The Physician Assistant Life

Secrets of Successful PA School Letters of Recommendation

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Whether we like it or not, other people's opinions matter.

A good letter of recommendation can make your day; a great letter of recommendation can change your life.

Whether it is a dating review on Tinder, a restaurant recommendation on Yelp, a movie review on Rotten Tomatoes or an open request for holiday vacation recommendations on Facebook, we look to our friends, colleagues, and specialists in the field for advice on how to make better choices.

"A good letter of recommendation can make your day; a great letter of recommendation can change your life"

Now don't get me wrong, I am not saying you should let Megan McCrorie ditching you at your high school winter formal establish your self-worth (that wasn't nice Meghan!). But the opinions of those we admire and respect, the ones whom we look to for guidance, the ones who will give us the cold hard truth in all instances – that matters!

Studies show that we value the opinions of our close network of like-minded individuals above other sources and with the availability of social proof and endless rating systems there has been a shift away from trusting the experts and more toward trusting the opinions of the many.

Just look at the sales figures for the latest summer blockbuster action pic!

Choice Overload

Recommendations play a very big role when we are faced with choice overload. Required to make a decision among 100's or 1000's of similar products with similar features and similar price points where does one begin?

For example, when faced with the seemingly simple task of replacing my broken iPhone 6 case I jumped on Amazon.com in order to make a "quick and easy" purchase. I love my current case and figured I would simply get a similar version.

Well, you can imagine how that went down.

Ninety minutes later I was still browsing through the endless array of case options, features, colors and Amazon recommended accessories. How about a new car charger? Dual USB adapter? Lightning cables ? The list goes on and on! Needless to say, it has been two weeks and I still don't have a replacement case. Maybe I will just keep my old one!

And what do we do when we get really stuck?

If you are like me,  you read the reviews! And it is often here that we make our final purchase decision.

Nowhere is this truer than when PA school admission directors are searching among 1000's of PA school applicants.

CASPA - The Amazon Marketplace for PA School Applicants

CASPA is the Amazon marketplace for PA school applicants. Like trying to find that ideal iPhone 6s case or perfect pair of sound isolating earbuds, PA schools have a need to fill.

They have vacant seats in their PA program and they want to find the best, brightest, financially responsible, capable, compassionate, forward thinking, well-prepared, resilient, like-minded candidates to fill their rosters.

The admissions directors place your application in their cart, click to preview, browse through a couple of pages and then if there is any doubt, they scroll down to read reviews.

Or, in this case, your letters of reference.

Secrets of Successful PA School Letters of Recommendation

What are you looking for in a letter:

It is likely that you will not see your letter, your letter writer is submitting a digital letter of reference.

On the CASPA application there is a page where you will submit the name title and email address of the 3-5 people you will be asking to include letters of recommendation to.

CASPA will send an email to your letter writers indicating that they have been selected to submit a letter of reference on your behalf.

Four guidelines to Letters of Reference for PA School

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When gathering your letters of recommendation focus on these 4 traits:

  1. Someone who has known you for some time
  2. Someone who practices in some field of medicine
  3. Someone who has seen how you interact with patients
  4. Someone who supports you as an applicant

Try to pick someone who has known you for some time

It is better to get a letter from someone you have known longer than someone you have known for a shorter period of time.

One of the questions asked of the letter writer is how long have you known the applicant? How well could they assess you if they have met you only once or had you in the office for just 2-3 hours of shadowing?

The most desirable is someone who has been witness to your patient care experience. This could be a physician, PA, NP, DO, etc. who have witnessed you work with patients.

You can use nurses and clinical managers although these references may not be as strong as the former. Ideally they want to see a letter from someone who knows what you are getting into and is enthusiastic about you.

Practices in some field of medicine

If you don't have a lot of healthcare experience this can be a hard one and you may not be able to produce a letter from someone who has seen you working with patients in a clinic.

If this is the case you are going to chose someone who knows you well and can speak to them about a domain that is relevant to the PA profession such as your ability to communicate effectively or your science ability.

Who should your letters of recommendation come from?

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There is ideal and there is real, what most of us have to work with is something in-between.
If you have decided to apply even though you don't have a ton of experience your options may be more limited and that is fine.

You work with what you've got. There is ideal and there is real, what most of us have to work with is something in-between.

One Academic Letter from an instructor or professor of a prerequisite science:

  • Someone who taught you one of the "big 5 sciences": anatomy, biology, microbiology, physiology, or chemistry. This is someone who can attest to your academic ability specific to the field of science and medicine.

You definitely need a letter from a medical provider where you have volunteered or worked:

  • A provider is the universal term for an MD, PA, NP, DO or anybody who cares for patients somewhat independently. Of course the ideal letter is going to be from a PA but this is not always possible. When I applied to PA school I did not have a letter from a PA, was this a big deal? I don't know I still got into PA school.

A letter from another provider from another discipline or supervisor in a medical setting:

  1. If you received a letter from a PA in #2 you can choose another provider such as an MD, DO, NP, RN who knows you personally and has seen you work directly with patients.
  2. If you don't have another provider you can choose a clinical director, charge nurse you worked under, volunteer coordinator or direct supervisor.
    1. I received a letter from from the supervisor of the medical records department where I worked. She ended up writing me a wonderful letter. You can see a couple of my letters here.
Summary of Ideal situation

Summary of the ideal situation: 

  • Academic letter + 2 provider letters (ideally one from a PA)
  • Academic letter + provider letter + health care work supervisor

What should they demonstrate? Dependability, honesty, and intellectual curiosity!

How good do your letters of reference need to be?

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You want the best letter you can get, you want a letter from someone who glows and raves about you. Why?

Anybody who reads letters of recommendation assumes that they will be writing for you because they believe in you, and letter writers who don't know you well will speak in "glowing" platitudes.

What is a glowing platitude?  A platitude is a remark or statement, especially one with a moral content, that has been used too often to be interesting or thoughtful.

Here are a couple examples:

  • Platitude: Stephen has a positive attitude and works well with others
  • Glowing recommendation: I don't ever remember him saying an unkind or angry word. He is the most positive person I have worked with in my Laboratory Medicine career of 25 years.
  • Platitude: Stephen has a strong worth ethic and has experience working in the healthcare field
  • Glowing recommendation: He works hard, but has a balanced life with leisure activities.  I'm impressed with his career development as a student... working in Healthcare information (1.5 yrs), laboratory (1.5 yrs), and a summer camp with special needs children.  he has since trained as an EMT, has a patent pending for a physical therapy machine, and worked at a Blood Bank center. All of these experiences give him a broad base of knowledge for a healthcare career as a physician assistant.
  • Platitude: I think this person would be a good fit and would be capable of performing the relevant duties.
  • Glowing recommendation: I am really sad to see this person go, but you are so much the better for it because they need to be in this field and I am enthusiastic about them.

Moral of the story:

  • Pick someone who is enthusiastic about you!
  • You want someone who can write well and will take the time to write well about you!

How do you go about getting letters or recommendation?

This can be tough, one way is to scout out early who you may want to write your letter and then do your best to impress.

Are you taking a human anatomy course and have a wonderful professor who you feel could provide an excellent reference?

Then do your best to show up early, attend or lead extra study sessions, create study groups, offer to assist the professor in lab setup or clean up. You don't want to be a "kiss ass" you want to be helpful, show that you are a hard worker, a leader, a dedicated student and make yourself stand out. Then at the end of the course, if all seems well, you can gently ask for a letter of recommendation.

Are you working or volunteering? Well, if you are not you should be. Then be the wonderful person you naturally are. Show up on time, offer to help out wherever you can, don't worry about pay, work for free, or pay them :-), always keep a positive attitude, grab every learning opportunity available... again the goal is not to shmooze, it is to be yourself. I know you are a passionate, caring person who obviously is highly motivated and goal oriented. Don't be afraid to take initiative... After 12 months or more of hard work and effort, the letters will be flowing!

Summary: 

  • We are not looking for good letters we are looking for amazing letters!
  • The letters should shout from the mountain tops that they would be stupid not to take you.
  • Quality of letters almost always trump where they come from, in other words don't get so caught up on the ideal letter writers that you choose a less enthusiastic writer in place of someone who adores you but sits outside the "ideal" category.
  • If you are applying a second time ask for new letters or if you know it was a great letter ask the same references to submit the same letter a second time.
  • Don't ever ask for letters from family!
  • Don't ask for letters based on credentials from people who don't know you well. I have had people ask me for letters after a couple of email exchanges through this website. This is not a quality letter and will not work in your favor. It also makes me extremely suspect as a letter writer.

Answers to common CASPA letters of reference questions (from the CASPA website)

  • Q: What is the difference between an evaluation, letter of reference, and a letter of recommendation?
    • A: Nothing. They are all the same thing.
  • Q: How many evaluations must you enter?
    • A: CASPA requires three letters of reference to be listed on your application in order to submit to CASPA, however, you may list up to five. These must then be completed through the CASPA reference website. CASPA will verify your application as long as two of  your evaluations are completed. Any additional references received by CASPA will be available to your schools immediately once they are completed.
  • Q: How long should the letters be?
    • A: The file uploaded by references may not exceed 5 MB (this is a pretty big file). The Evaluator Portal will not allow references to exceed this file size when uploading their assessment.
  • Q: Can I submit more than five references?
    • A: NO. You may not submit more than five references via CASPA, and CASPA can not accept any additional or substitute letters. However, you may want to contact the schools to which you are applying in inquire as to whether they will accept an additional or substitute letter. If so, you would send this additional letter directly to them.
  • Q: Why can I only have five letters? Why are letters restricted to 5 MB in length?
    • A: Restrictions regarding the length and number of references have been determined by the Physician Assistant Education Association (PAEA) and the CASPA Admissions Committee, which is made up of admissions officers from CASPA participating PA programs. These restrictions reflect the PA programs’ desire to receive concise assessments and allow a certain degree of standardization in the amount of consideration given to each applicant’s reference material.
  • Q: Can I have different evaluations sent to individual programs?
    • A: No. Each evaluation is sent to all programs that you applied to.
  • Q: Can I send letters of reference which are on file at Interfolio or a career center?
    • A: NO. All letters of reference must be completed via the CASPA reference website by the evaluator themselves.
  • Q: Does CASPA accept committee letters?
    • A: If you wish to submit a committee letter to CASPA, it must be a single composite letter written by ONE individual (usually an advisor) who will also complete the ratings section. This single evaluator must be listed on your application with the individual’s name. Do NOT label this letter as being from a group; i.e. “Thesis Committee.” The composite letter and ratings still must be submitted electronically through the CASPA Evaluator Portal, and must consist of ONE composite letter which fits within the  5MB upload limit. Do NOT upload a file containing multiple letters. Please note that a committee letter only counts as ONE letter of reference. CASPA applicants using a committee letter must still submit additional individual references, completed by evaluators who were not involved with the committee letter.
  • Q: What do I do if I want to change the person who is sending the reference or edit the information I entered?
    • A: Even after you submit your application, you may edit, delete, or replace references whose status is still listed as “new” or “incomplete.” Once a reference is “completed,” you may not make changes to that reference, regardless as to whether or not you’ve submitted your application.
  • Q: Can I e-submit my application before my references are received by CASPA?
    • A: Yes. Once you have successfully filled out your application, you can e-submit it to CASPA at any time. However, your application will not be processed until CASPA has received all of your official transcripts, at least two letters of recommendation and your payment.
  • Q: How can I view my letters of reference?
    • A: Even if you have not waived your right to view the reference, you still cannot access the reference via CASPA. If you have not waived the right to view your reference, this means that you may ask your reference for a copy of their recommendation, or, once you matriculate into a PA program, you may view the reference in their offices.
  • Q: Can CASPA forward my references to me, my evaluators, or schools not affiliated with CASPA? (i.e can I see what the reference said about me?)
    • A: NO. As per the Family Educational Rights and Privacy Act of 1974 (FERPA), CASPA may not release letters of reference to anyone other than your designated schools, including other schools or the applicant themselves.

For a complete list please visit the CASPA website - letters of reference

Want to see my letters of recommendation for PA school? 

Physician Assistant Application Letter of Recommendation Samples: Applying to PA School

Here are two letters of recommendation I received when applying for PA school. I am not posting them here as a way to fluff my feathers but merely to serve as an example of what I included as part of my actual PA school application. A great letter of recommendation weighs heavily in your favor, I believe this (and a passion filled essay) is the reason that I, an average student from a state university, was able to receive an acceptance letter over many Ivy league applicants with pedigree backgrounds and 4.0 GPA's. A great letter of recommendation must be earned. It comes when you provide a valuable service with the sole intent of doing your job, or providing your service for the benefit of others...[Read More…]

 

Physician Assistant Postgraduate Residency and Fellowship Programs The Ultimate Guide

Physician Assistant Residency and Felowship Programs - The PA Life

As a new, or even experienced PA, it is normal to feel uncomfortable with the thought of jumping into a medical specialty.

Often we have had little more than 30 days of training in a particular field, and we are joining a team of specialists who expect us to perform at the level of seasoned doctor.

PA training is generalist in nature with the ability to pick and choose among rotations as a student that may help one gain more experience in a particular field of study prior to graduation.

If you have been practicing in a field for some time and want to change directions, it can be very intimidating.

We want to do right by our patients, providing them with the very best care in all situations. While on the job training is fine and dandy, depending on your practice you may receive a lot or very little hand holding. This can be a setup for occupational success, professional and personal growth or, on the flip side, failure!

To help PAs looking to successfully transition into careers of medical specialty postgraduate PA programs began popping up in the early 1970's. As the profession grows and more and more PAs are entering specialty practice, PA residency programs have adapted to fit our needs.

Over the past four decades the PA postgraduate training movement has slowly expanded, and in 2017 there are more than 84 postgraduate PA programs with 70 of those listed on the Association of Postgraduate PA Programs programs (APPAP) website.

All of these postgraduate training programs also referred to as residencies or fellowships, provide some form of advanced learning in various medical and surgical specialties.

PA Residency Program Accreditation

Unlike PA schools across the country which must undergo a rigorous accreditation process through the ARC-PA, PA residency programs do not require a formal accreditation to exist. Although I think this will change with time, here are the two accrediting bodies:

  • ARC-PA: There are currently only 8 accredited clinical residencies for PAs in the US, listed on ARC-PAs website here. Accreditation is voluntary through ARC-PA and does ensure a certain level of educational standards, but it is not required and offers no current benefit. Since 2014 The ARC-PA has placed the accreditation process for clinical postgraduate PA programs in abeyance while it studies a different type of process to recognize program educational quality.
  • Association of Postgraduate PA Programs (APPAP): At the American Academy of Physician Assistants Convention in Los Angeles in May 1988 a group of postgraduate PA programs met to formalize a national postgraduate PA program organization. Bylaws were written and approved by the eight founding programs and the Association of Postgraduate Physician Assistant Programs (APPAP) was formed to further specialty education for PAs. Programs are not required to be registered with APPAP and certain membership criteria must be met to be eligible. While there are benefits to being registered with APPAP, there are also very expensive membership fees that programs may not wish to spend their money on.

Do not be hesitant if the program you find interesting is not on APPA's or ARC-PA website. In 2017 this says very little about the quality of the postgraduate program.

The Pros and Cons of PA Residency Programs

There are pros and cons to completing a residency program, but it is the decision of each individual PA to choose to participate, which greatly depends on the specialty.

PROS of PA Residency Programs

  • Residency programs allow the physician assistant to gain both clinical and didactic knowledge that would take years of on-the-job training to attain.  It provides a faster paced, formalized training program of supervised practice, which allows physician assistants to be utilized much faster than new graduates.
  • The PA can develop the judgment and technical abilities in a specialized practice area, thus increasing their confidence in their chosen specialties.
  • Many employers give preference to residency-trained physician assistants.
  • Residency programs can be a great way to transition to specialty practice for a mid-career PA looking for a new challenge.
  • It is also recognized that most employers are willing to pay more for a physician assistant who completed a residency program.

Emory University Critical Care Residency

PA Surgical Residency Personal Account
PA Cardiology Residency Personal Account

CONS of PA Residency Programs

  • PAs who jump into specialty without residencies claim you can get paid 2-3 x as much, work less, and learn just as much while getting your training on the job.
  • Even though employers are willing to pay more for a PA who completed a residency, the salary maxes out and becomes equal to those who did not do a residency program.
  • Residency requires more education thus increasing duration of school and structuring the profession more like a physician. Tuition for a Physician Assistant Program is around $78,000 for didactic months and the clinical year. If a student has to take out a loan for $36,000 for two semesters, and, with seven total semesters, our total debt at the end of our physician assistant program is around $126,000. This does not include any interested accumulated. Adding on more expenses and loans for residency programs may put the PA graduate in more debt and leave one with more accumulated interest that is more difficult to pay off in a timely fashion.
  • A negative aspect of employers’ rewarding those who complete residency programs with a larger salary is that it could become mandatory for physician assistants to complete specialty residency training in order to compete for the positions since more applicants may apply for higher paying jobs than lower paying ones.
  • Residencies require more education, therefore delaying those practitioners from entering the clinical setting on a full-time basis. This delay limits the number and availability of physician assistants as mid-level practitioners, exacerbating the lack of health care providers to meet the increasing demands of the population for health care.

As you can see, this can turn into a contentious debate! What do you think, are fellowship programs here to stay?

Cast Your Vote: Are PA Residency Programs a Good Idea?

PA program residency quick facts:

  • What about my loans? You can defer student loans during your residency and some programs offer loan repayment.
  • Do I get paid during my residency? Most residencies provide stipends of 40 - 75 k and require 40-80 hours per week up to 6 days per week.
  • How many hours will I be required to work? The average program length is 12 months but some programs are up to 24 months long.
  • How competitive is the process? 10-30 people interview at each program annually and accept on average 1-4 residents.

PA Residency Program offerings

US Postgraduate PA Residency Programs

Checkout the all new PASchoolfinder Postgraduate PA Residency Guide

Below, is an exhaustive list of US PA postgraduate residency and fellowship programs as of January 2017.

I have added a brand new section for Postgraduate PA residency programs as part of the PA School finder website. You can now search by program and specialty via a geographical search console or use the new interactive perfect match tool.

PA Postgraduate Residency and Fellowship Programs by Specialty (Updated January 2017)

Items in Yellow indicate ARC-PA Accreditation

All links will take you to the official PA postgraduate residency/fellowship website.

Name of Program Location Duration Class Size

Acute Care Medicine PA Residency

University of Missouri Columbia, MO 15 months 2
Carolinas Healthcare System Center Charlotte, NC 12 months 28

Cardiology PA Residency

Mercer-Piedmont Heart Atlanta, GA 12 months 2

Cardiothoracic PA Residency

St. Joseph Mercy Hospital Ypsilanti, MI 12 months 1
Dartmouth-Hitchcock Medical Center Lebanon, NH 12 months 2
Methodist DeBakey Heart and Vascular Center Houston, TX 12 months 2 to 3

Critical Care/Trauma PA Residency

Carolinas Healthcare System Center Charlotte, NC 12 months 28
Intermountain Medical Center Murray, UT 12 months 1
Einstein/Montefiore Division of Critical Care Medicine Bronx, NY 12 months
Emory Critical Care Atlanta, GA 12 months 2
Johns Hopkins Hospital Baltimore, MD 12 months 6
St. Joseph Mercy Hospital Ypsilanti, MI 12 months 1
St. Luke's Hospital Bethlehem, PA 12 months 4
Mayo Clinic Arizona Phoenix, AZ 12 months 1
WakeMed Health and Hospitals Raleigh, NC 12 months 3
Winthrop University Hospital Mineola, NY 12 months 1

Dermatology PA Residency

Medical College of Wisconsin Milwaukee, WI 12 months

Emergency Medicine PA Residency

Albany Medical Center Albany, NY 12 months 5
Albert Einstein Medical Center Philadelphia, PA 18 months 2 or 3
Arrowhead Regional Medical Center Colton, CA 14 months 15
Baylor College of Medicine Houston, TX 12 months 4 to 6
Brown Alpert Medical School Providence, RI 12 months
Carilion Clinic Roanoke, VA 12 months 3
Eastern Virginia Medical School Norfolk, VA 12 months 2 to 4
St. Luke's Hospital Bethlehem, PA 12 months 4
Jane R. Perlman / NorthShore University Health System Evanston, IL 12 months 2
Johns Hopkins - Bayview Hospital Baltimore, MD 18 months 1 every 6 months
Lakeland Regional Health Lakeland, FL 12 months 4
Marquette University - Aurora Health Milwaukee, WI 12 months
University of Missouri Columbia, MO 13 months 2
New York Presbyterian-Weill Cornell Medical Center New York, NY 12 months 4
Regions Hospital St. Paul, MN 18 months 2
Staten Island University Hospital Staten Island, NY 24 months 4
Team Health EMAPC Fellowship Oklahoma City, OK 12 months 2 to 3 every 6 months
University of Iowa Iowa City, IA 18 months
University of New Mexico School of Medicine Albuquerque, NM 18 months 2
UCSF Fresno Fresno, CA 18 months 2
The US Army/ Air Force-Baylor Emergency Medicine Physician Assistant (EMPA) Residency

  • Must be Active Duty Army or Air Force, with a minimum of 4 years (Army) or 2 years (Air Force) active commissioned service as a Physician Assistant.
JBSA Fort Sam Houston, TX 18 months
Yale New Haven Hospital New Haven, CT 18 months 2

Family Medicine PA Residency

Carolinas Healthcare System Charlotte, NC 12 months 28 per cohort, variable
Carilion Clinic Urgent Care and Rural Health Daleville, VA 12 months 2

Geriatric Medicine PA Residency

Michael E. DeBakey VA Medical Center - Houston, Texas - Physician Assistant Post-Graduate Residency in Geriatric Medicine

Houston, TX 12 months

Hematology/Oncology

Mayo Clinic Arizona Phoenix, AZ 12 months 1
MD Anderson Cancer Center - The University of Texas Houston, TX 12 months 2-Jan

Hospitalist PA Residency

Carolinas Healthcare System Charlotte, NC 12 months 28 per cohort, variable
Mayo Clinic Arizona Phoenix, AZ 12 months 1
Regions Hospital St. Paul, MN 12 months 1

Internal Medicine PA Residency

Carolinas Healthcare System Charlotte, NC 12 months 28 per cohort, variable

Neonatology PA Residency

Children's Hospital of Philadelphia Philadelphia, PA 12 months 2
University of Kentucky Lexington, KY 12 months 2 to 3

OB-GYN PA Residency

Arrowhead Regional Medical Center Colton, CA 12 months 6
Montefiore Medical Center Bronx, NY 12 months 2

Orthopedic Surgery PA Residency

Arrowhead Orthopedics Redlands, CA 12 months 4 to 6
Carilion Clinic Roanoke, VA 12 months 2
Illinois Bone and Joint Institute Park Ridge, IL 12 months 5 to 7
DMC Orthopaedics and Sports Medicine Warren, MI 12 months 2
UCSF Fresno Fresno, CA 13 months 2
Riverside University Health System Moreno Valley, CA 12 months
Navy PA Graduate Training: Orthopedics - Career military physician assistants Portsmouth, VA 12 months 2-4

Otolaryngology PA Residency

Mayo Clinic Arizona Phoenix, AZ 12 months 2

Pediatrics PA Residency

Carolinas Healthcare System Charlotte, NC 12 months 28 per cohort, variable

Primary Care PA Residency

Shasta Community Health Center Redding, CA 12 months 2-3
North Florida-South Georgia Veterans Health System – University of Florida Physician Assistant Residency in Primary Care Gainesville, FL 12 months
The Emory Physician Assistant Program and The Veterans Atlanta Medical Center (VAMC) Atlanta, GA 12 months

Psychiatry PA Residency

Nationwide Children's Hospital Child and Adolescent Psychiatry PA Program Columbus, OH 12 2
University of Iowa Iowa City, IA 12 2
The Cherokee Mental Health Institute (CMHI) Cherokee, IA 12

Surgery PA Residency

Bassett Healthcare Cooperstown, NY 12 months 2
Duke University Medical Center Durham, NC 12 months Varies
Hartford Healthcare Hartford, CT 12 months 2 to 4
Johns Hopkins Hospital Baltimore, MD 12 months Up to 11
Montefiore Medical Center - Albert Einstein College of Medicine Bronx, NY 14.5 months 5
Norwalk Hospital/Yale Norwalk, CT 12 months 12
Texas Children's Hospital Pediatric Surgery Houston, TX 12 months 6
University of Florida Gainesville, FL 12 months 4
University of Pittsburgh Medical Center Pittsburgh, PA 12 months 2

Urgent Care PA Residency

Carolinas Healthcare System Charlotte, NC 12 months 28 per cohort, variable
Carilion Clinic Urgent Care and Rural Health Daleville, VA 12 months

Urology PA Residency

Carolinas Healthcare System Charlotte, NC 12 months 28 per cohort, variable
UT Southwestern Medical Center Dallas, TX 12 months 1

Other Fellowships

Hepatology Physician Assistant Fellowship - Alexandria, VA
  • Department of Veteran Affairs (VA) - Nationwide, including Puerto Rico (paid)
  • Community Health at Drexel University - Philadelphia, PA (paid)
  • HHS/CDC - Atlanta, GA (unpaid)
  • HHS/NIH - Bethesda, MD (unpaid)
  • HHS/Office of Minority Health - Rockville, MD (unpaid)
Public Health Physician Assistant Fellowship - Atlanta, GA

  • Epidemic Intelligence Service (EIS) - Seeks physician assistants with a master of public health (MPH) or equivalent degree with an interest in public health and a commitment to public service. 2-year full-time program in Atlanta. Applications are accepted in May of each year.

 Gastroenterology Fellowship - Phoenix, AZ

By the Numbers - What do the studies say?

According to this PAEA study:

PA postgraduate residency education provides an important educational vehicle for training graduate PAs in specialty care. A substantial proportion of residents proceed directly from entry-level to postgraduate training. Residents report satisfaction with their programs generally and specifically in terms of knowledge and skills acquired. More information comparing the differences between academic and internship models of residency education is needed as is consideration of greater standardization in program record-keeping and support for research into the longitudinal outcomes associated with postgraduate education.

According to this PAEA study:

Although most students (89.3%) were aware of residency training programs, results indicated that few (7%) had definite plans to attend. Two-thirds of students stated that they received no information on residency training programs at school (journal ads were the most popular information source). Student perceptions of residency training programs were mixed. Their opinions varied according to their program level (p<0.03) and intended region of future practice (p<0.007). Additional significant variables related to student perceptions included student graduation date, age, and gender. However, these factors were not as significant as geographic region of intended practice and degree level.

Discussion: Although only one-third of students reported receiving material or information related to residency training programs from their faculty, two-thirds of faculty respondents stated that they provide students with residency information. Of those providing information, only 32.5% of faculty stated that they actually encourage their students to attend postgraduate training. Like their students, faculty members had mixed positive and negative perceptions of residency training programs

Final Thoughts

Personally, I have mixed feelings about residency programs for PAs.

I see the benefits for PAs, supervising physicians and patients. But, I fear that residency programs may become a requirement rather than an option.

This will lead to increase cost and time in school which is one of the key differentiators of the PA and MD profession.

An alternative model would be very short, inexpensive, 2-3 month programs that would allow PAs to gain valuable experience prior to entering specialty.  I would love a quick ER or orthopedic "refresher" if I were to change specialty at this point in my career. I think programs like this would be very popular. Especially as there seems to be less and less preceptorship to new PAs entering specialty.

Like PA schools, long, expensive programs are probably not the solution. I am curious to see how this all plays out.

Do you have an opinion? I would love to hear in the comments section!

Additional resources and links

  • If you haven't already don't forget to check out my Postgraduate PA Residency Section of the PA SCHOOL FINDER website and the new PA School Match Tool that allows you to narrow down your program search in real time!
  • Residency programs can be competitive and often only have 1-2 available seats per application cycle. We are more than happy to help you with postgraduate application materials/essays through our personal statement collaborative.
  • Do you know of additional residency programs not listed in this table? Let me know in the comments section and I will add them ASAP!

Murmur Madness: The Audio PANCE and PANRE Episode 45

Murmur Madness The Audio PANCE and PANRE Board Review PodcastWelcome to episode 45 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Today we are going to take a brief detour away from 10 daily questions and instead cover the murmurs you need to know for your PANCE and PANRE exam.

I have still included an 11 question exam at the end of this post so make sure you scroll down after you listen to the podcast.

There are a total of 17 cardiac conditions that may present on exam day in the form of a descriptive sound/murmur.

You will often be given supporting evidence such as the location of auscultation or radiation which you can use to narrow down your options.

There are total of 51 cardiac topics in the  NCCPA™ Cardiology PANCE and PANRE Content Blueprint which represents 16% of the PANCE and PANRE exam.

(click here to download the FREE NCCPA Content Blueprint cheat sheet)

These cardiac conditions and their associated murmurs cover a whopping 33% of the cardiology section of the PANCE and PANRE exam!

Take a listen to this week's podcast episode

If you can't see the audio player click here to listen to the full episode.

Let's break this all down:

Each of the links below opens the corresponding lesson on SmartyPANCE and is available to members (you must be logged in or join now)

There are 9 valvular disorders associated with murmurs:

Valvular Disorders (PEARLS and Flashcards)

  1. Aortic stenosis (ReelDx)
  2. Aortic regurgitation (Diastolic Murmur)
  3. Mitral stenosis (Diastolic)
  4. Mitral regurgitation
  5. Mitral valve prolapse
  6. Tricuspid stenosis
  7. Tricuspid regurgitation
  8. Pulmonary stenosis
  9. Pulmonary regurgitation

Five congenital heart diseases that have corresponding murmurs

Congenital Heart Diseases (PEARLS)

  1. Atrial septal defect
  2. Coarctation of the aorta
  3. Patent ductus arteriosus
  4. Tetralogy of Fallot
  5. Ventricular septal defect

One murmur associated with cardiomyopathy

  1. Hypertrophic cardiomyopathy

And a pair of conditions nested under the label of "other forms of heart disease" that have associated murmurs/heart sounds worth mentioning

Other Forms of Heart Disease (PEARLS)

  1. Acute and subacute bacterial endocarditis
  2. Acute pericarditis

Making Sense of Murmurs

Let's start with the valvular disorders:

You have 4 heart valves with two main conditions - half are diastolic murmurs and half are systolic murmurs. Here is a helpful mnemonic:

Recalling Common Systolic Heart Murmurs: MR PASS

  • itral
  • egurgitation
  • hysiologic (also known as functional, systolic flow murmur, a heart murmur heard in the absence of cardiac abnormality)
  • ortic
  • tenosis
  • ystolic - All the above murmurs are heard during systole.

MR PASS wins the Most Valuable Player award.

  • itral
  • alve
  • rolapse - Add MVP as another systolic murmur.

MR PASS often hangs around with MS ARD.

  • itral
  • tenosis
  • ortic
  • egurgitation
  • iastolic - All the above murmurs are heard during diastole.

Here are the nine valvular murmurs and their associated descriptions

Remember which are systolic and diastolic this can be very helpful at ruling out or ruling in a condition come exam day.

  1. Aortic Stenosis - Systolic harsh ejection crescendo decrescendo murmur at RUSB (aortic area) with radiation to the neck and apex
  2. Aortic Regurgitation - diastolic - soft high pitched blowing at LSB with patient sitting leaning forward and exhaling
  3. Mitral stenosis - diastolic - low pitched decrescendo rumbling with opening snap at the APEX (the mitral area) enhanced by expiration
  4. Mitral regurgitation - blowing holosystolic murmur loudest at the APEX (the mitral area) with a split S2 that radiates to the axilla and is increased by squatting, handgrip and expiration
  5. Tricuspid Stenosis - diastolic - mid diastolic rumbling at LLSB (tricuspid area) with opening snap
  6. Tricuspid regurgitation - High pitched holosystolic blowing murmur that radiates to the LSB (tricuspid area)
  7. Pulmonic stenosis - harsh midsystolic ejection crescendo-decrescendo murmur with widely split s2 at LSB that radiates to the left shoulder and neck
  8. Pulmonic regurgitation - diastolic -  high pitched, decrescendo murmur at LUSB increase with inspiration
  9. Mitral valve prolapse - Midsystolic ejection click head best at the APEX (the mitral area)

With these valvular murmurs you have 4 auscultation points which can be easily remembered using the mnemonic APT Ment watch this amazing video so you never forget!

Another helpful mnemonic: Aortic Pulmonic Tricuspid Mitral - ll P hysicians T ake M oney!

cardiac-auscultation-locations

  1. Aortic area: right 2nd interspace (Right upper sternal border RUSB)
  2. Pulmonic area: 2nd left interspace (Left upper sternal border LUSB)
  3. Tricuspid area: Left lower sternal border LLSB
  4. Mitral area: APEX

You can use the auscultation point to successfully narrow down your murmur and use the designation of systolic or diastolic to narrow down even further.

Five congenital heart diseases that have corresponding murmurs

Congenital Heart Diseases (PEARLS)

  1. Atrial septal defect - Systolic ejection murmur at 2nd left intercostal space with an early to mid-systolic rumble and fixed splitting of the 2nd heart sound (s2) and CXR will show pulmonary vascular markings.
  2. Coarctation of the aorta - Late systolic ejection murmur-posterior or continuous murmur if collateral flow. Will have absent or weak femoral pulses with a delay of palpable femoral pulse and HTN in arms but low or normal blood pressure in the legs
  3. Patent ductus arteriosus - Continuous, rough, machinery-like murmur, heard best in the first interspaces of the LSB
  4. Tetralogy of Fallot - Harsh systolic ejection murmur heard best at the left sternal border. Associated with bluish skin, trouble gaining weight, and sudden loss of consciousness during crying or feeding
  5. Ventricular septal defect - Harsh high pitched holosystolic murmur heard best at the LSB with ride radiation and a fixed split S2

One murmur associated with cardiomyopathy

  1. Hypertrophic cardiomyopathy - Medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining. S4 gallop and apical lift with thick, stiff left ventricle. HCM is the leading cause of sudden death in athletes and may cause angina.

Several of these conditions have a "tell" that make it easy to identify the condition and they are usually always part of the question stem

  • HOCM Sudden death in athlete
  • Atrial Septal Defect Fixed wide splitting of S2
  • Coarctation of Aorta X-Ray, Rib notching, absent or weak femoral pulses with a delay of palpable femoral pulse and HTN in arms but low or normal blood pressure in the legs.
  • PDA Machine like murmur
  • Tetralogy of Fallot Cyanosis with crying or feeding
  • VSD Holosystolic Murmur

And a pair of conditions nested under the label of "other forms of heart disease" that have associated murmurs/heart sounds worth mentioning

Other Forms of Heart Disease (PEARLS)

  1. Acute and subacute bacterial endocarditis  - A new mitral regurgitant murmur in a patient with a history of IVDA, fever (39.0º C),* and a blood culture that reveals 2 out of 2 positive growth
  2. Acute pericarditis - Although this is not a murmur, it is important to identify a pericardial friction rub heard best with patient upright and leaning forward. Chest pain is also relieved by sitting and/or leaning forward

You can listen to all these murmurs and see their associated waveforms at www.smartypance.com/courses/cardiology

Here is a wonderful video from the Khan Academy of how to approach murmurs video of murmurs

Murmur Flash Cards

Episode 45 PANCE and PANRE Murmur Quiz

You will see from these questions on the PANCE and PANRE things aren't always so straightforward.

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Congratulations - you have completed Murmur Madness. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.
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Shaded items are complete.
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Looking for all the podcast episodes?

This FREE podcast series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy + SmartyPANCE

I will be releasing new episodes every few weeks. The Academy is discounted and now includes complimentary access to SmartyPANCE so sign up now.

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ReelDx is now part of SmartyPANCE!

Included is a full cardiology content blueprint board review exam with over 147 cardiology specific questions and 51 cardiology blueprint topics covered in detail. This is in addition to 1,000's of additional board review questions and NCCPA content blueprint courses covering all 13 organ areas.

I am also happy to introduce ReelDX™ patient case based integration into many of the SmartyPANCE blueprint lessons. It's like a virtual rotation from the comfort of your couch!

If you want ReelDx just sign up on SmartyPANCE - It's just a $10 upgrade!  You can Sign up HERE

 This podcast is available on iTunes and Stitcher Radio (among others)

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

 

Does PA Program length matter?

does-pa-program-length-matter

In 2004 I graduated from the UMDNJ (now Rutgers) PA program.

It was a three-year PA program with a nearly 100% PANCE pass rate.  At the time, Rutgers was one of the best ranked PA schools in America and they continue to rank among the top 25 PA schools in the country.

As an avid practitioner of the confirmation bias I fell victim to the "more is better" principal and figured that my 3 year PA school program naturally must provide a more  comprehensive education.  Why else extend the length of a program?

But a recent article published by the PAEA in the Journal of Physician Assistant Education provides a more scientific answer to this question.

Does a longer PA program have any advantage over a standard two-year program?

In March of 2016 the PAEA published this research article examining the relationship between physician assistant educational program length and PA programs' 5-year  average PANCE first time pass rates.

Relationship Between Physician Assistant Program Length and Physician Assistant National Certifying Examination Pass Rates

Fifty years ago Duke University graduated the first class of physician assistants as part of a two-year program whose goal was to rapidly deploy these clinicians to assist physicians in delivering medical care.

During the past two decades, the PA program length has increased to an average of 26 months, with some programs spanning 36 months.

The longer programs were developed to accommodate the extra time needed to complete a master's program senior project.

The "more is better" attitude has some negative consequences including

  • Increased student debt
  • Delayed entry of qualified clinicians into the health care system at a time of practitioner shortage

As longer program became more common, some medical educators questioned whether 2 years was an appropriate length of time to train PAs, especially in light of their expanding scope of practice and the decrease in pre-pa school medical experience which defined the previous generation of PAs.

Since we PAs need to pass the PANCE exam to be eligible to practice and the fact that this is an indicator of entry-level clinical competence, there is an obvious advantage to knowing whether a longer length of training is associated with higher PANCE pass rates.

Time is of the Essence

The Association of American Medical Colleges predicted a shortage of more than 60,000 physicians in 2015, and a shortage of twice as many by 2025.

The PA field is experiencing rapid growth and increased demands.

The Bureau of Labor Statistics has predicted a 30% increase in demand for PAs over the next decade, a much faster than average rate of growth.

In response to the shortage of physicians and the increased demand for PAs, institutions of higher education have recognized the imminent need for more PA graduates.

Encouraged by the high rating of career potential for the profession, these institutions have initiated the development of many new programs.

As of October 2016, there 218 accredited programs (153 with continuing accreditation), with even more applying for provisional accreditation (46 schools) in the United States.

There are also a number of established and developing PA programs in other countries.

number-of-accred-programs-9-2016

Do longer PA programs lead to greater levels of PA competence?

Successful PANCE passage suggests PA graduate competency.

If study results indicated that shorter PA programs prepared students to pass the PANCE as well as longer programs do, then educators might have the incentive to structure shorter programs.

Reducing the length of training while maintaining competent graduates would help to reduce PA student debt, ease clinical site competition, and more expeditiously deploy PA graduates into the health care workforce.

Relationship Between Program Length and PANCE Pass Rates

pa-program-length-and-pance-pass-rates

Median total PA program length is 27 months, with total program length ranging from a minimum of 24 to a maximum of 36 months.

  • Median program's 5-year average first-time PANCE pass rate was 95%.
  • Program PANCE pass rates ranged from a minimum of 73% to a maximum of 100%.

Data on individual phase length (didactic and clinical phase) of programs

  • Median length of the didactic phase was 13 months, with a minimum of 10 and a maximum of 22 months.
  • Median length of the clinical phase was 12 months, with a minimum of 10 and a maximum of 24 months.

Program phase length and PANCE pass rates demonstrated no significant relationship for the didactic phase, and no significant relationship for the clinical phase

Discussion

Medicine is an ever-changing field that continues to grow in both volume and complexity.

As a result, the amount of information and skills that a PA student must master has become burdensome; this information overload may prompt PA educators to consider lengthening the educational process.

Although increasing the number of PAs graduating each year will help to partially mitigate the physician shortage, the effects of longer length programs on students and educational institutions must be considered.

There are several considerations regarding longer educational programs:

  1. Competition is increased for clinical sites because more new programs are being developed and longer programs require additional clinical training sites
  2. There is an inadequate number of experienced PA faculty to cover the required coursework needed for a longer curriculum
  3. Students incur increased tuition debt, which can exceed $100,000 at private universities. This expense may prompt PA graduates to opt for more lucrative careers in specialty medicine and forego the primary care field where the greatest need exists.
    • It is predicted that only 16% of new PA graduates will fill primary care positions by 2025!

How about shorter Medical School?

In a similar manner, it has been suggested that streamlining medical education for physicians and shortening the length of training would lower student tuition debt and focus attention on team-based medicine.

Several medical schools already offer shorter programs. Although there are limited outcome data on graduates of these schools, there is no evidence that they perform poorly on board examinations.

The authors of the study call for a 30% reduction in medical education length by 2020.

The Results

does-pa-program-length-matter-2

Study analysis indicated no relationship between total program length or individual didactic or clinical phase length and PA program's average PANCE pass rates.

The implications of this study suggest that shorter PA programs prepare students to pass the PANCE and enter the workforce as effectively as longer programs.

With the anticipated rapid growth of PA programs, these results could influence established and developing program directors' decisions on determining program length.

Since the current average program length is 26 months, program directors may feel the need to replicate this curriculum model; however, as noted, there are drawbacks to longer programs.

Longer PA programs are associated with:

  • increased institutional costs
  • increased demand for faculty
  • increased student debt
  • a delay in deploying clinicians into the workforce
  • increased institutional costs for faculty, advisor, and staff support
  • additional classroom space
  • an additional semester of preceptor stipends for scarce clinical experiential practice rotations

Not to mention, students in longer programs will accrue additional fees as well as housing, transportation, and tuition costs for each additional semester

Owing to clinical site shortages, many programs are now paying for clinical rotations, increasing the cost of operating the program.

Final thoughts

Since grading and joining the workforce, I have had the had the opportunity to work alongside dozens of competent, highly skilled, compassionate, hard-working, and dedicated PAs, most of whom attended 27 month programs.

Each one of them is proof positive that my superiority complex was completely unwarranted.

This article proves my growing suspicions that longer PA programs offer no real benefit with evidence to suggest longer programs have unwanted side effects such as increased student debt, a strain on faculty, institutions, and rotation sites.

The downstream consequences of increased PA school debt are pushing more and more new PA school graduates into specialty practice based on financial necessity.

While I admit PANCE pass rates are not the best predictor of professional acumen my anecdotal evidence supports the research provided in this study.

Also, I completely agree with the authors who support a 30% reduction in medical school education.

In many parts of the world the medical school didactic phase is combined with a two-year undergraduate program resulting in a much shorter and highly focused medical education. Often just five years. This would bring many new applicants (many who currently are on the PA school track) into the role of supervising physician.

Technological advances can not be ignored and will be a huge factor in augmenting and automating our medical knowledge allowing for greater ease of providing  real-time evidence based medicine using the most up to date clinical guidelines without the need to memorize and ever growing web of medical data.

Using knowledge from studies like these along with tools to gather, collect and digest big data we can work together to maintain a highly skilled compassionate medical workforce while decreasing student debt, reducing medical error and driving down healthcare costs.

PAs will continue to be at the forefront of this transition for years to come.

Resources: The Journal of Physician Assistant Education: March 2016 - Volume 27 - Issue 1 - p 3–6

The PANCE and PANRE Content Blueprint Checklist

pance-and-panre-nccpa-content-blueprintYour Blueprint to Success Starts Here!

If you are at all like me the hardest part of studying for your PANCE or PANRE is figuring out where to begin.

There is an ever growing list of review books, podcasts, online programs, in-person review courses, and anecdotal recommendations to choose from.

It is overwhelming!

So the key to success is to choose one or two, set a study schedule and STICK WITH IT!

The NCCPA is kind enough to provide us with a list of topics that will be on the exam in the form of the NCCPA™ Content Blueprint.

They do not deviate from this list of topics. Sometimes their questions are frustratingly complex or convoluted for sure, but, it is a safe bet that if you know the key terms from each of these topics you will pass your exam.

The take home message from the NCCPA is clear: follow the blueprint and your success is guaranteed, but who has time to review and memorize 467 diseases?

The NCCPA™ Content Blueprint Breakdown

  1. Cardiology 16% - 51 topics (diseases)
  2. Pulmonary 12% - 32 topics (diseases)
  3. GI and Nutrition 10% - 41 topics (diseases)
  4. Musculoskeletal 10% - 39 topics (diseases)
  5. ENT 9% - 57 topics (diseases)
  6. Reproductive 8% - 46 topics (diseases)
  7. Genitourinary 6% - 30 topics (diseases)
  8. Neurology 5% - 27 topics (diseases)
  9. Endocrinology 6% - 18 topics (diseases)
  10. Psychiatry 6% - 26 topics (diseases)
  11. Dermatology 5% - 45 topics (diseases)
  12. Hematology 3% - 18 topics (diseases)
  13. Infectious Disease 3% - 35 topics (diseases)

Total: 13 organ systems and 467 topics (diseases)

Some topics are very narrow such as viral croup, other topics are extremely broad such as normal labor and delivery... I mean seriously how do you even begin to wrap your head around this one?

To simplify this process, I am providing you with this interactive content blueprint checklist.

I have also been compiling pearls sets with flashcards to help simplify the review process and help you hone in on the questions stems that should help guide you to the correct answer.

Print it up and start crossing out the topics you understand, marking the ones you don't and making notes of key terms you should remember. The PDF version is interactive and linked directly to the individual lessons on SMARTY PANCE.

Follow this link to download your FREE copy of the Content Blueprint Checklist

pance-and-panre-nccpa-content-blueprint

FREE Download

This is a completely interactive checklist and unlike a static book I have created a searchable online index of the entire content blueprint as part of the Smarty PANCE/PANCE board review website.

The checklist links to each of these 467 topics, members can simply click on a topic to explore it further.

Also included are 13 topic specific content blueprint exams available to all members, as well as a slough of other exams and review material.

Members of both the PANCE and PANRE Academy and Smarty PANCE receive access to both sites with a single login... Cool!

If you are interested in becoming a member you can sign up here (The PANCE and PANRE Academy) or here (Smarty PANCE + ReelDx)

If you have any questions or need help along the way don't hesitate to drop me a line or leave me a message in the comments.

Warmly,

Stephen Pasquini PA-C

Episode 43: The Audio PANCE and PANRE Board Review Podcast

the-audio-pance-and-panre-academy-physician-assistant-board-review-podcastWelcome to episode 43 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover 10 PANCE and PANRE board review questions from the Academy course content following the NCCPA™ content blueprint (download the FREE cheat sheet).

This week we will continue to take a break from topic specific board review and covering 10 general board review questions.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full audio and written review is available to all members of the PANCE and PANRE Academy.

  • You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
  • You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

If you can't see the audio player click here to listen to the full episode.

Episode 43 PANCE and PANRE Podcast Quiz

1. A mother brings in her five-year-old boy for his school physical. She voices some concerns about his readiness for school, saying he seems to be socially immature. She has noticed he does not interact with other children well, and that when he plays with them, he has a tendency to "place them" and then run around them as if they were statues. He rarely cries when he is hurt, and he shrugs off any attempt to hug him. He has good attention to details, and will sit and draw the same geometric shapes over and over again, but does not seem interested in learning the alphabet. He avoids eye contact with anyone. Which of the following is the most likely diagnosis?

  1. Normal 5 year-old
  2. Social phobia
  3. Autism
  4. Avoidant personality
Click here to see the answer

2. A 3-week-old male infant presents with recurrent regurgitation after feeding that has progressed to projectile vomiting in the last few days. The mother states that the child appears hungry all of the time. She denies any diarrhea in the child. Which of the following clinical findings is most likely?

  1. Bile-stained vomitus
  2. Hemoccult positive stools
  3. Olive-sized mass in the right upper abdomen
  4. Sausage-shaped mass in the upper-mid abdomen
Click here to see the answer

3. A 65 year-old with COPD receiving their first pneumococcal polysaccharide PPSV23 vaccination should be revaccinated in

  1. 1 year
  2. 3 years
  3. 5 years
  4. Never
Click here to see the answer

4. Which of the following therapies is recommended for a 13 month-old child with sickle cell disease?

  1. Folic acid and penicillin V
  2. Ferrous sulfate and penicillin V
  3. Folic acid and ferrous sulfate
  4. Folic acid, ferrous sulfate and penicillin V
Click here to see the answer

5. A patient with severe COPD presents to the Emergency Department with a 3 day history of increasing shortness of breath with exertion and cough productive of purulent sputum. An arterial blood gas reveals a pH of 7.25, PaCO2 of 70 mmHg and PaO2 of 50 mmHg. He is started on albuterol nebulizer, nasal oxygen at 2 liters per minute, and an IV is started. After one hour of treatment, his arterial blood gas now reveals a pH of 7.15, PaCO2 100 mmHg and PaO2 of 70 mmHg. Which of the following is the most appropriate next step in his treatment?

A. Decrease the oxygen flow rate.
B. Administer oral corticosteroids.
C. Intubate the patient.
D. Administer salmeterol (Serevent)

Click here to see the answer
Explanations

6. A patient should be tested for tuberculosis prior to being treated with

A. etanercept (Enbrel).
B. cyclosporine (Neoral).
C. methotrexate (Rheumatrex).
D. prednisone (Deltasone).

Click here to see the answer
Explanations

7. Which of the following side effects is associated with long-term administration of phenytoin (Dilantin)?

A. Ataxia
B. Hypotension
C. Osteomalacia
D. Cardiac dysrhythmia

Click here to see the answer
Explanations

8. Hairy leukoplakia has the greatest prevalence of distribution on the

A. palate.
B. floor of the mouth.
C. lateral tongue.
D. gingiva.

Click here to see the answer

9. 75 year-old male presents for a routine physical. Vitals are normal with no orthostatic changes. On physical examination, a fine cortical movement with repetitive rubbing of the tip of the thumb along the tips of the fingers is noted at rest. Which of the following is the most likely diagnosis?

A. Seizure disorder
B. Peripheral neuropathy
C. Shy-Drager syndrome
D. Parkinson's disease

Click here to see the answer
Explanations

10. A 45 year-old female presents to the emergency department with generalized, hot, erythema of the skin. Physical exam reveals an oral temperature of 102 degrees Fahrenheit, purulent conjunctivitis, and mucosal erosions. Her skin is painful and separates from the dermis with touch. Which of the following is the most likely cause for this condition?

A. Penicillin
B. Prednisolone
C. Aspirin
D. Hydrochlorothiazide (HCTZ)

Click here to see the answer
Explanations

Looking for all the podcast episodes?

This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy .

I will be releasing new episodes every few weeks. The Academy is discounted, so sign up now.

Resources and Links From The Show

This Podcast is also available on iTunes and Stitcher Radio for Android

  1. iTunes: The Audio PANCE AND PANRE Podcast iTunes
  2. Stitcher Radio: The Audio PANCE and PANRE Podcast Stitcher

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Married with Children in PA School: How This Mom Makes it Work

Married with Children in PA School - How This Mom Makes it WorkMy name is Nikki, and I am a mother of two boys, 2 and 6 years old.

I am also a PA student.

For me, it was a long and difficult journey to get into PA school. I applied three consecutive years before finally getting accepted to a PA school in San Antonio, which is about a 3-hour drive from where I live.

Although I was excited to finally be accepted, it was a difficult decision for me and my family because it meant I had to move out to San Antonio while my family stayed behind.

I knew it would be hard, but I could not lose this opportunity. I was one of the 45 students accepted out of 1,800 applicants and I needed to figure out how to make it work.

I Couldn't do it Alone

My husband and my mom are very supportive and I would not be able to do it without them.

My mom decided to move in with us and help us to take care of the kids. The most difficult part for me at the beginning was to help my mom and my husband to get along. They are both great but it is hard for them to work well together because they both have very strong personalities. However, it seems to be getting better so I can’t complain now.

I go home to see my children over the weekends and try to communicate on Skype almost every day. It has been six months since I started PA school and it has gone by really fast since I am so busy.

My 6-year-old was getting into trouble in school and a couple of times I had to drive back and forth from San Antonio to be able to attend his class and the meetings with his teachers.

I used to overreact to his “bad behavior” but it only made things worse. I don't like to feel like I have no control in raising my children, so sometimes I get too emotional. I appreciate it when my husband or my mom do exactly what I ask them to do regarding the kids because it makes me feel like I can contribute to their life the way I think is the best for them.

I know it sounds silly and not very reasonable but I want to feel like I am still a big part of making decisions for my kids.

Finding Time to Study

I really need my weekends to study so when I come home to see my family I try to spend one full day and night with them and then go back to studying.

I do miss my family and some weekends I cannot come to see them, especially when we have finals or too many tests at once. On these occasions, we found a bus that my mom can take and bring the kids with her. I love it when this happens because I get to see them and will not waste 6 hours driving back and forth when I can spend this time studying.

The PA program in San Antonio is far more advanced than I expected. I have never studied so hard in my life even though I have two degrees. We already had some people that had to leave the program because they did not make it through the first semester. I know I have to be diligent and manage my schedule the best I can.

I don't think I have a typical situation since I do not really live with my family at the moment but I am sure there are people who are in my shoes or will be.

PA schools are very competitive and it is becoming harder and harder to get in. Unfortunately, you will not always be accepted at the PA school of your choice (or maybe fortunately because I love my school now).

I think the benefit of my situation is that I can actually study at home anytime and not feel anxious to go home and see my kids every day since they are not here.

I do miss them and love them very much but I keep reminding myself of my goals and sacrifices. I explain to my 6-year-old son that I study now so I can help people to be healthier and so we can afford to travel.

He is excited about this and sometimes says he wants to go to my school instead of his.

Advice to PA School Parents

If I were to give advice to future PA school students with children I would say stay focused on your main goal and know why you are doing this.

I do have my moments when I cry and get emotional but I talk to my kids, my husband, and my mom and they make me feel better. I remind myself that time goes by fast and I am pursuing my dream that will not only benefit me but my family and many other families in the future.

I would encourage you to connect with people in your class and make good friends. It has helped me to stay positive through difficult times. You have to develop inner strength that will carry you through any personal problems and still allow you to focus on studying. Otherwise, it will not be possible to make it.

We have a great tradition in our school. The class that was before us assigned each one of the new students a “Big person”. They just matched one person with another one according to some similarities. My “Big” has two children and they live with her. She was really helpful and supportive throughout my first semester. She made me feel more "normal” on several occasions when I did not know what to do.

She gave me advice on how to cope with problems and how to best address my needs along with those of my family throughout PA school.

I have two more years to go and I know they will go fast. I am enjoying my journey but I can’t wait to go back to my family and be there with them and for them.

All I can say is to get your support system together, make sure you have reliable people who can help you throughout the whole program and you can definitely make it through.

Best of luck pursuing your dreams!

This is a guest post by current PA student extraordinaire Nikki Clark

Nikki has been a licensed acupuncturist for 9 years. When a PA saved her son’s life it triggered her to choose a path of becoming a PA. She is pursuing her dreams to become a PA and to be able to educate people on prevention and treatment of illnesses and diseases. She has two sons and a supportive family that inspires her to be a better person and to stay strong and positive.

Also, in case you were curious, I asked Nikki about her mom, her husband's feelings about her moving to San Antonio to attend PA school and why they chose to live separately during her time as a student. Here is her answer:

I am originally from Ukraine and then lived in Houston since 2006.  My mom was living in Ukraine and had to make a big move for me. I really admire my mom. I do not think I could have been where I am today without her love and support. My husband's job keeps him in Houston so moving for him was out of the question.

My husband was supportive but truly very sad about me moving away. However, since it is only a 3 hour drive it does not seem too bad. I think the worst part for him is dealing with my mom and  trying to have his life arranged completely differently. But he has been with me throughout the whole process and is still there for me. We try to make date nights whenever we can and communicate over the phone every day. He sends me pictures of the kids and comes here whenever he can.

*If you or anyone you know is interested in submitting a guest post to the blog just drop me a line at stephen@thepalife.com - if your article is accepted you will receive a $50 Amazon gift card or a free 1 year subscription to the PANCE and PANRE Academy (your choice). Stay tuned our next PA parenting article will be from a father of two!

A Question for Physician Assistants: Why Are You In It?

Why Are You In It? The Physician Assistant Life

Are you looking to make money as a physician assistant or are you looking to make the world a better place with what you do?

It’s an honest question and the two options are very different.

The latter involves being interested in giving value to someone other than yourself. The former involves doing anything and everything to add zeros to your bank account.

Neither option is inherently wrong. The problem is that most PAs begin with a desire to help people and, over time, once fully indoctrinated into the "system" they (we) become fundamentally changed.

If you’re simply looking to make money, the strategy basically comes down to generating as much revenue as you can, while avoiding an unfavorable outcome. Or, as we in the medical field have so humbly named "covering your ass."

Sometimes it’s as simple as showing your boss that you can see 6 or 7 patients in an hour.  Sometimes it’s not speaking up in the face of gross healthcare inequalities.  Sometimes it’s taking the higher paying job in order to please others or prove your self-worth.

The organization you work for, and therefore you, do whatever it takes to maximize profitability.

Success is much easier to measure too—you simply look at how many patients you have churned out, and count how much money you make.

Did it cover costs? Does it cover your livelihood and expenses? Were you able to maximize your retirement accounts? Is your boss happy? Awesome - you win and you’re a success.

If you’re looking to make the world better with what you do, it’s a little more difficult.

Haiti-2013-023

Just because you want to make things better doesn’t mean the universe will align and show you the way.

Making the world a better place through the work you put out into it starts with you and how you answer the tough questions.

Do you actually like the work you’re doing? Does it align with a greater purpose in your life? Is the message behind what you do bigger than what you do? Are you truly stoked to do it?

People are attracted to excitement, so if you’re genuinely excited about something, others will take notice. Real excitement is contagious, like the flu (but with less sniffling).

Though doing something that makes the world better doesn’t stop with you. It also includes being super valuable and in service of others.

What about your work helps your patients? What about your work makes their life better? What about your work makes them truly stoked? Because when they’re excited, others will take notice of that too.

Measuring "Success" 

Haiti-2013-237

Measuring the success of doing work that makes the world better is also a little muddy. There are several key performance indicators (KPIs) involved, each of them based on your own unique purpose and passion.

Sure, patient wait times, satisfaction surveys and money or revenue may be a part of it, but they’re not the only indicators. How much did you enjoy the process, regardless of the bottom line?

How much did your patient benefit from your work, regardless of the volume (as in, maybe you only saw 10 patients today, yet all of them  left healthier, having an experience that positively changed their lives).

In measuring success this way, it’s fairly easy to succeed as well - you get to do work you love that’s lined up with your purpose and valuable to the patients it’s for.

So, did you like doing it and did another person like receiving your care?

Awesome - you win and you’re a success.

Haiti-2013-154

We get caught up and stuck in our thoughts when we change gears in our focus, or when we try to measure success for both types of work for the same outcome.

If you’re in it to make the world better and you only look at money, you’re doing your work and process a horrible disservice.

Similarly, if you’re in it to make money and you feel unexcited or uninspired, you’re also doing that work and yourself a horrible disservice too.

If you're in it to make the world better and you look at the patient sitting in front of you, you’re doing yourself, and your patient a great, and honorable service.

Magically, you're likely to find, the success that drove you to this profession in the first place, will follow.

PS: If you’re stuck before you’ve even started, check out my resources page for some help and inspiration. 

Photo Credits:  From our medical mission trip in and around Port Au Prince Haiti. photos by: Courtney Reese

Scholarships, Grants and Loan Repayment Programs for Physician Assistants

How to Bankroll PA School Without Going BrokeIt goes without saying, PA school is expensive.

PA school is also demanding, which means you will have limited time (if any) to work while attending school.

With the average undergraduate education debt prior to PA school at $36,300 and the average anticipated debt load from PA school at $75,000-$124,000, it is important that you have a rock-solid plan for how you are going to pay for your PA school education.

Funding sources vary and federal loan programs will probably form the foundation of your assistance package, many states also offer financial aid funding.

Additionally, there are specialized scholarships, traineeships, and loan programs available. Remember — apply the resources from scholarships and grants before you accept loans. Then, only accept loans that you need.

Work closely with your financial aid department. They will be able to inform you about special loans and scholarships for which you may be eligible.

Federal and State Resources

  • Numerous loans and grants guaranteed by the federal government are available to qualified students. Visit the website for Federal Student Aid sponsored by the U.S. Department of Education.
    • Direct Subsidized Loans are loans made to eligible undergraduate students who demonstrate financial need to help cover the costs of higher education at a college or career school.
    • Direct Unsubsidized Loans are loans made to eligible undergraduate, graduate, and professional students, but in this case, the student does not have to demonstrate financial need to be eligible for the loan.
    • The Federal Perkins Loan Program is a school-based loan program for undergraduates and graduate students with exceptional financial need. Under this program, the school is lender. You must check with your school's financial aid office to see if your school participates in the Federal Perkins Loan Program
    • Federal Stafford Student Loan Program: These loans are offered through your bank, credit union, or other lending institutions. Graduate students may borrow up to $8,500 per year up to a total of $65,000. To qualify for a Stafford loan, you must demonstrate financial need as determined by the CM formula mentioned above. The interest rate varies. These loans are based on need, not creditworthiness. Therefore, no cosigner is necessary.
  • State sources of financial assistance include an agency in each state that guarantees federal student loans. Also, some states offer their own educational assistance programs with loans or grants. Check with your financial aid office to locate the office(s) in your home state.
  • Tax Credits are another option to explore.                                            

Scholarships and Traineeships

  • Americorps is a national network of hundreds of programs throughout the U.S. and is open to U.S. citizens, nationals, or lawful permanent residents aged 17 or older. This program helps pay for education in exchange for a year of service.
  • The Indian Health Service (IHS) scholarship program provides financial assistance for American Indian and Alaskan Native (federally recognized only) students enrolled in health professions and allied health professions programs. The IHS Loan Repayment Program (LRP) was created to support this mission by providing health professionals the financial freedom to fulfill your career goals. The IHS LRP awards up to $20,000 per year for the repayment of your qualified student loans in exchange for an initial two-year service obligation to practice full time at an Indian health program site.
  • The National Health Service Corps Program (NHSC) is a competitive federal program. Students dedicated to practicing primary care in communities of greatest need can compete for educational scholarships. I was a NHSC Scholar and you can read more about that here. They also offer a generous loan repayment program in exchange for 2 years service in a designated healthcare shortage area (see the next section below).
  • The Physician Assistant Foundation offers competitive scholarships for PA students who are currently attending an accredited PA program, are in the professional phase of the program, and are student members of AAPA. Visit the Foundation web pages for a current application or see below.
  • The United States Navy Health Services Collegiate Program is designed to provide financial incentives for college students in designated health care professions while completing baccalaureate degree requirements.
  • The U.S. Army Health Care team, offers a three-year loan repayment program for any PA- C who wants to serve as an Army PA.
  • PAs for Latino Health (PALH), a caucus of the AAPA, offers a $500 scholarship to currently enrolled PA students each year.

Loans, Repayment Programs, and Consolidation Services

  • The National Health Service Corps (NHSC) Loan Repayment Program is available to PAs in primary care or current students who plan to become primary care providers after graduation. You must agree to provide primary care services in a priority health professional shortage area for a minimum of two years.
  • Public Service Loan Forgiveness Program: The Public Service Loan Forgiveness (PSLF) Program forgives the remaining balance on your Direct Loans after you have made 120 qualifying monthly payments under a qualifying repayment plan while working full-time for a qualifying employer. Physician assistants qualify.
    • IMPORTANT: Loan forgiveness is an option after 10 years of payments, but it may not be an option if you refinance your loan during that period. So make sure you read the fine print!
  • Sallie Mae Tuition Pay Plans provide quality, low-cost, innovative solutions to paying for education. Tuition Pay is an interest-free plan that lets you break down the large lump-sum payments due at the beginning of each semester into easy-to-manage installments.
  • Common Bond: Ever wished your student loans could have a positive effect on society? Common Bond seeks to "reimagine finance based on our belief that business has a responsibility to further social good and promote welfare outside of its immediate customer base." Common Bond is unique in that they bring a 1-for-1 model to education through Social Promise. For every fully funded degree on the CommonBond platform, they fund the education of a student in need for one year through the nonprofit Pencils of Promise. They even fund a trip to Ghana with Pencils of Promise so that borrowers (and employees) can go and meet some of the children who the Social Promise has helped to fund.

Insider's tip: Looking to refinance a loan? Magnify Money is a wonderful website that lets you compare and contrast student loan options.  Just beware that if you have federal loans, refinancing to private loans may result in losing protections like special repayment plans (such as the public loan forgiveness program) that can help you in a time of need. Make sure you can comfortably afford your new payments if you refinance. And take the time to get rates from several providers.

AAPA Constituent Organization Scholarships

  • The Physician Assistant Foundation offers competitive scholarships for PA students who are currently attending an accredited PA program, are in the professional phase of the program, and are student members of AAPA. Visit the Foundation website for a current application.  Here are some of their current offerings. The 38 PA students who were awarded scholarships during the 2014 application cycle are listed here.
    • Bristol-Myers Squibb Endowed Scholarship — four $2,500 awards
    • National Commission on Certification of Physician Assistants (NCCPA) Endowed Scholarship — six $2,000 awards
    • Procter & Gamble Endowed Scholarship — six $1,000 awards
    • AAPA Rural Health Caucus Scholarship — two $2,000 awards to students from a rural area, who are committed to serving a rural community.
    • Ron Pace Memorial Scholarship — one $1,000 award to Florida-based students who are veterans and in their second year of PA school. Named in memory of Ron Pace, a Florida Academy of Physician Assistants past president and AAPA Outstanding PA of the Year Award recipient, who served in the U.S. Navy for 20 years.
  • Association of Physician Assistants in Oncology offers a $2,500 award for PA students. The award consists of two parts: $500 to help with travel to AAPA's Annual Conference to receive the award and $2,000 (unrestricted). Apply by March 1st.
  • California Academy of Physician Assistants offers three annual student scholarships for student members. Apply online by December 31.
  • Lesbian, Bisexual, and Gay Physician Assistant Caucus offers $1,000 grants for two PA students to attend AAPA's Annual Conference to help foster involvement and awareness of the caucus within the AAPA. Apply by January 15.
  • Pennsylvania Society of Physician Assistants has six annual student leadership scholarships and three scholarships for students who choose to enter the writing competition. Apply online by June 30.
  • Physician Assistant Academy of Vermont offers a scholarship of $1,000 and free attendance at the annual PAAV Winter CME conference for PA students who are residents of Vermont. Apply by June 30.
  • Physician Assistants in Orthopedic Surgery offers one or two $500 scholarships from the Susan Lindahl Memorial Scholarship Fund, established to encourage young PA students to enter the field of orthopedics. Apply by August 15.
  • The Society of Army Physician Assistants honors the memory of Captain Sean P. Grimes, through the Captain Sean P. Grimes Physician Assistant Educational Scholarship Award. Apply by February 1st.
  • The AAPA Veterans Caucus Scholarship seeks to recognize the achievements of an outstanding veteran of one of the seven branches of the Uniformed Services who is currently enrolled in a PA program.

Note: Grants are similar to scholarships, and availability is based on resources and financial need. When you submit your FAFSA form, you will be considered for Pell Grants.

Also, check your place of employment, organizations and place of worship for any grants for which you may be eligible.

Scholarships and Grants Awarded by the AAPA

They are all due January 15, 2015.

  • Student Academy Outstanding Student Society
    • Description: This award recognizes three student societies for their outstanding service to the profession.
    • How to apply: Download the Student Academy Outstanding Student Society Award application
    • Award/Prize: $500 for each of the three top placing programs
    • Additional details: All of these student societies documented their work in the following categories: public education and advocacy of the profession, public service and outreach, promotion of the diversity and professional involvement. Seventy-five percent membership is required to participate in this award.
  • Student Academy Travel Grant Awards
    • Description: A $500 grant for AOR student society representatives and Student Academy selected HOD student delegates or alternates to minimize travel expenses to the annual conference.
    • Eligibility Criteria: HOD students must be one of the selected students; all applicants should be members of AAPA
    • How to apply: Download the Student Academy Travel Grant application
  • Student Academy PA Student Mentor Award
    • Description: This award recognizes a PA who has demonstrated exemplary service to PA students and has furthered the leadership, educational, and professional development of PA students.
    • Eligibility Criteria: none specified
    • How to apply or nominate someone: Download the Student Academy PA Student Mentor Award application
  • Student Academy PAragon Student Award
    • Description: This award honors a PA student who has demonstrated exemplary service as a PA student.
    • Eligibility Criteria: Need at least 5 applicants; student should be a member of AAPA
    • How to apply or nominate someone: Download the Student Academy PAragon Student Award application

If you have any questions about these scholarships and grants, you can contact the Student Academy Staff at the following email address: students@aapa.org.

Unites States Military Service and Loan Repayment Programs

  • National Guard Healthcare Bonuses and Loans
    • Physician Assistants and Social Workers:
      • $20,000 per year for a three-year contract
      • $15,000 per year for a two-year contract
      • $10,000 per year for a one-year contract
  • National Guard Student Loan Repayment Program
    • Must have 1 or more qualifying and disbursed Title IV federal loans
    • State and private loans are ineligible for repayment
    • PLUS loans are eligible
    • Loans must be listed on the Department of Education National Student Loan Data System (NSLDS) aid summary website
    • Must enlist for a minimum 6 year term of service
    • Must enlist for a critical skills (CS) vacancy in the grade of E-4 or below
    • Information:
      • Payments will not exceed $50,000 with annual repayments not to exceed the maximum amount established by law
      • Must enlist into a qualifying position in an MTOE or Medical TDA unit only
      • Must score a minimum of 50 on the Armed Forces Qualifying Test (AFQT)
  • Navy Clinical Care Provider
    • To qualify for Active Duty employment consideration as a Physician Assistant in the Navy Medical Service Corps, you must meet these basic requirements:
      • Be a U.S. citizen currently practicing in the U.S.
      • Bachelor's degree from an accredited college or university
        Completion of a physician assistant education program approved by the Committee on Allied Health Education and Accreditation (CAHEA)
      • Certification by the National Commission on Certification of Physician Assistants (NCCPA)
      • Be willing to serve a minimum of three years of Active Duty
      • Be between the ages of 18 and 41
      • Be in good physical condition and pass a full medical examination
      • General qualifications may vary depending upon whether you intend to serve Active Duty or Reserve Duty, and whether you are currently serving, have served before or have never served before.

Who Gets the Most Financial Aid?

You might think that the families who receive the most financial aid would be the families with the most need. In fact, this is not necessarily true. The people who receive the most aid are the people who best understand the aid process.

Can I afford Not To Go To PA School?

Can I afford to go to PA school? The question you should be asking is: can I afford not to go to PA school? If your goal is to become a PA, then the answer to this question is easy. The worst thing you can do is shy away from applying because you think you won’t be able to afford it, and then live the rest of your life wondering, What if?

When I applied to the Rutgers Physician Assistant Program and spoke with students at the open house, they explained that if I were to be accepted the program would do its best to ensure I got through financially. They were right.

I may have borrowed a little more than I intended, but the money was available and after an initial setback I ended up with a highly coveted NHSC Scholarship.

As you will soon find out, there are plenty of opportunities for loans, grants, scholarships, etc. It does, however, take a little work on your part. But since you have set your goals and you’re focused, you are prepared for anything.

References:

Bonus: The Today Show recently had a very good program about loan refinancing and avoiding debt. Take a look at the video here and review their 7 ways to stop loans from ruining your life.

A Surgeon Speaks: 7 Reasons Why You Should Choose PA Over MD

A Fellowship Trained Surgeon Shares 7 Reasons You Should Choose PA over MD

I am a fellowship-trained surgeon.

Besides the financial aspect, the following 7 points will make your decision of PA vs. MD easy:

1.  It takes on an average at least 15 years (after high school) of head in the sand (books) to complete fellowship and reach the $200,000 debt figure that you are quoting.

2.  A 40-50 hour work week is a dream for most MDs. Most of my colleagues work 60 hrs and some up to 80 hours a week.

3.  Not counting the hours after you go home and come back for ’emergencies’.

4.  Family life is a ‘possibility’ for PAs. Look around and see how many MDs have kids before 30. You will be surprised by the small number.

5.  Most of my PA friends work two jobs (totaling 60-80hrs/week), so their salaries go up accordingly. Ever heard of an MD working two jobs. I guess 120-160 hrs/week is kinda difficult. Huh..

6.  PAs work just as well and earn just as much respect by their patients and colleagues.

7.  The only trajectory this trend is going is upwards. Mid-level providers’ need and utilization has been increasing exponentially.

I am totally happy with what I am doing. But if I were to advise an aspiring student for MD vs. PA, I would totally refer him/her to this post. I think the round 1 showdown is won by PAs, not MDs.

- Dr. S

Dr. S is a fellowship trained surgeon who was kind enough to weigh in on the PA vs. MD debate in the comments section of this blog.

What do you think? Is Dr. S spot on or dead wrong? I would love to hear your thoughts in the comments section.  You probably know where I stand on this debate. 🙂

Who Gets Into PA School? Here’s What You Need to Know

What Does it Take to Get Into PA School? Here's What You Need to KnowLeslie Mean is a 26 year old single white female who presents to the PA school admissions committee on her first attempt to get into PA school.

She has a 3.5 overall GPA and a 3.47 science GPA. She is holding a bachelors of science degree in biochemistry, had an SAT score in the 1000-1100 range and above average GRE scores.

She has 2 years of hands-on clinical experience working as a CNA and a long history of volunteer work which exemplifies her desire to help her fellow man.

She is kind and considerate and has reference letters which demonstrate her maturity and strong interpersonal skills.

She was accepted into PA school on her first attempt.

Who is Leslie and Why did she get into PA School?

When asking the question: What do I need to do to get into PA school? You would be smart to talk to Leslie.

Leslie is a hypothetical PA school applicant who went on to become a PA school student, a perfectly average PA school student.

She also embodies what PA school's all across the country are looking for at this very moment.

How do I know this?

Because the most recent data from the PAEA semi annual report, representing responses from over 85% of PA programs detailing characteristics of applicants and students enrolled in PA school, show that they are filling their seats with Leslie.

As much as I like to talk about not being average and differentiating yourself from the pack it is good to know what average is. Average provides a baseline by which you can measure your own progress, set goals and develop an application timeline.

Does this mean you have to be just like Leslie to get into PA school?

Absolutely not, first of all, factors such as race, age, ethnicity, etc. are of no importance and you certainly don't have to be female to get into PA school  (I myself am living proof).

But, it is safe to assume that most schools are looking to keep their graduation and certifying exam pass rates high. They have an incentive to take less risks and because of this, anything below average is considered a risk.

Thus, take a good look at Leslie and focus on factors that you can control to differentiate yourself, like your academic standing, your experience, your volunteer activities, your references and your essay.

If you set the bar at Leslie, and end up being a Mother Theresa, I am pretty sure you will be accepted into PA School, although I have no data on religious preference and PA school acceptance rates. 🙂

So what does an average PA school applicant who is admitted to PA school (i.e student) look like?

Let's take a look:

→ The average PA school students age is 27 years old

  • The average age of first-year students ranged between 25 and 28 for all categories
  • The average age at application is 26 years old

Average age of Physician Assistant School Applicant

→ The average PA school student is female

The gender distribution of first-year students has started to stabilize after nearly a 20-year trend of a gradually increasing proportion of females:

  • Female: 72.4%
  • Male: 27.6% (mean)

First Year Enrollment in PA School by Gender

→ The Average PA school applicant has a bachelor’s degree

The majority of PA school applicants hold a baccalaureate degree.

  • No academic degree: 8.1%
  • Certificate: 0.2%
  • Associates Degree: 2.6%
  • Baccalaureate Degree: 70.5%
  • Master’s Degree: 6.6%
  • Doctoral Degree: 0.9%

→ Most students had four years of hands-on clinical experience prior to applying*

PA school applicants come to the table with a variety of medical experience, especially if they are strong applicants. On average, four years of prior experience in one of the following areas is common:

  • Nursing
    • Registered Nurse (RN)
    • Licensed Practical Nurse (LPN)
    • Certified Nursing Assistant (CNA)
  • Allied Health
    • Physical Therapist
    • Occupational Therapist
    • Registered Radiologic Technologist
    • Athletic Trainer
  • Emergency Services
    • Emergency Medical Technician (EMT)
    • Paramedic
    • Emergency Room Technician
  • Miscellaneous
    • Phlebotomist (that was me!)
    • Medical Researcher
    • Medical Volunteer

 

Average healthcare experience years and hours of PA School Student or Applicant

* 2015-2016 update: Some recent data suggests HCE hours are significantly declining with a new average of 1.88 years of health care experience among matriculating (accepted) students.

→ SAT/GRE scores of those accepted tend to be in the above-average range

  • GRE Percentile Math: 50%
  • GRE Percentile Verbal: 42%
  • GRE Percentile Analytical: 48%
  • SAT scores are in the 1000-1100 range.

→ The average PA school student has between a 3.36 and 3.47 overall GPA and an undergraduate science GPA between 3.36 and 3.47

  • The average undergraduate overall GPA for PA school applicants who WERE ACCEPTED into PA school was 3.49, undergraduate science GPA was 3.36 and non science GPA was 3.56.
  • The average GPA for students who WERE NOT ACCEPTED into PA school was 3.16

Interesting factoid: As the age of applicants increases, GPA tends to be lower.

Average GPA for PA School Student Undergraduate and Science

→ Most PA school students are White

Skin color has nothing to do with acceptance rates, but it is interesting (and maybe a bit sad) to know that the vast majority of first year students were White (86.5%) followed by Asian (11.1%) and Black or African American 4.1%.

First Year Student PA School By Race and Ethnicity

→ What are your chances of being accepted into PA school?

  1. If you apply to one PA program - you have a 25% chance of getting in
  2. If you apply to 12 programs (or more) - you have a 49% chance of getting acceptance
  3. Average number of PA programs applied to is 8

Interesting factoid: There is no additional benefit for applying to 12 programs or more!

→ Pucker up baby, most PA students are single!

Most students are single (67.7%), though just over a quarter were married (26.4%). A little over two percent were divorced and over one percent were in a domestic partnership/civil union. Most students (85.1%) have no legal dependents. For the nearly 15% of students that reported having legal dependents other than themselves, the average number of dependents was 2.02, with a range of 1 to 7 dependents. Over 30% of respondents said they were considered a dependent of their parents.

→ Most PA students are from "The Burbs"

Half of students reported spending most of their time in a suburban setting. One quarter of respondents reported spending most of their time in a rural environment, followed by 15% in an inner-city setting.

Where do PA School Students Come From

→ PA school students don't smoke pot and are not drug dealers or part of the Italian Mafia

Over three-quarters (82.8%) of programs reported that students were required to have a background check upon matriculation to the program, while 78.7% of responding programs now mandate drug testing.

Some Important Points

It's not Rocket Science: It is important that a candidate demonstrates reasonable aptitude in the hard sciences such as anatomy and physiology, chemistry and biology. It is more likely that the committee may overlook a grade of C in U.S History or Spanish I. They will be less tolerant of a marginal grade in the sciences.

Show compassion: Your GPA is stellar and you've amassed an impressive amount of medical work experience in the little spare time you have while keeping your grades pristine, but you still get that dreaded rejection letter. Why? You didn't do enough volunteer work. Volunteering exemplifies your desire to help your fellow man—the attribute identified by schools as one of the most integral to becoming a successful PA. "Students who have had experience in working with underserved populations, rural or diverse populations, performing volunteer service or disaster relief, or other experiences that illustrate a drive and compassion for others often stand out to the admissions committee,"

Quote Run of a Ladder Thomas Henry HuxleyIt's an easy race to the bottom, so set your sights at the top: Many people will be set aback when they read that only 25% of applicants will be accepted into PA school on any given year, but this should actually be good news. Being in the top 25% in any field is not nearly as hard as it sounds, simply because the majority of the competition is in the bottom 75% and has bottom 75% qualifications. For example, you have read this entire post so you now know what the average PA school applicant who has had some success looks like. You understand what a top 75 percent applicant looks like. Your goal now is to be better than the average 75% and exceed the top 25%.  If you aim high, you will be competing with a much smaller minority, and your odds of getting an acceptance letter will increase dramatically. It also helps if you apply to 12 programs.  😉

Tables and data were sourced from:

The 28'th and 29'th PAEA Annual Report

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