Congrats! You Got Into PA School, Now What?

Viet Le is an American Cardiology PA & Researcher, who teaches as part of the Rocky Mountain University of Health Professions Masters PA Program. His resume is quite remarkable, but is extremely helpful when it comes to giving pearls of advice for PA students and new PA grads on what it takes to succeed as a PA student and in the job hunt.

I was browsing my tweeter feed and noticed a twitter conversation taking place between a new PA Grad and a Cardiology PA @VietHeartPA. His advice in his replies were so helpful, rather than retweet each one of his replies – I felt it might be more helpful if I approached him and ask him to distill some helpful advice in a guest post. I really felt other PA students would benefit from his insights having secured a job quite seamlessly from his clinical clerkship year. I sent him a request, which he kindly agreed. He replied back within two days (fast!) explaining he was on his computer writing replies while flying back from a conference.

The tweet that caught my attention

Although Viet is an American PA, the approach to making yourself a strong candidate, reaching out to potential references are the same regardless if you’re in a Canadian or American clinical setting. We’ve inserted some helpful Canadian references throughout the article. Please enjoy getting to know Viet and learning from his PA journey!

Congrats! You got into PA school, now what?

For those that are preparing for their first PA school experience or are “Pre-PA”, that first year has been conceptually thought of as “trying to drink water from a fire hydrant”. It is fast, furious, high pressured, and seems like you will never catch it all, obtain it all, retain it all. The nice thing is, you don’t have to capture or retain it all, it is just the framework so that when you encounter it again (you will), you can add the information back into that framework.

The first year is didactic. Each program does this a little bit differently, but the basics come down to a 40 hour a week occupation in which your primary job is to be the student you would want to teach (if you were the teacher/professor/instructor). Be open minded, willing, ready, interactive, and inquisitive.

“In 1st year PA school, it is your primary job to be the student you would want to teach.”

Each program has set up their curriculum uniquely but usually comprises of something similar to Rocky Mountain’s Master of PA Studies PA program Curriculum. You can also view the curriculum of Canadian Schools including University of Manitoba’s, McMaster’s Physician Assistant Education Program and University of Toronto’s program.

If you have never laid hands on a patient, performing a physical exam may seem daunting. Many programs include skills practice and labs within the didactic year and may actually have you participate alongside a 2nd year with a preceptor to see patients on Fridays, mid-week, evenings at a clinic.

What if I find PA school challenging?

Don Pedersen, Professor Emeritus of Utah’s Physician Assistant Program  said something to me privately when I dropped by his office to let him know I felt I was struggling somewhat with balancing the amount of subjects being thrown at us. I am paraphrasing, but he said something to the effect of:

Viet, getting into PA school is not easy, we have many candidates that apply. We have the privilege of reviewing the applications of many wonderful people. You were chosen. Why would we want you to fail? We want you to succeed. You will be one of our future colleagues and we want to be able to be comfortable you will serve all patients well.”

I have assimilated that into my own paradigm of teaching and interaction with students, colleagues, patients, prospective PA students. I get the privilege and opportunity to introduce everyone to the PA profession and I may just be interacting with my future PA colleague, my co-worker, my supervisor, etc.

PA school was challenging in the sense that I had not been exposed to the many different areas of medicine outside of Orthopedics. I loved the basics of anatomy and physiology. This served me well. If you attempt to understand the what, why, and how, you spend so much less time memorizing and so much more time understanding and adding to your base knowledge.

Highlights of PA School

At the time, I was not far from my graduating with a Bachelor of Sciences and so studying and testing were not foreign or rusty to me. I enjoyed learning all of the new things and expanding on what I thought I already knew, which turned out to be, that I did not know a whole lot of anything. I enjoyed the camaraderie of the PA experience with my fellow PA student cohort. Perhaps it was like sharing a traumatic event, Stockholm syndrome, or something (wink), but it definitely was nice to know that I was not the only one struggling at times or having serious doubts at other times.

What I enjoyed most was the interaction with my preceptors (both PA and MD) and their desire to teach. It was heartening to hear patients say, “sure he can see me, y’all have to learn it somewhere, right?” I loved being able to shape each rotation to maximize what I wanted while getting the basics that gave me what I needed.

How to Succeed in your 2nd year Clinical Rotations

Be the student you would want to precept. Be the potential employee you would want to hire. Be kind, be on time, be attentive, be prepared, be willing to volunteer. These are not just for brownie points folks. This is your time to learn what you can in a setting where you are given the time to learn. In practice, it is much harder to break into a full clinic schedule and say, “I think I want to see XX procedure with so-and-so today.” You cannot change whether you studied or not during first year. You can’t repeat it. Do your best, and promise yourself that you will rectify any regrets you have from first year.

The mindset should be: “This is MY time to learn. This is MY time to highlight how well I work with others. This is MY time to fail and be ok with that. This is MY time to experience as much as I can of many things so that I know just “what I want to be when I grow up”. ..and know that you will continue to grow and may change practices, specialties, interests over the next many years of your PA career.

When you are going to a new clinical rotation, it is good to “scout” out where the location is. Feel comfortable with what the traffic will be like. Know when and where you are supposed to be there and who you are supposed to meet with first. Ideally, your clinical program director should have contacted the clinic director.

Know to whom you ultimately answer to at the clinic. The preceptor at that clinic should be the one. Sometimes, you will find yourself working well with another clinician at the site. Be careful. Please check in with your preceptor.

Please know this rule: the RN or MA or the receptionist KNOWS what is going on at that clinic and can help “grease the skids” for you. In general, be kind, but specifically, be extra nice to these individuals. You are NOT above them, let them guide you. This is advice you take into your PA profession as well.

How to Approach Getting References

This is where it is so important to cultivate good relationships with your preceptors. When there comes a time when a preceptor has a great 1:1 discussion and is excited about how well you’ve done, thank them. Ask them politely if it would be reasonable to have them as a reference as you transition from PA Student to fellow PA colleague. Remember, they have seen you in action, they can vouch for your ability to think through situations.

My PA Journey

I completed a Bachelor of Science degree in Exercise Sports Science/Athletic Training Emphasis at the University of Utah. While working for a Physical Therapy group that provided PT at a clinic and provided ATC services (including teaching) at a local High School, I realized 80+ hours/week was punishing for my family (in particular, at the wages). A fellow ATC had gone on to become a PA during my AT training and asked me to look at this option.I did. 1 year later, I found myself accepted and enrolled in the Masters PA program at the University of Utah. Originally, my intentions were to practice Orthopedic Medicine. During the summer before the didactic year and throughout the didactic year, I worked weekends at a local hospital as a cardiac rehab therapist and became known to the cardiac staff and cardiologists.

I decided to learn as much of internal medicine as I could, thinking I would still want to work in Orthopedics. We had Friday Clinic beginning our 3rd Semester of the Didactic year and I did those at the Salt Lake VAMC. I converted that to a 6 month Internal Medicine rotation during my clinical year (completing my other electives and required through the other 6 months).

My 2 last rotations were “working” interviews. A 2 week rotation with a Radiation Oncologist in Las Vegas and the a 2 week rotation in Cardiology with the group that had come to know me during my didactic year. They offered me a job and hired me just before I graduated from PA School, paid for the PANCE, state licensing, DEA, and set me up to go to an American College of Cardiology  (ACC) Board Review course.

I worked with them for 18 months. There were 2 PAs and 12 MDs. 1 general cardiologist, 4 electrophysiologists, 1 hospitalist, and 6 interventional cardiologists (2 also did peripheral procedures: renal and carotid stents). 8 of them read nuclear stress tests and other cardiac imaging modalities. My PA colleague and I covered outpatient clinic, inpatient admit, rounding, discharge, device interrogation (assessed pacemakers), supervised stress echos, stress treadmills, stress nuclear scans, and performed tilt table tests and electrical/chemical cardioversions.

This too, ultimately became a near 80+ hour a week position and I was forced to re-examine my work and family values. I could not fault my spouse for asking me to make a decision.

I left the group on very amicable terms. Upon my recommendation, 4 advanced practice clinicians (APCs) were hired to replace my position (3 NPs, 1 PA). Ultimately, the group became nearly a 1:1 ratio of APC/MD.

My second PA career had me working in Occupational Medicine, specifically, the Compensation and Pension department at the Salt Lake VAMC. I was hired on by an Occupational Medicine physician who owned a consulting company. The team consisted of himself, a family physician, a neurologist, and then me. The prior PA working with him (a classmate of mine) left to work with his father, a dermatologist. My name was given as a possible employee. I worked with the company for almost 7 years and became the Assistant Medical Director of our company over our operations at the C&P department as well as our consulting work with the Utah State Labor Commission completing disability examinations and providing medical opinions on disability claims . Due to contractual issues with the federal government, we left the VA. This led to a layoff of the family physician, neurologist, as well as a second PA (another classmate of mine) I had hired 2 years prior.

I hired back with the cardiology group that I started with, only this time as a cardiology researcher. In the interim of my absence they had been absorbed by the local healthcare system, Intermountain Healthcare. Since 2012 I have been heavily involved in clinical trials, presenting abstracts each year at the scientific conferences sponsored by the ACC, American Heart Association (AHA), American Society of Nuclear Cardiology (ASNC), National Lipid Association (NLA), International Academy of Cardiology (IAC), etc.

A recent case in Cardiology

I have a patient who is a very complex cardiac patient. Fortunately, he is fairly stable now.

His first presentation of heart disease was 14 years ago at the age of 54. He has type I diabetes. He has had 11 total stents and has undergone 2 intracoronary brachytherapy procedures for renarrowing in those stents (so called, ‘in-stent restenosis’).

His last procedure just under 1 year ago was the 2nd brachytherapy procedure I have mentioned and he presented at that time with a Non-ST elevated MI (NSTEMI). We have been quite worried because the stents now cover from the topmost portion of his coronaries (proximal) and proceed down to near the bottom (distal) parts. This precludes him from being able to have any coronary bypasses (there is nowhere to plug in the bypasses because of the stents) and leaves his options to optimizing medical care, palliative care, or possible consultation for a left ventricle assist device (LVAD) or heart transplant.

He has chronic stable angina from limited blood flow despite fairly recent brachytherapy and is maximal on multiple anti-anginal medications.

Yet, despite all of this, he persists. He does what he can and does not complain much, only dutifully letting me know about his chronic dyspnea he has which is brought on by very little exertion.

What are your thoughts on what it takes to succeed in PA school? Let us know in the comments!

Please thank your guest poster Viet Le, you can tweet him at @VietHeartPA.

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