PA-S to PA-C Imposter Syndrome

I began writing this post last weekend when I thought 8 weeks marked my two month work anniversary. But my actual work start date was July 20^th which means two months is September 20^th. Have I bored you to tears yet?  I’m clearly stalling to write this… Because it’s a really weird and awkward and uncomfortable thing to write about – going from PA-S to PA-C.

I wanted that letter change for so long. But now I realize it was kind of nice to hide in that S.  To use the “S” card whenever I didn’t know something (aka every question). And with the C, the big C, means way more responsibility.

I remember sobbing in my kitchen on my last rotation of PA school because I just didn’t understand how you could have the same exact brain, the same amount of insecurity, fear, imposter syndrome, but have the authority to give advice and prescribe medication. And I for certain didn’t understand how the evolution from new grad to competent provider happened. So many emotions coursing through me that naturally the only solution was to bubble over in tears and sorrow. Me sobbing? Are you surprised?? Nope.

But yeah it’s downright scary!! Caring for patients and having the idea that you could “miss” something important at any given moment is terrifying. Granted at my current job, I never feel alone. I am so lucky to be in an office where everyone is so incredibly supportive and eager to teach and answer questions. More about my work experience so far here.

But the imposter syndrome is VERY real. Cripplingly real. My rational mind knows this is completely normal, natural, and honestly necessary as a new grad to keep me on my toes and keep researching and asking questions about patients. But can patients tell how nervous and unseasoned I am? Am I ACTUALLY giving sound advice? Am I projecting my noise and energy onto patients? Will I make a difference? Am I smart enough to be doing this?

In every interaction, I have to pay very mindful attention to the confidence I give off in my voice. Because to me it feels nonexistent. And just unbelief that in the change of a letter, not of experience, I am now my very own healthcare provider.

My point in writing this is that all of these feelings are par for the course and it’s learning how to listen when this noise is telling you something important, and when it’s just being rude and manipulative.

For example, this voice keeps me pushing to learn more, look up pretty much everything, and continue asking questions. This is a good thing. To be propelled into the version of the provider I hope to be one day.

But when I get home from work and feel entirely anxious and paralyzed and just very down on myself, that’s when I know I need to re-evaluate.

When this happens, I turn off all the electronics, and disconnect from the thing that’s making me anxious. And start writing down very specific accomplishments that I’m proud of. Not just “I’m smart!” “I’m capable!” and “I’m strong!”. Because those things are a little too vague to get me out of a funk.

Instead, I’ll write “I had the highest rate of getting patients to try smoking cessation of any student in my primary care rotation.” And “I was accepted to a nutrition fellowship as a new grad.”

This feels so boastful to write on the internet and honestly makes me eye roll at myself. But is admittedly very, very helpful before I feel like I’m about to spiral into a complete imposter syndrome black hole vortex.

Every time I have a positive experience with a patient or co-worker I write it down in my note pad. That way, when I’m feeling particularly vulnerable or fraudulent, I have very specific and tangible action items that negate those feelings that are readily available.

I’ll write down the negative or nervous thought I’m having. And then next to it I’ll write down an action that I’ve done in the past to negate it. Or if that action hasn’t happened yet, I’ll write down one little thing that I can do in the future to negate the negative thought.

I also like to remind myself that growth is uncomfortable and often painful. But growing pains ultimately means expansion. Stretching in all directions. About to burst. But then your body adjusts and acclimates and then there’s room to grow some more. Or at least that’s how I’m choosing to think of it. 

Do I miss being a student? No. A resolute, resounding, oh hell no. But it was nice sometimes. Very minimal responsibility and an easy crutch when you didn’t know something. It continues to be a very strange feeling to have to confidently give advice and knowing the person across from you will (hopefully) take it.

Building trust with patients takes time. Being a competent provider takes time (5 years according to my medical director). Way more than two months that’s for sure. So this post is more certainly premature and will be added to in the future.

But in the meantime, paying attention to the small positives because those feel like very big wins to me right now. Patience while seeing patients. Yeah, let’s go with that. More to come soon but now celebrating this small wins of seeing 6 patients just my name assigned to them today (with asking a million questions along the way, of course).