My First Day as a Physician Assistant: Faking it Till You’re Making it

My first day as a real PA

I remember my first day on the job as if it were yesterday.

I was petrified . . . To put it mildly.

When I ask other PAs about their first day they often proclaim having had a certain sense of calm. For me, it was pure fear.

Possibly, it was due to my situation at the time. I was working as a brand new grad in a National Health Service Corps approved clinic, pretty much solo, in the middle of a very rural community with patients who spoke mostly Spanish. Sadly, at the time, I spoke little to none.

The fear that had compounded in my mind was based on a variety of predetermined scenarios which often ended with my patient either dying or coming very close to it. I had conceived of millions of different horrific situations mostly based on plots from my beloved medical TV shows like ER, House, and Grey's Anatomy.

My internal record played something like this:

• "I don’t have enough pediatric experience."
• "My orthopedic skills are shoddy at best."
• "I have never actually written a prescription."
• "Pap smears? Oh boy, as a male PA student I only got to do two during my OB rotation."
• "Vertical mattress suture? Yes, no problem I did it on a pig foot."
• "What if I make a mistake and get sued, or lose my job, as an NHSC scholar I will owe 4x my loans, and I will never work again . . . ahh!!!"

Hit play, pause, and repeat.

Faking it till you're making it

For the first time in my life, I was going to have to trust in my diagnostic skills.

Doctors don’t have to overcome this fear in the same way PAs do. Doctors have a residency to ease into things. As PAs, it is just one day you are a student, then the next day you’re a prescribing medical practitioner.

Honestly, as I write this, looking back at seven years of clinical experience, it is no wonder I was scared senseless.

There is an understandable and probably protective fear that every medical provider should have. That is the fear of harming someone. But there is another fear, and that is less protective, it is the fear of looking like a beginner, having to ask for help, letting your patients down.

For me this was difficult. I like feeling in control, I hate doubt, and I pride myself on my medical expertise. But there I stood, vulnerable and scared down to my bones.

I arrived at the clinic early this day of course, which only added fuel to my anxiety. I cleaned my workspace (which, of course, already was clean because I didn’t have any patients or charting yet), and I sat there in my chair. Living my dream that I had prepared for so many years. Why did I want to run out of there home to my mom?

I cleaned my stethoscope, made small talk with my medical assistant, re-cleaned my stethoscope, and sat nervously awaiting the clinic doors to open.

And as the front doors of the clinic did finally open there I stood, exposed, nervous for my patients mostly.

In fear that people would discover that I had no clue what I was doing.

Stephen Pasquini PA-C Physician Assistant

Stephen has been a family practice PA since 2004 and is the creator of The PA Life, Smarty PANCE Board Review, and PASchoolfinder websites. A National Health Service Corps Scholar and a graduate of The University of Medicine and Dentistry of NJ (Rutgers) PA Program and the University of Washington in Seattle, WA. Stephen's goal is to provide one-of-a-kind online resources for those interested in or practicing in the PA profession, to promote better access to healthcare for all, and to foster universal recognition/awareness of the PA profession. Read more about Stephen.

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