Workin' Gal

4 months and 2 days after graduation...the day I finally started my job as a hospitalist physician assistant!  Mark that on the calendar as the day I finally have accomplished my dream of becoming a PA in a hospital setting! :)

Yesterday was my first day of work which consisted of new hire orientation.  Quite a boring day as you sit through lectures on quality control, hospital policies and services offered for patients.  Even though it is not the most exciting day, I was just happy to be there and get going finally after sitting around for awhile waiting on licenses and such since graduation and passing the PANCE.  First thing was first, I received my ID badge that says "Hospitalist Physician Assistant" on it as well as a large "PA" so that I can be easily identified in case of emergency.  It's so crazy to see my picture on that ID badge :) 

Today included going to a lot of meetings with department heads so they could meet me face-to-face and know what I, as a new practitioner at the hospital, will need of them and their services.  It is great to have such a warm welcome when I am a new graduate. I feel as though I am so important to these department heads and its just a surreal feeling knowing that I do hold an important role in the healthcare services at this hospital.  SO happy to know that all this schooling and dedication was worth it.  

Tomorrow starts my first day on the floor and getting used to the computer system (Meditech) I will use to document and order.  Luckily I have a mentor PA who has been assigned to me whose name is Eric.  He will be my go-to person while I am settling into my new position with the hospitalist team.  I will be shadowing/working with him the first few weeks of my training and then I will be given a small patient case load.  Once I am feeling confident (in probably a couple months) I will start getting a full patient case load as a PA on the service would have.  

I'll let you know how it goes over this first week!

Update

So things are finally just about done on my end before the job can finally start!  I have received all of my state licenses and only 1 more national one to go then I am good to start work!  I am scheduled to begin a next week and I could not be more excited.  Only so much watching TV, going to the gym, reading a book, and relaxing that I can do.  I am ready to finally apply my skills I have learned over the past 2 years and get out of the house and earn so much needed money.
Other than that I have been acting as an adjunct faculty member for my school's 1st year students.  It has been great to help them out in lab and to help with the interview process.  I even was able to proctor the students' simulated patient lab experience which was an amazing opportunity to hone my skills and pass down what I have learned.  I have greatly enjoyed the experience and can not wait to continue helping the next group of students foster knowledge from my program.
Next time I talk to you I will be a working gal! yay!

Still waiting..

I feel like the process of getting licensed will never end.  It looks as though my start date for my job will be pushed back to the middle of March since the state takes a VERY VERY long time to hand out licenses to those who have had prior health care experience/licenses before.  Not much more to update on other than this quick rant.
Please ask some questions about PA school to cure my boredom waiting for these licenses lol

15,000 views

Thank you all so much!  I have reached 15,000 views on this blog and I am so excited that it is just the beginning.
I have tried to find new avenues to get more readership so I can continue to do this and write about my new career as a Physician Assistant.

So I went to my new job on Tuesday to fill out forms and sign tons of paperwork.  This job is not requiring me to sign a contract with a competition clause or anything of that nature so I was very happy to see that.  I also did a "photo shoot" while there.  I walked around in my long white coat and took pictures throughout the facility for my soon to be business cards.  I am excited.  Seems official!  Now I just have to wait for all my licensers to come through and I will be good to go and start working.
I am definitely getting anxious to get started since I am pretty much doing nothing of importance lately.  Been watching TV, getting excited for the Olympics to be on to watch that (since I love the winter olympics...so much better than summer).  I am headed out to go skiing on this weekend, will be my second time ever up on skis (besides waterskiing which I love to do).  The huge amount of snow we got yesterday should make for some great skiing :)

Ok, so that's about all new with me.  Please feel free to comment with questions since I have a lot of time on my hands to answer :)

Steps to Take After Graduation from PA School

One thing I wanted to talk about today is the steps of getting licensed and credentialed after you graduate from PA school.  A lot of people think once you graduate, the hard part is over.  This is half-right and half-wrong.  There are many steps to take after you gradate and i am here to break it down for you (as best as I can and to the best of my knowledge).  Be aware - the total process costs upwards of $2,000 to practice (on top of your tuition)!

1. PANCE Exam - you are able to sign up for your PANCE starting 90 days prior to your graduation.  My school handed out forms to expedite the process and verify our info on their side, a few days later we received an e-mail from the NCCPA saying we were able to create and account and contact a PearsonVUE testing center (where you will take the PANCE) to set up a date and time you want to sit to take the exam.  There are dates and times basically every day of the week and you can take it at either 8am or 1pm.  I think 8am was the best idea - less time to freak out and try to cram the morning of!
Cost: $475

2. State Licensure - After you receive your online confirmation that you have passed your PANCE, you may send out an application to your state government requesting to receive a state licensure.  Be aware - this application requires many steps including: getting a passport photo taken to attach to application, notarized form, copies of transcripts from all undergrad and graduate schools attended, if you hold other national licenses for other careers - must include a copy, and possibly more depending on your state's requirements.
Cost: varies by state.  State of MA - $225

3. DEA Licensure - After receiving a state licensure, you may apply for a DEA license.  This allows you to prescribe medications.  You may not apply for this licensure until you have a state license number.
Cost: $731 (good for 3 years)

4. NPI Number - this is your national provider ID.  It is a unique identifier that is necessary for Medicare services.
Cost: Free (I still have yet to apply for this but do not see a cost associated on the application)

5. State Control Substances Licensure: allows you access to prescribe scheduled medications according to your state mid-level practitioner laws.   Most allow anything from schedule II-IV (anything that your supervising doctor can prescribe, you may as well) with a few exceptions (example - methadone, suboxone, etc.)
Cost: varies by state.  State of MA - $150


Then, on top of all of those things, you are applying for jobs and filling out the associated applications.  Once a job offer is accepted, you then fill out all of the paperwork to begin the hiring process (including a CORI form, background check form, application, signing of paperwork, benefit paperwork, etc.)

So basically, I just wanted to forewarn everyone that not only is there a large expense to get certified and licensed as PA after graduating, but there is a good 3 month time lapse between graduation and when you will be fully ready to work. Be prepared for some time off with no income.  I have been filling my days with trying Pinterest recipes, household chores/cleaning, visiting my family and friends, getting good use out of my new TiVo, and enjoying quiet nights at home.

Let me know if you have any questions! :)

PANCE

Pretty sure everyone who has taken the PANCE from my class so far has passed.  This is seriously the best news.  Congrats to my fellow classmates! We made it!

PANCE and Job

This is by far the best thing to see after 9 anxiety-filled days of waiting!!


So I took the PANCE at 8am on January 14.  I was happy that 3 of my close classmates were taking the exam the same day and place as myself.  We arrived at the testing center for 7:30.  We signed in, read the instructions for the testing center, presented our forms of ID and got our finger print scanned and then were escorted 1 by 1 into the testing area to begin.
There are 5 sections of 60 questions that last 1 hour each (total test time of up to 5 hours).  You also get 45 minutes of break time that you may use in between sections if you choose to.  I completed 2 blocks, took a 10-12 minute break to go to the bathroom and breath a little bit.  Then came back and complete the final 3 blocks.  I think by halfway through the 4th block, I was definitely ready to be done.  The 5th block was just torture because I was exhausted.  It took me 3 1/2 hours to complete the 5 blocks.  Then myself and my 3 friends went to get margaritas and Mexican food!  It felt great to be done but so much wondering since I was not walking out of the exam saying "Oh yea, no problem, definitely passed that".  Each and every one of my friends thought the same thing I did, "wow, that was kind of harder than I expected.  I hope I did enough to pass".

So, after 9 crazy stressful days of constantly checking and rechecking my e-mail and the NCCPA website, it is official.  I am a PA-C.  So thrilled to finally have that last (and biggest hurdle) out of the way and I can now start to enjoy the last of my month off.   Oh yea, that's because I start my job in a little over a month!!

After interviewing at at least half a dozen places and sending out my resume to many facilities, I have found my perfect job to start my career.  I will be working as a hospitalist PA!  I interviewed and did a day of shadowing, at the end of which I was verbally told that the "job was mine if I want it" and subsequently received the official offer letter a week later.  I am so glad to have this great opportunity.  I will be working within a group of 6 already established PAs.  Out of those 6, 4 had been new graduates as well, and to see their level of competency within the hospital now shows me that this is a great position especially for me as a new graduate.  I will be working M-F 8:30-4:30 with no holidays, no weekends, and no call.  It can't get much better than those hours.  Even allows me room to apply for some part time work if I would like.
My days will look like this:
8:30-9:00: Morning huddle
9-9:30/10ish: Rounds on my floor
10-12:30: patient encounters, progress notes/charting
lunch
1-3: continue with daily needs of my patients and charting
3-4:30: admissions from the ER

Every 2 months we rotate which floor we are covering as to not get bored with the patient population.  The 4 rotations: medical, med/surg, cardiology, ER admissions.

I am so excited for the opportunity and can not wait to begin my career come March 3!!

Until then - TiVo.

Let me know if you have questions regarding the PANCE or job interviews/prospects! Looking forward to your comments!

I Passed my PANCE Exam!!!

I am officially a PA-C as of 9 am this morning!! After 9 torturous days of waiting, I finally know I passed and can start my new job come March 3rd!! Have not been this happy in I don't know how long :)

Will write about my job this weekend! Promise!! :-D

Thanks for all of my readers support!! So damn happy!! Great day!!!

Post PANCE and the rest of my year catch up!

Alright, PANCE has officially done.  I took it on Tuesday and will find out next week mid-week sometime how I did...eek!!

So now - as another distraction besides wondering how I did on the exam - I will finish up my summary of my clinical rotations


May-June: Internal Medicine
I did the 1st of my 2 internal medicine rotations as a small community hospital about 30 minutes away from my campus.  It was a private office with 1 doctor and 1 nurse practitioner.  I was placed with the nurse practitioner as my preceptor.  She was great!! She was relatively young, had been a critical care nurse prior to going on for her masters and all of the patients in the office loved her.  At this site they had a new EMR system so I could not do any charting of my own which was hard.  I was also not allowed access into the EMR system so I had to go in with the NP each time with a patient and I listened while she did their history.  Finally I was allowed to do all of the physicals (including DOT - department of transportation - physicals) for each patient that came in including problem visits, annual exams, and annual pelvic exams.  I was also in charge of administering all of the injections and PPD tests that came in when I was available.  This was a great way to practice my clinical skills.  Altogether this rotation was ok - just kind of long and tiring when you are not able to complete histories or see any of your patients solo.

June-July: General/Vascular Surgery
This rotation ended up being amazing!  I was so nervous going into my surgery rotation just because of all that you hear about surgeons being mean and yelling and all the pressure that comes with assisting in surgeries but it ended up being one of my favorite rotations/specialities!   The hours were the worst part (esp since it was over the summer), we arrived at 5:30am and left anytime between 4-7:30 depending on the cases we were scrubbed in on each day.  We would round in the morning from 6-6:30/7, then go down to the lecture of the day (each day was different, some days M&M, case presentations, whatever) then we had cases starting at 7:30 in the morning depending on what you were signed up for that day.  I did my rotation at a large teaching hospital in the city I went to school so it was hard sometimes always having residents on the cases that we went in on.  This allowed me to usually be the second assist, not the first which was hard.  Luckily a grand majority of the surgeons were great and allowed us PA students to still be involved and pimped us to a certain extend (luckily had the surgical recall book which I HIGHLY recommend).  I did get to first assist on a good half dozen cases so even though it was a resident-run service, I still got a great experience.  After we finished up with our cases for the day in the OR, we would either go observe pre/post-op visits in the clinic, do a surgical consult, or help create the patient list for the day.  I enjoyed the consults a lot because the residents would assign us one and we were able to go assess the patient our self and come back and present with our findings.  The residents seemed to appreciate the help and were great at teaching us.  My advice for a surgery rotation student is to each breakfast, get caffeine when you can, and carry snacks in your pockets :) Also, to read up on your case the night before so you know what the indications are for each surgery, complications, and your anatomy.

July-August: Orthopedic Trauma Surgery
This rotation was my biggest disappointment of my rotations.  I was so excited because I love orthopedics and the fact that this was trauma only orthopedics was so exciting!  My hours were 5:30-4ish most days.  I went in each day and rounded on patients until 7:30, along with writing a progress note on each patient.  I loved this part of the day because I chose to stick with the pediatric patients during my rotation and it was a lot of fun to see the come in "broken" and leave happy with their new favorite colored cast.  Then we would have fracture conference (which included free breakfast every morning!!!) from 7:30-8ish.  This was when all the residents plus the chief attending would look at all of the cases that came in over the past 24 hours and discuss how they were treated and their dispo plans (including planing their surgeries if it was necessary).  I loved this part of the day because it was fun to see all of the films with their corresponding pathology from the day prior.  The x-ray technician in me was thrilled :)  After conference we would go off to what we wanted for the day - whether it was assisting in surgery or going to clinic to observe one of the attendings.  I found this part of the day very hard to deal with.  I loved going into surgeries but it was hard because if there were no traumas that week, it was very slow in the OR.  I loved the OR when there were cases to watch because I got to assist and the orthopedic surgeons were AMAZING and were a lot of fun to work with.  They let me close up a lot which was a great experience and the residents were an excellent help when I was having a hard time.  Clinic made for very long days because the surgeons had to see all of their patients so I had no chance for physicals or histories.  I felt a lot of the time that the residents did not care where I was or what I was doing so it was hard to stay focused and enjoy the day.  Looking back, as I am writing this, maybe this rotation wasn't as bad as I was saying it was originally.  I think a bit more direction for the student was needed so I felt like I had some part in the patient's care.  Other than that, I think this was just the rotation I happened to be on when I was getting tired of clinical and was ready to be out on my own :)   I guess it was bound to happen at some point during this past year.

September-October: Surgical Intensive Care Unit
This was my assigned general medicine elective (it was this rotation and the next which was internal medicine).  I ended up loving this rotation experience as it was my first exposure to hospital medicine and showed me how much there was that I still had to learn and had no experience with and started to show me my passion as to how autonomous being a physician assistant can be.   This rotation was Monday - Thursday from 8:00-6:00.  I arrived in the morning and rounded with the team from about 8:30-10/10:30ish depending on our patient load.  I rounded with the attending for the week, the PA coming off the 24 hour shift, and the PA coming on for the 24 hour shift.  It was crazy the amount of care these patients needed after having a big high risk surgery or after having a surgical complication.  I learned so much about ABGs and mechanical ventilation.  After starting the rotation I was floored thinking that if I did not have this rotation that I would never have learned all that I did while doing my 5 week rotation there.  After rounding I would go around with the PA coming on duty and examine the patients, input order changes for the day, and manage our patients' constantly changing status.  This included a lot of bedside procedures such as A-lines and central lines.  I got to see many procedures done and even got to help insert a central line and femoral line.  This was also the rotation that I had a handful of patients die on my shift.  This hit close to home because I had been trying to get these patients out of the critical care unit when instead they died.  This was a rotation taught me a lot and I highly recommend all PA students have at least 1 rotation in an ICU setting.  Best experience.

November-December: Internal Medicine
My final rotation was at an internal medicine office that was within the same large medical group that I did my pediatrics rotation with.  I was placed with a physician who has been with this medical group since the beginning, he was also the chief medical officer for the medical group for awhile during his run with the company....no pressure!  In the long run, I could not have had a better physician as my last preceptor in PA school.  I learned soooo much from his years of experience including some clinical skills that are just not taught in schools anymore due to our reliance on diagnostic imaging techniques.  I worked M-F 8:30-5 with a half day on Wednesdays.  The first day I was there I shadowed the doctor to get a feel for how he completes a physical exam on a patient.  Then from day 2 on (since he knew if was my last rotation), I hit the ground running seeing as many patients as I could each day and doing a full H&P on them and reporting back to my preceptor who would then go in with me and double check my work and see his patient.  I could not have asked for a better last rotation to learn so much and have so much autonomy to show me exactly what it would be like in the real world for me working as an internal medicine physician assistant.  It was a great way to end my rotations and a great place to say for the final time "Hello, my name is Heidi and I am a physician assistant student".

So now, it's official.  I am a physician assistant.

I am also pleased to let you all know that after a month or a bit more of interviewing, I have accepted my first job as a physician assistant!!! :-D   I will post all about it next post (just for some suspense and to keep you coming back)!

I will post again within the week and look forward to telling you all about my new adventure which I am so excited about!!!

Pre PANCE Freak Out is Here!!!

Hi guys,
   Sorry I have not gotten around to completely finishing up my last year in review.
I swear I have a good reason.
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No, like seriously, I do.
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I take the PANCE in 3 days...
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and I'm starting to freak out.

So pretty much have been studying for 4-7 hours daily for the past 2 weeks so I can pass this thing!

On the bright side, I have had 2 job offers since finishing school and I am ready to sign on the dotted line with one of them!  So I'm just anxious and want to pass this one last (but the biggest) exam so I can go to work and enjoy my life as a PA at this great opportunity I have been offered!

I will go into more detail about my clinical year after Tuesday (PANCE day).
I will also talk to you all and give you job hunting tips and interview advice at that time!
Anxious to get back to at least weekly blogging...maybe even daily! :)

Ok - bed time so I can get up early to study for the day tomorrow!

Wish me luck Bloggers!

Wrap up of the last year (part 1/2)

So, as I promised here I am to tell you some of the highlights of my past year.  I will try to be as concise as possible as well as making it kinda short and sweet now that I am official graduated and am a Physician Assistant.   Please make sure to leave me a comment with any other questions you may have about my clinical year experiences or graduation, I will be sure to answer you! :) So I will just go rotation by rotation with a quick synopsis and add in the important stuff from the school end as well

January-February: Psychiatry
   Well....psych was definitely the rotation I was dreading and I was kinda disappointed to see that I had it as my first rotation.  Now looking back, I am so happy it was.  My rotation was at an acute care unit meaning patients came to the hospital, got admitted, and were to be out with follow-up within the week.  Most of the patients did just that but I was so disappointed with the number of people who came in just to have a place to stay for a week and use the system.  Some were fine the whole time they were admitted and as soon as we had outpatient care or a sober house lined up for them, they were "suicidal" the day we wanted to discharge them because they knew this was a free and warm place for them to stay.  It was disappointing to see but I suppose if I was in their situation, I don't know how I would survive either.  I learned that no matter what rotation you are on, psychiatric illness is all around you.  This is why this rotation was good to start with, plus, the hours were pretty short and the medicine was just patient interviews, no physical exams.  It really allowed me to settle into what a clinical rotation was nicely and I learned a lot of valuable patient interviewing skills like asking open ended questions!

February-March: Emergency Medicine
   My ER rotation was at a level 1 trauma center which made this very exciting!  The hospital has two campuses, with 1 being the trauma center and 1 being a tertiary hospital.  I started at the smaller, tertiary hospital which I think was a great place to begin especially since it was my first "real" medical rotation.  My first day in the ER I was placed under the supervision of a great and very friendly doctor.  Our first patient was a Latino male who spoke very little English.  He had cut himself while trying to move a couch and had a 3-4cm laceration in his mid-forearm.  the doctor looked at me and asked if I had done sutures yet.  I said "no, today is really my first day in any rotation besides psych" (which he went on to call my first real day of rotations lol) then he said, "ok, this will be a great first suturing opportunity for you!"  Nothing like getting tossed into the fire!! :)   Luckily he stood over me and instructed me and said that I had done an excellent job and that I must have practiced (yes!) which was a great confidence booster.  The rest of the time at the tertiary hospital was just like this.  It was great being the only student in this ER and they had no residents so I got to choose a chart, interview the patient, report back to my preceptor with what I would order and what my differential was, and follow up as results came back.  After 2 weeks I switched to the trauma center and that was a bit different.  Soooo many residents and students are at this ER that it was really hard to find a place as a PA student without really just trying to befriend the residents and take on one of their cases and going over it with them.  This was a key portion of my rotation that a lot of other students didn't fit into as well (as I had heard).  Be great friends with the residents, they know their stuff and really just want to help and teach you what they know!  I learned a lot from them.  I saw 2 traumas while I was on shift, 1 skiing accident that had run off the lane and into trees and 1 MVA that was car vs pedestrian.  It was a big eye-opener as my MVA was the first death I saw on my rotations.  She was talking when they got her in and then the next minute, she had lost consciousness and they were pronouncing her.  Everyone reacts different to death so I can only speak for myself in saying that it's a very different feeling when someone dies but you never knew the person.  You have feelings about it but not like you would for a friend or family member.   This rotation taught me a lot, not just about medicine, but about team work and using the resources you have around you to succeed.

March-April: OB/Gyn
   My rotation was purely gynecology as the doctor was in his 60s and closer to retirement (and his wife said enough with the all night OB calls).  This was one of my favorite rotations as I already had a clinical interest in women's health and the preceptor was hard but a great teacher.  I walked in the first day he told me to sit down then just started grilling me with questions about who I was, what my family was like, and my background before PA school - nothing like intimidating me on the first day but really he just wanted to get to know me.  I had homework assignment from him every night and had to come in prepared to talk about it with him throughout the day.  Since OB was not a part of my rotation, I had reading topics specifically for obstetrics and then one day we spent 2 hours as he presented a patient in labor to me and asked me questions and what I would do if certain things helped me.  Even though I really would have loved to have an obstetrics experience, I still feel like I am very knowledgable about labor and delivery and that someday it would be a cool thing to be able to experience and see first hand.  In this rotation he had a great progression of how he had me as a student get a full experience in gynecology.  The first week I watched, second week I did histories and only watched physical exams, 3rd week I did histories and exams from the waist up, 4th week I did the full history and he came in as I did the entire exam (including pelvic), and then the last week I went in alone and did the whole history and entire physical with pelvic and he came in after to see the patients.  It was amazing and his patient population has been with him for the most part of 30 years.  They were all so welcoming of a student that I got a great experience.  I would hope that everyone gets the experience that I had because this was definitely a favorite rotation of mine.

April-May: Pediatrics
     My pedi rotation was at a large medical group with one of their newer doctors (she had been with the company for 2 years).  This specific medical group does not allow students to be with the patients alone (which realllyyy hinders one's experience but you make the best out of it).  I loved this rotation because I happened to be there during the week that my supervising doctor had to do newborn rounds (which only happens once every 3 months so I was lucky!).  So not only did I see outpatients but for 1 week (including 1 weekend) I got to get up every morning and from 8am-12pm I got to go to two of the nearby hospitals and do newborn exams.  This was an amazing experience, I really enjoyed getting up everyday and seeing the little ones and the parents who were just so excited that their bundle of joy was finally here.  I also got to do 2 nights at the pediatric urgent care center that this medical group has (mainly ear infections, strep throat, sinusitis, and small lacerations).  On a daily out patient basis, my doctor also happened to be the only doctor at this location that was accepting new patients so it was great to be able to have many newborn baby visits including at 1 and 2 weeks then again at 1 month.  Being able to follow up and see these babies get bigger in just their first month of life was a great experience.  Then the daily milk intolerance and otitis media every single day.  Peds was a fun experience and even though a lot of the pathologies seen are very common, still great to make a kid smile everyday...and have them make me laugh tons!


OK...just realized how much I have to say and I need to go to bed lol - so part 2 coming tomorrow (including primary care x2, surgery, orthopedic surgery, and surgical ICU)
Feel free to ask any questions!! :) Hope you are enjoying the stories so far!