Trials and Tribulations of the Job Hunt

          Yesterday, I had the pleasure of meeting up with 2 former PCOM PA classmates! I have seen a few PCOM people since graduation.  It is unfortunate that many are in different states otherwise we would meet more often.  Over dinner we discussed the cons of job hunting.  Unfortunately, there are not many pros.  It was a pretty prevalent theme that job searching was not fun.  However, I am not a very aggressive job hunter and at times you really need to be.  It was definitely a learning process. It is important to follow up sending applications with a call but also it is just as important to know the line between aggressive and annoyingly pushy.  For example one of my classmates has even shown up to ground rounds in order to get a job.

          We also discussed stories of the let downs we have had in "the processes".  Many of us have had leads to jobs or the prospect of an interview that fell through.  For example, I was offered an interview a few weeks before taking the job I have now. The email stated they wanted to set up a phone interview that week.  I gave them my schedule and waited for them to contact me, a few days went by and and heard nothing so I called and emailed and still heard nothing.  To this day, 2 weeks later, I have yet to hear about setting up an interview. Luckily, I was offered a job somewhere else.

          Similarly, I was called in November by a place I interviewed in back in August.  In the voicemail it seemed like I had gotten the position and that they wanted to speak to me.  This was a Family Medicine job close to where I live, basically what I was dreaming for.  I called them back within 10 minutes and left a message. Over the course of 2 months I repeatedly called and left messages with no call back. How companies can do this to applicants is beyond me, but unfortunately it happens.  Some of my classmates have had similar stories.

          Another problem my classmates have faced is "the choice".  This is when you have more than 1 job offer and you are forced to choose within a certain amount of time.  During this time you could also be waiting for a call back for a position that you have always wanted.  So, the question is do you wait for the job you have always wanted with the potential of not getting the position BUT losing an opportunity on the job you were offered. Conversely, do you give up on the job you hoped for and take the job you were offered.  It is a tough game out there. I am lucky enough to no have the problem but the 2 girls I met with are in that predicament.

          Lastly, there are many places you will interview that will just never call you back.  I have had many interviews that I thought went great and I never heard anything.  It is definitely discouraging. I almost wish they would have called and told me I did not get the position. This way I could have asked what I could have done better for future interviews.

          This blog was not meant to discourage anyone, it is merely to show that this is what happens in real life.  If you know then you can prepare accordingly.  So, don't put all your eggs in one basket! Thankfully, it seems that my 2 classmates have job offers.  In this economy and job market, we have to be thankful for jobs. I know I am, especially right before the New Year.  It must be the holiday spirit in the air!

Peace of Mind

     I woke up this morning feeling so refreshed and happy. It is so amazing how much of a difference a job makes.  I just wanted to write a quick post for those who are still searching for jobs. DON'T give up and DON'T be down.  I was feeling like maybe there was something wrong with me, the truth is some places want people with more experience or a certain personality that I just did not fit.  Keep up hope, you will find something that fits you.  That being said, don't settle if you get a bad feeling. I had that happen to me twice. Once I felt like I was settling with the Long Term Care job and I felt uncomfortable with a Physician I met with in a Family Practice last week. My advice would be open your mind to new possibilities.  Dig deep into your personality, for me I wanted a job that I would get experience and LEARN.  It took me 5 months to find a job, initially I was searching for the perfect Family med or Peds job and when I could not find it I tried to get a shoo-in job.  Once I got that position, I realized that I was settling and not happy.  After that I learned that even though I have an interest in Family Med and Peds, I should be looking for a job that I should ultimately be learning from.  I chose a job that has a lot of promise and opportunity that allows for personal growth. I am very anxious about this position but I know deep down that I am confident in the training I received from PCOM and in my own abilities as a Physician Assistant.  I can't wait to start on my new journey!

Hired!

I can finally post that I have a job! After months of interviewing and job searching, I finally got a good offer and I took it.  I will be working in Orthopedics.  It was not a field I was initially looking for, I wanted primary care, however, if you read my last blog, I am looking for a job that I can learn from.  I did not think I could learn from the homecare job. I enjoy being part of a team. From that point on I decided to broaden my job search to positions I know I would enjoy and learn from. I immediately added ER, Urgent Care, and Orthopedics. I am so glad I got a hit.  I will be working with postoperative orthopedic patients. I know this job will be challenging but I am confident that with my training from PCOM and the additional training I will receive in this job that it will be a good fit. I am hoping to start in Jan or February! In the meantime I am going to enjoy the holidays and read up for the new job!

WE DID IT!

         PCOM has always been known for having high scores on our board examination each year. Last years class had the highest number of perfect scores.  This year was just as exciting and I am proud to be a part of this accomplishment.  We are the second PA class at PCOM to ever get 100% first time pass rate on the PANCE exam!!! Let me tell you, that was not an easy test.  The last 100% pass rate was in 2000 with the first PA class at PCOM. We were congratulated by our teachers for this great accomplishment. CONGRATS EVERYONE, WE DID IT!

Don't Settle, Go with your gut!

          This week I had to overcome an obstacle. This obstacle was not one that I predicted.  I thought I would share because maybe it will help someone else in my position. 

          On Tuesday I applied to a job.  The position was not in my field of choice but it was a job.  The job was in homecare, it paid really well, and the people who interviewed me were very nice.  At this point it has been 2+ months after graduation and I still don't have a job.  I have had a few interviews, all with no success. I say this not because I am disappointed but I want you all to know my current state prior to going into this interview.  A friend of mine from class got into this homecare job so I figured I would apply and see what they had to offer.  I went into the interview confident even though I knew I did not want to be in homecare for the rest of my life. The interview was straight forward, the staff friendly, and within 10 minutes I was offered the position.  I wont go into detail on the benefits of the jobs or the obvious red flags, but I will say that I told them I would think it over and get back to them.  Immediately when I got into my car I began to cry.  These were not tears of joy, for some reason I was very upset.
        
          Now, I have mentioned previously that both my parents are physicians so I came to them with my contract and asked for words of wisdom.   My parents were split on the decision but both gave sound advice.  My Dad said that it is a first job and it was good to get my foot in the door anywhere, however, he was concerned in the amount of distance I would have the potential to travel each day.  My mother recalled the days of her first job experience and how she felt terrified and needed the knowledge that there was someone in the office to bounce ideas off of if needed.  She feared that with me being alone on a daily basis that I would not get as much of the essential teaching during my first job that I need.  I have to admit, prior to talking to my parents I had more of a view of my father.   Later, I came home and my boyfriend immediately realized my distress and said, " You are so unhappy and you have not even taken the position yet."

          Long story short, I took a few day to think it over and decided not to take the position.  After making that decision I felt an immediate weight lifted off my shoulders.  I don't want to rush into a decision just because it's a job.  I want to be happy, after years of schooling I think I deserve that much. I wanted to tell my story because I felt that maybe someone somewhere would benefit from this.  Go with your gut, if something does not fit or you spontaneously start to cry after getting a position (like me) then maybe it is not right.

          So, I am currently still job searching and proud of it! I have a new perspective, I am applying to Family Med and Pediatric jobs like before but also other jobs that I know I will have a team by my side to bounce off ideas if needed.  This was definitely a learning experience but I know I made the right decision. 

Officially a PA-C

YAY! I am officially certified! I passed my PANCE exam!  I am so excited to finally not study.  My recertification exam does not happen for 6 more years! All that hard work really paid off. So far everyone has passed the PANCE exam. I am hoping that our class will be the 2nd class ever to get 100% first time pass rate. I am so proud of my classmates and all we have achieved. Currently, I am enjoying my free time while sending out my new CV and cover letter with PA-C on it.  I am anxious to work but I have not had so much free time in years.  It is strange to think that I am completely done with schooling, forever. It will be nice to start making money and do what I love. I feel like my life is just beginning, there are so many possibilities.

More good news to come I am sure.

~Jennifer Pilchman, PA-C

PA Class of 2012

Here we are the PA Class of 2012!!! The serious and the not so serious version! I am so proud!

PANCE exam

          3 more day until I take the PANCE exam! EEK! I am very nervous but excited to get this over with. Weeks of studying have all come down to this. What am I kidding, all of PA school has come down to this! So far, our class has 100% pass rate and I am hoping to continue this.  Am looking forward to relaxing once this test is done.  Wish me luck everyone!

More on Job Searching

          I wanted follow-up on a question I got from a reader.  She wanted to know the process of job searching.  I realized I did not fully touch upon this in my last post.
          I have been using indeed.com, the aapa job website, and doccafe.com.  I have also used monster. com and craigslist but there is really not much on those two sites.  I check every day.  I mostly have been emailing or submitting applications with my CV and a cover letter. Occasionally, there is a job that has their own online forms to fill out. Our school went over with us the correct formate and what to include in the CV and cover letter.  I made sure to have many people look it over before sending any of them out.  The worst thing you can do is send out something with spelling mistakes or format issues.  Makes sure your CV and cover letter are concise and neat.  I made a general cover letter and tweak it depending on what position I am applying to.  PLEASE don't lie in your CV or cover letter.  You may be asked about a position you "worked for" or they may expect you to demonstrate a skill that you said you had in your cover letter on the job.  This did not happen to me, I am always honest, but I have heard stories.  The best relationship you can have with your employer is an honest relationship.  Similarly, let yourself shine on paper.  I know that sounds corny but it is true.  I try to always put myself on that page, not just my credentials and experience.  I let them know who I am because ultimately, I want someone to hire me for me.  So, if you find a CV and cover letter template use it, but make it your own.
        Advice on interviewing: be yourself, be calm, and enjoy the experience.  The answers will come to you, just be honest.  Don't be afraid to ask questions!  At the same time, do your research on where you are interviewing before asking a question.  You are already a qualified applicant, that is why you got the interview so just be yourself.  They want to see how well you fit in with their practice and their patients. You got this!
         I hope this helps some of you.  If there is anything I missed shoot me a message and I will try to answer it the best I can.  Have a good day everyone!

Life After PA School

       Well everyone PA school has officially been done for a month!  I can’t believe how fast that was.  I have been doing a lot since graduation.  I took a much needed week vacation, a very important week of NOT studying.  Since then I have been trying to see as many friends and family as possible.  It is amazing how much I have missed in these past 26 months!  Currently, I am studying for my certification exam, the PANCE, which I take September 6^th.  Studying has pretty much been my job about 6-8 hours a day.  I have been going through each topic and doing questions.  Some of my classmates have already taken the exam and passed with flying colors.  I am so proud of them!  During my time off I try to relax and do something fun.  The monotony of studying can get to you sometimes so you have to know when to relax.  In the meantime, I have been job searching.

            I started my job search earlier than most, in June.  Looking back on it I think I should have started later.  It seems like most practices wont give you a second look unless you have graduated and taken the PANCE.  Here is what I have found in my job search.  I am looking for a primary care job: Pediatrics, Family Medicine, or Internal medicine.  I also have an interest in Dermatology and Gynecology.  The job market in Philadelphia, Pa for primary care is not very good.  If I wanted a job in Emergency Medicine, Surgery, Pain Management, Orthopedics, Oncology, or a Hospitalist position I would be golden.  This seems so surprising to me since I have always been told there is a need for primary care practitioners.  I am sure it is because this area is very flooded with applicants due to the location and the proximity of 6 PA schools.  While my training is extensive in all areas of medicine, I am unwilling to settle for anything less than what I know makes me excited about medicine.

 That being said, I have applied to a handful of positions and have had a few hits.  I have currently had 3 interviews and I am waiting on another.   The rush when you get your first call/email stating that a company is interested in you is very exhilarating.  It is a rush of nervous and excited energy all at once.  Reality hitting you in the face.  Thankfully, all the interviews I have had have been straightforward.  I feel as though I have handed myself well in them. I always answer honestly and ask appropriate questions. 

 I had my first working interview 2 weeks ago.  That was definitely nerve wracking.  It was really no different than a rotation.  You see a patient, formulate a plan, and meet with the attending physician and present to them.   I did that with 2 patients and I came up with the same conclusion as the doctor so that was good.  I felt calm with the patients and the Doctors.  In the working interview I also saw how the Doctors interacted with their patients. I have to say, I liked what I saw.  I prefer this type of interview to the standard meet and greet.  In a working interview you are able to show your stuff and prove that you have what it takes to be hired.  In a standard interview, they make the decision on how qualified you are by your responses but not with what really matters, the patients.  Similarly, I was able to evaluate my “hopefully” future employer just as much as they were evaluating me.  It is very important that you as well feel you fit in with the practice.  Sometimes, I feel we forget this because we just wanted to get our first jobs as PAs.  I hope that I get the job that I interviewed with. I am keeping my fingers crossed.  I will definitely post on here if I get good news. 

            Alright, it is back to studying.

Dermatology Elective

I completed my Dermatology Elective last Friday, July 20^th.   I really liked my elective.  I chose this as my elective because I wanted to do something different.  I enjoyed learning about Dermatology but I felt it was a weakness that could be used in primary care.  I was working with a very popular and well-known Dermatologist, so I saw a great deal.  There were people who came from all over the US to see him.  The majority of the time I saw full body exams on patients, checking for atypical moles, potential skin cancers, and pre-skin cancers.  I did see some very interesting rashes, systemic diseases, and a lot of acne.  I was unable to actually see patients on my own because of his popularity, however, he was a great teacher and I learned a lot.

  A common complaint I  saw in the office is constant itch.  These were the hardest patients to treat, especially if there were no visual findings like rash.  Thankfully, we treated them all, and many times I heard the words “Doctor, you saved my life.” Itch is a horrible complaint to have and to live with.  Itch can be constant, spontaneous, or occur during specific times.  Any of the above can severely decrease a patient’s quality of life.  Many have developed scars, some in cosmetic areas, because of this problem.  The first step is to take away the insult to injury, if there is one.  This is simple, if there is nothing there to scratch usually people do not pick.  The next step is something obvious but hard to follow- if it itches don’t scratch it.  This is a very cruel thing to say to a patient.  It is impossible for a patient to not scratch even though they know they should not.  Instead of saying this say, "If it really itches apply gentle pressure over the area for a few seconds, but do not use your finger nails."  This relieves the itch but does not cause any trauma to the skin.  Using this technique may allow time for the skin to heal and for the itch to go away.  The last step was to give a patient some medication.  Many of you are probably thinking, this is so simple, it is.  However, many practitioners do not follow this and the problem persists or worsens.

Wednesdays were cosmetic days.  Here patients would get Botox, fillers, etc.  I think that a lot of people have a misconception about these products.  I know this because when patients came in for a consultation they brought up these views.  In Hollywood, these products tend to be over used and the individuals tend to look like they are from another planet.  In the office I worked in, the Doctor emphasized that fillers and Botox should be done to make a person look fresher but still look like themselves.  The common medical practice of start low and go-slow is key, do not overdo, always under do when it comes to cosmetics.  You can always add more later.  Many patients that came in for consultations were apprehensive, not vain.  Each person left looking like himself or herself, just less worn down.  Throughout the process we would give the patients a mirror to help alleviate any anxiety that they were being altered.  We would mix lidocaine with some of the products to make the experience less painful. Comfort is key.  There was not anyone who was not happy with the results.  Radiesse, is the product we used the most often because it is a natural product that stimulates a person to continue to make their own collagen.

As it stands, I have 4 days until graduation!  This means that the next patients I will be seeing will be my own.  I am currently applying for jobs in Family Medicine, Pediatrics, and Dermatology.  I hope that I get some bites.  Please continue reading, I have been told that I am able to keep this blog.   I will be the alumni PA blogger.  I look forward to writing about job seeking, working as a PA, etc.  Thank you to those who have continued to read my student blog, I can’t believe I have 4 more days of being a student.

Comprehensive Review Week

            One of the most dreaded weeks in PA school is our comprehensive review week, or as many of us call “Hell Week”.  Essentially, we get lectured for three full days about everything we learned in PA school.  At the end of that week we have a two part 250 question written exam, clinical skills testing, and a patient encounter.  The clinical skills testing portion is on the skills we learned during the school year.  Many of you may remember my entry on splinting and casting. This was one of the skills we had to perform.  Others were injections, suturing, catheter placement etc.  The point of testing on this section was to show our skills in these areas that we had performed on our rotations.  For myself, I felt very comfortable with venipuncture because I done this skill about 15 times a day in my OB-GYN rotation.  There were other skills that I felt not so comfortable with. 

The patient encounter was the one that my classmates and I worried about the most.  I am sure you are all thinking, “Jen, you have seen patients all day long and will in the future, why are you worried now?” I can tell you all that I do feel comfortable with diagnosing and treating patients; however, when you are being watched and timed it can be nerve wracking. There was a 20-minute time limit to do a full history and physical exam, and then 5 minutes to present your findings, assessment and plan to the grader in the room.  My experience with this patient encounter was better than expected.  In the real world I know I could have done better.  It really is true that you know more than you think you know.  I think that I delivered one of the best presentations of a patient that I have ever given in my life.  It was short to the point and I had the correct diagnosis and treatment.  Rotations really prepared me for this. Sure, I made some mistakes as far as adding additional physical exam components that were unnecessary to do.  These were due to nerves.  Even now I still laugh about some of the things I did that day. 

            In the long run, comprehensive week is finished.  What is even more bitter sweet is that these were the LAST tests I will ever take in PA school.  At the end of the day, all of us went out to celebrate. The only thing I have left now before graduation, 23 days away, is my dermatology elective and presentation.  I am so excited!! Happy July 4^th everyone!

Behavioral Medicine Rotation

I finished my last rotation about 3 weeks ago.  I really liked it.  I was in a center working with patients who struggle with alcohol and drug abuse and dependence.  At first I was not looking forward to this rotation, but it grew to be one of my favorites. I did not do a lot of this rotation; I mainly observed psychiatry appointments and group therapy.

The psychiatry appointments were interesting; they were either medication checks or psych evaluations.  Many of these patients who I saw in the psychiatry appointments are some of the same individuals that I saw in-group.  One thing that I realized is that a lot of patients feel comfortable in either a group setting or individual setting but very rarely both.  There were patients who did not talk during group who really opened up to their psychiatrist. 

Group therapy I enjoyed the most because you get to see a wide variety of stories and experiences.  Each person, while different from the next, over time found the similarities in their addiction and helped each other through hard times.  Many of these patients are at different stages of their treatment, each with a different substance of choice.  Many have additional documented psych issues as well or even other addictions such as gambling or retail theft. It is amazing how some of these individuals bring each other up and are able to reveal such emotional struggles to their peers.  A lot of the stories I have heard are tough to hear: sexual abuse, physical abuse, enduring the loss of friends/family, and personal experiences of being shot/stabbed.  It is amazing to see the stepwise progression of a patient in treatment. One of the quietest patients began to open up during my last week, he said "I have no money in my pocket but I have a full heart and a strong mind."  Another patient who sold drugs for years and was known to people throughout the area for doing so stated,“ How do you become someone new when you are essentially famous to all the people around you.” One of my favorite days during group therapy was the day everyone on in the room talked about their families.  Many have children.  They spoke about how they are now able to spend time with their family and put them first.  One man talked about seeing his daughter walk for the first time and say dada.

I was very sad to leave this rotation and the people who I became close to.  While I am certain that I will not be going in to behavioral medicine as a PA, I do know that I will take this experience with me when I practice medicine. Having seen first hand group therapy and psychiatry appointments I can give an accurate account to patients about these experiences and what to expect.  I also can see how much improvement it can make in someone’s life.  At the same token I have seen how many friendships have been made during this experience.  Addition and dependence is a struggle that at times is dismissed by the unknowing public.  For patients with these problems finding a welcoming community of peers really makes a difference.  

End of surgery and onto Geriatrics

            Once I feel comfortable in place it is time to move on to another.  I love it!  I ended my surgery rotation.  I will miss the people I worked with there.  I am positive, however, that surgery is not my calling.  I have missed my sleep!  I had gotten very good at suturing.  I was even able to sew up a few necks by the end of the rotation.  I taught myself how to one hand knot tie in the sutures as well.  I actually ended my surgery rotation with the exact same surgery I began it with 6 weeks prior.

Geriatrics began last Monday; it is very different than surgery.  The atmosphere is more laid back, however, you are dealing with many medications and potential complications.  Working with geriatric patients especially in long-term facilities can be sad; many patients are suffering from dementia and consequences of their comorbid conditions. Saint Ignatius Nursing Home takes great care of their patients.  I love seeing 85-90 year old women with pigtails, side braids and twists. 

For the most part in evaluating patients I have continued their current plan of care.  All the patients were stable and content. My favorite patient was a 90-year-old woman who told me she was frightened because she felt a non-tender lump on the left side of her chest.  I told her to point to the area.  I politely told her that that lump was nothing to be worried about that it was her pacemaker.  She and I laughed very hard for about 5 minutes.  Afterward she thanked me and told me that I had just put to rest 2 days worth of worry.  I like to think of this story as a sad story with a happy ending.  Patients with dementia are just that, patients.  You cannot discard any complaint from them because even they need piece of mind and reassurance.   Later that day I came back to check on her, she did not remember who I was but she told me the story about some “nurse” who saved the day.   It made me smile because I knew that person was me.

            Behavioral Medicine begins on Monday so more to come!

Once in a lifetime experience

Today I officially had my first OPEN surgery. It was a cholecystecomy, bowel removal, removal of a fistula, and bladder repair. All in one patient. A cholecystecomy is a procedure where you remove the gallbladder, in this case it was due to gallstones. The bowel removal was done because this patient has bad diverticulitis which is a condition that causes outpouching of the bowel. In this case the outpouching in the bowel caused a tract from the bowel to the bladder (a fistula). The first part of the procedure was another laparoscopy, the second part however was an open procedure. I actually put my hand in someones abdomen today and ran the bowel. It was really neat! The surgery took like 6 hours and by the end my feet, knees, and back were hurting but it was totally worth it.

Rotation#6: Surgery

On Monday I began my surgery rotation. This rotation is definitely different from the rest. You never realize how much you appreciate sleep until you have this rotation. While my days are not jam packed with patients like in OB, some of the surgeries can be long. I see about 3 surgeries a day. I have seen a gastric bypass surgery, hernia repair, and a port a cath placement (a port used to place medications especially for oncology/hematology patients). Many of the procedures are done using laproscopic surgery. For those that are unaware, laproscopic surgery uses small incisions with the aid of a camera in order to perform surgery. Unfortunately, since I am a student so I am on the low end of the totem pole. This means that I don’t get to do much during a surgery. Thus far I have been able to suture, place catheters, and hold the laproscope. I am loving the experience of scrubbing into a surgery, wearing a surgical gown, mask, and sterile gloves. I am thankful for having the opportunity; however, I can tell I don’t want to go into surgery in the future.

4 more months until graduation!!!

Life in the OB-GYN Lane

4 weeks in this rotation have gone by in the blink of an eye. At my specific site, I am not doing deliveries, so I have more gyn exposure. My doc does take pregnant patients and she follows them up until the point of delivery. In this office I have really gotten do to a lot. I have done paps, lots of bloodwork, fetal heart tones, and helped assist in surgeries. My doc does hyseroscopies, colposcopies, and LEEPs in her office.

My favorite part of this rotation is the pregnant patients. I love seeing the parents’ faces when they hear the babies heart beat for the first time. I also like seeing the new moms change from week to week. Pregnancy seems like an exciting and tiring process at the same time.

This rotation moves very quickly due to the patient volume. I see about 35 patients a day and there is just one doctor. To some that may not seem like a lot but each initial OB visit is at least an hour long and new patients take about 30 minutes, so time adds up. That does not even include surgeries. To me this rotation is more stressful than the ER because of the pace. After coming from the ER, however, it is no sweat. In the ER there was some waiting time when all the tests have been ordered but the results have not come back. At this rotation, I hardly ever get a lunch, I may sneak off for a few minute to grab something and go. At this point I am used to it and for the most part I am not even hungry anymore during lunch. While being at work is not tiring I crash when I get home. It is also very hard to wake up in the mornings.

What makes this rotation unique is that OB-GYN is a very personal process. In other rotations it was as well, but this rotation in particular is more so. People are very private about their personal lives especially their gyn history, they will only tell their Dr this information. Also gyn exams can be a scary thing for some patients. My Dr also acts as a primary care doctor. She keeps her patients in line with their weight, makes sure patients are maintaining important medications, helps with depression/anxiety, and even goes over treatment of osteoporosis and osteopenia. She does it all. What I also enjoy is that she likes to teach me. With rotation 5 almost over and rotation number 6 (surgery) on the way, I officially have 4 months and 18 days until graduation!

Graduation

Today marks exactly 5 months until Graduation!

What the Future Brings

As my ER rotation begins to come to an end I can’t help but think MAN this went by so fast. I have enjoyed my time in the ER. I found my time here to be probably the most educational and hands on. I learned how to placing IVs, suture lacerations, splint broken bones, draining abscesses, perform CPR etc. More importantly I learned to evaluate the patient while keeping in mind “what is the worst case scenario” and how do I prevent it from happening. I have had amazing moments and moments so horrible I would never want to relive. Ultimately, I will is miss this rotation and the people I have worked with. In the beginning I thought ER was not my cup of tea, now I am not so sure.

This blog entry is a little different than all my other entries. As my student experience begins to end I can’t help but think about life working as a PA. What specialty will I go into? Where will I practice? In what state? There are so many questions. I have a little less than 6 months to graduate and my answers to all the above questions are “I don’t know.” I thought by now that I would have had some life altering moment where everything became clear and my path would be chosen for me. It is a blessing and a curse that I have loved all of my rotations, I still have 3 to go. I know that this means I have chosen the right profession for myself. Being a PA will allow me to work in multiple different specialties if I so wish. The flexibility was one of the main reasons for choosing the PA profession. I like having this option, however, I never thought I would need to utilize it.

Let me explain further. So far there are pros and cons to every rotation. For example, I enjoy monitoring my patient’s progress over years and seeing them grow. In the ER mostly you ship a patient to other departments. This means you may never see them again and the ultimate outcome may be unknown to you. In primary care it is the opposite you are the “gate keeper”. You need to be aware of symptoms that warrant a trip to the ER. You are in charge of making sure your patients have their colonoscopy at 50 years old if they have no family history or risk factors. You need to make sure you patients take their medication and follow up for blood work to track their progress. Primary care requires a lot of balance and coordination with other specialties. On the plus side there is more time to build a rapport. These examples are just scratching the surface.

As one can see there is a lot to think about for my near future. In the meantime, I am setting up my elective rotation, I have decided on dermatology. I find the skin fascinating and challenging. Dermatology was the first topic in our clinical medicine class and the topic I enjoyed learning the most about. I am a very visual person, rashes you can see and feel. However, it is challenging because some of the dermatologic conditions look alike and subtle differences in a person’s history can change your diagnosis and treatment. Important questions like have you travelled recently? What came first the rash or the fever? or Are there any recent changes in medication? etc are key. At the same time dermatology is not all about rashes, it can be about acne or skin cancer or simple cosmetic issues that affect a person’s daily life. My elective is in June-July, I hope it ends up being a great fit. If I end up not enjoying it I know that it can only benefit me in the future.

ER: My first hospital rotation

           I started my ER rotation about two weeks ago and so far it is going well. Out of all my rotations this has been the biggest adjustment for me. I am not used to the “treat them and street them” approach. I am not sure if it is because it is my first rotation in a hospital or if ER is just vastly different from my other primary care rotations. Coming from rural PA, ER seems very fast paced but I enjoy that. I am never sure what will come through the doors. Most of the time, surprisingly there are cases that we consider “non-emergent”. However, I have had some true emergencies, on my second day I performed CPR. Unfortunately, the patient did not make it, and I experienced my first loss. The worst of it is confronting the family. No matter how hard you look at it there really is no easy way to lessen that burden. My preceptor did do an excellent job at telling the family.
       On a happier note, I have really gotten to do a lot on this rotation: sutures, staples, abscess drainage, splinting, cleaning a wound etc. I have also gotten to work with a lot of PAs! In the ER I am working in there is a fast track and the regular ER. The fast track is for cases like broken bones, lacerations, abscesses, and more quick fixes. I like it there the most because I get to work with PAs who have been preparing me more for the regular ER. For example, I have gotten a lot of tips on my presenting skills. For those that are unaware, my job currently is to see a patient, get a full history, do a physical exam and come back and present this to my preceptor or the attending on staff. This is your chance to show your stuff so to speak and make a diagnosis and treatment plan. As a student, I have found a lot of times you are correct and many times you are not. This is a processes that over time gets easier. In the ER I have found that you need to be quick, concise, and to the point otherwise the attending will lose interest or rush you to get to the point. Getting tips on this process is crucial! So far I have gotten only positive comments and constructive criticism. All of which have really helped me in the ER. For example, in primary care and in school I am used to using the head to toe approach. Meaning, when you present and when you do your physical exam on patients go from head to toe. In the ER, unless it is for a case that is pretty simple, I was told "go for the meat". Meaning, if someone comes in for back pain go straight to that when you are describing your physical findings, then go to other body systems.
       So, far I am enjoying my experience but I am not sure ER is for me. There is something about tracking a patient throughout their life and sharing that bond that primary care physicians have with their patients. In the meantime, I am getting the most out of my experience and enjoying the people I have met along the way.