Time flies! I can’t believe I am approaching my first work anniversary as a Physician Assistant. It was a year fruitful of experiences – both good and bad. I was definitely very nervous prior to starting work. I remember actually meeting up with some working PAs who graduated the year before me to ask them for advice. Today, I want to share with you (the new graduates) 8 personal pieces of advice on getting ready for work.
Continue reading below.
I want you to introduce yourself to everyone. Not just the physicians, but the nurses, secretaries, allied health care, etc. Don’t wait for someone else to introduce you; make the first move. Put that hand out for a handshake and introduce yourself. Trust me, you don’t want to wait until you’re 6 months into the job, awkwardly introducing yourself to the clinic clerk who books all your patients’ appointments and imaging. Along with that line – it helps to remember their names. Be prepared to answer, “What is a Physician Assistant?” because your coworkers and patients are going to ask. I get this a lot, “How much longer are you in training? When are you going to become a doctor?” and it is a good time for me to explain to them what a Physician Assistant is and how I play a role in their care.
Track everything you do from Day 1
This will come in handy when you want to evaluate your impact to the clinic/service. You want to be able to see at 3, 6, 9 and 12 months where your value is. I am not saying this will be easy but it will be important. What you want to track will be totally up to you, specific to where you work. In family medicine, PAs can track the number of patients seen they see, tallying up the billings, assess whether wait-times have decreased, or if there had been an increase in patients added to the clinic’s roster. In an inpatient hospital setting, PAs can track the number of consults or discharges they’ve completed and the length of the patient’s hospital stay (eg. Are patients discharged earlier with the addition of a PA? Are patients seen sooner by consulting services?)
I had a hard time finding a good metric to track for myself. Where I function, I do bits of everything – OR, clinic, ward, referrals. In the end, I chose to track everything and anything that I could think of. In a notebook, I recorded the number of patients I assessed in the clinic, the number of surgical procedures was I involved in, the number of clinic procedures I have completed (which was helpful to show that by the 20th paracentesis, I felt confident doing it unsupervised with our nurse).
The upcoming CAPA Conference has a session that touches on this topic: “CPAEA: QUANTIFYING THE PA ROLE – USING EMR METRICS FOR PROGRAM EVALUATION”
Advocate for yourself
You are not a student anymore. No one will be advocating for you now. It is your responsibility to do so. If there is something that you want to do, speak up. If you want to do a procedure, let the staff know. I made it known to our wonderful nurses in the clinic that if there is a patient requiring a paracentesis, I want to be the one going in with the staff to do the procedure. If I was in the operating room, I would ask my staff if I can sterile prep the patient or suture close the incision. This goes along the same lines for if you don’t like something at work. This will hopefully be a long term position so it is better to resolve issues earlier than later.
Learning does not stop on the last day of clerkship. It does not stop when you graduate. Learning is lifelong and there will always be something we do not know in medicine. Especially in the first few months of working, review your notes at home.
I highly recommend asking questions around patient cases. Why is this the most likely diagnosis? Why did we choose this management? How do we manage (insert symptom/condition)? Sometimes there are guidelines or research papers the physician would refer to. There’s a library in the hospital I work at and I signed out textbooks that were recommended to the residents. I also asked to attend any teaching sessions lead by our staff for the residents which I found super helpful when I started in this specialty.
This piece is still a work in progress for myself. I definitely have self-doubts and occasional feelings of incompetence – especially the first few months when I started working as a new grad (I definitely had imposter syndrome). I KNOW I should not compare myself to the clinic nurses who have been working closely with our staff for over 10 years and the residents who have completed 4 years of medical school and residency. However, it’s easier said than done! We all need validation that we are doing well and what we are doing has a positive impact..
In the same notebook that I record my metrics (see number 2), I note down any personal accomplishments I had and any positive constructive feedback from my staff. For example, performing my first paracentesis unsupervised, helping to manage patients on the ward when we were short residents on the service, or when a patient tells me she had a positive encounter with me. It serves to remind me that I am growing as a PA and that my job is meaningful.
Connect with working PAs and keep in touch with your classmates
Work can have its good days and bad days. Talking to your classmates or other PAs in your field can be therapeutic because they understand what you’re going through. My class created a group chat where we share strange cases with each other, as well as any frustrations at work. We are each other’s listening ears. And we are always down for a group get-together. It goes without saying, they miss you too 🙂
I try to attend any PA events and keep in touch with practicing PA that I meet. They can be great mentors, always willing to suggest/give advice. I also find it helpful to talk to them about how the PA role is integrated into their workplace – it gives me some ideas on what I can bring to my workplace. There are Facebook groups for working Canadian PAs organized by specialties that I highly recommend joining.
Finance and Budgeting
This is my first full-time job. I was excited to have a steady income and what I can do with it (I can afford a drink with my meal without feeling guilty!)…until I realize I have a lot of expenses to pay. For one, I have to repay the Ontario Student Assistant Plan (OSAP). Then, there are professional fees and liability insurance. Some employers cover the PA’s medical malpractice insurance but I definitely feel better having my own. If you’re living alone or in a different city, there is rent to pay, phone bills, groceries, etc. Having a benefit plan is great. There is something called HOOP in Ontario that you should read more into and see if this is something you want to join (it’s a pension plan).
Everyone’s financial journey and priorities are different. My first priority was paying off OSAP. For some reason, I just don’t like the feeling that I am in debt. I feel like I can’t start truly saving until I was free from OSAP. I used an app called “WALLY” to help me track my expenses. It is not anything fancy but straightforward and user-friendly. Every month I know exactly how much I spent on groceries, eating out, clothes, etc, and this helps me stay within my set budget. An app like “MINT” syncs with your bank card so you don’t have to manual input it. I tried it out but didn’t work for me. It works for other people though. Also, some banks have apps to help save as well like TD’s MySpend. I am happy to say that I have officially finished repaying OSAP as of yesterday!
Don’t neglect yourself
Work life can be physically exhausting – waking up early when we are used to student life hours, commuting through rush hour, or working through lunch. Make sure to get enough sleep. Take vacation when it is due to avoid feeling burnt out.
Work life can be emotionally and mentally exhausting. Try not to take negative remarks personally. If you need, talk to a colleague or friend about it (refer to #6). Exercising can be a form of stress relieving, others chose yoga or meditation (I use an app called Headspace). Say yes to going out and doing activities unrelated to work for a change in the monotonous work life cycle (eat, work, sleep).
If any PA grads have something to add to this, please let me know! I would love to hear your advice too.
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