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  1. Sounds like these were some sick patients and who knows what would have happened if you acted sooner. You'll exhaust yourself focusing on the "what if's". I did that for years. Also sounds like you are given a lot of responsibility in a small rural community hospital to be covering the ICU by yourself with phone back up with only 1.5 years of experience. That's a tough job from an experience standpoint alone. All you can do is learn from the experiences and how you feel now. Look towards the future and think about what you could do better. The first 3-5 years of being a PA are the hardest and most dangerous because you don't know what you don't know but you are starting to build confidence about your medical reasoning and feel bad about asking questions sometimes. Fortunately or unfortunately, you graduate PA school and don't have a mandatory training regimen for a couple of years so you just learn on the fly at the mercy of others. The real world doesn't care as much about teaching you as it does about the bottom dollar. If you're motivated to minimize situations like these, you need to read as much as you can about the ICU care of patients and find a good mentor to bounce ideas off of. Also, never hesitate to call the attending on call - they're getting paid a lot more than you to answer that phone. Consider a one year residency which would put you light years ahead of your peers if that is a possibility. I think we all have bad outcomes sometimes and wish we would have handled things better at one point or another. Don't let it keep you up at night. You'll wonder about it but eventually you'll accept that it is what it is. Success should be measured in how well we overcome failure and improve not how many times we did something smoothly or perfectly.
  2. Something similar happened to me years ago. I was told that I would be rounding on weekends and taking first call for minor problems after I worked with the practice for a little while even though when I interviewed I was told I would not. Very frustrating since I had asked before I signed that those details be included in my written agreement (no contracts for us). I was denied the opportunity for such details to be included in my agreement and the hospital certainly didn't care when I expressed my frustrations and asked for more compensation. There was really nothing I could do but change jobs to remedy the matter which is a frustrating situation to be in... Unfortunately, the business of medicine takes advantage of the altruistic nature of most providers.
  3. Safe to say that the first two years will consume the vast majority of your time. I studied for 3-5 hours per week day (in addition to the class requirements mentioned above) and 8-12 hours per weekend day. Overall, I took the first two years pretty seriously and would equate it to a 50-70 hour a week job depending on the week with very few days off. Don't think I every took a full day completely free of academic activity off. Being a PA helps but it's not a cake walk since there is increased emphasis on science stuff that was probably glossed over in PA school. Third year can be as difficult as you like since APAP students set up their own rotations but that may be changing. Would not expect much free time to spend with spouse/kids during the three years. Don't have a family but I definitely didn't have time to take a vacation or make special trips to do things.
  4. Yep! Matched into anesthesiology at my first choice residency!
  5. Also a LECOM Erie APAP-er in my 3rd year. Agree with everything above. 1st two years are basically the same as everyone else in your class. You're treated as one of the pack. The third year, the last year, is all basically core rotations with only one elective. I did rotations between 1st and 2nd year and haven't heard that that was changing but I'm also on my way out the door! Any questions, let me know!
  6. @Ohiovolffemtp and @SedRate gave excellent advice and I agree with what they have said, especially the bullet point list @Ohiovolffemtp did! Just as a little background, I graduated from PA school then went into practice in cardiothoracic and vascular surgery for a few years. During that time I would moonlight in the ED on weekends before I enrolled in LECOM's APAP program (PA to DO in 3 years instead of 4). I am now in my last year of med school and graduate in May. Heading off to a residency in Anesthesiology in July. The decision to do PA vs MD/DO is one that I thought about for probably 8 or 9 years before finally starting my first day of medical school. Some of the reasons I went the PA route initially was because I thought it was the fast track to medicine with a high level of respect and autonomy early on, the quality of life would be better, and I would be be able to make similar money because I wouldn't have all the debt of medical school plus I would be able to take advantage of an extra 7 or so years of compound interest from investing. Turns out, the fast track to medicine comes with some pitfalls. The PA's I saw while shadowing before going to PA school were the best of the best who had been doing it for at least a decade. They knew how to manage vents, put in central/arterial lines, take vein/radial pretty quickly, could close the chest without the surgeon in the room, manage patients in the ICU, etc. Looking back, I was thinking I was just going to do all that cool stuff with one or two years of on-the-job training after I graduate while getting paid twice that of a resident. Nope. Turns out there isn't much incentive to teach you that kind of stuff at most places, even at the community hospital I worked at which was constantly short on staff. There was already a PA to do that stuff, so we can teach you at a leisurely pace over 10 years! Plus, the respect that the other staff (physicians, nurses, RT, etc) have for you comes with working with them and being good at what you do over a long period of time. You don't just walk on the floor after you graduate and have swoons from everyone around you just because you have graduated from PA school. You have to earn it from being good at what you do. So what happened to that fast track with loads of respect from colleagues? Takes at least 5 years when you could be finishing medical school and residency in the meantime. Next was the quality of life. "PA's work less hours than docs and have less responsibility!" At least where I worked, every PA I worked with and talked to was working the same or more hours than the physicians. The PA would pre-round, then go around with the doc (a handshake and review of the plan), then the doc would leave and the PA would do all the notes and orders. So the PA might pre-round for an hour or two on 10 patients, the doc would round with the PA for 30-40min (sometimes less) on those same 10 patients, then the PA would do notes and orders for another hour after the doc left. Who was rounding longer and needed to wait to get home to their family with less control over their schedule? The PA. Same with surgery. The PA consents the patient in the PACU and sees if there are any issues, gets the patient into the OR, updates the surgical H&P, maybe puts a few preliminary orders in, helps set up, (in my case) starts the vein harvest, then the doc comes in. The PA first assists during the surgery (still can be fun) but the doc will leave to talk to the family while the PA closes. The doc usually goes to relax in the break room or round with one of the other PA's on the floor while the PA in the OR transports the patient back to PACU or ICU and pre-ops the next patient. Rinse and repeat. Who was in the OR longer and did more of the paperwork and grunt work? The PA. Granted, the doc does the surgical note so that's paperwork too. In regards to responsibility, yes, the doc is ultimately responsible but you are still at risk for what the doc chooses to do. Operate on a risky patient that you think is unnecessary? You don't get a say. Unhappy with how a surgery was performed? Doesn't matter. Your name is still tied to the case. Again, you'll probably not get sued or have severe repercussions for those examples but it sure would be frustrating to go to court over something you knew was dumb to begin with. Also, remember, if the hospital administration has to pick between who to fire, the PA or the doc? They will try to pick the PA as they are much easier to replace and don't have as much of an ability to fight back thus the physician profession is more stable. Furthermore on quality of life, at least where I was in one of the most saturated parts of the country for PA's, the family medicine residents at the hospital got more vacation and CME money compared to the PA's. They also worked less hours than the CT surgery PA's! The surgeons I worked with were making at least 4x what I was (25% of their salary) with 9 more years of training but 8 weeks of vacation versus my 2 weeks as a first year PA and the 4 weeks of our senior PA who had been there for 20 years or so. The hospitalist PA's were getting paid about $100k with a patient load of 15-20 while the docs would not see any patients by themselves and get paid north of $250k. Who rounded on the weekends, holidays, and took first call except for emergencies? The PA. Obviously, the road is much longer for the doc and the benefits as a PA are pretty good compared to your average American job. But if you're smart, young, don't have a family to tie you down, don't plan on practicing part time until you are at least in your fifties, and are motivated enough to do some sort of specialty, the quality of life increases dramatically for just a few extra years of your youth. In regards to the financial incentives, the Medscape reports of physician salaries are pretty accurate now that I've talked to multiple physicians across many specialties about their income. Before PA school, I thought those salaries were inflated and I had to pay for malpractice insurance and other overhead. They definitely aren't inflated and most physicians are employed now and thus malpractice is taken care of by the hospital you work for so it isn't a factor so much. Also, remember there are bonuses for physicians. At least for most PA's I've worked with, the bonuses are much smaller or non-existent for PA's like myself. Yes, it disappoints me that I will not be maxing out my 401k and and IRA to take advantage of some sweet, sweet compound interest for an extra 8 years with most of those years being in my twenties but it's the price I have to pay for more freedom, independence, stability in my position, and future annual income. With all that being said, I still really enjoyed my time as a PA. I learned a lot, did some cool stuff, made some friends who changed my life, and was proud of what I did. It just made sense for me to go back as I was young, had no family to tie me down, planned on working full time for as long as I can, and just wanted to know more about why we do the things we do. In the time it would take for me to become the superstar PA I wanted to be, I could have just gone to medical school and did residency and gotten it over with. Plus, I wouldn't have to deal with the never ending confusion between myself and a medical assistant which happened all the time with both patients AND the hospital that employed me! No one doesn't know what a physician is. If you are similar to me, young, smart, good academic record, not a whole lot to tie you down, and don't plan on being part time immediately upon finishing training, it's probably is better for your own career and bank account to just go to medical school! If you want the freedom to start living your life as soon as possible with a house, picket fence, and dog with the option of working part time with a good income while your spouse works full time, PA is probably the way to go and there isn't anything wrong with that! Ultimately, what should influence your decision is how much you are okay with medicine controlling about 8 years of your life. If those 8 years are much too valuable, then PA is the way to go. If you are going to be a superstar anyway, might as well get the superstar training. So far I've learned a lot and look forward to my first year as a physician in July. Wouldn't change a thing about my life. If you want to DM me specific questions, feel free! I get them all the time. Happy choosing! It's a big decision!
  7. Didn't read the whole thread but I would have been very interested in doing a PA Anesthesia residency prior to going back to medical school. There is certainly a market for it. It really just makes sense to me. I even looked into the PA to AA program at Emory and seriously considered it. However, it was just easier and made sense logistically to go back to med school for me rather than do a PA to AA bridge program since I don't believe AA's can practice in my current state and I didn't want to limit where I could work. In regards to the training during PA school to prepare one for anesthesiology, I can honestly say that I can't name a single person I know or have met that did an anesthesiology rotation during PA school. There wasn't much training on the gases, the physiology of how anesthetics work, how to induce, or even the different types of blades during my PA school program so you would probably being starting mostly from scratch with a residency. Obviously, the best candidates for such a program would be more experienced PA's. I think a successful PA anesthesiology residency would involve an "anesthesia boot camp" at the beginning with anesthesia didactics for a few months to catch one up to speed followed by a year of clinical residency. Totally do-able! If you are designing such a program, PM me and I'd be happy to share my insights as I am starting anesthesia residency this July! I would love to see such a program.
  8. Can confirm that here in Western PA, the hospital ED's are similar - slower than ever. Weird how amidst a national emergency, some ED's are almost empty in anticipation of a flood of infectious patients.
  9. Current 3rd year APAP student here. If you already took all the prerequisites and are about to take the MCAT, stick to that plan and apply to both MD and DO schools. Currently being in the midst of residency interviews, the weight of almost any MD school is greater than any DO school. All the residency programs became governed by the ACGME (think MD accreditation for residencies) this year so a MD degree and the USMLE has become much more important. The DO bias is real and you need to score 10 points higher on the USMLE exams (Step exams) than whatever is competitive for that specialty to be considered equal to a MD candidate at a lot of places. Ten points higher is an appreciable increase btw. Unless, of course, you are pursuing a very non-competitive specialty or going through the military match of which you can just stick with the COMLEX in most cases. The headaches of the LECOM APAP program are not worth it if you have an opportunity to go to any MD school. Plus, things are getting worse since Kaufman is no longer in charge. The new director of the program is consistently offering a "4 year option" to anyone for any reason. What's the point of a 3 year program if the director is offering you a switch to a 4 year program because you had a question about something? Also, you used to have some lee-way with substituting rotations for other rotations so you can get audition rotations for residency in (pretty important) but that is now a thing of the past. The emphasis is strongly for primary care even if you are in an undeclared spot. Feel free to review my previous posts for more details regarding the hoops you need to jump through as an APAP! Basically, the reasons to do APAP, in my opinion are as follows: 1. Financial - the MD and other DO schools are too expensive and finances are extremely important. LECOM has some of the cheapest medical school tuition in the country. This certainly comes at a cost! (See previous posts) 2. Primary care - if your goal is primary care, this is a wonderful option as you are strongly encouraged throughout your medical school career to do primary care. Primary care means IM, FM, pediatrics, and OB/GYN at this institution, just to be clear 3. MCAT and other Pre-reqs - If you haven't taken all the stuff you need to apply to other schools and can't be bothered with it, this is a great option. I knew I didn't want to take all the pre-reqs or the MCAT and wouldn't be taking them if I didn't get into the APAP program (personal choice). It would have added another 2-3 years to the whole process for me and I didn't want to wait that long If you meet one or more of these criteria and are willing to put up with the hoops you have to jump through, this is a good option. Otherwise, you should pursue a MD school preferably or another DO school if you have the option. Again, MD is the way to go and saves you much effort during school and when applying to residency so you can get the specialty of your choice in the location of your choice. With all that being said, I still strongly appreciate the opportunity I was given as I wouldn't be in medical school otherwise at such an affordable tuition without taking most of the pre-reqs for other schools. But boy, are there a lot of unnecessary obstacles that are put in place on the journey through the program!
  10. Yep, Pennsylvania is pretty saturated because of all the PA schools in the state, esp in Western PA. Agree with everything stated above. Would also strongly advise asking for more than 2 weeks PTO and clarifying if you can take it in chunks of 1 week to 2 weeks at a time. 2 weeks PTO seems like the entry level amount for Western PA, unfortunately, but would still ask for at least 3 weeks even if in Western PA. Or even asking for an increase in the weeks of PTO after 1 year of working. The non-compete clause you described is ridiculous and a 3 year contract for a first job seems like a lot. The docs in the practice could be malignant and you'll be wishing it was a much shorter contract in that scenario. I would also clarify what "profit sharing" means. Is it 0.00025% after you bill above 10,000 RVU's per year? I haven't seen many profit sharing opportunities for PA's so this intrigues me. Also, what part of Pennsylvania is this job in?
  11. Hello. I am interested and in process of applying for LECOMS APAP program. Any tips regarding their interview? Do they allow you to rotate in your home state? Any info will be much appreciated! Thx..berta


    1. Show previous comments  4 more
    2. CVTSPA

      It's actually not as competitive as people think as most people don't want to live in Greensburg, PA and most people applying already have families or are used to making above average income.  Once people start crunching the numbers and realize they will be taking a step backward financially for about 10 years or more, they pull their application.  Or, quite commonly, about half the APAP class drops out by the end of the first semester once they realize medical school isn't a cake walk and you are forced to go back to learning basic science concepts for two years.  Even if you don't get one of the 12 spots, they will probably offer you a four year position (bec the PA med students usually significantly outperform the others) and traditionally once someone drops from the APAP program, you can slide right into their spot.  They usually offer the four year position with the same requirements as APAP.

      My recommendations for getting in:

      1. Apply the day primary applications open up.  Lecom has rolling admissions and if your application is the first one they see, you'll get an interview earlier and offered a position earlier.  By the same regard, respond to the secondary application immediately.  It shouldn't take more than 30 minutes to fill out since there is no essay requirement for the secondary application (at least when I did it).

      2. Get a letter of recommendation from a DO physician.  Does not matter if they ever worked with you or even know your name.  Lecom is all about osteopathy and this is a requirement to getting accepted despite whether or not they tell you that you need one.  

      3. If your MCAT/SAT scores are on the lower side, consider taking the pre-requites either before applying or being in the process of finishing them by the time interview season is wrapping up.  It brings you up on the list.

      4. On the interview, they will ask some stupid questions about professionalism and ratting out your peers.  Make sure you emphasize how important professionalism is, how you would help a peer do the right thing (wearing a tie, buttoning a shirt, report themselves for cheating, etc) and you would consider reporting it if they did not.  I assume this is a result of the sex slavery case involving two lecom students back in 2008... but you aren't supposed to know about that!

      5.  If you have to meet with Dr. Thomas (the program director) at Seton Hill during the interview, he likes to have his ass kissed and he likes it when you agree with him about how PA's are not to be trusted. This is practice for a future life at Lecom.  The program director changed within the last year and the program is taking a new direction that is not ideal.... less opportunity to do specialties as he believes 3 year programs should only produce primary care physicians. 

      For reference, I had a 3.9 for undergrad and grad school.  A 600 in each category of the SAT.  Little volunteering.  And I worked in CT surgery and EM while a PA.  However, you sound like a good applicant and if you do the above, you should get a position if you want it.

      Good luck!


    3. ryanpb09

      Nick, this is quite useful and I can’t thank you enough for the ‘inside scoop’! How did you fare in the match? 

  12. Also did cardiothoracic surgery for a while and completely agree with SquarePeg's response. Varies from hospital to hospital and recommend asking the specifics of what you'll be doing in the OR (i.e. harvest vein and leave, harvest vein then first assist, rotating the RNFA's out for a break from time to time, etc). Valve: CABG ratio varies on the population you are serving and what your surgeons are known for (generally speaking, younger patients = more CABG, Older = more valves). Also good to ask if you help position the patient, put in the Foley, and put in arterial and central lines. I did those things but most CVTS PA's didn't in my experience! My situation was once you are in the OR, you're in the OR until the case is done or the call person relieves you (at 5PM). Did vein/radial harvest then first assisted. If there were enough PA's available, another PA would come in to close while the surgeon talked to the family. Whether or not the surgeon starts working on the chest while you are harvesting is also hospital dependent. My surgeons would be opening the chest, harvest the LIMA, then start to place the venous and arterial cannulas while I was harvesting (so we would both cut at the same time). Wouldn't go on pump and cross clamp until the conduit was ready. Whenever I was done prepping the vein (tying branches), I would jump up to first assist and help them. Hopefully, I was done with the harvest by the time they were done harvesting the LIMA but it varies depending on difficulty of the harvest, whether or not nursing is paying attention to you, etc. It's an exciting field for PA's! Good luck!
  13. Yep, the former PA med students are usually among the best students in the class, shouldn't they want to show us off to clinical sites to build a better reputation for the school? If the now 6-7 APAP students left in my class year are causing that much of a problem with taking other LECOM students' rotation sites than there must be a bigger problem.
  14. Yep, the recently eliminated the other pathways for the APAP program and now you can only do PBL at the Seton Hill campus. My understanding from people I've talked to is the the Seton Hill campus is a more friendly environment but I obviously don't know since I've only been at the Erie campus. The PBL pathway is supposedly decent at Seton Hill but I've heard that the one at the Florida campus is ideal (not an option for APAP). Don't let my words discourage you if you want to do anesthesia! Anesthesia is DO friendly and you don't need high boards scores to match, especially if you are willing to go almost anywhere. The LECOM APAP program is still the best deal in town for PA's going back to medical school for the reasons you mentioned (no MCAT, less rigorous class requirements, one less year, etc). I still don't regret my decision to go back to medical school based on my personal situation. I just want people going into the program to understand some of the pitfalls before they get there because no one warned me about setting up my own rotations, needing to be in class during finals week for a mandated lecture on financial management, the fact that there is this obsessive compulsive need to have you in the classroom as much as possible, needing to do an 8 hour class on pelvic exams on a randomly assigned Saturday, needing to take a preclinical review class with mandatory attendance during "dedicated board study time" instead of just letting me do my own thing like most other medical schools, having 4 hours of OPP lectures/lab every week even this semester when I'm focused on board studies, etc. Most rotation sites I call inquiring about needing a rotation gives me the same response, "Normally, the school does this. Why are you calling us?" But the fact of the matter is that they need to place you in a site if you do not fill all the rotation slots otherwise the school looks bad in the eyes of the AOA. So they will eventually give you rotations in an untimely fashion (April of 2nd year with rotations starting in May of 2nd year).... but they will probably end up being in Erie, PA if you don't set them up yourself (which is fine with me because I only care about where I do my two anesthesia rotations).
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