As I'm sure many new PA's can attest to, the end of PA school is a bit of a blur. One minute you're finishing up classes and studying for the PANCE and the next you're ... here? Three months into practice and wondering how it happened.
Graduation was on May 13, 2022, and that was a really wonderful day. My parents came to support me, I enjoyed beers on the terrace with my friends, and I felt wonderful standing on the other side of three years of grad school.
After a quick day of relaxation, I hit the ground running with my studying. I stuck with my plan for the most part, and felt equal parts "I can't possibly study any more!" and "But I'm not ready!" when exam day arrived.
I happened to be at the very same testing center as a fellow student, so when we finished our exams, we headed over to the local mexican restaurant to enjoy tacos and well-deserved margaritas. Hilariously, our brains were so absolutely melted from testing that we could barely hold a conversation!
And then ... we waited. And waited. For what felt like eternity.
On June 3, 2022, I found out I was officially a PA-C.
After that, I jetted off to Canada for a hiking and camping trip with my sister in Banff. After sitting in front of a laptop and study materials for ages, being able to unplug and reconnect with nature was blissful. Even if it was freezing at night and we basically slept with all our clothes on plus hats and three pairs of socks in our good sleeping bags with a small heater taking the edge off. Better than studying!!
With my remaining time off, I moved into my new house and tried to get myself settled (with breaks to go kayaking on the lake, of course).
I started my job in family medicine on June 20, even though I didn't have my license from the state yet. Unlike bigger hospital systems, I was able to work at this clinic in a student capacity until my license was approved. And I have to say, that process was unnecessarily long.
Perhaps it's not this bad in all states, but Wisconsin did not have anywhere near the staff at our department of professional services to handle all the applications. Plus, right around graduation they started to change things over from paper to online applications. Not ideal.
Students, including myself, were calling daily (and never getting calls back), showing up in person, sending emails, contacting our elected officials, and literally begging and pleading to anyone who would listen to help push our applications through. What a mess.
I know multiple people who had to delay starting jobs or fellowships because of how long it took to get their license. I mention this so that future graduates understand this process can be very lengthy. Even though you graduate in May, you may not start a job until September or even October. Prepare yourself.
Starting my job early seemed like a good idea. But in all honesty, I was envious of my friends who were enjoying some prolonged time off. And even more, I felt very alone during the transition into new practice. I was struggling, and I don't think you can really understand that feeling unless you're going through it, too.
I had been told that the first year of practice was the hardest. They weren't kidding.
When you're done with clinicals, you're ready to be done being a student (at least, I was). I knew there was still plenty I didn't know, but I was ready to learn it on the job. Or, so I thought.
I didn't appreciate the weight of, well, everything. The onslaught of tasks and in-basket messages and result follow-ups and paperwork. The full schedule and medication management and decisions being made independently. The anxiety about managing real patient's lives.
And no matter what they tell you about onboarding and how reasonable it sounds, it feels like being dropped in the deep end of a very, very deep pool.
When you're a student, there's the pressure of getting the answer right. But you have time to think about things and look them up. Knowing that someone is checking your answer provides such a soft place to land.
Clinical year students are probably reading that and thinking, soft place to land?! When my preceptor is ripping me a new one in the middle of the OR in front of other people? That ain't soft!
Okay, that's not, but it's a lot different than having to independently decide the care plan for a patient and move forward with that. Your preceptor may embarrass you and that sucks, but no patient's well-being is on the line in that scenario.
My supervising doctor told me after being at the practice for a bit -- if you're 40% confident or less, let me know. But if you're at least 60% confident, just go for it. I know he was pushing me to be more independent, but 60% does not leave a warm, fuzzy feeling in your tummy. More like a gnawing, uncomfortable feeling.
During these first three months, I have felt exhausted. With the variety of patients I've been seeing in family practice, it's like mental gymnastics all day long, jumping from cysts to ear infections to recent strokes to possible appendicitis to controlled substances to dementia to wounds to anxiety and on and on. It's hard to do all this learning and feel so overwhelmed and to be second guessing every little thing you do.
When I compare how I felt the first couple weeks to how I felt this past week, I can say there has been progress. I am starting to feel better about my decisions. I'm nowhere near where I want to be, but I'm growing.
If I have some thoughts after being a PA for a few months, here they are in no particular order:
- Choose a workplace where you'll feel comfortable asking questions. Lots of questions.
- Be prepared to be kind to yourself. Therapy can help with that.
- Have healthy ways to shut your brain off. Puzzles while listening to podcasts is surprisingly effective.
- Have a support system ready. Classmates, of course, but also friends and family.
- Make a schedule that accounts for plenty of time to sleep. And take naps.
- Convenience is key. If there's ever been a time for meal delivery kits and Target deliveries, this is it.
- Listen to the thing everyone says but sounds like crap -- it'll get better. At a glacial pace, perhaps, but it'll get better.
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