Category Archives: Physician Assistant

My thoughts about my journey getting into (and soon attending) PA School.

All in the Same Boat

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Orientation starts in just under two hours, but I can’t sleep, so here I am blogging.

Last night, 1/7th of my local cohort, in other words, 7 of us, got together for a dinner I organized. The food was good, but the company was better. Our ages ranged from “just graduated undergrad two weeks ago” to me. We had the extrovert to the one that appeared to be more introverted. One of us has already completed the Public Health portion of her dual degree program. Another was from Connecticut and yet another had a background as an ED Tech like me. In other words, a pretty diverse group, even with just the seven of us.

But, we all had one thing in common: we’re all nervous as all get out! We’re about to leap into the great unknown and it showed. We talked a bit about our upcoming Medical Terminology exam on June 11th (sort of a make or break exam, if you can’t pass it on two tries, good-bye. But apparently no one has failed it in two tries.)

We all wanted to know what today, Orientation Day, will bring. Fortunately I was able to chat with my mentor via text after dinner so I got some idea.

And we were curious how classes will work. Our schedule gives us some clue. Many are local but some are remote via Zoom with the Glenside campus outside of Philadelphia. That’s the mechanics, but the zeitgeist is still a bit up in the air. I suspect for the remote classes, many of us will still come to the classroom in order to stay in “student” mode and not be easily distracted back at our apartments or homes.

I have to say I had a feeling of relief after dinner since it was nice to know I wasn’t the only feeling like I did yesterday morning.

So in two hours, the great adventure begins.

My only regret is that I failed to get a group photo. Maybe in two years we’ll get the same group together for a good-bye photo.

Holy Frack! Less than 24 Hours

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In just under 24 hours from the time I’m writing this blog I’ll be starting orientation with my fellow cohort of students at the Christiana campus of Arcadia University’s PA program. I can’t believe it. Everything I’ve worked for in the past 2 plus years is about to bear fruit.

That said, in the last 24 hours I’ve had two dreams.

The one two nights ago had me starting class. Strangely, one of my classmates was my wife. While she loves medicine and enjoys hearing me talk about it, she decided years ago that my path wasn’t for her. Still, it was an interesting subconscious take on where I’m headed. What’s interesting is we decided we’d sit in completely different parts of the classroom. You’d think we’d want to sit together, but we realized (at least in my dream) that our learning styles were different enough that we’d be better of separated. In any case, in that dream, things were going smoothly and I felt confident and excited.

Contrast that to the dream I had this morning. In reality, last night, via GroupMe, I started to organize a get together dinner for my classmates tonight. So far it looks like 8 of us (out of 49) will be showing up. That much is accurate.

But in my dream, I had been sitting on a sidewalk in the downtown of some city (I’m going to assume it’s Wilmington) when a childhood friend (who now lives in Florida) shows up and tell me it’s 6:27 and I had promised to make the reservation for 6:30 so I really had to move. I started to follow her to her car and then lost track of her. Fortunately after turning around and taking a turn, I found my car. Which turned into a bicycle when I got there. Which would be fine, but I had a large box of items I needed to carry with me. So I figured I’d text or call my friend back but now mysteriously on my phone all her contact information was gone.

Some more hijinks ensued, but suffice to say I didn’t make it to dinner in time and was panicking.

So in 24 hours I had gone from confidence and excitement to panic.

I suppose this sort of mirrors the thoughts swirling in my mind. I’m excited, but I’ve got to admit a bit of panic running through my head. Can I cut it? Will my current knowledge help me enough to get through? Will my improved study habits make a difference? What am I forgetting to panic? Will I make friends? What will it be like being the oldest student in my cohort?

Well, tomorrow I will find out!

I’m Too Old!

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They say age is just a number. I wish that were true.

Otherwise my outlook sometimes wouldn’t be so blue.

The reality is quite mundane

One age and two is not quite the same

Ok, I give up, rhymed meter isn’t my thing.

But it’s still better than if I did sing.

Seriously now…

As the date of for starting PA school gets close (less than a week away) I have mixed emotions in my head. On one hand, I sometimes feel as giddy as I did when I first went off to college, or perhaps when I was in my twenties. For the first time in years, I intentionally won’t be earning an income. Instead, I’ll be paying good money for an education. I feel young in so many ways. In just over two years if all goes well, I’ll be starting a whole new career. I feel like I’ve got a whole new life ahead of me.

And I do.

But… the reality is, unless something changes, I have fewer days ahead of me than I have behind me. In fact, statistically, I have fewer days ahead of me than I have between when I finished college and now. My next career will certainly be far shorter than my previous one.

So I’m not too old to start school. I don’t feel all that old emotionally. Even physically I don’t feel too bad, though I’ll admit I’ve noticed the vagaries of aging in my body.

But I’m too old to mature in this career as much as I did my former one. Too old to do this career the justice I’d love to give it and then move on to something else.

But, I don’t care. I’m going to love and enjoy the heck out of the years I’ve got left and the career I’m moving into.

That said, if anyone has any secrets to longevity, reach out to me. Or heck, even if I could live to 200 or 300, that might do for all I want to do. Though I suspect at 150 or 250, I’d be wishing for more time to do more things.

So for now, my plan is to die young as old as possible.

T – 1 Week and Counting

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Pardon the language, but “shit’s getting real!” Technically as I write this, it’s less than 1 week. Officially I start orientation at 9:00 AM on Tuesday the 27th. It’s about 9:30 as I write this and publish it. But I think I can say 1 week without being accused of lying.

But then again, technically classes don’t start until Wednesday the 28th. So there’s that.

Then I have my nervous breakdown scheduled for Thursday night on the 29th as reality hits me.

Seriously though, the time is coming fast. I’m finalizing my housing plans (yes, I waited longer than I had planned, that’s a story in and of itself). I’m starting to put together a packing list of stuff I need.

And, I’m trying to set up a dentist appointment because apparently I had a chip come off a tooth last night. Fortunately there’s no discomfort.

Oh and last minute paperwork and drug testing for school.

And projects around the house.

But other than that, I’m ready.

I think.

People have asked some questions, so I guess I should put together a FAQ. (by the way, technically the term FAQ predates my Internet introduction, but only by a few years. It was partially developed by Eugene Miya, a name I know well from my early days on Usenet.)

So, just the FAQs Ma’am, Just the FAQs

  • Is the family going with you? – Nope. Two of the three have local jobs, the third is looking. Besides someone has to maintain the family estate!
  • How long will you be gone? – Two years, but not really. It’s one year of didactic and then one year of clinicals. I have ten clinicals I have to complete in variations specialties. Most will be within 90 miles of where my campus is, but I can do several in other locations including at least one overseas rotation. So more like nine months of the second year I’ll be in Delaware, and if I can group the other three into a single block, I’ll be elsewhere, but not sure where yet. That will impact any apartment leases I book.
  • Will you come home weekends? – In most cases not. This is for several reasons. For one, since I won’t really be working, not coming home every weekend will save money. For another, I expect to be studying most weekends and wouldn’t have time for travel. That said, I expect often if I do travel home, it’ll be via train so I can sleep or study while in motion.
  • How hard is the program? – That’s a great question. One analogy I’ve been using and is told is accurate is it’s like drinking from a firehose. Another is that I’ll be sprinting a series of marathons. Imagine packing three semesters into one year for starters. The first semester is 18 credits. The second 25, and I believe the third also over 20. Basically I can count on a test every week. I’ll be learning in one year what many medical students spread out over a couple of years.
  • Are you nervous? – I’d be lying if I said I weren’t. There are moments where I completely doubt myself. But, as a member of my Council of Moore reassured me the other day when I asked for a confidence boost, that’s exactly the right attitude. It’ll keep me from becoming complacent. Mostly I think I’m nervous about the amount of rote memorization I’ll need to achieve. This is something that older brains in general aren’t necessarily as good at as younger ones. Most of my classmates will be half my age or even younger, so they’ve got me beat there. On the other hand, just because of my experiences in general, including working in the ED, I am fairly confident that understanding systems, pathophysiology, and physiology in general are strong. I’ve always been good at the “big picture.” I even noticed this, to brag a bit, in the ED when sometimes an attending would be quizzing a medical student or even a resident about a case and while I might not know some of the details, I was often able to understand the overall picture better than the student or resident.

    I also worry that my student habits from my BS will resurface. But that said, I proved my study habits in my prereq classes worked and I’ll of course be using them again. I’ve also built a good support system for myself.

    So yes, there will be moments where I doubt myself and even moments where I might not do as well as I’d like, but overall, I think I’ll do fine.

    But ask me in two years.
  • Are you excited? – Overall yes. But ask me in a week. Right now I’m just stressing about all the final prep.
  • Isn’t this costing a lot? – Honestly, yes. One reason I had hoped to get into a local program (there’s really only two that are considered local) was to save money and be home more. But alas, that’s not what happened. And honestly, I’ll be trading two years of income for two years of spending. And even when I graduate, I’ll probably be making less than if I had simply stuck in IT or even teched in the ED for those two years. But, ultimately I’m pretty confident I wouldn’t be as happy or as fulfilled.

    Years ago in either Dear Abby or Ann Landers, I recall someone writing in who was I believe like 46 asking if she should spend four years going to college or if it was a waste of time. The response was, that either way in four years, she’d be 50, so she should do what she thought would fulfill her the most. That’s my attitude. In two more years I’ll be 59. So I might as well be 59 with a masters in something I believe I have a passion for than 59 without that masters.

    Now, that said, if anyone wants to give me money, let’s talk 🙂
  • I like PAs, can you be my PA after you graduate? – I’ve already had one person ask this. I pointed out my goal is to work in the local trauma center. Do you still want to see me at work? 🙂
  • Will you keep blogging? – Definitely. I’m actually surprised and appreciate how many people (i.e. more than one person) actually appreciates to hear about my PA journey. It’s also my way of venting and keeping sane. Thanks for reading.

That was Then, this is Now

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I had a few photos that didn’t really fit into my previous post so decided to create a separate one.

Heading into my final shift

This was my first shift actually in the ED. I think the bottom set of scrubs were some I bought locally. Marginally better than what I was given at the end of my first week of preliminary orientation.

Celebrating the 1000 hour Mark

By now I was 1000 hours into teching. You can’t tell from this photo, but my scrubs are better fitting and I’m feeling far more comfortable in the job.

Heading into work for my final shift was a fulltime tech

Definitely comfortable now!

Poised for a quick getaway!

While we don’t have assigned spots, I usually considered one of the spots around here as “mine”. I could usually get such a spot about 90% of the time. Why so important to me? My car was headed straight down the ramp. So by not having to back out, or come down from other areas, I could get out of the garage that much faster.

I make this look good

5,500 hours ago I know I would not have looked so relaxed and comfortable at work. But now, I’m definitely comfortable and relaxed. Even in the middle of a trauma. I think I’ve come pretty far. And now I set off on the next part of my journey.

It’s the End of the World as We Know It

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And I feel fine…

Ok, that’s not quite true. It’s actually pretty bittersweet. As I’ve written in my last few posts, my last scheduled shift was last night. I said farewell to many people. Actually all week it’s been series of goodbyes.

Sunday was my second to last official shift. But even before it was over, I had already planned on picking up a shift Monday night. The ED was short staffed and I figured I’d take the extra money and also help out. I mention that because I knew that one of my fellow Techs, Mike S. had been planning something for my final shift last night.

So I was a bit confused when my ANM (Assistant Nurse Manager) came to me around 6:00 AM or so and whispered in my ear, “I’m going to need you for a special huddle.” I was a bit confused, but thought perhaps she was going to privately say good-bye or give me some final words of wisdom.

Around 6:45 I took aside the orient I had that night and told her she was going to give the report to the incoming tech and asked her what she was going to present. I’ve done this dozens times as part of a new techs orientation, especially when they’re about done. Well, it’s a good thing I did since at about 6:58 the ANM came and practically dragged me by the elbow, “we’ve got to get to huddle.” Now I was completely confused. I couldn’t figure out why it was so important I get to huddle. That’s generally only for the incoming shift and the only folks who brief is an ANM or the person taking over as Charge Nurse. In any event, my orient ended up giving the hand-off report without me and did great.

Well imagine my surprise when I walked in and saw a table full of donuts and bagels and folks congratulating me. All I could keep saying was “but I have two more shifts!” I was at first a bit embarrassed, partly between the attention being given me and the fact that I felt it was a bit premature. But by the end I’ll admit I was on the verge of tears. It was a very touching moment.

Last night, despite it not being a surprise, was also very touching. While I greatly appreciated the day shift send off, the truth is, most I hadn’t worked with much or if I had, it had been well over a year ago. The night shift send-off though; I knew most of them very well. We’ve done battle together. We’ve broken bread together. We’ve staved off death together. And sometimes, we’ve mourned together. They’re my ride or die crew. So having a chance to celebrate with them was extra special to me.

Some of my night shift ride or die crewmates

Besides the food and music though, I was looking forward to one more tradition afforded folks leaving. The picture in one of our trauma bays.

Nurses, doctors and techs sitting in a trauma bay.
Part of the Night Crew giving me a silly send off

After the photo in the trauma bay, we received a Level 1 trauma that took me the rest of my shift to help with, including getting them to the OR. It was a sad, but somehow appropriate way, to end my shift.

The part that meant the most to me tonight were the well wishes and votes of confidence from my colleagues. In a few short weeks I’m going to embark on what’s probably going to be one of the hardest, prolonged challenges of my life, and it really meant a lot to hear so many people saying positive things.

Yes, I’ll pick up a few shifts over school breaks, but it won’t be the same. This was the end of an era. Over 5,500 hours (by my best estimate) of working as a tech. I’ve learned so much and made such friends and gained such mentors. So I walk away a bit sad that I’ll miss working with such great people on a regular basis. But also extremely excited about my new challenge and honored that such folks have such faith in me.

And as always, my views and thoughts do not reflect those of my employer Albany Med Health System.

T-12 hours and Counting

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I’ve been counting down my final shifts for about a month ago. You’d think it would be easy, but it’s a bit harder than you think. Officially I’m what’s known as a .6 FTE (Full Time Equivalent). This means I’m scheduled for 24 hours a week (i.e. 60% of a 40 hour work week). In reality, I pick up a LOT of extra shifts. I’ve done this for three main reasons:

  • To get into PA School I needed a high number of Patient Contact Experience hours.
  • I get overtime pay
  • Often times the apartment is very short-staffed and well, I can help out and get the above benefits.

So, even two months ago I could easily say, “Ok, with my vacation. I have X number of shifts left.” But like how NASA countdowns don’t proceed uninterrupted or without changes, my countdown had its own changes and interruptions, including picking up more shifts.

So, I had a rough idea that when I had say 8 official, scheduled shifts left, I likely had 12-16 total shifts left.

So barring any changes, Thursday is my last shift as .6 FTE ED Tech.

Note I tossed in the .6 FTE. That’s because for a few reasons I applied for and was accepted as a “student” track tech. This means during my few breaks from PA school I’ll be able to pick up a few shifts. But I won’t be picking any up right away. Between Thursday and the start of school I’ll be finishing figuring out where I’m living, packing, finishing some projects about the house. So Thursday is it for awhile.

But honestly, I’m ready to move on. I’m excited and nervous. I’m also a bit sad. I will miss working with so many great people and having such an impact on the lives of people.

So, “We are at T-12 Hours and counting.”

Countdown T – 1 Month

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I’ll be posting a few more follow-ups to my recent road trip but for now a break from that and something else: counting down.

One month from today, on May 27th, I’ll be going through orientation for my PA program. I’ve already met a few classmates at the open house a few months ago, but this is the first time all of us will be in the same place at once.

Then the very next day classes start. Or as I like to think of it, I’ll be starting a marathon of sprints. The next two years will be very busy for me.

I think I’ve mentioned before, the first year is all didactic teaching. I’ll be spending a lot of time in the classroom, lab, study areas, and in my apartment, focusing on learning and memorization.

While I took over 40 credits of classes as prereqs in prep for this, that was spread out over the course of about two years and I never took more than 12 credits at a time. And these were undergrad level classes. My first semester I’ll be taking 18 credits. All graduate level. (Ok, I’m not sure I’m too worried about the one credit class, “Professional Practice I” but still that leaves a lot). On the other hand, I won’t be doing any IT consulting or ED teching during this time, so my primary focus will be just that, learning. But I’m still nervous. I want to do as well as possible. I can’t afford to have a repeat of my undergrad experience in terms of grades and study habits.

The second year is my clinical year. This is where I have 10 clinical rotations of 4 weeks each, with testing between them. This I’m not too worried about. For one thing, my hands on experience and observations in the ER should help me a lot here.

In fact I recently spoke to a friend of mine who is currently in a PA program. She’s had years of hands on experience as a paramedic. She mentioned it was striking how uncomfortable some of her fellow students whose medical background was basically that of “scribe” were with the hands on stuff. I mean I get it. For example, sticking a needle to draw blood in a living breathing human being is a bit daunting. For her, that was just another Monday.

In the meantime though, before I can even start classes, I have a number of things to do:

  • Put the BMW on the market – it needs work and I don’t have the time for it or need.
  • Find an apartment – I’ve got a place picked out, just need to sign the lease. Ideally I’d have a roommate to cut costs, but looks like that’s not happening.
  • Come up with a list of items I’m bringing with me for the apartment (clothing, cooking utensils, etc)
  • Acquire bigger items (like a bed, possibly a dresser).
  • Finish projects around the house
  • 4 more scheduled (and I’ll probably pick up 1 or 2 other) ED Tech shifts
  • Work to change from a .6 FTE ED Tech to what they call the “school” track where I can work during breaks.
  • Get a lot of paperwork done. I’ve already authorized the background checks and other paperwork. I have to start getting my vaccination information together. One they want details on is chickenpox. Well I was born well before the varicella vaccine was even out there. So I don’t have any vaccination records for that. Fortunately they’ll accept a titer for that.
  • Mow the lawn!
  • Finish up some other projects around the house.
  • Attend Rebecca’s Senior Film showing (that I also happened to act in!)
  • Attend Rebecca’s graduation!
  • Run an Orientation to Cave Rescue class in two weeks
  • Give a talk to the local ER docs (and others) about Medicine in Cave Rescue
  • Write above talk!
  • And much more.

There’s a lot to do, and on one hand a month seems like forever, on the other hand, it seems like it’s not enough time.

I made the decision in December of 2021 to apply for PA School. At the time I had the outrageous idea that I’d be able to apply in 2022 and start in 2023. I realized very quickly that was unrealistic and impractical so I set a new goal of applying in 2023 and starting in 2024. I knew that was an outside shot, something like 70% of first time applicants don’t get in, and I had my very low undergrad GPA hampering me. So, here it is, I did a second round of applications in 2024 and am, starting in 2025. So not too far off my first realistic schedule.

I’m excited. And nervous. But mostly excited.

The Next Decade

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This past week I visited an open house at the PA school I’ll be attending starting in late May. It definitely made things feel very real. It almost reminded me that I’ll be the oldest there by far. This gives me a feeling of cognitive dissonance.

On one hand, often when I’m at work, or when I was taking classes, I feel very young, often decades younger than my chronological age. One of the best compliments I received from a fellow tech was, “Greg, you run the techs in their 20s into the ground.” The tech saying it was herself in her 20s.

And the idea of going back to college makes me feel pretty young.

That said, the reality is, I’m entering a career that while will probably last me the rest of my working life. But I at most probably only have a decade in it or so.

I’ll be 57 when I enter school. I’ll be in the didactic phase for 12 months.

That makes me 58 when I finish the first half and start my 12 month clinical phase.

This means I’ll be 59 when I graduate and take my PANCE (the certifying exam that officially makes me a PA and allows me to practice as one.)

Many people plan on retiring at 65. I have never really had that as a goal. I figured I’d want to keep busy beyond that, even if I ended up working at a more relaxed pace.

But the real limit may come when I’m 69. PAs have to basically take an exam every 10 years. The honest truth, as I approach that date, I’ll have to give it some thought if it’ll all be worth it. Perhaps it’ll be the sign to retire. But also, working in the ED (as is my current plan) requires a certain physicality that at 70, I’m not sure I want to deal with. And while PAs can make lateral moves, I’m not sure what other specialties I’d enjoy.

So, we’ll see. Do I make it the full 10 before retiring? Do I re-up? I can guarantee I won’t be re-upping when I’m 79! (Unless someone discovers the fountain of youth!).

So if I have one regret about my approach PA career, is perhaps I should have done it decades ago.

But in the meantime, I’m going to enjoy the living hell out of the time I’ll have for it

ED Teching vs My Future – A Step Forward?

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Over the coming weeks I’ll probably cut back on my hours as an ED Tech. And I have mixed feelings about that. The main reason being is I’m picking up some IT consulting work that pays a lot better and well, I’ll be honest, the money will help pay for me being in PA school.

Originally I had two goals when I tried to get a job as a tech in the local Emergency Department. The first was to gain the Patient Contact Experience that most PA schools require in order to apply. The second was to confirm whether I really wanted to be in Emergency Medicine. I was able to confirm the second goal fairly quickly.

As for the hours, every school had different requirements, from as few as 200 hours to as many as 1000 hours. Of course the minimum is different from the average and most schools only accepted students who were closer to the average number of patient contact experience hours.

I was able to quickly surpass the 1000 hour minimum within the first 6 months or so of me working in ED (this despite being in theory only a .6 FTE). Obviously that wasn’t enough for my first cycle (and most likely other factors). By the time I applied for the second cycle, I was at over 3,000 hours. I’m now at over 4,000, probably 4,500 hours and odds are I’ll be at close to 5,000 by the time I leave the job. (Edit: I looked through my old pay stubs, and turns out I’m actually over 5,000 hours now, so probably will be over 5,500 by the time I leave.)

In his book, Outliers, Malcom Gladwell cites a “10,000 hour” maxim which basically states to become an expert at something, one needs to spend approximately 10,000 hours of training for it. If it’s accurate, there’s a lot of question about the accuracy of this rule, then I suppose I’m half-way to being an expert. That said, I’m not really sure what being an expert tech means.

However, looking back, I definitely think my extra time in the ED as a tech was well worth it. I’m a far better tech (at least in my mind) than I was 1 year ago, let alone 2 years ago. (Though strictly speaking 2 years ago I was just off orientation). And that extra experience I think will go a long way to helping me in PA school.

Partly it’s a matter of confidence. Partly it’s a matter of skill. I appreciate that my place of employment is a teaching hospital and encourages a team approach. I’ve been in cardiac codes where the attending will run through what we’ve tried and ask, “anyone have any suggestions.” And they truly mean anyone, even a tech can speak up if they feel inclined. In other situations I’ve offered advice and had it accepted. I’ve actually had nurses and providers ask for my input or to help with some more advanced procedures.

I find I really enjoy doing the ED Tech work. And it’s made me both want more and not want more. I’ll be taking a two year gap (other than perhaps some per diem work) from working in an ED while I get my PA degree. Once I have that and pass the certifying exam, I’ll be a PA-C and be able to do a lot more in the ED than I do now. I’m excited about that!

But, I also look at the downside: being a tech, when my shift is over, I do about a 5 minute hand-off and I’m done. There’s no paperwork. There’s also no paperwork during the shift. It’s pretty much all hand’s on. Once I’m a PA-C, it won’t be that easy. When my shift officially ends, I’ll be responsible for paperwork and doing a more extensive hand-over. And, of course during the shift, I’ll be responsible for discharge paperwork and a lot of non-hands on work. I’m…. at best ambivalent about that. But, I suppose it comes with the terrority.

That said, I’m still excited about the next few years!