Sage Advice for New Graduates
Robert M. Blumm, PA-C Emeritus, DFAAPA
Congratulations! Many of you will be graduating from your PA & NP programs in the coming months. You are about to set out on a clinical career journey that could be as long as forty years. A few years ago, my wife and I planned a trip to Italy where we would visit all of the sights of Rome and Florence. Twelve days in Europe was a gift to ourselves - for me after many years of practice and for her, a lifetime of teaching Humanities to high school students. Our journey started six months before when she, as my task master, gave me several books earmarked with all of the relevant sights we were to experience. This homework was an invaluable crash-course on the art, architecture, poetry and history of all of the places we were to visit. Had she not crafted our course of study, I would have been like a child awakening on Christmas morning to twenty gifts which I could not open, let alone understand.
You have just completed an arduous course of study which has demanded a lot of sacrifice: study, financial cost, neglected friendships and delayed marriage plans. The initial goal was just to graduate; now you are required to take a certification examination to determine if all of your hard work was fruitful. When the large envelope arrives with your certification you are then ready to start. Correct? No! Now you will now need to make more decisions that determine your future. And these decisions are just as complex as your clinical training. Just like our trip to Italy, you will need to weigh many options and choices whose decisions will impact your success as a new PA or NP. My graduation present to you is this article which has the potential to better prepare you for your new journey as a professional clinician. It’s advice from me and my colleagues in business, administration and professional practice and will likely make your career journey safer and more satisfying. Like any advice, you can heed or disregard it – but hopefully, it will be a helpful component of your career blueprint for success.
These suggestions come from a variety of sources such as well-known PAs, like EMEDPA, a senior moderator on PhysicianAssistantForum.com, many of your PA Colleagues, myself included, Personal Liability Experts such as those from the AAPA endorsed provider and years of observing the pains and rewards of those who have provided healthcare to our nation in their professional capacity.
Ø Your first job is about learning your clinical skills, not about money.
Ø If you can afford to do a residency in your field of choice, do it! see #1 above.
Ø As a new grad you can have two of the following, three if you are lucky: location, specialty, salary. Choose wisely.
Ø Read your contracts thoroughly before signing them. Look for hidden details, such as mention of a non-compete clause. [A non-compete clause is a legally binding contract whereby the employee agrees not to work with a rival company or start a similar trade or profession for a specified period of time after leaving his current employer.]
Ø Choose a favorite maxim and then try to live by it. Mine remains: “Tis far better to show what you know than to say what you know”. Equally important: “Say, rather than show, what you don’t know.”
Ø Join your professional organizations and support them so that you will be empowered to make changes that the first fifty years of PAs were unable to accomplish.
Ø Don't take the first job you are offered unless it's ideal. Don't settle for mediocrity, ever.
Ø Don't accept a position in a specialty that you detest just because “it’s a job”. You will be miserable in a job that you dislike and you will never achieve excellence.
Ø Don’t accept a position that does not offer CME and vacation time that is adequate for you and your family. Do not accept call without pay, weekends without pay and no more than two weekends monthly.
Ø Do not work in a critical care setting immediately out of school. Hospitalist, ICU, CCU, pediatrics are all specialties for experienced providers. Spend at least two years of non-critical care clinical work so that transitions to other specialties can be accomplished more effortlessly.
Ø Don't work in a very narrow field right out of school unless it is your dream job and you never intend to leave the specialty. I know lots of folks stuck in jobs they hate who can't leave them.
Ø If you are getting burned out, consider the following: work fewer hrs./mo., see fewer pts/shift, switch specialty, switch location. Find something new where you are appreciated.
Ø An essential lesson that I learned which I discovered after working too hard for others. Your husband/wife/significant other and children should be your first priority, yourself your second, your practice third, and professional politics last. No one will ever care for you like your family. Jobs expire, positions fail to exist beyond their time limits and then you will be forgotten. You can never recoup the time you have lost working for others. I have served this profession as a leader for about thirty years. But I paid a price: my kids placed a photo of me at the dinner table at a certain time in our life. Sad commentary.
Ø Don't take a job where your clinical supervisor is an RN or office manager. We are not medical assistants.
Ø Don't refer to yourself as Dr Smith's PA. They don't own you. Say instead, “I'm John Doe, one of the PAs here." Or "I'm John Doe, I work with Dr Smith on the surgical service.” Words matter. Don't let yourself be treated like an assistant. Don't regularly take out trash, take your own vitals, room patients, etc. unless the docs in the group do so, too. I can see this in a small office, but there is no excuse for it elsewhere.
Well, we have covered many of the rules and suggestions but now let me conclude and write about the most important task on your new medical journey. Remember my trip to Italy which I spoke about earlier? Your excitement as you begin your career is comparable to the thrill and anticipation one feels as they set off to explore the Renaissance. But unforeseen events can destroy that cherished vacation: robbery, an injury to you, a crisis at home. So, as your journey begins, a critically important item to secure is a professional liability insurance policy, better known as a malpractice policy, and it is never more affordable than when you first graduate. The AAPA, your professional organization, has endorsed an excellent provider and secured special rates for you, the new PA.
Every PA should carry personal liability insurance for all time periods during which they have practiced. A malpractice suit can be brought against you at any time after seeing a patient (days, weeks, months or even years). And a malpractice suit can jeopardize your professional reputation and impact your credentials with the potential of losing your license by suspension or revocation. Your malpractice history is a matter of public record and your NPI number creates a profile of your lifetime practice. Your ability to secure employment will be decided partly upon this information. New graduates have a one-time opportunity for securing discounted insurance premiums for five years which offers comprehensive protection. Congratulations on your graduation and best of luck!
I am done with didactic and is about start rotation soon. I think should feel excited to be done "the hard part" yet I'm filled with doubts and anxiety about moving forward. I originally came into this profession with the idea that I want to help patients understand diseases and empower them with knowledge to help themselves. Looking back now, I somehow feel like I've been passively heading toward this direction all my life because when people asked me what I wanted to do, I just said I want to do something medical related. Be it after school programs in high school or medical related jobs after college. There were times before PA school where I had doubts that this may not be right for me but then quickly brushed it off. When I do bring this up with family and others, I always get asked "what else do you want to do if not this" and I never had an answer because I wasn't actively looking at alternatives. Then I would get told that just do this if you don't know. I felt like I set this expectation for myself to set out to be a medical provider when I was way younger and now im feeling kinda stuck with having to follow through. Else i'd be a disappointment. I'd be lying if I didn't feel any familial pressure to stay the course.
Then I got into PA school and it gave me a sort of adrenaline rush like "yeah! i got in, i can do it!". I thought it was gonna be simple and all I had to do was keep my head down and get through it. Yet throughout didactic there was always this tiny inner voice whispering to me "this feels wrong". I chalked it up to just being stressed out by the heavy workload and imposter syndrome and buried it. Sometimes when I do talk about it with my family I just get told to keep going because I've invested so much into this so at the very least just stick out the first year and see how it goes. Now that i've clawed my way through didactic, I feel completely burnt out. I took a month long break without doing anything PA school related. I spoke with friends who graduated already who tell me that clinicals would be completely different, similar to the countless other posts i read online.
Looking ahead to clinicals I just don't even care much less feel excited and I know that won't help me make it through. Thinking back to when I decided to enroll in the first place vs now make me feel like I'm in a totally different person. I feel like the spark of interest for medicine that could have ignited a flame of passion just kinda fizzled out as time went on for me. I don't get interested in medical topics anymore. I don't feel motivated anymore and have trouble feeling empathy for anyone. I sure this is part of the burn out but can't shake the feeling that it's more than just that. I lay awake at night contemplating whether I've had enough and seen enough to say "I've gave it an honest attempt and now it's time to move on" or if actually being in clinicals will make a difference. When imagine winding up to grind through a 2nd year for clinicals, i get a sinking feeling in my stomach. When I imagine not being a PA, i think, "im ok with that". If I quit now, it would feel like be a huge financial and time wasted on this path and a lot of resistance from those around me. If I continue, it could possibly be an even bigger wager of time, money, and effort on a "maybe" I'll change my mind during clinicals. I think about this on a daily basis now. Anyone who have experience care to give some advice?
In search of preceptors!! I am currently a PAS1 student and our school is looking to expand our clinical rotations for next year. I would absolutely love to do my rotations at home in Chicago and our school will allow us to plan away rotations if we make contacts and provide the preceptor (can be PA, NP, DO, or MD). BUT rotations anywhere are very welcome!!!
If you, or any of your colleagues would welcome a student rotation in your office please PM me. I would greatly appreciate any and all advice, Thank you!
There is a lot of information about average GPA for incoming students, however, there is little statistical data about PA students in their didactic year regarding GPA and grades. I realize that grades “don’t really matter” in the grand scheme of things, especially when it comes to jobs (from what I have researched). However, I would really like some input on what GPAs look like in didactic year compared to undergrad GPAs. I realize that every program is different, so this comparison can be hard to make. Is there anyone willing to share their GPA from undergrad and didactic year? Thanks!😀