Getting In: Direct Patient Care

     In my last "Getting In" post I wrote about the courses required for admission to PA programs. Today I'm going to tackle another requirement: medical experience. I was actually torn over which topic to post about first because both are things you should start thinking about early. Like course prerequisites, the required medical experience differs from program to program. It differs not only in how much is required, but also in what kind of experience fills the requirement. Some very rare school require no prior experience at all, whereas others require 3000 hours of direct patient care, preferably paid. Some schools will accept shadowing hours, some will not, and some will actually require shadowing. Often the schools that require shadowing are those that require less direct patient care. The difference often seems to be regional. Schools on the West Coast, where there's only a few options (just two in Oregon and only one in Washington) tend to have much higher requirements and are also stricter about what they accept. Schools on the East Coast and in the Midwest, on the other hand, tend to require fewer hours. Many are even moving away from medical experience requirements because the evidence doesn't necessarily indicate that PA students with greater prior experience do better in the end. The median requirement tends to be about 500-1000 hours, and direct patient care is recommended or required for these hours. 

     So what counts as direct patient care? Essentially the term means sort of what it sounds like: you have to be directly involved in the patient's care. Some schools call it hands on care and the ability to have physical contact with the patients you see if a good indicator whether or not your medical experience will be accepted. Another good way of judging whether certain medical experience will count or not is to ask if your actions, decisions, or input will have an impact on the patient's care. A technician in Radiography may not have a great deal of physical contact with a patient, but their knowledge will directly affect how the patient is treated and thus can count as direct patient care. Tufts provides this helpful list for prospective PA students to help them determine what experience will count: 

     Not all direct patient care experience is created equal. The University of Florida's PA program warns prospective students "Patient care experience in settings such as nursing homes and private homes utilizing the services of home health aides, offer limited exposure to a wide range of patients and providers and are therefore not as favorably regarded by the Admissions Committee as settings such as hospitals, clinics, and physicians’ private practices." This one of the first times I've actually seen a school state this opinion outright, but UF is certainly not alone. I've heard this thought expressed before from members of another program's admissions board, so it is something of which to be aware. CNAs are excellent and necessary members of the healthcare field, and becoming one is often a popular option for people hoping to gain medical experience, but as CNAs are primarily employed in places like nursing homes it might not be the best choice for those hoping to use this experience to later apply to PA programs.
     You may have noticed that some of the suggestions for gaining medical experience to start a PA career are careers in and of themselves. Most require at least some schooling, and some require a few years. This is part of why becoming a PA can be such an excellent choice for people who worked as a paramedic, exercise physiologist, or respiratory therapist who decided later that they wanted to go further in the healthcare field. However, this is also why it can be so difficult to apply to PA school straight out of undergrad. Personally, I chose to go on a medical missions trip and then do an accelerated EMT course, as well as a bit of shadowing, to get the experience I needed. I loved it all and only wish that I had done my EMT program earlier.

     Medical mission trips may be one the best ways to gain the necessary experience for students in or after their undergrad programs. For one thing, they are typically in rural, poverty-stricken areas that so desperately need any and all medical help, so medical mission trips are a great way to help out around the world. For another thing, you can often get a great amount of experience in a short amount of time. Depending on the trip you may have a set schedule, or the amount of work you do could be entirely up to you. If you're motivated enough to work, you can usually gain a lot of hours and do some pretty awesome things. Most medical mission trips take place outside of the US, so the opportunities to learn and perform a variety of medical tasks are often much more available. All this to say, if you are looking for an interesting, fast, and rewarding way of gaining medical experience, I would recommend some sort of medical trip. 

     I wish I could recommend a particular program or place to go on a medical missions trip, but sadly I cannot. My own experience is limited to my trip to Kenya with Medics to Africa (described in the first posts of this blog), and it seems that a variety of problems have arisen with that program since I went there. The most recent, and most serious, problem involved three students being held hostage at the hotel in Migori because the hotel claimed that the program director had not paid the bills. The students did eventually escape, the program director was temporarily arrested, and it appears that the problem was partly due to the hotel owner breaking some agreements, but it still seems like there is much work to do to redeem the honor of the program. The story from the perspective of one of the students can be found here. 
     My next post will cover two other types of medical experience: shadowing and volunteering. Both are wonderful options, but may not be viewed as favorably by PA schools as direct patient care, which is why I did not include them in this post.