The Answers to All Your Questions

     I'll admit right away that this post will not answer every question you've ever had. In fact, it might just answer a bunch of questions you've never had, but hopefully it should at least clear up some of the confusion about what PAs are and what I'll be doing very soon. I've actually had quite a bit of experience answering such questions already. Almost every school I applied to asked me, either in an essay or in an interview, to explain what a Physician Assistant is, and most asked me to explain the profession as if I was talking to a friend or family member who had never even heard of a PA before. That was decently easy for me since that I have had to do just that over and over since I decided to pursue a career as a PA. There's still a lot of confusion though, amongst friends and the world in general, so I thought I'd take a moment to explain a bit about what Physician Assistants are and what they do. I'm also going to explain a bit of what's in store for me as I begin PA school this fall. First though, a little history.

History of the PA Profession

Dr. Charles L. Hudson

     Many people don't realize that Physician Assistants have been around for almost half a century already. The idea for the PA profession is credited to a physician, Dr. Charles L. Hudson, who in 1961 proposed “an advanced medical assistant with special training, intermediate between that of the technician and that of the doctor, who could not only handle many technical procedures, but could also take some degree of medical responsibility.” Dr. Hudson recognized, as did many at the time, that there would soon be a shortage of general practitioners in the US and he thought that the sort of medical assistant he described could help solve this problem. Another physician, Dr. Eugene A. Stead Jr., realized that the US already had men with intermediate medical training thanks to Korean War and the necessity of training soldiers to act as medics on the battlefield. He thus assembled a few former Navy medical corpsmen to create his first class for a new "physician assistant" program.  This first PA program began at Duke University in 1965, the same year that the first Nurse Practitioner program began at the University of Colorado, and the first PAs graduated in 1967. In 1971 the American Medical Association officially recognized the profession and created guidelines for practice and program accreditation. 

Dr. Eugene A. Stead Jr.

     The program has grown and expanded since its early days. Today there are at least 150 PA programs in the US and approximately 100,000 practicing PAs. PAs have prescriptive authority in all 50 states, which means that they can prescribe medications to their patients. The scope of practice for PAs, as I will describe in a moment, has also expanded. This has led some people to suggest a change of name for the profession. Many people mistakenly refer to PAs as "Physician's Assistants" which gives the impression that the PAs belong to, or merely assist, physicians who control their actions. As this is simply not the case some people have suggested that the title be changed to "Physician Associate." This is actually the title that Yale University already uses for their PA program. Whether or not this will change someday in the future is yet to be seen, but for now the standard title is Physician Assistant. Also, while the program began in the US, it is spreading to other countries, particularly ones that are experiencing a similar shortage of primary care providers.

So What Exactly Does a PA Do?

     One of my regular customers at the coffee shop recently told me that I'd picked an excellent career choice. I heartily agreed until he finished his thought by cheerily saying, "after all, physicians will always need assistants. So will you be taking blood pressures and things like that?" This just demonstrates the confusion prevalent amongst Americans about what a PA does. Hopefully I can clear some of this confusion up. The shortest, and probably least helpful description is that a PA is like a doctor, but not. Let me expand that. 
      PAs are healthcare providers who work in a team with doctors to provide care for their patients. They must have a doctor on their license to practice, and thus they are under the doctor's supervision. However, this does not mean that the doctor is standing over the PA's shoulder and observing everything they do or telling them how to treat the patients; i.e. "supervision" does not necessarily require the doctor's presence. In fact, the doctor may not even be in same office as the PA, let alone the same city. This means that PAs exercise a great deal of autonomy within the doctor/PA team. PAs have their own patients whom they interview, diagnose, counsel and treat. PAs can order and interpret diagnostic tests, as well as prescribe medications. A PA is truly centered on patient care, so they tend to spend a bit more time with their patients than a doctor would, and they also place emphasis on patient education and preventative care. PAs can be found not only in primary care positions, but also specialty care, like surgery. PAs can also be found in any healthcare setting, whether it be a multi-specialty practice group, hospital, large institution or rural clinic.
     PAs are required, like most medical professionals, to maintain a certain number of Continuing Medical Education (CME) hours (100 hours per 2 years for PAs). This is can be fulfilled by reading medical journals or attending lectures, but there are many options. Furthermore, PAs and NPs must both take a recertification exam every 5-6 years to maintain their certification. Some people think this is unfair because many physicians are not required to maintain their board certification, but there are many PAs who like it because they think it forces them to keep on top of medical news and continually hone their skills. Besides, so long as you are still practicing and using your skills, the recertification exam should not be ridiculously difficult.

     If it helps, here's a rather cheesy little video of the frustration most PAs, or even future PAs, go through trying to explain what a Physician Assistant does: Physician Assistant -A Conversation We've All Had.

Back in my Senior Tech days

Why PA and Not MD?

     Another question I was asked at every interview is why I decided to pursue a career as a PA and not a doctor. The answer is probably different for each PA, and I personally have multiple reasons. The shortest answer is that I think it's a better fit for my personality. The longer story is that being a PA appeals to me because of the team aspect and greater amounts of patient interaction. During my undergrad, I worked as a Media Technician, which meant that my coworkers and I took care of any and all technical aspects of events at school. This could be as simple as setting up a mic for a lecture, to controlling the lights, music, projection and recording at the annual talent show (If you're interested what this looked like you can check out some Golden Videos: Closing Dance 2011 or Sophomore Stage Act 2012). During my senior year, I was promoted to Senior Tech which meant that, for the completely student-run events, like Gordon Globes and Golden Goose, it was just my fellow Senior Techs and I calling the shots. I was actually the only Senior Tech at Globes, which my parents were able to see. While I enjoying running those shows, and I believe I did a pretty good job, I liked the fact that my bosses were only a phone call away if I ran into serious issues. Most of the time my coworkers and I could figure out the problem on our own, but it was nice to have a lifeline. Similarly, as a PA there will be a doctor on my license who will always be able to help me think through issues and come up with solutions whenever I cannot figure them out on my own. This system encourages a real spirit of teamwork and cooperation, and many PAs often find that doctors ask them questions as well. In the end, the patients benefit the most because they have healthcare providers humble enough to ask for help when they need it, and they get the experience of multiple people working on their case. 
     PAs also tend to spend more time with patients, and less time on paperwork, than doctors do. Since the time with the patients is one of the aspects I value the most, becoming a PA certainly seems like a better option. Another bonus is that, frankly, as a PA, I will be able to do many of the same things that a doctor can, but I will require only 2 1/2 years of schooling, saving me both time and money. In fact, a recent study my undergrad advisor just heard said that female PAs tend to have higher lifetime earnings than their physician counterparts. The reasons aren't completely clear, but the current hypothesis is that female doctors start working later and spend more time paying off school loans so that, even though their salary may be bigger than a PA's, they make less in the long-term. I'm not sure why this is not true for men as well (probably something with women taking time off to have kids), but it's an interesting tidbit. 

So What's Up for Me Next?

A bit of my future home at night

     This August I will be moving to Boston to begin the PA program at MCPHS University. This is a Master's program so I will be graduating with a Masters in Physician Assistant studies. The entire program at MCPHS is 30 months. This is a bit longer than most other PA programs, which are generally 24 months, but MCPHS includes one 4-month break after the first year (which many students use to work and earn money since working while attending PA school is highly discouraged, if not forbidden, by most programs). Aside from this break and some holidays, I will be in school year-round for 2 1/2 years. PA programs are largely set up to be a sort of rapid version of med school, so the first half is always didactic (the classroom, book, and lab learning) and the last half (about 11 months, beginning summer 2015 for me) are the clinical rotations (known at MCPHS as "clerkships"). Each student in a PA program must complete certain rotations (including pediatrics, internal medicine, surgery, emergency medicine, psychiatry, women's health, etc.), but most programs include room for at least one elective rotation. At MCPHS I will be able to do one elective rotation, and there's a possibility that I could do it out of the country in either Brazil or Germany, which is quite exciting. After completing the program I will need to take the Physician Assistant National Certifying Examination (PANCE). Once I pass I will be a Physician Assistant-Certified or PA-C. Then I just need to get a state license to begin practicing.  

     So there's the PA profession, and the next few years of my life, in short. I hope you're all enjoying this journey as much as I am and I look forward to experiencing and writing about the next steps.  

Much of the information I used for this post comes from these sites:

• http://www.aapa.org/uploadedFiles/content/Common/Files/1-Milestones0610Final.pdf 
• http://www.aapa.org/the_pa_profession/history.aspx 
• http://www.aanp.org/all-about-nps/historical-timeline 
• http://medicine.yale.edu/pa/profession/index.aspx
• http://www.paeaonline.org/index.php?ht=d/sp/i/197/pid/197
• http://www.aapa.org/the_pa_profession/what_is_a_pa.aspx
• http://www.pac.ca.gov/forms_pubs/what_is.shtml 
• http://www.aanpcert.org/ptistore/control/recert/index 
• http://www.fiercehealthcare.com/press-releases/certification-matters-most-americans-want-their-doctors-participate-lifelon
• http://www.ucdenver.edu/academics/colleges/medicalschool/education/degree_programs/PAProgram/prospectivestudent/Pages/WhatisaPhysicianAssistant.aspx

Interview Travels -Moving Pictures Style

     I may have lied in my last post when I said that the next post would be about what a PA is. Instead I have a video surprise! I brought my camera along with me when I went to Idaho, California and Massachusetts for interviews, and I decided to film along the way. The result is a short video that may have very little with my actual PA journey, but was still fun to put together. I hope you find it enjoyable and normal blog posts will return soon.

     For those who are interested, these are the songs featured in the video as well as the websites for each of the artists. Check them out and support these artists.

• "Ocean (2012)" by John Butler
• "Flight" by Ian McIntosh
• Piano Cover of Imogen Heap's Song "Wait It Out" by Katherine Cordova

      If you enjoyed this video, or if you want to see more of the city I'll soon be calling home, you should check this out: The Boston Song (So Good). Some students at Berklee College of Music decided that Boston needed an anthem of its own, so they wrote, performed and produced such an anthem (after researching not just what's important to Bostonians, but the city's musical history as well), and then created a music video to go with it. I think it's pretty awesome. And catchy. 

Blessings and Joy Heaped Beyond Measure

     It has been very difficult these last few weeks to keep silent about my interviews and hearing back from PA programs. It's a great relief to finally talk about how they went and what's happening in the future. The short story is that I'm starting PA school this year!! Here's the longer story: 

Just beyond Deadman Pass

     My first interview was at Idaho State University, which has two different campuses for its PA program. My interview was supposed to take place in Pocatello, the main campus in southeastern Idaho. The day before the interview my mother and I drove to Boise, arriving safely despite the snow we encountered while crossing the Blue Mountains (which was the heaviest as we passed through the alarmingly named "Deadman Pass"). That night we heard repeated warnings about road closures and accidents due to the snow. My interview wasn't until 2 pm, but we planned to leave early the next morning so we'd have plenty of buffer time for bad weather. We never left. 

Driving back through the Elkhorn Mountains

     During breakfast I received a call saying the Pocatello campus was closed due to the weather and road conditions (the first time in years that this had happened). However, they were willing to open the campus for the interviews since most of the applicants were from out of town. When ISU learned where I was they suggested a safer alternative to driving hours through hazardous roads: I could simply go to their Meridian campus just outside of Boise and conduct my interviews via video conferencing. I'll admit that it felt a little weird to do an interview with someone via video but it worked quite well, and it really was the best choice. Everyone at ISU was very friendly and made me feel quite comfortable. 

It was a bit cold in Baker City.

     Once the interview was over my mom and I were able to begin our journey back home. That night we stopped in historic Baker City to get well rested before finishing the last 5 hours of the 8 hour drive and to celebrate my first interview. We soon had added reason to celebrate. ISU uses a system for their PA program that allows them to give almost immediate feedback on an applicant's acceptance status. Applicants are given a score based on a few pieces, the interview being the last one, and applicants with a certain score or higher are automatically offered a seat in the program. Everyone else is considered "in review" until interviews are completed, though they can ask the school at any time where they are in the rankings. Shortly after arriving at our hotel for the night, I received an email saying that my status had been updated. I went to the site to check it, fully expecting to see that I was "in review" and was absolutely floored to see this: 

There was great celebrating in Baker City that night. And tears. And excitement. And laughs of disbelief. The celebration did not end that night. I came home the next day to find this: 

My dad was very proud of his decorations. 

     A few days later I left home again, this time on an airplane to southern California for an interview at Western University of Health Sciences. While I flew down alone, I was again blessed to go to this interview with family. My dad's sister's family lives just north of LA I was lucky enough to spend almost two whole days with my aunt and uncle. I don't get to see them nearly enough so it was a real treat. My aunt was amazing and even drove me to my interview, which was quite an act of love considering check-in was at 7:30 am and Pomona is about 2 hours from my aunt and uncle's house. It was a very early morning, but we made it, and even had time to stop for breakfast along the way. 

Another testament to my aunt's love for me.

     I'll admit that I hadn't been sure how I'd felt about Western before I arrived. Talking with an alumna, as well as my own research of the program, had made me feel that perhaps Western was not a good match for me. Being there definitely improved my opinion. I still felt that perhaps I was better suited for ISU, due in part that I still have the native Oregonian's dislike of California and find the constant heat and sunshine unnatural, but the people at Western were quite nice and helpful. They even included tips on financial aid that were applicable for any PA program. The interviews were also over quickly, which meant that my aunt and I got to have a little fun at Disneyland before meeting up with my uncle for my last night there. No matter how I may feel about year-round warmth and lack of seasons, I have to say that it was nice to wear sandals and actually feel heat from the sun again. I needed that extra warmth because just three days after returning home from California I boarded another flight, this time to Massachusetts, my home for my undergrad years. 

Boston Public Gardens at night

     My trip to Massachusetts was a bit of a mini-vacation, something I certainly needed after the recent craziness of work, EMT classes, and interviews. I was able to spend a week just catching up and hanging out with friends, including my professors and bosses from college, as well as just generally relaxing, preparing for my final interview, and getting caught up on work. Finally, the day arrived. The night before my interview at Massachusetts College of Pharmacy and Health Sciences University (a ridiculously long name, I know) I'd headed into Boston to stay with a friend there so I wouldn't have far to go in the morning. My friend lived conveniently close to a T stop so all I had to do was hop on and ride to the Longwood Medical Area. 

     I'd had a feeling before I even made it to the interview that MCPHS was my top choice school. For anyone who read the post about my "belated birthday present," MCPHS is the school to which I was referring. Still, there was always the possibility that I would get there and something would radically change my mind. One question I was very curious about was how MCPHS did their anatomy labs. One of the alumna from Western University had informed me that the PA students there had a lab to go along with their anatomy class, but they didn't actually do the dissections; the medical students did and they just watched. I then asked an alumna from ISU about their anatomy classes and found out they don't even have labs, basing this policy on the fact that a PA cannot simply open up their patients to look inside them and figure out what's wrong. I sort of understand that, but at the same time, surgery is a required clinical rotation, and I just think it is very important to have an excellent understanding of the internal anatomy of a human person if you are going to correctly diagnose and treat them. Before I could even ask someone about the labs at MCPHS, a faculty member answered my question: they didn't have enough room on their facilities for an anatomy lab, so instead they purchase cadavers for the PA students and then have them walk across the street to use the anatomy lab at Harvard School of Medicine... which is just awesome. It's pretty much one of the best setups I could imagine.  

The Longwood Medical Area with MCPHS highlighted

      As I mentioned earlier, MCPHS is in the Longwood Medical Area, pictured above. For those of you who don't know, this area is one of the most highly concentrated areas of medical learning, research and practice in the country. I already mentioned that the Harvard Medical School is across the street, but just a block or so in other directions there are Simmons College and Emmanuel College, to name a few of the other colleges in the area. Northeastern University is a bit further down and MIT is just across the Charles River. When it comes to hospitals and medical research centers, the Longwood Medical Area is also home to some of the best. Brigham and Women's Hospital is just two blocks away, Dana-Farber is next to that, and the Joslin Diabetes Center is next to that. If you want to know all the universities, hospitals and research centers in the area, just look at the Wikipedia page. What I'm saying, in short, is that MCPHS has one of the best locations of any of the PA programs in the country, and it's really rather exciting. This is just another reason why I wanted to attend MCPHS, and why I really wanted to make a good impression at my interviews. 

     This post has already become rather long, so I'm going to try to wrap it up quickly. Here's the dealio: the interview day (applicants were given an overview of the program, a lecture, a timed written essay, lunch, time with members of the student association, and a tour before the actual interviews) went really well. I felt super comfortable and I left the campus thinking that I truly wanted to be accepted to this program. I flew home though thinking that I would have to wait a whole month before I heard anything. It was an amazing surprise when I arrived home early from work two Saturdays ago and saw the lovely letter to the right waiting for me. I could barely make it into the house because I was basically bawling my eyes out with tears of joy. It still seems hard to believe. I feel so incredibly blessed. Not only am I going to be starting PA school this fall, something I'd been sure would probably not be for another year, but I get to go to my first choice school. I look forward to where God will lead these next three years. It's quite an adventure I'm starting and I want to thank all the friends and family who have supported me the whole way. THANK YOU SO MUCH!!

Coming Soon: There seems to be a lot of confusion about what a PA is and what they do, so I'll be clearing that up in my next post. :)

The Waiting Game

Mt. St. Helens, Mt. Rainier, and Mt. Adams from the flight home.

     Now comes one of my least favorite parts of applying to PA schools: the waiting. The crazy month of interviews is over and now things are out of my hands. There is nothing left for me to do but wait. Well, wait and work that is. My boss was nice enough to let me take off half the month of January in order to travel to my interviews so now I'm definitely going to be making up for all that time off by working much more than usual. I'm certainly not complaining though. From everything I've heard, PA schools are very intense and most schools actually forbid their students from working while they're in the program, so I have no problem with working a lot now so I can completely focus on school later. Now the big question is: which school will it be? The schools at which I interviewed all have different time schedules for when they make their final decisions, so I will be hearing from them at various times. The latest I should hear back would be late March, but most of the schools said they'd get back to me by the end of this month. Until then, I'm going to enjoy my time at home and try to be patient.

Brrr... It's Cold Outside

This was my life just 1 1/2 weeks ago.

My life this week.

     The time has finally arrived for my final interview. These last few weeks have been fun, but I have to admit that it will be nice to be at home for more than three days at a time again. It'll also be nice to have to deal with just one temperature range again. I've gone from 12F in Idaho to 75F in California, and now I'm facing 22F plus windchill in Massachusetts. I'd forgotten just how quickly wind can turn your face into ice. At least all the places I've visited have been quite sunny. I don't often get to see the sun in the winter in Oregon, so it's nice to see a bit more of it, even if it's a bit too cold to stay outside long. 

     Despite all the crazy weather and the stress of interviewing, I've been pretty good about making these trips for interviews into mini-vacations. After my interview in Idaho I was able to stay in an old, historic hotel with my mom, and when I went down to California I not only got to stay with my wonderful aunt and uncle, but I also got to go to Disneyland. Considering how nerve-wracking interviews can be, I think an afternoon of fun was the perfect way to de-stress. My last interview is in Massachusetts, and there is no Disneyland there. However, I might have something even better. I did my undergraduate studies in Massachusetts, so many of my friends are still in New England, and coming back here for an interview means it's reunion time. I've been here since last Wednesday night and it's been just wonderful. Sure there's no roller coasters or people dressed as cartoon characters, but I think ice-skating, cannolis, trips to the beach (wind and all), chats over coffee, and good times just hanging out with good people may trump the happiest place on earth. No matter how my interview on Thursday goes, this trip was definitely worth it. 

All bundled up and ready for ice-skating.

Hello Sunshine!

     Tomorrow I leave for my second interview. This one is down in California, and it looks like the recent "cold snap" (the people in LA just kill me with their inability to cope with temperatures below 50F https://www.youtube.com/watch?v=_6t-EjrtD3U) has come to an end. I think I'm actually going to have to bring shorts for after my interview. Such craziness. Of course, when you consider the perpetual fog and rain that are so characteristic of winters in western Oregon, I think a bit of sun and warmth will be quite nice. 

 

 So I'll be going from this:

To this:

I'm So Legit

     Today I arrived home from my first PA school interview to find this lovely letter and patch (as well as a very nice certificate) waiting for me. It was an excellent surprise, especially after some long days of driving. If I so desire, I can now apply for a job as an EMT in Oregon. At the very least I actually feel legitimate now. My fellow baristas at the coffee shop where I work have also greatly enjoyed this news. They claim that they feel much safer now, though I'm not sure there's a great amount of danger in a coffee shop, aside from hot water burns and slipping on wet floors. The last, and only, time I was asked to consult on a medical issue at work was when someone got glass in their eye while changing a light bulb. Hardly a medical emergency, but still, I think it's fun. :)