Selection Conference / PA School Interviews #2

Yesterday I had the privilege of participating in my school's selection conference for the fifth time.  The first two times I participated as an applicant.  I still remember the first time that I went.  I remember the awe-struck feeling that I had when I walked into that room and saw 40 of my peers milling around.  The awe increased when I realized who my peers were - these were respiratory therapists, paramedics, military medics and corpsman, athletic trainers with 10+ years of experience as the head ATC for a professional sports team...  I remember thinking, "How did I get grouped in with such highly qualified professionals?"  I seem to remember thinking to myself that if these were the type of people who were applying to PA school, how could I consider myself ready when I had the bare minimum of qualifications?  I was excited to be there, honored to be there.  But perhaps not really ready.  There was an undeniable desire to get into the program, to spend years learning alongside intelligent and driven people like these.  There was no question of what I needed to do for my future - I needed to be a PA.

I didn't get accepted that first year, and by the providence of God.  The second interview was much smoother for me - I was less nervous, certainly put a better foot forward, and had the confidence necessary to get the job done.   But again I was awestruck by the quality of my peers.  Again I felt that I paled in comparison to some, but would benefit others with my perseverance and diligence.  It was a great group.  I was honored to be among them, and this time I felt that I had something to bring to the table.  It was an absolutely delightful day.

I got accepted the that year and began my PA school evolution the following year.  As a student I helped out with some administrative details of the interviews and I helped to "sell" the program to the candidates by discussing with them the aspects of the school that I liked most, the things that were hardest but how they could be overcome,   and just how interesting studying to be a PA is.  We had several meetings with the students throughout the day - lunch and a social after the interviews.  Again I was honored to be a part of the process in my small way.  The group, once again, represented an amazing conglomeration of individuals, outstanding experience, and amazing drive.

Last year I was able to participate in the interview process for the fourth time.  But this time I was given the opportunity to help select the next class of students to attend the program.  You can read what I wrote about that last year, here.  The experience was once again remarkably exciting, inspiring, and at the same time humbling.  Again I was struck by the fact that there were some highly qualified applicants who were rejected for one reason or another, but here I was interviewing them as a current student.  How did I get in, and these people were not going to?  Again, the grace of God.  But on top of this, and something I didn't realize until this year, is that now I am part of selected and building the class, and thereby the future of my PA program.  What a great responsibility and privilege.

This year, that responsibility and privilege was more tangible.  As a graduate now I have a new perspective.  First of all, I am so thankful for my PA program - the instructors, the office folks, the student affairs coordinators - these people invested a lot in me and have helped me succeed.  I owe them a lot.  I have always appreciated them, but I didn't see it well as a student because I was in the middle of just trying to survive PA school.  Secondly, I now see that I am part of their history, the school's history.  And now, as a part of the profession that they have worked to protect and build, I feel greatly inclined to continue to be part of their future as well.  The school and the people who make it up are all outstanding, and they have put together one of the top programs in the nation.  From this new perspective on the PA program itself and on the people we select to represent us as future colleagues, I think there may be a place for me among the faculty.  I feel a slight but not subtle calling to try teaching the next round of "kids" that come through our doors.  It is an exciting calling, a humbling calling, and one that I look forward to. 

And yet, I know I still have a lot to learn. 

First birthday

Today is my first birthday as a PA.  Looking back over the last year, a lot has transpired.  You can read the posts if you'd like, but to summarize it I have to say that I feel like somewhat of a different person.  I feel a heavier weight on my shoulders daily, but I bear it gladly and it really doesn't impinge upon life in general.  I still enjoy the things I used to, but to a different extent and I balance enjoyment with responsibility a little better than I used to.  I feel, basically, like I've grown up quite a bit over the past year.  My family can tell me if they believe that...  I guess we'll see.  But it's been a great year and I'm looking forward to what this next one has in store for me. 

Busy month

This past month has been a blur.  So much has transpired that I have difficulty keeping it straight.  I think I saw something like 160 patients last month (though I had well over 200 on my schedule) - this is not a lot for some practices, but I work in a managed care organization so our rate is a little slower.  That said, every patient that we see has 2-3 chronic medical problems - diabetes, hypertension, hyperlipidemia, coronary artery disease, chronic kidney disease/renal failure, congestive heart failure, chronic obstructive pulmonary disease (and still smoking a pack-a-day), you name it - and they are on a host of medications.  So all our visits are just enough time to take care of them thoroughly and stay sane.  I'm seeing almost the same number as my peers - some of whom have been there for 2-3 years, so I feel comfortable with my patient load.  I know it will get higher as time goes on and I change jobs, but it really is perfect for a new graduate.  I have seen some fairly scary things, picked up some odd diagnoses (though nothing spectacular like a pheochromocytoma), and done a few surgeries (minor things like skin biopsies).  It has been humbling, frightening, exhilarating, and challenging.  It is everything I had hoped for in a new career, and it pays the bills.  I am remarkably blessed to have this opportunity and can't wait to see what the future holds.

Comments

I invite anyone who might read my blog to post comments - especially feedback or questions about PAs.  I would be glad to answer anything that you'd like to know including questions about getting into PA school, what the didactic year was like, anything that has remained unanswered about the clinical year, and anything you'd like to know about clinical practice (that I can answer). 

Thanks for reading.

So far, so good.

After 2 weeks on the job, I can gladly report that all is well. 

Last Monday presented me with a unique challenge - I had my first afternoon as the provider assigned to minor care.  Minor care is, essentially, a mini-emergency room.  Most ERs now actually have attached minor care departments - a walk in clinic for everything from lacerations, to acute infections, to traumatic injuries sustained while playing sports (generally stuff that is acute but non-life threatening).  Ours is no different from the ones attached to an ER except that we are a stand-alone facility.  We are at least 20 minutes from the closest ER, thus in our minor care we often have patients walk in with worse problems than your average family practice clinic minor care.  Crushing substernal chest pain (we're worried about heart attack here), inability to breath because of a COPD exacerbation or acute asthma attacks - these are but a few of the potentially life threatening problems we handle at our facility.  We get fractured bones of all types, and there is a rumor that we once had a patient who had sustained a gunshot wound.  We, of course, contact the local ER and stabilize these patient while paramedics are called to transport them to definitive care.  But the process of getting a patient with acute ST segment changes stabilized and ready for transport can be... intense.  I didn't have anyone complaining of chest pain, but my day was still jam packed with patients complaining of acute problems.  The patients came every fifteen minutes, some complex, some simple.  It was a busy day, the adrenaline flowed freely, and in the end everything went as smoothly as my first day in minor care could go. 

The following day was also quite challenging - I had 12 patients on my schedule.  Most were people I'd never seen before, so this requires an added level of attention to detail.  I need to essentially do a complete H&P and complete their chart notes in 30 minutes plus I have to address their chief complaint with a plan and directions for follow-up.  Generally this is a minimum 45 minute process (at least, for me it is).  So I was stacked to the rafters again.  Add to that an hour long surgical procedure in the middle of the day and by the end I was done.  I can't remember the last time I was that tired.  But it felt good to have accomplished so much.

By Wednesday I was only 6 notes behind in my charts.  I had another relatively intense day (for a new provider) in that I had to man the minor care again to see the pediatric patients coming through our doors.  Thankfully it was all straightforward and everyone, to my knowledge, was fixed up appropriately.  I have only had a few of the 75+ patients I've seen so far come back in for care sooner than the scheduled 2-3 weeks - so hopefully this means I'm doing something right.  Thursday came my reprieve. 


I was scheduled for minor care again, but since Thursday is day #4 of minor care, there are generally only a few people who seek treatment.  It was nice, slow, and nothing complex came through so I was actually done with work almost on time. 


Friday was a sweet gift straight from God (all days are, but this one was particularly sweet).  I saw just an average number of patients and all went smoothly.  I had the opportunity to leave by 3:15 (very early, which is almost unheard of).  I picked up two minor care patients - both with complaints in an area that I am very comfortable with - and was done precisely at my scheduled 5:00 leave time.  A marvelous day!


I ended the week completely caught up.  Tomorrow the cycle begins again.  I find myself not exactly looking forward to it, and hoping that it goes better than last Monday.  That said, I am not dreading the proposition and I think that this week will be a good one.  As always, time will tell. 

Calling the shots

This past week has been an incredible week.  A year ago I posted about needing to get used to not knowing all the answers.  In the classroom, I felt confident that I had the right answer most of the time.  A year ago I transitioned into clinical learning, during which I felt confident in my abilities but remarkably uncertain about diagnoses and treatment because someone's physical being was dependent upon, in a small way, what I did - how I performed; whether or not I got the right answer.  Clinical year was difficult because of the uncertainty, but excellent in that I had a safety net - a large and proactive safety net that would essentially reach out and catch me if I stumbled.  My preceptors were there, watching over me, monitoring my decisions and consulting with me actively.  I felt uncertain, but grew comfortable with that uncertainty because that was the name of the game.  Last Monday, the game changed again.  Now, instead of having people looking over my shoulder and actively consulting with me, educating me; I am calling the shots - making the decisions - about how to treat my patients.  My patients.  These are no longer someone else's responsibility, they are my responsibility.  Yes, there are doctors, physician assistants, and nurse practitioners to consult with - and I do (especially for dermatology stuff) - but no longer do they look over my shoulder, review my charts, and guide me along actively.  Now, the safety net exists only if I activate it - if I fall but forget to turn it on, the potential exists for me to fall a long way.  And what hangs in the balance?  People.  My patients.  It is both thrilling and frightening at the same time.

I enjoyed every moment - including the discussions about whether or not to send a patient to the ER for abdominal pain, kicking myself for missing something obvious (and taking solace in the fact that I wasn't the only one), fixing children (see a previous post - but there seems nothing more wholesome than having a child come into my office sick and leave with answers and medicine that has made them feel better), and falling back on my training when certainty about the next step avoided me only to have it reveal solid answers.

I am still intimidated, but having survived my first week in the trenches I feel bolstered about the next one and ready to take on more challenges.  Uncertainty is still there, but it has served me well and I think I will grow comfortable with a little bit of uncertainty in my life - as long as I use it to the benefit of the patients for whom I am now responsible.  

Day #1

Rest assured - I won't be doing a post-a-day about my experiences as a PA in a family practice clinic.  But the first day was one that I will always remember - some good things, some bad things. 

It was far from perfect, but always comical - the very first patient of the day needed a procedure.  The procedure was one I know how to do and have performed several times.  I got all ready to do it - pulled all my sterile instruments, laid them on a tray.  Prepped the patient including an injection and then I realized that the equipment I had available was not correct.  Not only that, we didn't have the correct equipment for the procedure I wanted to do.  So he needed  a different procedure at a different time.  That was frustrating. 

I also made a patient cry on my first day.  It was completely inadvertent - but when I explained all the possible etiologies of her condition, it was a little much to take in.  I was quick to explain that every one was treatable, there was nothing to worry about, but we needed to find out the right cause so we could help her.  That softened the situation a little. 

And of course there was the patient who comes in for one thing, but, "Oh, by the way...."  and the problems keep on coming. 

It was a good first day...  typical.  I loved it.

Brief Update

On 29 September I woke at 0700 to my alarm blaring.  This being the first Thursday after I had taken my boards, only one thing was on my mind: my scores. 

I rubbed a little sleep from my eyes, then immediately picked up my iPhone (the first time I have ever been truly thankful to have this little gem that allows me to use an internet browser almost anywhere, any time) and looked up my board score. 

To my utter elation, I passed.  I lay there in bed contemplating that thought....  I passed.  I passed!  I PASSED!!  I don't know that, aside from my wedding day or the births of my two children, I have ever been as happy as I was that Thursday morning.  (Yes, these four events are comparable in the amount of happy that they made me.)

I am now  Physician Assistant, Certified.  It is among the most incredible feelings in the world.

And tomorrow morning, bright and early, I begin my practice of medicine. 

The oddest thing - in two words I can sum up how I feel today: scared stiff. 

Tension

As life has slowed significantly, I have directed my focus into 1 of 3 activities -

1. Spending time with my family.
2. Studying for my board exams.
3. Putting in my share of the work on our local ambulance company.

The only one of these three that has been at all stressful has been #2, otherwise life has returned to what we would consider normal.  However, #2 has produced within me a significant amount of tension.  I try not to presume that I will pass on my first attempt, thus allowing me to have a good work ethic.  But the more I remind myself that it's possible for me to fail, the more I feel I need to stress about studying and preparing.  On top of this, I'll score 80% or better on a practice test one day, then the next day I will score a meager 65% (sometimes lower).  The latter days are very stress producing.  All this serves to throw more uncertainty onto my perception of how I rank amongst my colleagues and whether or not I will pass on my first attempt.  I add into the mix the fact that my employer is expecting that I will pass (and will be less-than-happy if I don't) and it goes up a notch. 

All this to say that, though I've dealt with an inordinate amount of stress over the past 2.5 years without a hiccup, the final hurdle is causing me a little bit of heart-burn.  I am trying to avoid worrying, doing my diligence by studying, and trusting that God has got me right where He wants me.  I try to be reminded often that He got me into school, He helped me pass every test, He carried me through clinical year, and now, because of Him, I've graduated.  If I were to fail, it would have happened long ago.  So my hope is that this final hurdle will pass without difficulty.  I'm scheduled to take the exam on 23 Sept, at 1100 hours.  I think it will be a good day. 

But in the meantime - I'm thoroughly enjoying having some extra time to take EMS calls with the wonderful crew of our volunteer ambulance agency. 

Graduation!

Yesterday I graduated.  It was awesome and awe inspiring.  I, along with 18 other outstanding individuals, received the certificate that will allow us to practice medicine.  I am humbled to be in this group.  Our school has graduated almost 1500 PAs over its history and I am honored to be in this group. 

I also received an award for exemplifying the spirit of our school.  Our founder had a vision for the PA profession - namely participation in rural communities, improvement of access to the underserved, and commitment to excellence in medicine.  On top of that, the school has made a commitment to the success of their students.  To be very frank, I had no hopes of special awards and didn't purposefully alter any behaviors to achieve any.  But my goal all along has been to be of service and support to my classmates, to maintain a positive attitude throughout all of the challenges we've faced, and, ultimately, to glorify God as Christians are called to do.  I give Him all the credit for any achievements or excellence that I obtained over the past couple of years. 

The past 2.5 years have been a wild ride.  In reflection I went from someone who thought he knew a lot to someone who realizes, at least to a certain extent, just how little I really understand about science and the human body.  There is a lot I have to learn and now I have been given the magical piece of paper that says I'm allowed to.  Very exciting times.