Letter for New Physician Assistants: PA Life Hacks and PA Career Advice for Those New to the PA ProfessionFrom a Seasoned Physician Assistant
After 17 years of practice as a PA, I’ve learned a few things and made a number of mistakes. If only I could write my prior self a letter - a letter that would traverse time and land into the hands of my 17-year younger self, what would I say - what would I say to a new physician assistant?
Here are ten points I would make to any youngling clinicians as they step into clinical practice, especially the new physician assistant.
1) Make thou a financial plan and start saving for retirement now.
This seems obvious but there are a number of reasons that new graduates don’t always follow a sound financial plan.
First, new PA graduates frequently have an enormous amount of educational debt. Between my wife and I, we paid off around $50,000 in the first few years of my practice. When you are aggressively paying off debt, it’s easy to put off saving for retirement or having an emergency fund. Nevertheless, I recommend that your financial plan be a balance between paying back debt, having an emergency fund and then an incremental retirement plan so that you benefit from time in the market. Even saving a little bit early can pay significant returns on down the line.
In my first job as a PA I worked with the physician who was 78 years old and was forced out of retirement because of financial burdens. Bad spending habits and extravagant lifestyle choices left them virtually destitute at retirement age. Every weekday morning he would grab his sack lunch and leave their rickety mobile home to come work in our busy clinic. I’ve never seen anybody look so exhausted at the start of clinic.
Certainly, it’s possible to work in our retirement years but it should be on our terms and not out of financial desperation. His story points to another financial pitfall of new graduates, spending habits. After all of the hard work we feel entitled to some congratulatory consumption and we may even feel an urge to indicate our newly-earned status with some lifestyle choices.
You can have it – the Land cruiser, Maui vacations, wine tastings, season football tickets, trips to Martha ’s Vineyard – but if it’s not covered by your financial plan, you could be working until the wheels fall off when you should be slowing down.
2) Never let thine work interfere with a healthy lifestyle.
A few years ago my typical work day would look something like this: awake at 9:30 in the morning, breakfast and coffee, commute to work for an 11 AM to 11 PM shift. ER blows up at 10:30pm so I don’t get to leave until 1 AM, too busy to eat dinner so I inhale Taco Bell on my way back to the house, I sit on the couch and watch dumb TV while my brain oozes out of my ears, crawl into bed, rinse and repeat. When I see photos for myself in this time frame I look bloated, I have dark circles under my eyes, I’m pale and I look exhausted. “But you do important work” I would tell myself. This is all well and good, emergency medicine is a fascinating and rewarding career, but if you can’t find a schedule or a job that will allow you to maintain some semblance of health, it simply isn’t worth it.
I am convinced that diet, regular exercise and proper sleep are essential to human flourishing.
3) Value ye job satisfaction over filthy lucre.
Life is too short to work at something you don’t genuinely enjoy. I have a friend that works in a medical salon doing injections and lasering body hair. When I asked her if she liked the work she responded with “nobody likes this stuff - we do it for the money and the lifestyle.” To be sure there are several important factors like compensation and lifestyle that enter into the jobs we choose. Sometimes it may be a matter of pure availability or our need to find a particular job in a particular location.
However, all things being equal I recommend that you choose a field/job that provides you with vocational satisfaction. If working in Native American health or the VA brings you a sense of fulfillment then that’s where you belong. (I LOVED my first job out of school at the North Eastern Tribal health system in Miami, Oklahoma.) With a sound financial plan and some lifestyle adjustments you can work at the job that provides you with satisfaction and the money will work itself out.
4) Thine family and friends come first.
Never let your career interfere with your relationships with family and friends.
I was speaking with a friend of mine who had been a cardiologist for 20 years. At some point in our discussion the topic of family came up and he very plainly stated that he had been virtually absent from his child’s life;. “I just haven’t been there as a father.”
Every career, particularly medical careers, will require the occasional absence from your child’s ballgames etc.-that’s just part of the deal. However if your job requires chronic absence from your family and disruption of your friendships, it may be time for a change.
5) Stay ye above the fray.
John-Paul Sartre famously once said “Hell is other people.” I can’t help but think that he muttered those words after working a 12 hour emergency department shift on New Year’s Eve.
Some work environments are intrinsically stressful because of the nature of the work that we do. As professionals we can work and behave in ways that redirect that stress into a positive workflow. However, there are always other actors in our workplace that incite conflict and increased stress levels. Whenever possible, avoid toxic workplaces and people.
6) Lichenify thine epidermis.
Developing “thick skin” doesn’t mean that you need to become callous or emotionally detached in the workplace. Just recognizing that the world is a complex and sometimes bitter place and that you don’t have to emotionally respond to every slight or insult.
When I graduated from PA school I thought the medical world was going to pick me up, give me a big hug and say “Welcome to medicine Mark - we’ve been waiting for you!” That never happened. Although I had a very rewarding job and interesting work there were conflicts and problems.
Acceptance of the PA from other practitioners or patients is not 100% guaranteed.
I found that with hard work and maintaining professionalism, I could win over a few of the doubters.
7) Be thou a good colleague.
Always do your best to be a good colleague - cover a shift for someone who has a sick child, stay late to help out with the extra patients or be called in early, offer good advice particularly to new clinicians and the humility to ask for advice in return.
8) Remain ye sharp.
In a previous post we discuss how medical professionals are high-stakes knowledge workers with the need for ongoing and continual education. The intellectual demands of medical work is one of the things I find most satisfying about my job.
Make sure that you seek out CME opportunities that identify and fill in gaps in your knowledge base. Also, it’s crucial to develop an evidence-based mindset.
9) Givest thou back.
As a physician assistant practicing in 2020 I am the beneficiary of all of the PAs that have come before me. Since its inception in 1970, PAs have worked to not only serve our patients but also to build up the profession to what it is today. The PAs that came before me demonstrated a kind of professionalism and effectiveness that gave our profession staying power.
Now the physician assistant is one of the most sought after jobs in the current marketplace. We should be good stewards of this profession and give it the same professionalism, hard work and care as those who came before us.
Also, it is a great privilege to work in the medical field. At some point all PAs experience a sense of gratitude that makes us want to give back to the profession. Whether it’s teaching, volunteer work, or precepting, giving back to the profession and our community is a very satisfying experience.
10) Forgive thyself.
We are fallible human beings working in high-stakes situations - mistakes are inevitable. We can do things to manage and to learn from them but moving on emotionally after we’ve properly addressed our mistakes is sometimes difficult. In time you will need to learn how to forgive yourself after making mistakes.
Several years ago a colleague of mine who also worked in emergency medicine gave the commencement speech at one of our program’s graduation ceremonies. I remember one bit of advice she poignantly offered students about to step into the medical field -- “You will make mistakes, don’t let them destroy you.”
Here's to all the new physician assistants out there! Oh and "Welcome to medicine - we’ve been waiting for you!" You got this.
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