My answer to PA instead of MD - is this a good answer?

[Lemon Bars]

I'm thinking about applying to PA school in a year or two and I've read about PA vs. MD. I think I have a personal answer to the question, "Why do you want to be a PA and not an MD." But I don't know if this is an acceptable answer and I'd like opinions. (I'm also a bit old for medical school and my grades are a bit low, but neither of those is my true answer.)

 

Interviewer: "So why do you want to be a PA? Why not go to medical school to become a doctor?"

 

My proposed and truthful answer: "I feel that the traditional role of the PA is exactly what I'd like to do in medicine. I'd like to work in an urgent care center or ER fast track, doing mostly primary care. Honestly, I would prefer that my patient not present with a missing leg, bleeding out all over the table and needing major surgery. I would prefer a patient of mine to present with a minor or moderate laceration so that I can clean it, suture it, bandage it, and prescribe antibiotics for healing. As another example, I would prefer not to have to tell a patient that his cancer has returned, and that he has only six months to live. The doctors can do that. I want to tell my patient that yes, he has bronchitis, but that I can prescribe him the appropritate medication and that he will recover fully in a few weeks."

 

Does this sound too wimpy? Is this a bad reason for wanting to go PA? Is this a good start as far as an answer? Any help is appreciated!

 

Thanks!

[adjk1229]

To me, that kind of sounds like you're putting a wedge between you and a doctor when you two are supposed to be working as a team. Maybe answer more along the lines of the fact that you'd rather work as a partner with a physician and that you prefer the deeper patient relationships that you can develop as a PA vs. an MD (not necessarily true in all instances) but quite common. Also, maybe mention how managed care has really affected the way MD's treat their patients. Really emphasize that you enjoy the role of a PA and that you want to work as part of a "team" rather than independently as an MD. Might be a start and you can kind of elaborate from that.

[mktalon]

So what will you tell a woman when you are doing a routine exam and feel a lump? That she has bronchitis? I'm not trying to be mean here, but if you are having these kinds of feelings then you really need to do some soul searching to figure out if medicine is for you or not.

[Lemon Bars]

So what will you tell a woman when you are doing a routine exam and feel a lump? That she has bronchitis? I'm not trying to be mean here, but if you are having these kinds of feelings then you really need to do some soul searching to figure out if medicine is for you or not.

 

No, no. If I gave the impression that I would not do my duty then I definitely need to change my response. If someone has a lump, they will need tests and yes they might have cancer and I would be straight with the patient. What I mean is that I do not want to be an oncologist and have to deal with dying cancer patients all the time. I know that as a PA I will see some dying and dead people, but as a general rule I'd prefer to deal with patients who are not dying, enviscerated, burned over half their body, that sort of thing.

 

Another way of putting it might be that I want to work in primary care and that I do not feel the need to become an MD unless I want to go into certain specialties or become a supervising physician.

[HopefulPA]

The right answer is your answer not anyone elses!

 

As a PA with 2.5 yrs, I have had to tell pt they have Cancer, change code status, and pronounce death. I have also had to discuss code status with family as well to break the news to the family that their loved one has passed away. Quite honestly this isn't easy but usually the patients and the family take the news as well as can be expected.

 

Now on the flip side giving someone the news of the STD or no to narcs and well watch the fireworks.....

[Lemon Bars]

In what setting do you work, HopefulPA?

[IdahoPA]

Lemon, have you had a chance to shadow PAs? Maybe you will have a different perspective once you've "seen them in action."

 

But I agree with Hopeful; there is no "right" in such a personal question. We all have our own motivations. I will, however, say that I find it interesting that you have a desire to work in the ER but don't want to work with serious traumas. Depending on where you work, you well could be the only provider on duty at times.

 

I would consider adjk's advice, and discuss more what you LIKE about the PA profession, rather than what you don't like about the MD one. Good luck!!

[Just Steve]

Not knowing your background, my input may come in off target but reading your post my first thought was "how much medicine has this person been part of"?

 

There are about 2 gazillion...maybe 2.5 gazillion fields of medicine that deal with all kinds of things. If you come in the door hoping you get to go to fast track and see "minor care" all day, are you really sure what you're asking for? It's pretty specific. If you have a pretty deep background in a variety of settings so the adcom can see that yes, you do know what you're walking into, then that's one thing. But if your experience is lacking depth then I think that answer could open the door for more difficult questions such as "tell us about your ER experience that has left you so tainted against the main ER?" "Where did you shadow/work/experience the fast track? How did you feel when critical patients got mis triaged? How would you manage a miss triaged patient who turned critical in front of you? What do you know about same day surgery clinics?" What can you tell us about inpatient hospital care? What can you share with us regarding infectious disease? Internal medicine?"

 

My point is that if you ask for something of such a finite focus, the school may see you as close minded...Or they may see you as someone they can educate and guide through a discovery of what the PA program has to offer. It's a gamble. Do the school(s) that you are applying to have a focus on primary care/ER care? Are you trying to match with a good school?

 

As for care in the ER...trauma and big obvious injuries of "OMG where is their leg?" are easy. Everything is laid out in the open for you in a pre determined order of importance. It's the "I have been really sleepy for awhile and don't know why" or the "I have had numbness around my mouth for a day or so" who present in fast track that will sneak up and crush any sort of confidence that you may have. Very vague, non descript complaints that turn into medical emergencies before you even have time to think of a differential diagnosis...That stuff will make you loose sleep at night. Check out this thread: http://www.physicianassistantforum.com/forums/showthread.php/4501-quot-it-s-probably-nothing-quot-fast-track-disasters

[cinntsp]

 

Does this sound too wimpy? Is this a bad reason for wanting to go PA? Is this a good start as far as an answer? Any help is appreciated!

 

Your answer makes you come across as being ignorant about the PA profession. Have you done any shadowing or gotten any HCE?

[moonlightlove]

I think this makes you sound like you think being a PA means you wont work as hard as a doctor, which is not true. A lot of the kinds of patients you will encounter or the load of work you have will depend on the setting you work in as opposed to whether you are a doctor or a PA. I dont think you really exemplify your passion for medicine by saying I just want to flush wounds and dispense antibiotics. If this isnt how you feel, then try and rephrase your answer so you focus on the things you WANT to do as a PA rather than what you dont want to do.

[EMEDPA]

Why don't you try nursing school instead of pa school? That actually sounds more your speed and comfort level.

agree. while you will see sick pts as an rn you won't likely be the one to deliver bad news or make final decisions regarding pt care, those are provider level responsibilities.

[greenmood]

If you had stopped after the first sentence you would have been fine. I think you need to reconsider the way you present it. My gut reaction to it wasn't positive - I thought it sounded selfish, and that is not something people want to see in potential future colleagues and providers.

 

It's perfectly natural to have a preference of where you'd like to practice after graduation, and even for a certain patient population, but the way you said it came across very badly. You also need to research more. Physician Assistants aren't protected from dealing with difficult cases and you will not always be able to pass it off to the MD.

 

I wouldn't want to, anyway, but that's me. Sadness is sometimes part of healthcare, and you shouldn't hide from it.

[adjk1229]

No hard stuff please. That's for someone else. And nurses clean up poop. Who wants to do that?

 

All the nurses I've ever met don't clean poop, that's my job as a CNA. Nurses can't be bothered.

[Lemon Bars]

Okay, well, thanks for all the responses all. Since you took the time to answer me I will try to respond to all the posts. Some of you said, in a nutshell, that I should focus on what I want to do, not what I don't want to do, and that's solid advice. I have spent some time in ER and in doctor's offices where there are PAs and NPs. Before they tightened up the HIPAA laws I spend an entire night in an ER shadowing an MD and that was the coolest thing ever. I saw PAs working there, too. In response to health care work experience, I have none, except for first aid/lifeguard stuff when I was younger. I'm finishing up an EMT class, and I've taken Wilderness First Responder, and I will be the night medic (EMT) at a kid's camp this spring.

 

It's interesting that several of you have stated that PAs, even in non-ER settings, have run into deadly illnesses and injuries. I didn't expect that, except as a rare occurance. A couple of responses said that it sounded like I didn't want to work hard or be challenged, and I think that's a bit unfair, but I guess any hint of weakness might look bad to an interviewer or employer. Perhaps honesty is not the way to go and I should just say that I'll be ready for anything even if my city is nuked.

 

A couple of responders suggesting nursing, and I've given it a lot of thought. But I know some nurses and I don't think taking care of multiple patients at the same time is for me. If I can't get into PA school I plan to go to Respiratory Therapy school, but I'm worried that I'll have trouble finding work as an RT because apparently there are a lot of RT graduates looking for work (this according to web forums I don't know any RTs). I'm shadowing an RT next month, so we'll see how that goes.

 

Thanks again for all the responses! More comments are welcome!

[bellajoy]

I second this. (I was/am an RT and am currently a PA student.).

 

But definitely check it out and see what you think.

 

If you like the idea of being a pa for the reasons you mentioned, you will HATE RT. you will have multiple patients with very serious conditions that rely on you for each breath they take. You will be disconnecting people from life support and have front row seats for their death. Lots of secretions and gore. Lots of important decision making.

 

 

 

Sent from my ADR6300 using Tapatalk

[Lemon Bars]

Okay Just Steve, I just read the thread that you linked to. Wow. I guess a PA has to be prepared to diagnose just about anything. That's very enlightening!

[Just Steve]

I don't think taking care of multiple patients at the same time is for me.

 

The ER gets all the glory for being life savers and heart breakers. It is the most chaotic scene in the hospital outside of a surgical procedure going wrong in the OR (like a ruptured aorta). However...there are life defining decisions being made on every floor, in every aspect of medicine that a hospital or clinic covers. For example, while working in family practice clinic you probably will not be faced with the immediate demands of an acute critical patient but you will face with management of their chronic diseases. If you manage them poorly, you can cut years off their life, potentially leading to their early demise. If you manage them correctly you get to add years to their life, or in the very least, greatly improve the quality of their life for years to come. And you do this for 8-15 patients a day, every day. Out of your 15-20 patients that you will see in a day, over half of them will be life long management visits. You'll have to keep track of their meds, conditions, labs, needs...

 

Let's say your day is slotted for 9 hour day (8 a.m. to 5 p.m.) 20 minutes per patient x 8.5 hours (I'll give you a half hour lunch break but you'll be too busy charting to eat it). That's 25 patients a day...most of whom will be presenting with multiple management issues ie: "I am obese, have diabetes, hypertension, a non healing foot sore, bilateral knee pain, and am depressed". Or it could be "both my wrists have been aching for the past few weeks and I've noticed this bump under my skin in my hand"...or "I am super tired all the time, I bruise really easy, and I noticed some lumps in my neck."

 

So your first patient could be headed for dialysis for the rest of their life, your second patient is looking like it may be rheumatoid arthritis, your third patient smells like cancer and none of them has adequate health insurance to afford half the exams you want to do, much less buy the medicines that will help them. And you haven't even made it to 9 a.m....

 

So in a more realistic approach you move some time slots around...more 40 minute appointments, cut back your patient load to 15 a day. Then you get your pay check. You notice that the amount isn't nearly on par with what the quotes were for this profession. Did I mention your pay is heavily based on productivity? Don't forget that you probably work for a business that needs providers that will see a certain volume of patients. You have to keep up or find a new place to work.

 

Medicine is a complex, intricate dance balancing everything from socioeconomic situation to mental health, to access issues, to quality of life...it's like juggling flaming chainsaws while riding a unicycle on a tight rope over a shark tank. I suggest you keep shadowing, keep exploring medicine, be very very sure you know what you are getting into before you sink 100,000 dollars into a profession that you end up really hating.

 

Do you like research?

[whimsygirl]

If you like the idea of being a pa for the reasons you mentioned, you will HATE RT. you will have multiple patients with very serious conditions that rely on you for each breath they take. You will be disconnecting people from life support and have front row seats for their death. Lots of secretions and gore. Lots of important decision making.

 

As an RT - I appreciate you saying that. I often wonder what people think we do.

[panelson]

A couple of responders suggesting nursing, and I've given it a lot of thought. But I know some nurses and I don't think taking care of multiple patients at the same time is for me.

QUOTE]

 

Just to warn you...in basically any medical field, you will be taking care of more than one patient at a time. I definitely think shadowing is something you should try and schedule asap so you know what you are getting into before you get any further into looking for a potential career.

[mdebord]

A couple of responders suggesting nursing, and I've given it a lot of thought. But I know some nurses and I don't think taking care of multiple patients at the same time is for me.

QUOTE]

 

Just to warn you...in basically any medical field, you will be taking care of more than one patient at a time. I definitely think shadowing is something you should try and schedule asap so you know what you are getting into before you get any further into looking for a potential career.

 

I just wanted to expand on this because the same line stuck out to me also. Some specific examples from urgent care: You see Patient A and it looks like they may have a UTI, so you send off the urine; meanwhile Patient A stays in the room. Patient B needs stitches, so you order some lido. Patient C has arm pain after a fall, so you order an Xray. You go check Patient A's urine - not back yet. The lido is here! You go suture Patient B. Check Patient A's urine again - call the lab to follow-up; they say they're working on it. Patient C's Xray - not back yet. Write the discharge paperwork for Patient B. See Patient D, let's say it looks like she's having a spontaneous abortion - call OB consult. Patient A's urine is finally back, so you discharge her with antibiotics. Patient C's Xray is back - you go do the splint then arrange follow-up with Ortho. OB comes to talk to you about Patient D. And so on and so forth. It is important that you realize that you will be taking care of multiple patients at a time. I think this has been one of the most challenging things for me, not necessarily managing any particular situation, but REMEMBERING what you have to go back and do. Now remember, you don't have to commit to working in a particular environment at this time, you just have to decide whether you want to be a PA or not. I mean no offense, but I suspect your motivations are misplaced at this point. Definitely talk to some more people in all fields and shadowing is a plus, working will further clarify for you. Good luck!

[Lemon Bars]

The ER gets all the glory for being life savers and heart breakers. It is the most chaotic scene in the hospital outside of a surgical procedure going wrong in the OR (like a ruptured aorta). However...there are life defining decisions being made on every floor, in every aspect of medicine that a hospital or clinic covers. For example, while working in family practice clinic you probably will not be faced with the immediate demands of an acute critical patient but you will face with management of their chronic diseases. If you manage them poorly, you can cut years off their life, potentially leading to their early demise. If you manage them correctly you get to add years to their life, or in the very least, greatly improve the quality of their life for years to come. And you do this for 8-15 patients a day, every day. Out of your 15-20 patients that you will see in a day, over half of them will be life long management visits. You'll have to keep track of their meds, conditions, labs, needs...

 

Let's say your day is slotted for 9 hour day (8 a.m. to 5 p.m.) 20 minutes per patient x 8.5 hours (I'll give you a half hour lunch break but you'll be too busy charting to eat it). That's 25 patients a day...most of whom will be presenting with multiple management issues ie: "I am obese, have diabetes, hypertension, a non healing foot sore, bilateral knee pain, and am depressed". Or it could be "both my wrists have been aching for the past few weeks and I've noticed this bump under my skin in my hand"...or "I am super tired all the time, I bruise really easy, and I noticed some lumps in my neck."

 

So your first patient could be headed for dialysis for the rest of their life, your second patient is looking like it may be rheumatoid arthritis, your third patient smells like cancer and none of them has adequate health insurance to afford half the exams you want to do, much less buy the medicines that will help them. And you haven't even made it to 9 a.m....

 

So in a more realistic approach you move some time slots around...more 40 minute appointments, cut back your patient load to 15 a day. Then you get your pay check. You notice that the amount isn't nearly on par with what the quotes were for this profession. Did I mention your pay is heavily based on productivity? Don't forget that you probably work for a business that needs providers that will see a certain volume of patients. You have to keep up or find a new place to work.

 

Medicine is a complex, intricate dance balancing everything from socioeconomic situation to mental health, to access issues, to quality of life...it's like juggling flaming chainsaws while riding a unicycle on a tight rope over a shark tank. I suggest you keep shadowing, keep exploring medicine, be very very sure you know what you are getting into before you sink 100,000 dollars into a profession that you end up really hating.

 

Do you like research?

 

 

What you describe is still one patient at a time, no matter how many patients you see in a day, or how quickly you are expected to treat them, or the number of patients you care for in your practice. What I'm afraid of is being a nurse and having three call lights go off at the same time while I'm are busy cleaning the wound of a fourth patient and an alarm is going off because a fifth patient has low oxygen levels or whatever. Aren't nurses usually responsible for several beds at the same time? Or have I got that wrong?

[Lemon Bars]

 

I just wanted to expand on this because the same line stuck out to me also. Some specific examples from urgent care: You see Patient A and it looks like they may have a UTI, so you send off the urine; meanwhile Patient A stays in the room. Patient B needs stitches, so you order some lido. Patient C has arm pain after a fall, so you order an Xray. You go check Patient A's urine - not back yet. The lido is here! You go suture Patient B. Check Patient A's urine again - call the lab to follow-up; they say they're working on it. Patient C's Xray - not back yet. Write the discharge paperwork for Patient B. See Patient D, let's say it looks like she's having a spontaneous abortion - call OB consult. Patient A's urine is finally back, so you discharge her with antibiotics. Patient C's Xray is back - you go do the splint then arrange follow-up with Ortho. OB comes to talk to you about Patient D. And so on and so forth. It is important that you realize that you will be taking care of multiple patients at a time. I think this has been one of the most challenging things for me, not necessarily managing any particular situation, but REMEMBERING what you have to go back and do. Now remember, you don't have to commit to working in a particular environment at this time, you just have to decide whether you want to be a PA or not. I mean no offense, but I suspect your motivations are misplaced at this point. Definitely talk to some more people in all fields and shadowing is a plus, working will further clarify for you. Good luck!

 

This is informative. It sounds somewhat stressful. However it sounds kind of fun, too. You make it sound like a team effort, which is appealing. I much prefer the idea of seeing this or that patient in short bursts rather than being responsible for the needs of the same five or ten patients all day, like a (non-ER) nurse. Am I making any sense at all to anyone?? (Maybe not.)

[jdosanjh29]

Hmm..So I've skimmed through this a little bit. I'll start off by saying I'm neither a PA (obviously) or an RN, but I think I have a pretty good idea of both professions. I've worked with nurses for 6 years now and have experience shadowing with a PA. From my experience the scenario mdebord described is exactly what to expect working as a PA in an urgent care setting. And yes, you work as a team but there is actually a lot of autonomy as well. As for nurses, yes they normally care for maybe 5 patients in their 12 hour shifts, but I don't think its any harder than the scenario mdebord described. They both have multiple patients, they both have to work quickly and efficiently, and they both have to prioritize. Also, I think you are misinformed in thinking that nurses do not work as a team. If multiple call lights scare you, don't worry because most nurses have CNAs that can answer those lights and usually take care of whatever the patient needs. Not only do most nurses have CNAs but they also have all of the other nurses there that are usually willing to help, and they have coordinators that will help. A nurse is in no way alone to take care of these patients, so if that's what is turning you away from the nursing profession maybe you should have a second look? Just my two cents :)

[Just Steve]

What you describe is still one patient at a time, no matter how many patients you see in a day, or how quickly you are expected to treat them, or the number of patients you care for in your practice. What I'm afraid of is being a nurse and having three call lights go off at the same time while I'm are busy cleaning the wound of a fourth patient and an alarm is going off because a fifth patient has low oxygen levels or whatever. Aren't nurses usually responsible for several beds at the same time? Or have I got that wrong?

 

I doubt I can find the right words to describe the complexity differences of the two roles, especially when one considers the huge variety of settings that can inflict their own set of unique circumstances.

 

My point in my earlier scenario was that you will HAVE to multi task as a care provider on a very intellectual level. There is not the option to completely work up, diagnose, treat, and discharge one patient at a time. You will be in a room seeing a patient, come out, and find the lab results on your previous two patients who now require phone calls to find an admitting hospitalist. You will make those phone calls and get the first two patients in the right direction and start to chart on your third patient when the staff informs you that your fourth patient is waiting for you. You'll walk into the fourth patient's room while you are still thinking about your first three patients and have to put those thoughts on hold while you process your fourth patient...in the meantime the families of the first two patients are calling wanting to talk to you about why you admitted their loved one....the cycle continues

[EMEDPA]

Medicine is a complex, intricate dance balancing everything from socioeconomic situation to mental health, to access issues, to quality of life...it's like juggling flaming chainsaws while riding a unicycle on a tight rope over a shark tank.QUOTE]

... in the nude, while people(lawyers) are throwing rabid dogs at you.