My first day as a real PA
I remember my first day on the job like it was 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, I 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.
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I have definitely thought of becoming PA for quite some time. I am 15 and speak French, English, and Spanish. Is there books or websites i could get on now to have a more clear understanding when i am older? What are some tips you might have for me?
Thank you for such an honest and open article on your feelings Stephen! I am a second year PA student going into my final year and even after completing 6 rotations I feel like I’m not ready or competent enough. I know I have a year left but I’m always drowning in the fear that I won’t be ready after graduation, especially since I still don’t feel ready after 6 core rotations! It was refreshing to hear your take on your first day.
What would you advise me looking back? I still have 10 months to go but I fear the feeling of incompetency upon graduation – not only for when I go job searching but when I also see my first patient!
Stephen Pasquini PA-C says
My advice would be to take every opportunity you can to make mistakes and put yourself out there while on rotations. I wish I had taken more chances and asked/stepped up to do more. This is your chance to learn so embrace it! Take an elective rotation in your specialty of choice if you can. And don’t worry everybody feels unprepared… it’s just part of the process :-).
Stephen Pasquini PA-C