PA School Updates + Incorporating Nutrition into Rotations

You guys. One semester left. It’s hard to even imagine.

I’ve recently been thinking about next steps. Such a strange concept being that I’ve been in school for so, so long. And this means I’ll then have to look for jobs!!! **internally screams** Who am I kidding: **externally screams**

Given my background, my ultimate goal is to integrate nutrition into a medical practice (duh). As a PA, this means I’ll be operating alongside a physician. There is a lot of autonomy in the profession, but especially as a newly minted graduate I anticipate spending a lot of time with / directing a lot of questions to the physician I work with. Or the fellow PAs / advanced providers. Literally whoever is available / makes eye contact long enough. That is who my question will go to.

Which then arises an even more terrifying question: what if I can’t find a physician or practice whose ideas regarding preventative medicine don’t echo my own?

Going into PA school – superimposing an eastern medicine philosophy on a western medicine model – I knew this would always be my challenge. If you want to go into functional medicine right away, you likely won’t face this issue. But I personally don’t see myself in FM after graduation, for two reasons: 1. A functional medicine practitioner personally recommended I shouldn’t and 2. I don’t know enough western medicine yet. I still don’t even know what I don’t know!! And in order to fully grasp why people look to alternative medicine, I think it’s important to deeply know and understand evidenced based medicine – what’s taught in med schools, PA schools, hospitals, medical journals etc. 

It’s also vitally important to me to be covered by patient’s insurance. I never want to make myself or my services unattainable or unavailable to patients. Oftentimes functional medicine providers charge out of pocket, which amounts to hundreds and even thousands dollars paid independently.  This is definitely not my goal.

So as of now, I plan to apply to jobs in Boston in either psychiatry, GI, or primary care. I still have three more rotations to go, so this could change. But based on the rotations I’ve done so far, these are the fields that have felt most like home. And the ones where there seems to be good opportunity to weave nutrition into a daily practice.

Now onto integrating nutrition into rotations:

Being a student is perpetually awkward in that you’re always questioning your role. You’re itching to be a bit more independent, desperate to advance from 4 training wheels, elbow and knee pads, a helmet, and fully padded bodysuit to something a hint more hands off – maybe just one set of training wheels, knee pads, and a helmet. You never want to educate beyond what you’re capable of, but you also don’t want to simply shadow or be doing histories and physical forever. This subtle shift – wanting to take a stab at the assessment and formulate a plan for a patient on my own to run by my preceptor – started occurring around my 4^thor 5^throtation. Because during the first semester my confidence was guttural and I felt like I wasn’t even capable of diagnosing something as simple as dehydration. But slowly, slowly, slowly, I am starting to feel a little movement. Not a ton, that’s for sure. Most days I still feel like a complete and utter fool but there are a few glimpses of that feeling of “hey I think I’m maybe sort of starting to get the hang of it?” (most of the time this feeling is paired almost immediately with foolishness once again. Alas. Life of learning and being a student).

I also have a different background than most students in that I feel confident that I can provide some useful tips in nutrition and preventative medicine.  Most preceptors (who have all been incredible!!) are entirely eager of this and encourage educating patients based on your background. I like to have a conversation with preceptors at the beginning of each rotation explaining my background and how I intend to use it during that rotation. During my primary care rotation, I was able to educate on elimination diets and print out a handout for my preceptor for patients. And she was so open to this; it was awesome! During my psych rotation, I asked if I could lead a small group session for inpatients on the different ways food has a powerful impact on mood. I also provided a handout to my psych preceptor recapping the information I discussed in the group session. This was always, always done after asking my preceptor and ensuring they were there to supervise, especially if I was doing nutrition education with patients. It was always done in a spirit of respect and collaboration, never independence.

And that is my ultimate tip for rotations if you have a different background that you hope to integrate into medicine: ask to do more work. Ask to educate, ask to lead group sessions, ask to provide more research on whatever it is you’re passionate about. I was so incredibly nervous about this year and really questioning where I would fit in. And quite honestly I don’t think I’ll ever be plopped into a situation or field and magically just “fit.” I’m realizing I have to be the one to take charge of what it is I want to do and forge where I fit. This means more work. But it also means a far more rewarding experience.

What about you guys? Ever try to sprinkle in one of your passions into the workplace? If so, how’d you do it / where did you see the most success?