Answering some FAQ about my job as a new grad PA!
- How have they transitioned you in? Are you still “training” / in orientation or on your own?
The training has been absolutely wonderful! I started the first week with EMR / billing + coding training. I also did some shadowing to just sort of get the flow of the office. For the rest of the month, I’ve been seeing patients on another providers schedule each day. Sometimes I’m assigned to providers, other times I just go in and see if I can tag along and see patients with someone. I’ll usually take a look at the schedule beforehand and see if there’s a procedure or patient that that looks interesting / is something I need more practice with. I still don’t have my insurances in (crazy, I know), which means I still can’t have my own schedule and panel.
While I was skeptical about beginning training during COVID, it has turned out to really work out in my favor. The clinic I was hired for is still closed, and most providers from other clinics around the state are seeing patients at the one center I started at. This is a complicated way of saying I have the opportunity to see and work with providers I otherwise never would have met.
If my insurances had been in, I would have started seeing patients on my own in my third/fourth week. But now it’s just a waiting game until that happens!
- How much on the job training do you get?
The training is really dependent on the person. I’ve spoken to PAs who said they worked off of other people’s schedules for 3 months before transition to their own schedule. Once I have my own schedule, I’ll have hour long appointments. And then I can take as long as I want (usually under a year) to transition to 40 minute appointments. And I have up to two years to then get down to 20 minute appointments. It really is a spectacular model and was a reason I was so intent on waiting for this job.
- Do you find yourself going to your supervising doc often for confirmation?
As of right now, yes! I’m always working off of another provider’s schedule for now, so I’m often going and reporting what I saw followed by my assessment and plan. Sometimes I feel really confident, and other times I’m like uhhhh…….help hehe. I am so lucky in that everyone is very aware I am new and is so eager to help.
- How long are you on orientation for?
As above, I have up to two years to get to a full schedule. A full schedule means you’re seeing a patient every 20 minutes. Which right now feels entirely overwhelming. So I’m SO INCREDIBLY GRATEFUL I get to start with hour long appointments with patients.
- How is adjusting to being a real live medical professional? Do you feel like you’re keeping up? Are you still “in training”? How long did it take you to start diagnosing / treating by yourself?
The adjustment is…interesting, haha. I am definitely not keeping up that is for sure. In fact, I feel like a complete deadweight. However, given I have barely any experience, I’m not expected to be keeping up by any means. My medical director described me as “3 minutes old” in regards to being a provider. Which is exactly what being a new grad is. You’ve seen a lot and can recognize some patterns but you’re nowhere near the other providers who have been working for 20+ years.
I started diagnosing and treating already in my first month. I’m putting in orders, calling patients with test results, and ordering meds when appropriate. But still definitely asking a TON of questions, looking pretty much everything up, and feeling like a nervous wreck most of the time (hehe).
- What kind of support when the training is done?
When training is over, a few PAs I’ve spoken to had a “physician of the day,” in that they’d be assigned to a provider that knew they’d be going to them with any questions if they arise. There have also been lots of different providers around to run a question by during the day.
I also was speaking to my medical director about a telehealth model. She was discussing an idea where there’d be a sort of google hangout that providers could pop in and out of during the day so they’d be available to answer questions. Not sure if that is still feasible because the senior providers are seeing patients every 20 minutes when doing televisit days, but a cool idea nonetheless.
- Do you think they have a good on boarding program for new PAs?
It’s honestly the best I’ve ever seen. They specifically have a long and slow ramp-up process because they want to retain their PAs for more than two years. This was super important to me when I was in the interview process, and is one of the main reasons I was so adamant about wanting to work there!
- Play-by-play of what your typical day looks like?
My day starts at 8am and I start seeing patients with whichever provider I’m leeching off of / desperately clinging to that day. I try to see as many patients as I can, including writing the notes, prescribing meds, calling the pharmacy when I inevitably mess up prescribing them lolol. There’s an hour long lunch break to catch up on notes, etc. And then the day ends at 5pm.
When I start having my own panel, I’ll get two 4-hour session as “admin time.” So I’m hired for 32 clinical hours, 8 hours admin time. But because I’m not seeing my own panel right now, I’m going in for the full 40 hours.
Wventually I’ll start doing group sessions teaching nutrition and doing some yoga but I’m still working out the logistics of that and preparing the lectures. I don’t start my nutrition fellowship until the end of this month, so updates to follow on that!
- Who are the other providers in your office? MD/PA/NP and age/experience wise?
The office has such an amazing and diverse provider set-up. There are MDs, PAs, and NPs. A few PAs are on the newer side with 1-2 years experience. Others have 20+ years. Same goes for the NPs and MDs. Some are on the newer side, ie first year of being an attending. Whereas others have been working for 20-30 years. It’s amazing to see and interact with so many different providers with such vastly different experiences. It makes it so that I’m super inspired and a goal for myself of eventually feeling like I’m a competent provider. But also nice to see other new(er) grads and how they’ve navigated the onboarding process.
- Do you work with any NPs? What’s the dynamic like?
Yes! I’ve worked with a a few and had the opportunity to shadow one for a day and it was amazing! They have the same role as PAs and we work really harmoniously together.
- How do you get patients when you’re new? Without any patients to refer you, etc.
I’m at a public health clinic, so patients come and are seen by any provider that’s available. Ideally within their primary care team but because of COVID, now they’re really being seen by whoever has an opening in their schedule.
- How independent are you expected to be as a new grad?
After the orientation process, pretty independent! There’s always someone around to ask questions and collaborate with / have a little bedside consult with but for the most part, if you’re comfortable with your diagnosis, assessment and plan, then you’re independent and doing your thang. As a PA in this office, I don’t need to staff every patient. Meaning I don’t need to give report and notify a physician of my plan for each patient.
- Do you get anxious before work every day?
Right now, yes. There’s just no way to avoid it. But I’m viewing the anxiety as a good thing. It’s good to be nervous and on your toes as a new grad. If I wasn’t terrified, I think it’d be more concerning tbh.
- Is the role different than what you thought it’d be?
It’s pretty much identical. Except I didn’t think I’d be seeing a much pediatrics as I am. I thought it’d be mostly (if not all) adults, and it’s probably ~65/35 adults to pediatrics.
Preparing / feeling prepared
- Any tips for the first day?
Get a good nights sleep, pack a lunch, learn and write down everyone’s name, write everything down for that matter (bathroom code / lunch room code, bring your stethoscope and the tools / resources you liked most from rotations, and just go with the flow! There’s no way to predict or be prepared. But a good attitude / willingness to learn and be flexible goes a long way .
- Did you feel prepared by what you learned in PA school?
In a way, yes. In a larger way, no. Granted I took a year off of medicine. But I’m not sure if there’s every any way to feel really, truly prepared. It’s part of the learning process and curve. You can’t expect to jam a lifetime’s worth of medical training into two years. Or into a few hours (trust me, I tried to google how to do it and was not successful).
- Did you feel prepared on your first day?
As prepared as I could be! Idk, again, I don’t think there’s any way to truly be prepared.
- How different did this feel from clinicals in terms of how much you were expected to do/know?
Right now it feels pretty similar in that I’ll see the patient, write the note, diagnose, come up with the assessment and plan, and give the provider I’m with the run-down. Then I’ll treat if they agree with my plan. With some providers, I go through this whole process.
With a provider last week, she said “okay so I think we need to transition you out of this student role.” Which really made me laugh. Every day is different, and each provider has different ways in which they like doing things.
- Did you feel ready and competent being on your own?
Definitely not. Especially in the first two weeks. Again, I took quite some time off and it took a bit to dust the cobwebs off, which I’m still for sure doing. And likely will still be doing for this whole year. Just trying to give myself grace and go with it, knowing some days will feel really hard. And some days are like okay, I’m okay, everything’s okay.
- What resources do you use?
quick resource books: Maxwell Quick Medical Reference, Bates Pocket Guide to Physical Exam and History Taking, Pocket Primary Care (A Massachusetts General Hospital Handbook), EMRA antibiotic guide
computer: UpToDate, Lexicomp
apps: MDCalc, USPSTF, ASCCP, ASCVD plus, Dxsaurus
For a full list of what’s in my backpack, check out this post.
Imposter Syndrome / Confidence
Check out this whole blog post about imposter syndrome.
- What’s been the most helpful thing in feeling confident as a provider?
So I certainly am not confident in my medical acumen, haha. And likely won’t be for a very long time. My medical director says 5 years. What does help is that a few providers have had me call their patients / do mini-televisits for nutrition related questions. So I at least feel like I’m sort of contributing in some way, shape, or form.
- What is the most challenging part of being a new grad and transitioning from student to provider?
Knowing that you have so. Long. To. go. And just being patient with yourself when you feel so question mark about everything. Primary care / family medicine has such a vast and broad range of things you need to know about. So it feels entirely overwhelming to try to compile all of that information, spanning from newborn to elderly, all in one brain. But I know that it takes grace and time and I have to go easy on myself. It’s so much easier to retain and absorb information when you’re not in a panicked state, so that’s where I’m trying (and mostly failing) to live.
- On a scale of 1-10, how overwhelmed do you feel?
On any given day, I range from a like 4-8. I think a full 10/10 overwhelmed only comes when you feel overwhelmed and alone. And I’ve never felt alone whatsoever in this new position. It’s been a healthy amount of anxiety so far. Nothing crippling or unmotivating. Instead, sort of inspiring to keep trying to be the best provider I can be.
- How is imposter syndrome?
Oh huge. To be expected though. I just remind myself that literally every single person feels like this when they’re new in a position. Okay, maybe not every single person, but I’d say the vast majority. And it takes getting accustomed to a job and to a job location for those very loud yells to become mellow whispers.
- In general, what’s your biggest advice for combating imposter syndrome?
Go easy on yourself! Know that it’s entirely normal to feel this way. And that (hopefully), with each passing day it will dissipate a little more and more.
- Is there anything during the day that you dread? Like a procedure or certain visit?
Not really. The clinic I work at is so cool in that PAs have the ability to do a bunch of procedures after being trained. Nexplanon insertion / removals, IUDs, joint injections, etc. Hoping to get trained in some of these things because procedures are fun!!
- Are you getting to practice the way you want to practice medicine?
Yes!! The great thing about having such a slow and methodical orientation process is that I have time to make my practice into what I want. I had a wonderful discussion with my medical director and she said I have a ton of time (2 years) before I need to be at full panel (meaning seeing a patient every 20 minutes). I’m still in the process of creating the lectures I want for my nutrition group sessions, and hope to incorporate these into my practice soon! It’s a lot to orient to at once, but I really want to get these up and running early on in my practice so that they can continue to grow with me.
- What is something you wish you knew about your job prior to accepting the position?
As mentioned above, I didn’t know I’d be seeing so much pediatrics. And like PEDI pediatrics. I’ve seen 2 day old newborns!!
- Does it feel so good to finally have what you’ve been working so hard for?
YES YES A RESOUNDING ROAR YES. Exhausting? Yes. But oh so good. Also yes. It will be a lot of hard work before I get to a place of feeling competent and comfortable but I’m so excited to grow in this practice for years to come.
When interviewing for this position, I was very specific that I wanted to stay. I knew a PA that worked there before I applied and after hearing about her experience I knew this is really where I wanted to be, especially in terms of career longevity. I found a place that has an amazing orientation process, and a lot of room to grow for PAs. PAs are respected, independent, and valued. And have room to grow vertically, especially taking on leadership positions.
- How do you balance working and still being a person outside of work?
WOOF. Really hard. Especially because I have to reserve 90% of my blog work to weekends. The past few weekends have been really rough, to be honest. I’ve been working on really fun projects but it’s tough to go from working all week to then working all weekend. I definitely need to re-evaluate and re-prioritize the things that are important and allow myself time to rest. Somehow I was super behind on blog projects and ended up working ~20 hours two weekends ago. And then last Saturday had another project that had me on a video set all day Saturday. Again, all incredibly exciting things that have me bursting with joy, but at the end of them I was just wiped and it was tough to go into the work week not feeling all too rested. Also BLESSINGS to my management company for keeping me organized. Wow, I’d be lost without them.
So yeah with my PA job and blog stuff my days have felt really cramped. On each weekend though I’ve made it a point to see at least one friend just to help center me. I always schedule a dinner with a friend early in the week so I have something to look forward to. I’m introverted by nature so I don’t need huge, crazy weekend plans, but if I don’t get to see anyone in my immediate social circle for an entire week, I start to go a little stir crazy. I’ll also call friends and family to/from my walk to work.
Hopefully as I get a little more comfortable with work, having energy to socialize will feel a bit easier. Because when I get home from the day, I’m pretty much just hitting the couch, trying to read up on cases I saw, and heading to bed by 8:30 (LOL). My brain is working so hard right now which leaves little energy for much else. But I know this is only temporary and as I start to feel more competent at work, I’ll have more energy for other things.
- How are you dealing with being busy 40 hours a week and working within a schedule again?
See above. I like the structure! Definitely tired and still adjusting but not as bad as I thought it’d be. Especially because once I have my own schedule, I’ll have some admin time. Meaning I can choose a few mornings a week to go in at noon instead of 8, which is a DREAM!
- Favorite part and thing that makes you most nervous?
Favorite part: the people. Makes me most nervous: someone’s care (with really complicated chronic diseases) is in my hands. GRANTED there’s always someone around to ask for help. But still. The general concept is…terrifying.
- How do you go about telling your supervising doc that you have no idea what to do?
My supervising physician has been at another site during the pandemic, so I haven’t been with her during every shift. However, she is always available by phone and I often text her with questions about patients. The bright side of COVID (said no one ever) is that it’s allowed me to be with so many different providers who I otherwise never would have met. My clinic has served as the anchor to two additional clinics, which means I have triple the exposure to providers! At this point, BECAUSE I’m so new, I have no issue going up to someone and simply saying “hey can you help me. Plz. Help.” Especially if I’m feeling overwhelmed and just have no idea where to start. These are the BEST learning cases in the end. I think feeling embarrassed about saying you aren’t sure where to start or what to do very quickly trickles away because you always want what’s best for the patient. ALSO – if you find someone in your clinic you connect with, ask right away for their number and if you can call them with questions.
- How often have you feel like you were out of your depth since starting?
Depends on the day. I would say anywhere between 40-100% of the time (LOL). I thought I was maybe sort of getting a bit of handle on things, but then I started at our respiratory care clinic. Here, the acuity and medical complexity is just inherently higher. The learning has been absolutely amazing, but (wo)man oh (wo)man is it overwhelming. Luckily, at the respiratory clinic there is a lead provider that you can call from the room at any time. Before each shift, I make sure I check in with the lead provider, tell them I’m new and will likely be calling them for every patient. I’ll also sit by them so I can easily review an EKG or lab, ask a question or just try to absorb their intelligence by process of passive diffusion (kidding…sort of).
The thing is, I often feel out of MY depth, but that’s because I’m so new that my knowledge basis is still pretty shallow. It grows deeper and deeper with time. And luckily I have the DEEP DEEP middle of the ocean level knowledge depth of my coworkers to help me in the meantime and serve as a life jacket.
- What’s been your favorite part?
I must say, even though it’s hard, my baseline level of life satisfaction has skyrocketed. I really do love being a PA. I feel like I’m stepping into my life’s purpose and can’t wait to see what the future holds for me as I grow within this career. The patients at my clinic are wonderful, so that is certainly a big part of my favorite part. Also – I get to WALK to work! This may seem small but it allows me to set my intentions for the day to focus on how I want to show up: giving my all to patients. I also LOVE my coworkers.
- General tips on handling the stress / insecurities of staring a new job in a pandemic / mitigating the inevitable overwhelm that you know nothing?
Remind yourself that it takes TIME. My medical director says that it takes 5 years to REALLY feel comfortable. And I’m just in this early, early stages. I also like to take pause at the book ends of my day (morning and evening) as a way to warm up and cool down. I’ll drink my coffee slow, do the NYT mini crossword, and a slow skincare routine (sounds so insufferable, I know), maybe a little movement. It engages my mind, taste buds and body, and forces me to reconnect with myself. When I get home from work, I like to shower right away and make dinner. Then I’ll do a little stretching or foam rolling. It’s sort of like a physical version of closing the chapter on the day and allows a little separation / distance from the stress. This has surprisingly helped so much. Because otherwise the whole day just blends together in one exhausting blur. Having these intentional moments of separation allows me to still my mind and reenergize a bit so I feel a SMIDGE more human by the end of the day.
- What resources are you able to use very to educate yourself on a new diagnosis?
See above. UpToDate and other apps / humans that are around.
- How often do you come home and study? Or is it mostly on the job learning?
Truthfully, very minimally. I’m looking things up SO often at work (like 80-90% of the time) and asking coworkers about things that when I get home I truly am exhausted. So part of my “avoid burnout 101” is not feeling pressured to study at home. Maybe once a month I’ll spend some time on topics that I can’t get to while at work.
- How do you avoid burnout?
Having a good (fiction) book at home to escape with. Planning time off and taking vacation time, even if that means just staying at home. A daily mindfulness / meditation practice. Yoga. Walking. Getting out in nature. Therapy. Talking and processing with my coworkers. Facetiming my sister every day. Asking my parents for help. Revisiting my “why” list – the reason why I wanted this career in the first place. Making a list of sounds, smells, tastes, sights, feels that I love and then seeking out those things. Fueling my body with nutrient dense, gut friendly, brain food. Drinking water.
The most important thing for me: when I feel the pangs of burn out is when I need to immediately reach out and ask for time off. So when you start to recognize these symptoms in yourself, write them down! And that way you can more easily recognize them in the future.
OVERALL. It’s a lot, but it’s manageable. And it’s exciting to be in a place where I feel like I have the support to step into my potential. When days are hard and I’m so incredibly anxious and nearly want to cry (I’ve only gotten teary at work once so far. So proud of me hehe), I just am going to recall this message from my grandmother,
“I know how difficult it must be to have such a responsibility for someone’s health and how scary that must be. Just reflect on where you have been and what you have accomplished in your short 28 years. Your journey has been nothing short of amazing. You are more than capable and ready for this new challenge. It will be down right scary but you have everything you need to be great!!!
Hang in there and it’s ok to be scared that’s all part of the learning process. Lousy but you will remember this some day and it will be all the more sweet when you walk in to the clinic and no butterflies remain.”