post, tag @thePAplatform, and I’ll be sure to check it out!

Find ways to stay active. As a full-time physician assistant, wife to a busy medical resident, mom to a 10 month old, and blogger, sometimes I get a little tired or overwhelmed. (Understatement of the year.) I’ve had to get creative to find ways to keep myself moving and still be able to spend time with my family. Back in undergrad at the University of Georgia, I walked everywhere. Buses were available, but the campus was beautiful, so I only took advantage of hopping a ride maybe 10 times total. I took that built in exercise for granted, and realized how great it was once I was sitting in the same classroom for 8 hours a day in PA school. That changed things. I would never have made it to the gym if it wasn’t for two of my classmates. We were close friends, and they didn’t really give me a choice. I wasn’t always the best sport, but they encouraged me to at least put forth some effort in making my health a priority. Now, as a family, we love to go on walks and get outside. My baby certainly keeps me moving and chasing her, so that helps too. My medical assistant is great at walking during lunch, even if it’s only for 10 or 15 minutes. Find your small pockets of time and try to dedicate at least some of that to moving your body. I know some of these fancy Fitbits and Apple watches will even tell you when you’ve been sitting for too long.

Make the best food decisions you can with the resources available. With fast food (that is delicious) on every street corner, I find myself jumping to the easy option most times. This is something I’ve really been working on this year. I’ve even found that some salads and wraps are just as good, if not better, than the burger or fried chicken I would have previously ordered. Does this mean I always “eat clean?” Definitely not! I love the good stuff too much. I am trying to live in moderation though instead of indulgence. Less sugar, watching portions, and trying to actually understand what’s in my food and what it does for my body. We get so busy with school and work and life, and our food choices tend to be the last thing on our minds. In Emily Freeman’s new book about decision making, The Next Right Thing, she states that we make over 200 decisions a day just in relation to food! Planning out meals, even just for the next day, can make a huge difference.

Schedule dedicated workout time. With some trial and error, I’ve figured out that if I want to get an actual work out in, it’s more likely to happen in the morning. I’m not a night owl. Definitely more of a grandma/early bird. If I put it off and wait until the end of the day, there are too many distractions. I’m too exhausted from seeing tons of patients at work and all I want to do when I get home is love on my baby. Not my body. From making this shift to morning workouts, it helps me start the day on a good note. I feel energized and productive and ready to take on the day. That encouragement keeps me going and helps me continue my streak. You may find that night time or even at lunch works better for you, but make a commitment. Write it in your planner or put it in your phone so you make sure to prioritize dedicated workout time.

Invest in tools that hold you accountable. Another thing I’ve found that I pretty much have to do is put some skin in the game, aka pay for things. I’ve tried the On Demand and YouTube workouts and read tons of blogs on staying healthy, but because I’m really good at convincing myself out of things, I usually give up. I recently bought a spin bike for my house and invested in nutritional coaching with a fellow PA. Guess what? It’s the first time I’ve actually stuck to something for longer than a week or two! Having the accountability of a coach checking in to see how I’m doing and encourage me, and my husband saying I better get my money’s worth out of that bike have both made me actually take steps in the right direction. I hope you have better self control and more determination than I do, but it’s okay if you need a little motivation. There are a lot of great facebook groups centered around accountability that you could join or find a friend who is trying to live a healthier lifestyle as well and partner on helping each other out. Taking these steps has also removed some of the frustration of trying to figure everything out myself.

Take time off mentally and physically. I’m a proponent of vacations and “treat yoself.” We carry so much responsibility and mental load in our daily lives, that you have to give yourself a break. I’ll take days off where I don’t touch social media or even a computer. While those things are great for connecting, it can also be discouraging to see an illusion of someone else’s life if you’re not where you want to be. I also tend to always have a vacation planned. While I would love to go on elaborate trips all the time, usually it’s just a weekend at the beach or visiting with family. Taking these opportunities to invest in your mental health is so important for preventing burnout. Working in medicine is tough and very taxing. We have a lot on our plates and it’s okay to take some time off.

If you have tips for how you stay #healthyinmedicine, please share in the comments or on social media! Let’s encourage each other to take time for ourselves this week.

Read how other PAs stay healthy:

Erin - Stethoscope and Sparkle