Posted 1 week ago
I just wanted to say, thank you so much for putting the time and effort into this blog! I'm a freshman undergrad and came across your blog a couple months ago. I had been dreading the whole med school route, even though I really wanted to go into medicine. Now I'm planning on applying to PA school, working as a CNA this summer and I'm really excited about it! I was wondering how much volunteering you did before you applied? Do you have any programs you would recommend? Did you ever go abroad?
finally-findingfit asked

Thank you!

I had a couple of years of experience volunteering 2-4 times per month at the local emergency department. I also had quite a bit of non-healthcare related volunteering, mostly some Sunday school type teaching at my church (I don’t know the first thing about kids so this was actually helpful for my peds rotations!), and several volunteer reconstruction trips to New Orleans.

However, remember that most programs require paid hands-on healthcare experience for a reason. Check out this post for more insight. I would urge you to let volunteering be the cherry on the top of your experience rather than the bulk of it, both for your own benefit and to increase your chances of being accepted into PA school. I took two years off before PA school and worked as a CNA and it was the best decision I ever made.

The right program for you will be different likely than what was the right program for me, but some good guidelines are to choose programs that have been established (you don’t want to be the guinea pig!), have a high first time PANCE pass rate, and give you a good vibe during your interview. Apply to several rather than just one or two.

I did go abroad! It was actually one of my requirements in selecting a program. I never had time to go in undergrad so I wanted to make it happen in PA school. I chronicled my time in Ecuador earlier on in this blog, both the touristy and medicine aspects. It also was a really good decision for me, and despite me being ill most of the time I was there I look back fondly on my memories!

Posted 1 week ago

Finally something to use those miscellaneous accessories on your student otoscope for- investigating what lies beneath the plaster and 1960s vinyl tile in your bathroom wall!

Posted 1 week ago
I was looking through your resources and thought I should let you know that surgery study guides are psychiatry.
Anonymous asked

Whoops, they were. Should be fixed now. Thanks!

Posted 2 weeks ago

The journey thus far and new Q&A section

Hey guys, I just finished tagging all of the questions you have submitted over the years with “q&a.” I’ve linked them all to a tab on the side so they can be browsed through. I realize I’ve answered the same kinds of questions a few times over, which I don’t mind at all, but makes it repetitive to any regular readers. If you’re new and have questions, please take a minute to browse through them and see if I’ve answered your question in a previous post. Thank you!

Secondly, in doing the tagging I managed to skim through my two years worth of posts and it made me realize just how far I’ve come! A welcome feeling since I am really new in my job and feel pretty inadequate most days. My journey as a PA student and now a PA-C has taken me across the US and the world. I sat in a lecture hall and rotted from 8-5 for one whole year, I’ve survived nearly 100 PA school exams, done well child checks in the rural south and in the rural Andes, got ?malaria as well as fleas from petting the doggies while studying medicine in Ecuador, delivered babies and placentas in a small oceanside US town, brought a dude back to life doing CPR in the ED, and drank a lot, laughed a lot, and cried a lot on my surgery rotation, amongst many other memories. Then I went crazy for 10 days studying for my boards, passed, said goodbye to my close-knit group of classmates and friends and moved across the country again for a new life and (hopefully) a new job with my new husband.

I racked up some credit card debt for the first time in my life, sold my plasma and textbook collection to stay afloat, and waited for the medical boards and hospital credentialing committees to approve me before finally starting my new job this year. Even then it was still hard. I found a house but couldn’t make it mine until the bank believed my pay checks (the first in 2 1/2 years!) so I lived in a basement with a nice retired cat lady from Craigslist and her 3 fur babies for a while.

Now I’m in my new house, a couple months into my new job, and finally feeling a little bit settled. Between my mortgage, student loan payments, car loan, and credit card debt things are pretty tight and I’m a little disheartened to have worked so hard for so long and still have to worry about my finances, but I know that it will all be worth it in the end! I made it this far following my heart and my gut and can’t wait to see what the future brings.

Posted 2 weeks ago
Hi, One of the more difficult questions I wonder about is what is relationship ship like between PA and Supervising physician? What are the limitations, boundaries, and how much are PAs allowed to do? What do you know understand about this relationship ? Thanks so much!
Anonymous asked

Good question! And good timing, because I’ve thought about this a lot this past week at work.

The hard thing is that every relationship is different, as is every scope of practice determined between you and your supervising physician. And these things change over time as you become a more seasoned PA and your supervising trusts you with greater responsibilities. There are settings where a PA is very autonomous, such as a rural urgent care clinic where they run the show with perhaps a medical assistant or lab tech to room patients and run tests with a physician available by phone if needed, to settings where a PA’s training and skills are completely wasted when a physician does not understand how to properly utilize them. I saw this on my surgery rotation, where the NPs/PAs were not allowed in the OR (some had never even observed a surgery), saw patients in clinic for follow-up on procedures they did not assist with, with the attending surgeons berating them for not knowing the finer details of the procedure/situation, and only managed the hospital cares pertaining to ambulation/bathing and discharge coordination (something the nursing staff could handle perfectly well). The surgery intern wrote all the orders and notes and managed all the real hospital issues on their own.

There are hard limitations determined legally which varies by state, but of course in almost every state we have prescriptive authority. Some states need you to get a special DEA number for controlled substances. Some states mandate that a physician must sign a death certificate, durable medical equipment referral, nursing home referral, admission notes, etc.

In my current practice we are having some issues with certain providers that are wary of giving us PAs/NPs a lot of autonomy. Part of that may be because a lot of us are new to our careers. Additionally, we all have very different backgrounds and skill sets and it can be difficult to streamline the types of patients that are assigned to us. So that’s one thing we are working on. But the physicians are very receptive to our feedback and I hope to extend my skills as my comfort level and our relationship permits.

Currently I see 3-5 patients per day. Sometimes the physician gives us a run-down at the beginning of the day, but most times not. I extract the information I need from the EMR and nursing, see the patient (sometimes with the NP training me, sometimes on my own), write orders and formulate plans I’m sure of (at this point its med changes, follow-up labs, electrolyte and fluid supplementation, ordering echos and EKGs, calling consults, writing notes and discharge summaries, and answering patient questions as best I can). I usually meet up with or call the physician to run by anything I’m not sure of (usually there’s at least one thing), if I think we need to consult another service such as cardiology or GI, or if there’s a special test that may need to be ordered (stress test, MRI or CT, etc). Eventually I will work up to managing 10-12 patients per day.

Posted 2 weeks ago

I got the cutest email at work the other day!

Opened up my inbox to two pissed off emails from a nurse upset about my awesome discharge skillz… and then a true gem from a middle schooler who somehow got my work email and wanted to interview me for a school project on physician assistant hospitalist careers. (And seriously my patients don’t know what a hospitalist is and neither did I until PA school, how does a middle schooler figure this stuff out so early in life?)

Anyways, I had some down time so I answered all of her questions and she sent me this reply back:

Dear Miss Running PA,
       Thank you so much for answering me:) You helped me out a lot. I’m not specifically looking to be a physician assistant but I would love to learn more about it. I do want to be in that field though. That must be so rewarding to take care of people everyday. That is exactly what I’d like to do for my career.That is so cool that you went to XX College because that’s a school that I dream about going to. Thank you so much again for answering my questions. You have no idea how much it means to me. It is an honor talking to you. Your’e an inspiration. Thank you!:)
                                                                            Cute Middle School Girl
OHMYGAWDDD MADE MY DAY!
Posted 2 weeks ago
Hi! Could I ask you a question about PA prerequisites? I'm an undergrad, and I'm not sure whether to 1) take organic chem 1 & 2 and then biochem, 2) take "fundamentals of organic chem" and then "fundamentals of biochem" or 3) just take organic chem 1. I know most PA schools don't even require orgo and biochem, and many only ask for "1 semester of organic chemistry or biochemistry". Do you have any thoughts or advice? Sorry for the hard/specific question! I'm a bit desperate :( Thanks!!
thinkingtooprecisely asked

Most of the schools I applied to actually did require organic chem and biochem. If time is not of the essence, I’d take a listen to the rumor mill around you in your specific institution and see which classes have more favorable reviews or better professors and go that route. I had to take tons of chemistry (general, organic, analytical, biomolecular), but found that biomolecular chemistry was most applicable to PA school. If you’re in a rush, then just go with whatever’s fastest. I don’t think it matters to the admissions committees.

Posted 3 weeks ago

Tough week

I like my job, really I do. I’m sure I made the right choice. It’s just been a hard week for me. It’s hard to even write this post. I kind of just want to lay in bed and try not to dwell on it.

My training period is 2/3 done. It feels weird to think that. I feel like a total dumbass still. I have to question every thing I do, and run most parts of my plan by the NP I’m training with. This week I’ve been trying to see patients on my own and call the NP when I need her. Which is all the time.

I thought maybe I was finally feeling more confident, my patient interactions felt a whole lot more normal with nobody watching me the whole time, but then I had to deal with Mr. Pretend Cardiac Surgeon MD when consulting him on my atypical chest pain with history of prior stents lady. And he picked on me sooo bad. Every. Little. Thing. And what he had to say could have been constructive, but the tone brought me straight back to my surgery rotation. And ruined that day for me.

Then came the most unhappy curmudgeon old man VA patient who let loose his 45 years of medical care frustrations on me, then decided to up and leave while I was in the middle of several phone calls trying to make miracles happen for him. Then the attending MD was mad about how it turned out, partially at me. Then same attending, after I carefully constructed a plan for another patient over the phone with the NP, ran in and took the scene over and changed everything up.

Then I forgot to follow up on an important lab. In talking through the patient’s case with another attending, she was really nice about it, but I could tell by her face that she was so disappointed in me, probably thought I was incapable, and now I have to expect that she’s going to feel like she has to check up on every thing I do with her patients.

Icing on the cake was my car had engine trouble in the middle of a blizzard on the way to work today and had to be towed.

Ugh. Ugh. Ugh. This too shall pass. I will get better and earn my respects. I’ll learn when to let it go and when to stand my ground and tell people when they’re being pricks and to go @#$! themselves, in true hospitalist language. It’s just really hard being new sometimes.

Edit: Thanks for your kind words, folks! It made all the difference when I woke up for work the next morning :-)

Posted 1 month ago
…patient requesting “Communion and a shamrock shake”…
Occupational therapy note on one of my patients. That sounds like quite the party!
Posted 1 month ago
Hey, I really have enjoyed reading your blog! My husband is currently in his first year of PA School and it is HELL on him. I work full time in the medical field and am being as supportive as I can. My question is - what has been helpful to you ? what did your friends and family do that was helpful for your journey Thanks
Anonymous asked

Thank you!

I went to PA school far from home, so really no family or old friends nearby. Just my now-husband and classmates, many of whom I became very good friends with!

The first year of PA school just kind of sucks. You are so excited in the beginning, you spent forever preparing for this, and then it just hits you. And hits you some more. And again. And again. And you’re really over it and would like a break but it just keeps coming so you must sink or swim…

My advice to you as a significant other would be to take it day by day. There will be good days and bad days. On the bad days, just remind him that you’re there for him and there is a light at the end of the tunnel. Do small thoughtful things for him, like leave love notes in his lunch (or hell, pack the lunch too!). Try not to take it personally when he’s crabby all the time, but remind him gently when it’s time to take a break. Remind him to get out and take walks (hopefully there’s not mountains of snow where you are!).

Be prepared to feel a little neglected. He will need more than his fair share of help, because unlike your job his will be 24/7. Remember to schedule a date night every now and then that’s NOT the night before an exam :-)

Since I was far from family, and so were most of my classmates, we found a LOT of support in each other. Hopefully your husband’s class is tight-knit and he’s found a niche. Because there is only so much complaining about class and medicine talk that a non-PA student can take, and you need a break too! I would say it was fundamental to my survival to be able to vent it out with other PA students, so if he hasn’t found a few friends in school I would strongly recommend he start with a study group or something like that.

Let me know if I can help you further!

Posted 1 month ago
Hey! I am a long time reader! I know you have already touched upon the topic of NP/PA, but I wanted to know if you are premed (who is wants to go the mid-level provider level) , with clinical experience, which option is better. I am stuck because I love the autonomy NP have and the respect PA have. What are your thoughts, do you recommend any blogs?
2dream4life asked

I can only speak from my personal experience, but for me going the PA route was shorter, had a more well-rounded experience, and ended up being a really good foundation for me to start in hospital medicine.

Going the NP route means you need to go to nursing school first, work at least few years as a nurse, then apply for NP programs. I don’t know it is elsewhere, but the couple of NP programs I am familiar with were all part-time options, with students taking 3-4 years to graduate and working at least 20 hours per week as an RN during that time. There is currently a movement for all NPs to have a required doctorate-level degree, so this would mean more time in school doing research.

You also choose a specialty right away, Family Med, Adult/Geri, Neonatal, etc.Some of the Adult Med NPs I work with wish they had a more well-rounded experience that included inpatient, psych, or surgical experience like my PA education did. Now, the pros of going this route mean that once you are finally a credentialed practitioner, you have a boatload of experience, likely a really firm understanding of barriers to good patient care, you are a great communicator, and probably have healthcare research experience. Perhaps your pay would reflect this vs a PA without such experience.

I think that the thought of NPs having more autonomy over PAs in reality varies greatly by state and practice. In my current job, there is no difference in my autonomy vs the NPs, only I have to submit an additional form to the state medical board once a year. It is true in some states NPs can practice autonomously, I believe this is mostly in clinic settings. There may be a misconception that because PAs are trained to work in collaboration with a physician that we are tied at the hip, everything must be cosigned, the patient must be seen and examined by both, and that we just act as a helping hand on the sidelines. Now, a few PA jobs are like this, some people might like it as such, but in most situations this is just not true and I feel this would be a total waste of a PA’s education and training. In most settings, PAs see patients independently, make decisions about tests and imaging to order based on their own knowledge and resource consultation, and come up with an impression and plan on their own. It varies by state, but cosignatures are frequently not needed. Actually, the worse case of underutilization and attending physician micromanaging I saw as a student happened to the NPs I worked with on my surgical rotation.

I enjoy the collaboration with my physicians. I never feel like anyone is breathing down my neck or micromanaging things. I like having someone around to consult and bounce ideas off of. I would actually hate practicing autonomously right now as a new grad, there is just so much for me to learn. And really, the learning never stops!

Hopefully I helped you answer your question. There is really no “better route”, it depends on your particular goals and preferences, and even then the end result, your career, will vary highly based on location and the team you work with.

Edit: I forgot about your blogs question. Dr. Cranquis actually made a post about PA blogs here if you want to check it out.

Posted 1 month ago
Hello, I'm currently a second year university student studying philosophy. I'm planning on trying to get into med school in psychiatry. I came upon your blog and read that towards the end of your years as a PA student, you began to have doubts about your career choice as it left you emotionally exhaustedwhile feeling unable to "fix" most of the patients you came across. Thatpost was almost a yearago. Could you tell me how you're doing now and more about how you feel about your career now:) ?Thx
Anonymous asked

Ahh, I am pretty sure you are referencing my psychiatry rotation. God bless you people who are into that!

Psych was very difficult for me but also prepared me well for many things that I didn’t realize until I began my new career as a hospitalist.

Psychiatric diagnoses are hard to make, hard to treat, and often tear apart families and patients’ lives. Now I actually enjoy the garden variety anxiety and depression and pride myself in acknowledging and treating these as very important and real issues. However, when you get into psychoses and especially personality disorders, it just gets murky. Families want answers and you don’t have them. Patients spend their lives shuttled from one facility with an open bed to another, always getting new treatment teams who don’t know them and can’t get their story, alternating between being undertreated and psychotic to overtreated zombies adjusting to new med regimens. This is not something I am comfortable with or get fulfillment from.

I like internal medicine. I like to work things up, make specific diagnoses, give specific answers to patients and families, and generally I am able to treat the underlying issue successfully. In medicine the goal is to make the patient back to 100%. In inpatient psychiatry the goal is to make the patient as functional as possible in society; they will never be 100%.

For all of these reasons, pursuing a full-time career in psychiatry was not for me. It has taught me valuable lessons, however. I work mostly with NPs, and the majority of them did not get clinical experience in psychiatry. As I once did, they have a really hard time avoiding getting caught up in the patient and family drama that often surrounds psych disorders. They have a hard time letting unjust insults and complaints towards them go by the wayside, instead they become exasperated trying to make things better or help the patient understand, when in reality their efforts are not going to be successful because the patient is getting what they really want/need, attention and drama. We have a hard time avoiding getting manipulated sometimes, but my bullshit sensor has gotten more fine-tuned in treating patients with personality disorders or malingering behaviors. I also feel much more comfortable treating anxiety, depression, and chronic pain with something other than SSRIs, benzos, and narcotics. I don’t feel the need to pass off every little psych need to the psychiatry consult service.

While I am much happier in this role as a medicine PA rather than a full-time psych career, don’t let me turn you off to psychiatry either. Lawd knows we need more of you people out there. My preceptor loved what she did, was a very confident and assured lady, worked good hours, and went home at night feeling satisfied with her work, and that could be you too!

Posted 1 month ago
Hello, I love your blog by the way. Everything you post and the questions you ask are all so helpful! I am going to start PA school in a few months. I was wondering if you could share how you went about studying in PA school? I know everyone has a different way of studying and I just wanted to hear how you studied usually on a daily and weekly basis. Did you have time to review? How much of the material did you feel like you actually retained after exams were over?
Anonymous asked

Thanks!

I think I have made a few posts about this already, but as I’m not ready and willing to wade through and tag my things nicely for you I don’t expect you to, either! So here’s a brief not so brief rehash. Because I love to yammer on.

Everyone studies differently. I took what worked for me in undergrad (retyping my handwritten lecture notes/slides, filling in the gaps, printing, then doing the accompanying reading and taking more notes and drawing pictures on the printed outlines) and reinvented it for the fast pace and high volume of PA school. So it became making typed outlines of my lecture slides (which were just powerpoint PDFs that I took notes on with my computer), consulting Drs. Google and Wikipedia to fill in gaps in my outline (seriously), pasting in helpful pictures or diagrams I came across, printing said outlines, and usually just trying to memorize that shit at 2am the night before the exam. If I was really on top of my game I would do some of the “required reading” to solidify concepts, but most of the time I just didn’t have time. (I would say this method worked well for everything except for Anatomy, which I regret not hand-drawing more pictures for.)

Every night after class from 8-5 I would try and work on above said outlines for 2-4 hours or so. I tried to take Friday nights off, but the weekends were 8-12 hour marathons of catching up on my outlines. It was a heavy price to pay, filled with moments of insanity and despair, but in the end it was so worth it because I relied pretty heavily on the electronic PDF I compiled of all those outlines during the clinical year, and even today when working as a PA. No one medical text or pocket reference tells you everything you need or want to know about a topic, and for me it’s helpful to review things in the manner that I learned them rather than searching through a new pocket reference and trying to learn it in a new way/format. It’s amazing how many times someone will tell you to treat or know something one way, and you think you must have been crazy to think it was the other way, then reference your old notes to find out you weren’t crazy and you really did learn it that way!

Oh, and as far as retaining what you learn after exams, some days you will be surprised about what pops in your brain and you remember, and most days you can’t believe how much you don’t remember. BUT things will always come back to you much more easily that when you first learned, so don’t stress about that, it’s normal.

Posted 1 month ago

Umm sorry for the lack of posts… Been too busy furniture shopping cuz I finally CLOSED on my house!!! And yes all of that snow is really disgusting…

Posted 1 month ago
I was hoping to download your "Detailed H&P" document from the Internal Medicine Rotation Resources page, but it doesn't seem to work. Any chance you could fix that? I just started my surgery rotation and would love something like that to use for my H&Ps. Thanks!
Anonymous asked

Oops, sorry about that! Link should be fixed. Here it is again, also. Just a warning, though, in my experience those surgery attendings will freak out if you try and do such a thorough H&P :-O I never had to do a full H&P, but my morning report literally had to be less than 60 seconds or they would cut me off and just rush in and see the patient themselves, so I imagine they would want an H&P with a plan of less than 5 minutes.