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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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.

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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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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