The Physician Assistant Life

The Audio PANCE and PANRE Episode 7

The Audio PANCE and PANRE Episode 7The Audio PANCE and PANRE is an audio board review series that includes 10 Multiple Choice PANCE and PANRE Board Review Questions in each episode.

I created this audio series to help you fill some downtime when you are unable to read (like in the car) with some useful board review.

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

  • You can download and listen to past FREE episodes here or on iTunes.
  • You can listen to the latest episode and take an interactive quiz of the questions below.
Download a Free PDF Transcript of the Questions and Answers

Listen Carefully Then Take The Quiz

Questions 1-10

1. Which of the following is a staphylococcal infection characterized by a localized red swollen and acutely tender abscess of the upper or lower eyelid?

A. Hordeolum
B. Uveitis
C. Chalazion
D. Dacryocystitis

Click here to see the answer

2. Progesterone influence on the breast tissue prior to menstruation causes

A. proliferation of the mammary ducts.
B. growth of the lobules and alveoli.
C. proliferation of Cooper’s ligaments.
D. increase in the number of glands of Montgomery.

Click here to see the answer

3. A 3 year-old girl is diagnosed with atopic dermatitis. Which of the following disorders is this child at risk for in the future?

A. Asthma
B. Tinea pedis
C. Squamous carcinoma
D. Systemic lupus erythematosus (SLE)

Click here to see the answer

4. A patient presents with chronic back pain. On physical examination testing, the patient is found to have abnormalities of proprioception and vibration discrimination. Which of the following portions of the spinal column are most likely affected?

A. Lateral spinothalamic tract
B. Ventral spinothalamic tract
C. Posterior column
D. Transection of the cord

Click here to see the answer

5. A 44 year-old female presents for follow-up results of her lipid profile. She is asymptomatic and has a past medicalhistory of hypothyroidism treated with levothyroxine and hypertension controlled with atenolol (Tenormin). She drinks an average of 6 alcoholic beverages a day and smokes 1 pack per day for the last 32 years. Her family history is unremarkable for premature coronary artery disease. Her fasting blood glucose is 98 mg/dL, total cholesterol is 198 mg/dL, LDL cholesterol is 132 mg/dL, HDL cholesterol is 56 mg/dL and triglycerides of 90 mg/dL. Excluding LDL cholesterol levels, how many major risk factors for coronary artery disease does this female possess?

A. 2
B. 3
C. 4
D. 5

Click here to see the answer

6. A 65 year-old patient with steroid-dependent chronic obstructive lung disease presents with a headache that has been increasing in severity over the past week, accompanied by nausea and vomiting. He denies fever, but has had photophobia and a stiff neck. Which of the following is the most likely diagnosis?

A. Transient ischemic attack
B. Bacterial meningitis
C. Migraine headache
D. Cryptococcosis

Click here to see the answer

7. A 40 year-old female presents with a 1.5 cm well-circumscribed mass noted on mammography in the right upper, outer quadrant. Which of the following procedures is most appropriate and should be done next?

A. Fine needle aspiration
B. BRCA 1 and BRCA 2 genetic testing
C. Serum CA-125
D. Radiation therapy

Click here to see the answer

8. On examination of a pregnant patient the physician assistant notes the fundal height is at the level of the umbilicus. This corresponds to what gestational age?

A. 16 weeks
B. 20 weeks
C. 24 weeks
D. 28 weeks

Click here to see the answer

9. Which of the following is a common symptom associated with laryngotracheobronchitis (viral croup)?

A. Drooling
B. High fever
C. “Hot potato” voice
D. Barking cough

Click here to see the answer

10. A 23 year-old female with history of asthma for the past 5 years presents with complaints of increasing shortness ofbreath for 2 days. Her asthma has been well-controlled until 2 days ago. Since yesterday, she has been using heralbuterol inhaler every 4 to 6 hours. She is normally very active, however yesterday she did not complete her 30minute exercise routine due to increasing dyspnea. She denies any cough, fever, recent surgeries, or use of oralcontraceptives. On examination, you note the presence of prolonged expiration and diffuse wheezing. The remainder of the exam is unremarkable. Which of the following is the most appropriate initial diagnostic evaluation prior to initiation of treatment?

A. Chest x-ray
B. Sputum gram stain
C. Peak flow
D. Ventilation-perfusion scan

Click here to see the answer

Looking for all the episodes?

This FREE series is limited to every 3rd episode, you can download and enjoy the complete audio series by joining The PANCE and PANRE Exam Academy.

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

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


And, as always, if you haven’t already, make sure to download Brian Wallaces’ excellent Physician Assistant Exam Review Podcast. Follow along with Brian who covers new topics twice monthly and really does an amazing job!

2015 Physician Assistant Program Tuition and Cost Comparison Table


Updated 2015 Physician Assistant Program tuition and cost comparison table.

Tuition and cost data of resident and non-resident tuition including length/duration of the PA program.

Keep in mind that these are estimated costs and variables such as tuition and fees will vary greatly from year to year.

Make sure to visit the appropriate PA program website for the most up-to-date tuition, estimated costs and fees. You can find detailed information on each school as well as links to its corresponding website on my companion website at www.paschoolfinder.com.

  • Red = Top 3 most expensive Physician Assistant Programs
  • Green = Top 3 least expensive Physician Assistant Programs

* Correction 10/2014:  Stony Brook University has recently listed on their website: Resident tuition $35,000 Non resident tuition $58,000

 Program  State Resident Tuition Non Resident Tuition Months
Adventist University of Health Sciences Florida  see site  see site  27
Albany Medical College New York  $53,144  $53,144  28
Alderson-Broaddus University West Virginia  $79,880  $79,880  27
Anne Arundel Community College Maryland  see site  see site  25
Arcadia University Pennsylvania  $72,000  $72,000  24
Arizona School of Health Sciences Arizona  $73,840  $73,840  26
Augsburg College Minnesota  $80,000  $80,000  31
Baldwin Wallace University Ohio  $72,000  $72,000  24
Barry University Florida, Virgin Islands  $76,600  $76,600  28
Bay Path College Massachusetts  $97,000  $97,000  24
Baylor College of Medicine Texas  see site  see site  30
Bethel University Tennessee  $75,600  $75,600  27
Bethel University Minnesota  $85,000  $85,000  27
Boston University Massachusetts  $85,800  $85,800  28
Bryant University Rhode Island  $85,000  $85,000  27
Butler University Indiana  $36,000  $36,000  24
Campbell University North Carolina  $70,875  $70,875  28
Carroll University Wisconsin  $61,218  $61,218  24
CCNY Sophie Davis School of Biomedical Education New York  $16,530  $41,820  28
Central Michigan University Michigan  $63,050  $99,580  27
Chapman University California  $96,000  $96,000  24
Chatham University Pennsylvania  $78,870  $78,870  24
Christian Brothers University Tennessee  $79,000  $79,000  27
Clarkson University New York  see site  see site  28
Concordia University Wisconsin  $76,764  $76,764  26
Cornell University New York  $74,982  $74,982  26
CUNY York College New York  $13,041  $22,290  24
Cuyahoga Community College/Cleveland State University Ohio  $26,908  $50,900  28
D’youville College New York  $23,000  $23,000  54
Daemen College New York  $93,080  $93,080  33
Des Moines University Iowa  $30,420  $30,420  25
Desales University Pennsylvania  $63,000  $63,000  24
Drexel University Pennsylvania  $79,326  $79,326  27
Duke University Medical Center North Carolina  $76,190  $76,190  24
Duquesne University Pennsylvania  $94,000  $94,000  27
East Carolina University North Carolina  $30,581  $71,963  27
Eastern Michigan University Michigan  $61,020  $107,474  24
Eastern Virginia Medical School Virginia  $69,356  $76,573  28
Elon University North Carolina  $78,030  $78,030  27
Emory University Georgia  $94,731  $94,731  29
Franklin Pierce University New Hampshire  $86,562  $86,562  27
Gannon University Pennsylvania  see site  see site  24
Gardner Webb University North Carolina  $71,132  $71,132  28
George Washington University District of Columbia  $78,288  $78,288  24
Georgia Regents University Georgia  $46,473  $95,732  27
Grand Valley State University Michigan  $56,341  $75,190  28
Harding University Arkansas  $71,778  $71,778  28
Herbert Wertheim College of Medicine (FIU) Florida  $62,997  $62,997  27
Heritage University Washington  $71,000  $71,000  24
High Point University North Carolina  $71,000  $71,000  27
Hofstra University New York  $86,900  $86,900  28
Howard University District of Columbia  see site  see site  33
Idaho State University Idaho  $61,272  $102,708  24
Indiana State University Indiana  $39,843  $78,800  29
Indiana University School of Health and Rehabilitation Sciences Indiana  $56,584  $84,875  27
Interservice Texas  see site  see site  29
James Madison University Virginia  $40,016  $86,428  28
Jefferson College of Health Sciences Virginia  $72,720  $72,720  27
Johnson & Wales University Rhode Island  $79,872  $79,872  24
Keiser University Florida  $57,564  $57,564  24
Kettering College Ohio  $74,550  $74,550  27
King’s College Pennsylvania  $37,500  $37,500  24
Lake Erie College Ohio  $70,000  $70,000  27
Le Moyne College New York  $77,162  $77,162  24
Lenoir-Rhyne University North Carolina  see site  see site  27
Lincoln Memorial Tennessee  $90,290  $90,290  27
Lock Haven University Pennsylvania  $26,789  $38,275  24
Loma Linda University California  $81,500  $81,500  24
Long Island University New York  $106,000  $106,000  28
Louisiana State University – New Orleans Louisiana  $43,632  $92,321  29
Louisiana State University – Shreveport Louisiana  $30,000  $44,000  27
Lynchburg College Virginia  $77,000  $77,000  27
Marietta College Ohio  $71,656  $71,656  26
Marist College New York  $85,500  $85,500  24
Marquette University Wisconsin  $102,600  $102,600  33
Marshall B. Ketchum University California  $89,775  $89,775  27
Mary Baldwin College Virginia  see site  see site  27
Marywood University Pennsylvania  $57,275  $57,275  27
MCPHS University (Boston) Massachusetts  see site  see site  30
MCPHS University (Manchester/Worcester) New Hampshire  $81,900  $81,900  24
MCPHS University (Manchester/Worcester) Massachusetts  $81,900  $81,900  24
Medical University of South Carolina South Carolina  $22,941  $32,865  27
Mercer University Georgia  $65,478  $65,478  28
Mercy College New York  $83,250  $83,250  27
Mercyhurst University Pennsylvania  $75,185  $75,185  24
Methodist University North Carolina  $73,430  $73,430  27
MGH Institute of Health Professions Massachusetts  see site  see site  25
Miami-Dade College Florida  $25,000  $45,000  27
Midwestern University (Downers Grove) Illinois  $90,254  $90,254  27
Midwestern University (Glendale) Arizona  $95,193  $95,193  27
Misericordia University Pennsylvania  $76,800  $76,800  24
Mississippi College Mississippi  $67,080  $67,080  30
Missouri State University Missouri  $35,240  $56,073  24
Monmouth University New Jersey  $102,265  $102,265  31
New York Institute of Technology New York  $102,900  $102,900  30
Northeastern University Massachusetts  $69,000  $69,000  24
Northern Arizona University Arizona  see site  see site  24
Northwestern University Illinois  $80,082  $80,082  24
Nova Southeastern University, Fort Lauderdale Florida  see site  see site  27
Nova Southeastern University, Jacksonville Florida  see site  see site  27
Nova Southeastern University, Orlando Florida   $28,960   $28,960  27
Nova Southeastern University, Southwest Florida Florida  $70,953  $70,953  27
Ohio Dominican University Ohio  $71,370  $71,370  27
Oregon Health & Science University Oregon  $78,408  $78,408  26
Our Lady of the Lake College Florida  $92,000  $92,000  28
Pace University New York  $84,588  $84,588  27
Pacific University Oregon  $73,374  $73,374  28
Penn State University Pennsylvania  $70,000  $70,000  24
Pennsylvania College of Technology Pennsylvania  $44,850  $56,982  24
Philadelphia College of Osteopathic Medicine Pennsylvania  $66,000  $66,000  26
Phladelphia University Pennsylvania  $76,000  $76,000  25
Quinnipiac University Connecticut  $84,991  $84,991  27
Red Rocks Community College Colorado  see site  see site  25
Riverside Community College California  $4,623  $18,134  24
Rochester Institute of Technology New York  $76,500  $76,500  30
Rocky Mountain College Montana  $93,861  $93,846  26
Rocky Mountain University Utah  $88,500  $88,500  31
Rosalind Franklin Univ of Medicine Illinois  $63,176  $63,176  24
Rush University Illinois  $93,150  $93,150  33
Rutgers University New Jersey  see site  see site  30
Saint Catherine University Minnesota  $73,920  $73,920  28
Saint Francis University Pennsylvania  $86,900  $86,900  24
Saint Louis University Missouri  $75,550  $75,550  27
Salus University Pennsylvania  $63,175  $63,175  25
Samuel Merritt College California  $88,000  $88,000  27
San Joaquin Valley College California  see site  see site  see site
Seton Hall University New Jersey  $102,336  $102,336  33
Seton Hill University Pennsylvania  see site  see site  27
Shenandoah University Virginia  $68,714  $68,714  30
South College Tennessee  see site  see site  27
South University Georgia  $68,535  $68,535  27
South University, Tampa Florida  see site  see site  26
Southern Illinois University Illinois  $69,210  $103,815  26
Springfield College Massachusetts  see site  see site  see site
St. Ambrose University Iowa  $87,000  $87,000  29
St. John’s University New York  $72,900  $72,900  24
Stanford University California  $53,042  $63,581  21
Stony Brook University New York  $22,500  $36,000  24
Sullivan University Kentucky  see site  see site  24
SUNY Downstate Medical Center New York  see site  see site  see site
SUNY Upstate Medical Center New York  see site  see site  see site
Texas Tech University Health Sciences Center Texas  $32,392  $78,460  27
Thomas Jefferson University Pennsylvania  see site  see site  27
Touro College (Bay Shore) New York  $73,200  $73,200  24
Touro College (Manhattan) New York  see site  see site  32
Touro University – California California  $59,000  $59,000  33
Touro University Las Vegas Nevada  $36,150  see site  28
Towson University CCBC – Essex Maryland  $24,000  $51,000  26
Trevecca Nazarene University Tennessee  $78,532  $78,532  27
Tufts University School of Medicine Massachusetts  $71,050  $71,050  25
Union College Nebraska  $108,160  $108,160  33
University of Alabama at Birmingham Alabama  $77,535  $146,959  27
University of Arkansas Arkansas  $42,000  $70,000  28
University of Bridgeport Connecticut  $75,000  $75,000  28
University of California-Davis California  see site  see site  27
University of Charleston West Virginia  $78,634  $78,634  28
University of Colorado Colorado  $53,550  $115,950  36
University of Dayton Ohio  $75,500  $75,500  27
University of Detroit/Mercy Michigan  $89,988  $89,988  24
University of Findlay Ohio  $85,057  $85,057  28
University of Florida Florida  $54,080  $120,754  24
University of Iowa Iowa  $45,290  $91,142  28
University of Kentucky Kentucky  $41,300  $84,900  29
University of Maryland Eastern Shore Maryland  $39,320  $66,109  28
University of Missouri – Kansas City Missouri  $65,075  $78,090  27
University of Mount Union Ohio  $66,325  $66,325  27
University of Nebraska Nebraska  $35,055  $104,511  28
University of New England Maine  $88,000  $88,000  24
University of New Mexico New Mexico  $28,902  $51,926  27
University of North Carolina North Carolina  see site  see site  24
University of North Dakota North Dakota  $34,287  $34,287  24
University of North Texas HS Center Ft Worth Texas  $33,260  $89,285  34
University Of Oklahoma, Oklahoma City Oklahoma  $30,000  $60,000  30
University of Oklahoma, Tulsa Oklahoma  see site  see site  30
University of Pittsburgh Pennsylvania  $72,601  see site  24
University of South Alabama Alabama  $56,335  $104,009  27
University of South Dakota South Dakota  $44,604  $86,049  24
University of South Florida – Tampa Florida  $69,267  $111,267  24
University of Southern California California  $47,562  $47,562  33
University of St. Francis New Mexico  $79,343  $79,343  27
University of St. Francis (Fort Wayne) Indiana  $60,000  $60,000  27
University of Tennessee Health Science Center Tennessee  $100,979  $130,979  24
University of Texas – HS Center at San Antonio Texas  $36,000  $76,000  24
University of Texas – Medical Branch at Galveston Texas  $36,000  $74,000  25
University of Texas – Pan American Texas  $68,000  $96,000  28
University of Texas – SW School of Health Professions Texas  $28,436  $69,503  30
University of the Cumberlands  Kentucky  $79,331  $79,331  27
University of the Sciences of Philadelphia Pennsylvania  see site  see site  34
University of Toledo Ohio  see site  see site  27
University of Utah Utah  $59,150  $87,970  27
University of Washington Washington  see site  see site  26
University of Wisconsin – La Crosse Wisconsin  $42,813  $79,671  24
University of Wisconsin – Madison Wisconsin  $35,031  $71,680  24
Wagner College New York  see site  see site  see site
Wake Forest University North Carolina  $66,662  $66,662  24
Wayne State University Michigan  $36,000  $72,000  24
West Liberty University West Virginia  $48,000  $72,000  24
Western Michigan University Michigan  see site  see site  24
Western University of Health Sciences California  $71,480  $71,480  24
Wichita State University Kansas  $24,022  $55,948  26
Wingate University North Carolina  $75,000  $75,000  27
Yale University School of Medicine Connecticut  $83,162  $83,162  27


If you found this table useful please share it with everyone you know :-). If you would like more info, updates from the blog and occasional free goodies please make sure to sign up for my email newsletter using the opt-in form below.

The Number 1 Regret People Have in Life is…


The ward was bleak.

Always eerily quiet.

A clinical world where clock ticks seemed to scream, and that vile smell attacked more than the air, the walls, and the floors.

It attached itself to the people themselves as if they, too, had been harshly scrubbed down with disinfectant.

The worst part was the uncertainty.

You never really knew who would survive the night. Forming relationships felt as futile as trying to build a house in hurricane season.

The foundations could be swept away at any time.

The morning would come and the bed would be empty. Then, in a blink of an eye, a new soul on the verge of departure would fill the space.

There was one woman in particular. Her gaze alone stripped me down to my very core. She oozed fear, regret, and sadness.

Our time together was deeply confronting and undeniably life altering.

The woman that changed me could barely speak English. Her condition was incurable. She seemed to have some idea of who I was but it really didn’t matter.

As the young, “gung ho” PA student on clinical rotations part of my job was to assist on the Palliative Care ward.

Naively, I thought I was ready to go in and help solve the problems of the dying.  Only it wasn’t I who would be offering the greatest life lessons, instead, I would be receiving them.

After all, how much counselling can you give to a woman you can barely speak to?

As it turned out, it wouldn’t be an issue.  The majority of our time together was spent in silence, holding hands, with her squeezing mine at increasingly irregular intervals.

Hand in hand, mostly in silence, we contemplated life.

I wondered why her family never seemed to be around, how she had come to this ward, and why she hadn’t taken the time to learn English, having been in the country for many years.

Occasionally, she would speak in her broken tongue, and almost every word was tainted with regret.

She would frequently apologize about her English, speak about doing work she used to hate, family relationships that had soured, and I would listen.

It really was too late to do anything about it.

I thought about the other people I worked with on the ward. It was strange. Those in the most physical pain almost always were in the greatest emotional pain and had the biggest regrets. Their language was littered with “should have”, “could have”, “wished I’d,” “why didn’t I” …

Then there were the few patients I came across who were at peace.

Despite their circumstances they would smile often, joke, and ask about me with great curiosity.  Even though their bodies were on the verge of final retirement, their eyes were bright and alive.

Often surrounded by friends and family, these people would tell fascinating stories about the risks they had taken, failures learnt from and the great rewards received.

Just like me, they didn’t know what would happen tomorrow, but they seemed ready.

Her name was Maria


After what would be my final session with her, I actually knew I wouldn’t be seeing her again.

I had done my best to assist her, and I could tell she appreciated it, and yet we both knew she had not found peace.

Following the last time we spoke, I sensed she would be leaving soon, and I became very angry. I stormed out of the hospital, and with a red-hot face and clenched fists I started walking. My head was swirling with confusion.

I had no idea why I was so angry. I soon realized what it was. I hated the feeling of helplessness.

I was angry at the truth. All those life clichés had punched me straight in the face. You only live once, follow your dreams, blah, blah, blah; it was all excruciatingly true.

After that day, I thought more and more about the importance of happiness and the meaning of time.

Maria had shaken me out of my naivety.

I had become afraid! But I was not afraid of death. Rather, I was afraid of not living. Not living fully, openly, and wholeheartedly.

Then I heard her last words to me:

“The Number 1 regret people have in their life is not taking enough leaps of faith!”

The reality inside that statement floored me. I struggled to breathe as the realization sunk into my body. It wasn’t just statistically true; a vocal arrow had struck a personal bull’s- eye.

My mind pulled me back to the hospital.

I took a deep breath, lifted my head to sky… and jumped.

Physician Assistant School and Program Directory eBook

Physician Assistant Programs eBook

Are you Looking for a good end of the summer read?

I am so happy to offer my newly compiled PA Programs eBook to you for FREE.

The Physician Assistant School and Program Directory is a complete list of every accredited Physician Assistant Programs in the United States.

And best of all: It’s been fully updated for 2015!

This eBook will help make your search for the right PA school painless.

The 2015 PA Programs eBook includes the most pertinent and up-to-date information on tuition, fees, application deadlines, GRE requirements, GPA requirements, medical experience requirements and CASPA participation.

This interactive PDF document includes direct links to each corresponding PA program website so you can search and explore every school in depth, and with a click of your mouse.

Oh, and did I mention, I am giving it away for free?

You can download the book here.


Why the eBook?

In 2001 I left my hometown of Seattle, WA and ventured 3,000 miles across country to Piscataway, New Jersey.

I had been accepted to the Rutgers Physician Assistant Program and I was ecstatic.

In those days, I don’t remember searching the internet much to find a PA program that fit my application requirements and if I did, it was incredibly slow over dial-up internet.

Instead I opened a book, sent letter’s to each school and waited patiently to receive the application packet in the mail. It was painful.

Now, 13 years later, things are a little bit different.

I dreamed of an online directory where I could perform a categorical search to find a program that not only fit my geographical preferences but also was affordable, didn’t require the GRE and met my GPA requirements.

I built the Physician Assistant Schoolfinder Directory with this in mind.

That being said, many people have emailed me asking for a print version of the directory.

And now, it’s all yours for free.

I hope you find this to be a useful resource and a valuable companion to the paschoolfinder website.

You can download the eBook through Noisetrade.

This book is available FREE, but if you like what you find, please leave a tip. A little generosity goes a long way. 


And if you haven’t already, make sure to sign up for my free email newsletter where you can receive updates from the blog and notification of new releases by email.  Just enter your info over there in the sidebar or below this post.

Have a great day, and best of luck on your PA School search.

Stephen Pasquini PA-C

Do You Recognize These 7 Common Mistakes in Your Personal Statement?

7 Common Mistakes People Make on Their PA School Essay and How to Correct Them

You’ve written your essay.

You know what you want to say.

But will the admissions committee get your message?

You’ve chopped and changed the order of the paragraphs. You’ve polished each sentence.

After all that hard work, you’re still not sure whether your essay flows along nicely. Will readers stumble over a paragraph? Or effortlessly glide through your text?

Creating a hypnotic flow doesn’t have to be so difficult.

Let’s have a look at 7 of the most common mistakes I see people make while reading and editing PA school applicants’ essays.

We will also discuss how to correct them.

* The following was written by Duke Pasquini – Physician Assistant Essay Collaborative editor.

1.  Most Essays are too long

You want to tell everything about your life and you hate leaving anything you think is important out.

How to correct this:  If you are on the admission committee and are reading your 75th essay in three days, would you rather read a short concise essay or a long rambling one?  I think you already know the answer.  I refer to this as “Don’t get lost in the library.”  You don’t want who you are to get lost in too many details.  You don’t want to be just another book on the library shelf.

2.  Paragraphs are too Long

How to correct this: Always put yourself in the admission committees place.  If you look at an essay and see large blocks of text, are you inclined to think, “Oh, this will be an easy read.”  OR  “This is going to be a hard read.  Look at all those words crammed into two or three long paragraphs.”   You want to make a good first impression on the reader before they ever begin reading your essay.   Create more open space by using shorter paragraphs.  Break long paragraphs into shorter ones.

3. Applicants Prefer Telling

You want to tell the reader every wonderful thing you’ve done in a long list of accomplishments rather than showing them.  This is similar to number 1, but let me explain further.

How to correct this:  A picture is worth a thousand words.  You need to paint a picture for the reader that will make them identify with you and the patient.  This requires an anecdote.  Tell them about Johnny (be sure to use his or her name) who came into the hospital unconscious.  You came into his room every day and said a few words to him and one day you came in and he was awake or he died or moved his fingers or toes or whatever.  Tell us what Johnny looked like and how you felt when he awakened or died.  Did you feel like you failed him or that it was the first time you faced death.  All these things will grab the admission committee’s attention.  Always remember the admission committee has read a lot of these essays and you want yours to stand out from the rest.  Refer to #5 below for a more detailed example.

4. Applicants Love to Talk in Glowing Platitudes

What is a 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.

Synonyms:  clichétruismcommonplace –  trite, hackneyed, stock phrase.

Here are a couple examples:

The first is a statement by a teacher who is applying for a teaching certificate.  Sometimes is it easier to recognize platitudes in a field other than your own.

The second is an example of a statement filled with platitudes from one of our PA School applicants.

Example 1: 

The example below is from someone who wants to be a teacher.  I’m using it because I think it’s a great example of what I’m talking about.  You probably won’t want to finish reading it.  The point is, don’t write like this when you’re writing your PA essay.

My goals are to consistently and constantly better myself as a teacher.  To help achieve this goal, I am constantly looking to my peers for suggestions and will continue my personal strategy to their emulate creativity, procedures, methods, and techniques that I witness or hear of; my current master teacher serves well as an example of how much there is that I can learn.  My desire is to be the most effective and proficient teacher I can be.  Charged with curriculum that is extensive in classroom time that is limited, I commit myself to achieve the best functioning classroom possible and through my experience as a student teacher, I have seen the benefits of this; through my experiences as a substitute teacher, I have witnessed the deterrents to learning in environments with discipline and behavior are not properly handled with effective routines and procedures.  The classroom is a learning community and needs to be addressed as a joint effort of students and teacher.  The developmental ages of the students being taught needs to bear great consideration when implementing instruction, I will continue my efforts to understand my students, their motivations, and their shortcomings to the best of my ability.  I will continue educating myself, not just in content, but in strategies and means to differentiate and modify so that each individual child placed in my care stands the best opportunity to learn to their maximal abilities.

Example 2:

I have always wanted to be a PA since I was a child.  It is the type of profession that will allow me to help people and helping others is the highest calling anyone can have.  I have had this desire in my heart for many year beyond my childhood.  The medical field offers a person a chance to make a difference in a person’s life.  The PA is given a chance to feel like they have made a positive difference in a patient’s life every day.  This is why I want to be a PA.  PAs also have the advantage of working as a team member with a doctor.  I like the idea of having a mentor to guide me.  I am a willing learner.  Patients need someone with patience.  This is something I have in spades.  If given the chance to become a PA, I will bring enthusiasm, love, and a caring heart to the job.

Note:  All this may sound great to the writer, but there isn’t one example that would lead the reader to believe the applicant is capable of doing any of what he/she says they can do or shows they actually believe in the statement they wrote.  They are just generalizations that sound good but mean nothing.

As Shakespeare said in the final soliloquy in Macbeth, It is “a tale… full of sound and fury signifying nothing”

Life’s but a walking shadow, a poor player,
That struts and frets his hour upon the stage,
And then is heard no more. It is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

Macbeth Act 5, scene 5, 19–28

How to correct this:  If you are on the admissions committee, would you ask this person to come in for an interview?  Did they create any images in your head or show you how they will do all the things they say they will do?  No, they just put a bunch of words on the paper that sound good, but in the end, makes the reader believe they’re just trying to impress them with glowing platitudes that say nothing.  What the reader will probably ask is so what?  And who cares?

5.  Poor First Paragraphs

The first paragraph has to grab the reader’s attention and give them some idea of what will follow.  It is great if you can lead with an anecdote that summarizes what is in the rest of your essay.

Here’s a bad example.  “I want to help people and save lives.  Becoming a PA will give me a chance to do that.  One of my best qualities is that I take initiative and don’t stand back and wait for someone else to do what needs to be done.  As a PA I will also be helping families who could have lost a loved one if I hadn’t been there to help.”  This is filled with platitudes.

Here’s a good example of an anecdote that shows the same thing.  “I heard a car crash and ran out of the restaurant to see what happened.  A man was lying on the ground and wasn’t breathing.  His wife had her arms around their two little boys and was screaming, “Someone please help.”    People gathered around but no one did anything.  I ran to him, gave him chest compressions, and mouth to mouth resuscitation.  I had never done this before, but I kept him alive until the ambulance arrived, they restarted his heart, and took him to the hospital.

Let’s examine what the anecdote tells us:

  1. There is an accident.
  2. No one did anything.
  3. You take the initiative to do something.
  4. You saved the man’s life.
  5. You kept a woman from becoming a widow.
  6. You kept the children from losing their father.

You said all of that in the anecdote.  Your theme for the rest of the essay could easily be how you take initiative (shown through other examples) and how by being a PA you can save lives and help families.

The bad example paragraph said the same thing, but what a difference.  Which one would grab your attention?  Which applicant would you call in for an interview?

6.  Incorrect use of the Word I:

How to correct this:  You want to avoid the use of the word I in most cases, but not in all cases.  You don’t want to say “I did this” and “I did that.”  “I am a dedicated person who will give everything to the job.”  “I am hard working and resourceful.”  “I inspire my co-workers with my dedication to my job.” etc.  What you want to say is “I spent three months working in an orphanage and the children inspired me with their cheerfulness.”  OR  “I had no idea the experience would change my life.”  OR “I have often failed, but failure has made me better at what I do.”

 7. Incorrect use of Contractions, Poor Grammar, Punctuation, or Spelling

How to correct this:  It is only acceptable to use these when you quote someone.  For example:

Johnny said, “And I ain’t going to eat none of this hospital food cus I didn’t ask for it, don’t want it, and won’t eat it even if you force me to.”

We used “ain’t, began the sentence with a conjunction, ended the sentence with a preposition, shortened because to cus, and used the contractions didn’t and don’t.”  This is acceptable in a quote but never in the body of your essay.

As you can see, I’ve broken many of these rules myself, but I have the freedom to do so because I’m not applying to PA school.

I wouldn’t call these the seven deadly sins of writing the PA essay, but they are the most common and often fatal mistakes I’ve found in reading and editing essays. 

This was a guest post by Duke Pasquini 

IDuke-Imagef you are struggling to write an effective personal statement or you have an essay that is in desperate need of help please consider signing up for our Physician Assistant personal statement collaborate.  We have worked with over 50 applicants to date and the results have been amazing.

 If you are interested, you can read more about the essay collaborative or submit your essay for review here.  We have helped many applicants not only complete their essay’s, but actualize their dream of admissions to PA school. Which is why we do this in the first place.


The Daily Eponym – A FREE Email Series That Will Impress Your Preceptor and Save Lives – All From Your Inbox!

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An invaluable daily email series with a short description of the most common medical eponyms. Impress your preceptors with your vast abundance of medical knowledge :-)


The Case of The Missing Eponym

A Clinical Case: by Eve Purdy

An otherwise healthy 44 y/o male presents with R ankle pain and inability to weight-bear after falling off a horse. The exact mechanism of injury (external/internal rotation or pronation/supination) is unclear. R ankle is diffusely swollen with tenderness over the tip of the medial malleolus. Neurovascular intact. He has no other injuries.

The important historical fact that this man was thrown off a horse and positive screening with the Ottawa ankle rules which make me think that he needs an x-ray. I present to the attending with this plan.

screen-shot-2013-03-03-at-3-22-13-pmAfter discussing our fear of horses, she agrees and we order the ankle series. This is more or less what we get back.

A perfectly normal looking ankle…on x-ray at least →

There is no way- I don’t believe it. I express my surprise at the negative x-ray given the patient’s presentation to the attending and she asks, “well did he have any proximal fibula tenderness?”. I had checked, and he did.

screen-shot-2013-03-03-at-3-31-00-pm← So we order an AP proximal fibula. This is what we get next.

A spiral fracture of the proximal fibula. So now we are working with: medial malleolar tenderness, bruising and swelling and a fibula fracture.

With the new knowledge in mind we review the original ankle films and are able to convince ourselves (maybe with a little confirmation bias) that the joint space might be a tiny bit wide.

screen-shot-2013-03-03-at-5-57-59-pmNothing like some more impressive Maisonneuve’s that look like this  →

We consult ortho and sure enough they agree. He is scheduled for follow up, and likely surgery (necessary for most Maisonneuve fractures) the next day.

A discussion of the treatment is beyond the scope of this article but a nice review of evidence-based management of this injury can be found here.

So what about the Eponym? 

This whole clinical encounter would have been much smoother if I had just known the eponym.

At the time I didn’t know what a Maisonneuve fracture was. I knew enough to look for proximal fibula tenderness in my initial physical exam because I had remembered learning something about energy transfer through the interosseous membrane in ankle injuries, but I couldn’t put it all together. I didn’t know the words to describe what I was worried about. The word Maisonneuve would have really helped me express what I was thinking.

In the online Clinical Problem Solving course through Coursera you can learn about the importance of problem processing. The importance of taking a patient’s complaint and turning it into medical language that triggers our memory about the condition and that allows us to communicate efficiently.

I know they are a hot subject but like it or not in this case and for many other conditions eponyms are an important part of problem processing.

Instead of sending the patient back and forth to x-ray and taking up time and space in a busy ED if I had said the first time, “I am worried about a Maisonneuve fracture” he could have had both x-rays at once.

Sign Up For The FREE Daily Eponym

What is an Eponym?

If you are, or ever have been a PA student and you are not familiar with eponyms then you just may be living under a rock.

“Eponyms” is best known as an app that gives a short description of more than 1,700 common and obscure medical eponyms.

Medical eponyms are terms used in medicine which are named after people (and occasionally places or things). New discoveries are often attached to the people who made the discovery because of the nature of the history of medicine. This has produced a large number of medical eponyms:Wikipedia

Why are Eponyms Important?

The case above gives a beautiful demonstrations of why knowing medical eponymous can save dollars, unnecessary testing and even lives.

The Daily Eponym

The Daily Eponym on your iPhone

Eponyms come up all the time, they are hot topics during preceptor pimping sessions on your PA school rotations and they make excellent post rotational and PANCE or PANRE exam questions.

In the old days when I was toting around my beloved palm zire 71 eponyms was one of the most talked about and downloaded (or “beamed” – shout out to my fellow gen X’ers out there) of every medical students arsenal. Well that, and the infamous Palma Sutra :-)

The problem with eponyms is that there really are only a handful of those 1,700 medical  terms that are important to know and seem to come up all the time.

So, in the spirit of the daily PANCE and PANRE I wanted to do something for all you hard working, nose to the grindstone PA students out there (and maybe even help save a life along the way).  And with this intention I am delighted to bring to you The Daily Eponym.

This is an email series designed to do exactly what it sounds like, send you an eponym a day to your inbox for the rest of your life. (ok not really, but until I run out of good ones to send you)

Who knows, you might wake up one day to the answer that will save you from your next surgical rotation pimp session (read the section about “ego dementor’s” and doctor Dick) or make that inspirational diagnosis that you can tell at dinner parties.

Better yet, it is FREE!

You can sign up to start the series using the form at the top of this post.

When you know everything, or you are just sick of it, cancel your subscription, I won’t be hurt although don’t blame me if you miss that surprise question about The Apley Scratch Test.

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My PA School Rejection Letters – How to Turn Your “Set Back” into a “Set Up”

small__6811140195“If I fail more often than you, I win.” – Seth Godin

I have written before about the importance of becoming an epic failure and how this is a fundamental part of becoming an epic success.

I was cleaning out some of my old file cabinets today and came across my PA school application documents from 2001.

I will be sharing three of them below.

If you are experiencing setbacks on your path to becoming a Physician Assistant I want you to know that this is a normal part of the process.

Do not be discouraged: failure, met with perseverance, is the key to long-term, sustainable success.


My PA School Rejection Letter #1 (Ouch!)


In order to help you reach your goals it is important that you see my failures along with my successes.

Otherwise, you will be fooled into believing that success is a simple, pain-free process, when in reality the path to each of my successes has been lined with the road kill of my many epic failures.

Got a Moment for Some Inspiration?

Weather it is God or otherwise, how we perceive a setback matters!  (Listen 25 minutes)

This week, I won two free tickets as part of my daughters kindergarten raffle to see James Durbin, an American Idol “outcast”, play here on our shared home town stage of Santa Cruz, California.

Although I am not that familiar with all of James’ music, last night as he stood on stage I realized just how much I respected this 25-year-old rocker.

Knowing all the public criticism he had to endure during his time on the Idol stage, the sting of being “voted off” and rejected by his peers, not to mention the many obstacles he had to overcome in a lifelong battle with Tourette’s and Asperger’s syndrome.

Last night, he spoke to the sold out crowd (many of whom were young, screaming teenage girls) and divulged his story of how his pediatrician told his parents to keep their expectations low. Just goes to show what you can do with a dream and a whole lot of grit.

Don’t even get me started on the Olympics!

It may sound cliché to say that we learn more from our failures than from our successes, but nevertheless this is true.

Because life is a process of trial and error, and error, and even more error until finally you succeed!

The key is to hang in their long enough, don’t give up with the struggling masses, there is light at the end of the tunnel no matter how dim and distant it may seem.

PA Rejection Letter #2 (Your Killing me)


So success is simply the end result of a long series of epic failures if you have done things right.

Reading the above rejection letter so many years later I am almost embarrassed to admit that I didn’t have a 3.0 GPA, but there is a back-story not written on this rejection letter. This proves the point that an isolated number outside of any context is just a point along a curve that when seen alone is pretty much useless.

Don’t become a point on a curve, the trend is what matters! In what direction are you trending?

And just when you thought the pain and suffering couldn’t go on…

My Rejection Letter to the National Health Service Corps (The kick in my proverbial balls)


Yes, I was even rejected by the National Health Service Corps the first time I applied. Although not the second

And yes, I received even another rejection letter from OHSU, but I must have thrown that one into the fire.

My Acceptance Letter to PA School

At first it seemed odd to me that among this stack of failed attempts I could not find my acceptance letter into pa school.

I remember it so well, that simple single sheet of white paper with red and black-ink letterhead, about 4 sentences long sporting an official UMDNJ seal.

I read it in the rain, on a cold Seattle evening by streetlight, heart beating, exhausted after a long day of work. The feeling of nausea rose to my chest as I held the two corners of that letter, and I said a short prayer before I tore it open.

I made a promise to God and myself that if this dream would come true I would use my training always to relieve the suffering of others and to make the world a better place.

Spoiler alert… I was accepted and I am still working hard to keep my promise.

My Message to You

If you have received a rejection letter fear not my fellow epic failures, I too have stood demoralized in your shoes.

But do not let that define you, let it guide you, let it be the road kill that you can look back upon with pride years later when you are writing a blog post hanging out your dirty underwear with pride for all the world to see.

Here are my rejection letters. I am posting them as a reminder of what should make you stronger. I saved them because they gave me motivation, and I hope they can be a part of yours as well.

If you can learn to see adversity as a tool to help you reach your goals you can turn what seemed to be a “set back” into a “set up” for something truly wonderful.

Thank you for reading, and I wish you the best wherever you may be on your journey to PA-C.

–  Stephen

photo credit: venspired

MD Versus PA Showdown Round 1 – Show Me The Money!


Before you read this post I want you to take a quick survey.

What do you think?

Physician Assistant vs. MD – Show Me The Money

Often the decision between PA and MD is considered a difficult one, but should it be?

Today I am posting the first in a series of posts to help prove to you why this age-old debate is not a debate at all.

And since the biggest search phrase in Google following the word “Physician Assistant” is “Salary” I thought I would start by addressing the elephant in the room and show you the numbers.

Annual salary numbers themselves are useless, as they are not a good representation of salary in relation to all the hidden variables such as time spent in training, debt, residency, and average hours worked per week.

This post is going to address all of these variables using an elegant equation and we will calculate a more important indicator:

True Hourly Wage!

This post is heavy with numbers so you may need to grab your glasses (and a calculator), but as you will see the results are interesting!

So lets get going…


Medical Doctors (MD) – True Hourly Wage

Becoming a physician is expensive!

For the 2013-2014 academic year, the average total student budget for public and private undergraduate universities was $19,338 and $39,028, respectively.

If one attends an average priced institution, receives subsidized loans and graduates in four years they will have about $100,000 of student loan debt from undergraduate college.

For the 2013-2014 academic year, the median cost of tuition and fees for public and private medical schools was $24,384 and $43,002 per year, respectively.

This does not include the cost of rent, utilities, food, transportation, health insurance, books, professional attire, licensing exams fees or residency interview expenses.

Therefore, the average medical student budget is about $45,000 per year; $30,000 for tuition and $15,000 for living expenses.

If one attends an average priced medical school, receives 1/3 subsidized loans and graduates in 4 years; at a 7% APR they will have $200,527 of debt from medical school at graduation.

If one borrows $22,500 bi-annually and two-thirds of this accrues interest compounded bi-annually at 3.5% – their total student loan debt for both college and medical school will then be $300,527. Forbearing this debt through 5 years of residency and paying it off over 20 years will cost about $788,880 of one’s net income.

Loan repayment programs such as those offered by the military are not a solution for the majority. Each year, about 22,000 medical students graduate from U.S. allopathic and osteopathic medical schools. Each year the military matches 800 students into its residency training programs, because that is the military’s anticipated future need for physicians.

The U.S. tax code allows taxpayers to deduct a maximum of $2,500 per year of student loan interest paid to their lender.

This deduction is phased out between incomes of $115,000 and $145,000. Therefore, this benefit is of no help to most physicians.

If one were to start a business, they could deduct nearly all of their expenses. Yet for unclear reasons, one cannot deduct the cost of becoming a physician; not the tuition or even the interest on the money they borrowed to pay their tuition.

During residency, if one makes payments of $1,753 per month, or $21,037 per year, to pay off the accruing interest, their debt will be still be $300,527 at the end of residency.

However, they will have spent $63,111 over the course of a 3 year residency or $126,222 over the course of a 6 year residency to keep their debt from growing.

Though paying off the interest during residency is the responsible thing to do; coming up with $21,037 each year from one’s net pay of $40,000 may be quite difficult.

Time spent training, student loan debt and the U.S. tax code makes the income of physicians deceiving. A board certified internal medicine physician who is married with 2 children, living in California and earning the median internist annual salary of $205,441 will be left with $140,939 after income taxes and $106,571 after student loan payments.

This is assuming a federal Income tax rate of 28%, California state income tax rate of 6.6%, Social Security tax rate of 6.2% and Medicare tax rate of 1.45%.

You can go to paycheckcity.com to get an idea of what one’s net pay would be for different incomes, states of residence, marital status, number of children, etc. Paying off a debt of $369,425 over 20 years at a 7% APR will require annual payments of $34,368.

Those student loan payments will continue to consume about $34,000 of their net income for 20 years until they are finally paid off.

What started off as $300,527 in student loan debt will end up costing $687,360. This debt that consumes one-fourth of their net income for 20 years wasn’t accrued because they bought a house they couldn’t afford – it is because they chose to become a physician.

Believe it or not, the amount of money reaching a physician’s personal bank account per hour worked is only a few dollars more than that of a high school teacher.


In order to make this calculation we will neglect inflation of the U.S. dollar by assuming that inflation will increase at the same rate as the purchasing power of the U.S. dollar decreases.

We will also assume that physician incomes keep pace with inflation. We will also assume that tuition costs, student loan interest rates, resident stipends, physician reimbursements and the U.S. income tax structure are as described above and do not change.

The median gross income (income before taxes) among internal medicine physicians is $205,441.

The median net income (income after taxes) for an internist who is married with two children living in California is then $140,939.

Internal medicine is a three-year residency, so throughout residency they will earn a total net income of about $120,000 and spend about 34,000 hours training after high school.

The total cost of training including interest, forbeared for three years and paid off over 20 years as explained above is $687,260.

One study reported that the average hours worked per week by practicing Internal Medicine physicians was 57 hours per week. Another study reported the mean to be 55.5 hours per week. We will use 56 hours per week and assume they work 48 weeks per year.

If they finish residency at 29 years old and retire at 65 years old they will work for 36 years at that median income.

Lets Run The Numbers:

True Hourly Wage for a Medical Doctor

[(140,939 x 36) + (120,000) – (687,260)] / [(56 x 48 x 36) + (34,000)] = $34.46

The adjusted net hourly wage for an internal medicine physician is then 

$34.46 per hour


And Now The Moment You Have All Been Waiting For…


Physician Assistant – True Hourly Wage

The median gross income (income before taxes) among Physician Assistants is $100,000

The median net income (income after taxes) for a Physician Assistant who is married with two children living in California is then $76,277

Physician Assistants do not have a residency. They spend about 6,400 hours training after high school plus they will need roughly 2,000 hours of direct patient care experience prior to applying to PA School. PA school is roughly 4,300 hours of training. This is made up of 2,000 hours of didactic and 2,000 hours of clinical hours plus the amount of time it takes to get a bachelor’s degree.

The total hours of training for a Physician Assistant is roughly 12,400 hours of training after high school.

The total cost of training if one attends an averaged priced institution and pays off their debt over 20 years at a 6.8% interest rate is roughly $197,176. You can estimate your own payments here.

One study reported that the average hours worked per week by a practicing Physician Assistant was 40 hours per week. Another study reported the mean to be 42 hours per week. We will use 41 hours per week and assume they work 48 weeks per year.

If they finish PA School at 27 years old and retire at 65 years old they will work for 38 years at that median income.

Since most PA’s do not receive a pension we will say our hypothetical PA will get a 3% employer match for 38 years and I am going to ignore interest on this income so it is about $114,000.

Lets Run The Numbers:

True Hourly Wage for a Physician Assistant

[(76,277 x 38) + (114,000) – (197,176)] / [(41 x 48 x 38) + (12,400)] = 42.63

The adjusted net hourly wage for a Physician Assistant is then 

$32.29 per hour


And Just For The Fun of it Because Both of My Parents are Teachers


True Hourly Wage – High School Teacher

The median gross income among high school teachers, including the value of benefits but excluding their pension, is about $50,000.

The median net income for a high school teacher who is married with two children living in California is then $42,791.

This is assuming a federal Income tax rate of 15%, California state income tax rate of 6.6%, Social Security tax rate of 6.2% and Medicare tax rate of 1.45%. You can go to paycheckcity to get an idea of what one’s net pay would be for different incomes, states of residence, marital status, number of children, etc.

Teachers spend about 6,400 hours training after high school, the amount of time it takes to get a bachelor’s degree.

The total cost of training if one attends an averaged priced institution and pays off their debt over 20 years at a 7% interest rate is $186,072.

At this income one would be able to deduct the interest on their student loans from their income taxes; however, those savings are not accounted for in the calculation below.

High school teachers have about 10 weeks off each summer, 2 weeks off during Christmas, 1 week off for spring break and 1 week of personal paid time off. Therefore, high school teachers who work full time average of 40 hours per week for 38 weeks each year.

Yes, teachers spend time “off the clock” preparing for class, correcting papers, etc. However physicians also spend time “off the clock” reading, studying, going to conferences, etc. If a high school teacher finishes college at 22 years old and retires at 65 years old, they will work for 43 years.

Most teachers also receive a pension. We will assume their gross annual pension including the value of benefits is $40,000 which is a net pension of $35,507. If they die at 80 years old they will receive this pension for 15 years.

Lets Run The Numbers:

True Hourly Wage for Teacher

[(42,791 x 43) + (35,507 x 15) – (186,072)] / [(40 x 38 x 43) + (6,400)] = $30.47

The adjusted net hourly wage for a high school teacher is then

$30.47 per hour

For The Love of Money

The median gross income among internal medicine physicians is $205,441.

The median gross income among high school teachers, including the value of benefits but excluding their pension, is about $50,000 per year.

The Median gross income among physician assistants, including the value of benefits is around $115,000 per year.

Accounting for time spent training, student loan debt, years worked, hours worked per year and disproportionate income taxes – the net adjusted hourly wage of an internist is $34.46 per hour, while that of a high school teacher is $30.47 per hour and that of a physician assistant is $32.29.

Though the gross income of an internal medicine physician is 4 times that of a high school teacher, the adjusted net hourly wage of an internal medicine physician is only 1.13 times that of a high school teacher and 1.07 times more than that of a Physician Assistant! Click To Tweet

PA vs. MD Round 1 – goes to MD (but by an extremely narrow margin)

*Oh yeah, and how about that stay at home 35-year-old living in the basement in our poll? If anybody has time to do that calculation please post it in the comments section… We may all be working way to hard!

If you liked this post please feel free to share with a like :-)

– Stephen


If You Take the Red Pill: Reflections on the Future of Medicine

“Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.” – Martin Luther King, Jr.

This blog post is an excerpt (and my PA friendly adaptation) from a speech by Dr. Paul Farmer given at Harvard Medical School, Class Day June 5, 2003. Featured in “To repair the world“. 

Red pill Blue Pill Phizer

The Matrix…

It’s an action film starring that great thespian, Keanu Reeves.

The plot is murky but not uninteresting: his character is a cog in the great wheel of industry and finance, just another programmer working in front of his computer screen in a gray cubicle.

Lives in a big city, looks like Chicago or Toronto.

Mr. Anderson, as he is called, knows something is very wrong with the world but doesn’t know what it is.

It’s “like a splinter in his mind.” There’s got to be more to life than this, he’s certain. He feels most alive under a different alias, his hacker name, Neo.

To make a convoluted story short, Neo is contacted by a certain Morpheus, someone the company drones and police term a terrorist.

Morpheus is played in completely over-the-top fashion by Laurence Fishburne.

If Neo wants to find out what’s bugging him— all the mediocrity and meaninglessness of life in the machine— then he, the fellow named Morpheus, will be only too happy to show him.

Neo hooks up with Morpheus, of course. And Morpheus offers Neo a choice: he can choose to see the world as it really is, to extract that splinter from his mind. Or he can chicken out.

Morpheus outlines Neo’s choice with all the subtlety of a mediocre Shakespearean actor who’s had a few too many vodka tonics.

Morpheus pulls a pillbox out of his stylin’ leather coat. He proffers a red pill and a blue pill.

Morpheus says something like this:

“You take the blue pill, the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill, you remain in Wonderland and I show you how deep the rabbit hole goes.”

Like any good action hero with a splinter in his mind, Neo goes for truth, which is all that Morpheus promises. And the truth is ugly.

It’s that Neo, and indeed everyone he’s ever known, is a slave.

The message is clear: Neo’s been duped, deluded by job security and certain material comforts like cool club music and hip garb. It’s all fake.

If You Take the Red Pill


It’s my contention, of course, that a certain amount of red-pill popping is just what we need in medicine and public health. But how many of us want to see how deep the rabbit hole goes?

Do we dare take the red pill? A serious question from a guy who is gagging on the red pill and still falling down the rabbit hole.

As a character in the film says— he’s a bad guy, of course—“ Ignorance is bliss.” But ignorance is not bliss. Ignorance is just that— ignorance— and ignorance and medicine are simply not compatible. Our own red pill may well be more bitter than any other, because it’s easy to argue that, for doctors, as for scientists, the blue pill is an unacceptable option, even if it’s what most of us have swallowed.

If you take the red pill and you’re a medical provider, you see that there’s unnecessary sickness and suffering everywhere on this planet.

You see too that certain epidemics are completely out of control and that there are horrific health emergencies all over the third world.

You see that some people are denied access to the most basic fruits of science, to the tools developed over the past few decades as medicine itself earned its name as “the youngest science.”

You think diseases such as SARS is bad, and it is. But allow me to put this in perspective. As of today, although fewer than a thousand people have died of SARS, several Fortune 500 companies are scrambling to put together a global SARS fund; I’m told that hundreds of millions of dollars have been pledged.

During the 2003 scare, certain airports in Asia installed thermal scanners to identify febrile travelers. All this in the space of a couple months.

All good. But over 8,000 people die every day of AIDS, the leading infectious cause of death in the modern world. And many more die of tuberculosis and malaria: during the course of this year, six million people, most of them children and young adults, will die of these three diseases alone.

Six million deaths, almost all of them preventable with modern medicine, but the red pill reminds us that we have no plan in place to serve those most in need.

And even the newspapers, whose editors and publishers seem to subsist on a steady diet of blue pills, report that the Global Fund to Fight AIDS, Tuberculosis and Malaria will soon run out of money.

The plagues of the poor don’t seem to interest industry, the press, or even basic science. So it is everywhere.

  • Take the red pill and suddenly you see that 40 million Americans have no health insurance and as many more are poorly insured.
  • Take the red pill and you see that the bottom billion of this planet don’t have enough food or clean water while in other places, including this country, we are called to subsidize agribusiness and then destroy excess crops or dump them on faltering peasant economies, so delivering their coup de grâce.
  • Take the red pill and you wonder why it is that, in the global era of connectivity, millions die of hunger while others battle obesity.

You learn that some companies short-date perfectly good medications and equipment in a process known as “planned obsolescence” while tens of millions will die without ever having benefitted from the discoveries of Salk or Sabin or even Pasteur. This has been going on for some time in the desert of the real, and it’s getting worse.

Why dredge up this dreary stuff?

Because you, can change all this

Stopping the Blue Pill

Indeed, we must. It’s urgent.

Sure, it’s utopian, but it’s also feasible. Here’s a glass half full for you: as PAs, you are granted special license to fight for a better world. You can carp about health insurance in a way that politicians cannot, because you are merely fighting for your patients.

You can gripe about drug prices in a way that others cannot, for the same reasons. You can even deliver a red-pill speech like this one without being considered a pill yourself.

Because this is what we’re called to do: to fight for the survival and the dignity of our patients, especially the sickest and most vulnerable.

You don’t have to travel far to meet people who receive substandard care.

Many students are astounded at how few of your patients have ever had a medical provider visit them in their homes.

But the red pill suggests that it’s after the patients leave the hospital that many of them have troubles:

  • Troubles understanding or following their providers orders.
  • Troubles filling prescriptions.
  • Troubles getting to clinic appointments.
  • Troubles paying rent or utility bills.

You could address some of these troubles yourselves. Say you’re an orthopedic physician assistant and on the way from the gym to the hospital, you pop by and see the lady who fell and fractured her femoral neck. You helped to put in the hardware and all went splendidly, as you noted in your brief (very brief) op note. She lives on the fifth floor of a run-down public housing building not a mile from the medical mecca in which you train. The elevator’s out. If you’d taken the blue pill, you wouldn’t even know this fact, because she lives in the desert of the real, invisible, it would seem, to the majority of doctors.

Whether a Physician Assistant or Nurse Practitioner or internist or pediatrician or pathologist or cardiac surgeon, we are working for others.

It’s not about us, or our incomes, or our sense of personal efficacy. It’s about what happens to our patients.

After a few long workweeks, there may be moments when you want to take the blue pill. Don’t do it.

Wonderful things are happening in clinical medicine and the allied sciences, in large part because of medicine’s embrace of science.

The yield of this embrace has been nothing short of marvelous. No branch of medicine has been untouched.

From pathology to oncology to infectious disease, the revolution continues. But for those who take the red pill, we are obliged to see the dark side of progress.

More and better discoveries, every day, but an erosion in our ability to use them wisely and equitably.

More capacity to engineer new therapies but a lack of commitment to directing our efforts toward the world’s great killers.

In my field, there have been many victories, certainly. But there hasn’t been a new class of antituberculosis drug discovered in decades. As of October 2014, there are no effective vaccines for AIDS, TB, or malaria— the big three modern plagues. Visits to the lifeworlds of the sick help us see how terribly behind we are in the equity arena.

We’re failures in the equity department.

There are many reasons to visit patients in their homes:

  • They help us understand why excellent in-hospital care can come to naught if we lack an equity plan.
  • Visits help us understand why prescriptions go unfilled, why appointments are missed, why medications are taken incorrectly or not at all.
  • Visits connect us to people whose lives are very different from our own.

This failure, which you can see for yourselves, is emblematic of the even more shocking failures one can see when one leaves behind nationality, a blue -pill side effect, and takes on the globe’s medical problems.

If you’ve agreed with me so far, then you’ll see all the vast promise of modern medicine and also the dismal state of our global village.

More and more for fewer and fewer

It’s true in so many realms, but it’s excruciatingly so in medicine and public health.

Martin Luther King is credited with having said the following: “Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.”

Taking the red pill is a scary process.

There are those of you out there today who threw back the red pill but are now reaching for the ipecac.

And who wouldn’t be?

We live in a world of medical haves and have-nots, a world in which most of the bottom billion have no modern medical care at all, a world in which current trends promise that the situation will get worse during the early years of your medical practice.

What are the boundaries of your world?

Over time, they will shrink to a hospital or clinic, and all you’ll want to do when you leave work will be to watch an action film by yourself. Or listen to some music. Or do whatever it is that transports you out of the desert of the real.

But in your heart, and in your practice, you know that most of the boundaries are ones we create ourselves.

They’re boundaries we erect in order to lessen our pain, not the pain of others.

Where exactly do you fit in?


Taking the red pill and seeing the world of the sick as it is today leads us to painful choices. I’m not seeking to be Manichaean: the choices before you are not between good and bad.

They’re between doing good and doing better.

To do better, don’t we have to take that red pill and fight? Your generation is going to have to answer this question. Because unfortunately, as Morpheus says, you and I have run out of time.

Of course, the clock isn’t really ticking on us. It’s ticking on others. Again— how many people have died of treatable diseases during the time it took you to read this blog post.

Allow me to leave you with two take-home messages.

First, apply the Golden Rule in your practice — especially during that last admission, in the wee hours of the morning or at the end of a long day in the clinic. Or to a particularly difficult or crabby patient. Could you ever care as much about her as you do about, say, your own mother? Could you ever love someone as much as you love yourself or your own child? The answer to these questions may well be “certainly not,” but at least the red pill pushes us to ask them.

Second, make home visits now and again. Don’t buy the received wisdom about “respecting boundaries.” What’s wrong with helping housebound patients wash their dishes? Or helping hut-bound patients transform dirt floors into cement floors? Break down boundaries. Think outside the box.

Do you want to wake up some day and discover that your life has become dim, without color? That you took the blue pill?

Even though your ectopic soul, stowed away, say, in your left axilla, forgotten, neglected, was exhorting you all along to make the leap, to take a chance?

You know the questions. The answer is out there, and you will find it if you want to.

Now you know. And knowing, as another action figure was fond of noting, is half the battle.

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

what does it take to get into pa school The Physician Assistant Life 2Leslie Mean is a 27 year old 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 3.4 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 4 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.

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 to five 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
    • X-ray Technician
  • Emergency Services
    • Emergency Medical Technician (EMT)
    • Paramedic
    • Emergency Room Technician
  • Miscellaneous
    • Phlebotomist (that was me!)
    • Athletic Traner
    • Medical Researcher
    • Medical Volunteer


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

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

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 accepted into PA school was 3.47, undergraduate science GPA was 3.36 and non science GPA was 3.56.

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?

Roughly 5 out of every 100 applicants will be accepted into PA school or, if you like percentages, you have a 5% chance of being accepted.

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

Over three-quarters of programs reported that students were required to have a background check upon matriculation to the program, while 47.1% of responding programs mandated drug testing during the 2011–2012 academic year.

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 5% of applicants will be accepted into PA school on any given year, but this should actually be good news. Being in the top 5% in any field is not nearly as hard as it sounds, simply because the majority of the competition is in the bottom 95% and has bottom 95% 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 5 percent applicant looks like. Your goal now is to be better than the average 95% and exceed the top 5%.  If you aim high, you will be competing with a much smaller minority, and your odds of getting an acceptance letter will increase dramatically.

Tables and data were sourced from:

The 28’th PAEA Annual Report