Dear New Graduate PA – YOU DID IT!

Congratulations and welcome to the ranks of the greatest profession on Earth. Now I may be a *little* bit biased when I say that being a PA is truly the most awesome career, but that’s neither here nor there.

What we are celebrating today is the fact that you did it.

You made it!

You did all the testing.

You took the PANCE.

The NCCPA let you into the club!

You are now officially a PA-C.

This episode of The PA Is In is dedicated to all the new graduates that are joining our ranks. If that’s you – I’m cheering you on loudly from here. 

It bears noting that some things have to be lived to be learned. There’s something to be said for your unique lived experience.

Here are my top ten tips for new graduate PAs! 

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1. It’s a marathon, not a sprint.

Your career as a PA is a marathon, not a sprint. 

Pace yourself.

We have, lately, come to propagate the narrative that, when we first graduate, we must work ourselves to the bone – become burned out and jaded – then work backwards to find a way to practice medicine in a sustainable way.

Things that lead to this burnout are the lack of boundaries, being at the bottom of the pecking order, or the feeling that you need to prove yourself to your team and collaborating physicians.

What if, for you, and those who are joining our ranks as certified PAs – you skipped the crash and burnout part of that story – and instead of racing to the bottom in this career, you focus on the fact that this career is a marathon, not a sprint.

What do I mean by your career as a PA being a marathon?

I mean that your career needs to be sustainable for years and years, decades, really. In order for that to happen, you need to pace yourself.

You didn’t work so hard to become a PA for your career to be a flash in the pan. You want to be able to have a lasting impact on your patients’ lives and do that for years to come.

Alongside pacing yourself in your career, you need to be strategic. It’s important to be intentional about making strategic career moves. Take time to see how work would fit into your life, not how you can squeeze your life into the cracks of time between shifts.

Be prudent about choosing your specialty and clinical practice setting. Think about what you want your life to look like and feel like in the coming 2-10 years. 

In short, look further into the distance in your career. Take a wider view of your career. Consider it like chess – think 2 moves in advance and be strategic.

2. All specialties matter. 

No specialties are more significant or important than others. We are not in competition to see what specialty is best.

The question is, instead of figuring out what specialty is the most cool or the most badass, but to determine what specialty will fit YOU the best.

It’s not about your classmates or your friends and what THEY want to do specialty-wise.

Listen, when it comes to the patient sitting on your exam table, seeking your help with their symptoms, you are the provider that they need.

There are no bonus points for choosing a specialty that is higher acuity or more sexy and well-regarded by others in the medical community.

Follow your heart and do what’s interesting to you. 

Consider, beyond the content of the medicine you’ll be practicing, how the schedule and that lifestyle sounds this year for you.

3. Get to Know the Culture

Before taking a job, work as hard as you can to determine what the culture is like at the place you’d like to work. 

Ask many questions about how the providers treat each other, how they deal with sick time, and what it feels like to work there.

Inquire how they are treated by administration, leadership, other APPs and physicians. 

Understand how the schedule is handled, how calling out sick is received and what the current team members wished they had known before joining the team.

Go in for a working interview or a several day or several hours-long shadowing experience at potential employers. How does it feel when you are there? Does it feel like you fit? How do you think you’d feel when you leave work? How do the providers speak about each other? How do they talk about patients and their families?

After working for over a decade I have realized that culture matters more than specialty. 

Yes, I know that we make such a big deal about specialty. It’s the question that we ask students, the one we ask each other, and the thing we focus on. 

“Do you know what area of medicine you’re interested in?”

I personally have asked many students this when they have come across me.

I think it matters more how you feel about where you work, the care you take of patients, and how the providers treat each other, than the specifics of the medicine that you practice. 

Instead, I’d love to start asking students (and ourselves) “How do you want to feel about the medicine that you practice?”

Be diligent about learning the culture before you accept a job! Culture is incredibly important.

4. Embrace lifelong learning (yes, I do mean other than your required CME).

The great thing about being a beginner, starting in a new specialty, and being at the start of your career is that you get to soak in the newness around you. The healthcare system is ever evolving, so make sure that you have time for learning new things and leaning into your professional development. 

There is certainly a steep learning curve at the beginning of your career and time in your specialty. 

Find a way to review general journals and specialty-specific research, technological advancements and best practices in your group or department. 

Make conferences, journal review, and keeping up on your CME part of the rhythm of your life. You will come to know what your patients need the most. Think about how you can meet those needs with your ongoing education!

Yes, you need 100 CME hours every 2 years, 50 of which need to be Category 1, to log for the NCCPA to maintain your board certification – these hours are important. 

But making learning a part of the rhythm of your life matters just as much. Be willing to admit when you don’t know something, look it up and expand your knowledge. Your future patients will thank you for making learning, advancing your skills and abilities and weaving this learning into the fabric of your life! 

5. Hone your communication skills. 

Everything is communication. Being able to communicate is vital for everything from advocating for your patients to creating change within your department. It’s crucial to be able to effectively communicate in both verbal and written ways. 

This communication category includes active listening, empathy and the ability to break down complex diagnoses in a way that patients will understand.

When it comes to charting, start out strong with habits that enforce clear notes that encompass the true nature of the visit and completeness of your physical exam. 

I tell all my students that, each day when I leave the hospital or office, I aim to have it that, if I were hit by a bus, the person who assumed care of my patients after my death would know exactly what I was thinking. 

They’d have an understanding of the plan, pending testing, a general understanding of my differential diagnosis and what we’ve ruled out or ruled in so far. 

For inpatient notes this would include disposition and timing of discharge planning! 

I’ve said it before and I’ve said it again – everything is communication! Knowing how to communicate effectively to patients and staff, to your peers, supervisor and collaborating physician, are crucial to success.

If this is a weak spot for you, focus on how to improve your communication. Seek feedback on your verbal communication, charting, emails and speaking in meetings. 

6. Prioritize Self-Care

After PA school I can remember feeling utter relief that I had no more end of rotation exams, no studying for the PANCE, and feeling like I would have all the time in the world to do so many new things.

Turns out that practicing medicine clinically, commuting, and feeding myself took a lot more time than I anticipated.

Self-care strategies are essential at preventing burnout… or if you’re feeling burned out after graduation and the amount of stress that comes along with taking the PANCE… self-care is crucial in recovering from burnout as well.

Find out what you need in order to thrive. Whether it’s regular exercise, making sure you are drinking water throughout the day, and making sure you are getting enough high-quality sleep, you need to identify what you need in order to feel great.

The more you know about your personality, the more you can gauge what you need the most in order to be whole and well-cared-for. Check out the PA Personality Quiz linked in the show notes to learn what your predispositions are as a provider. 

I mentioned earlier that this career is a marathon, not a sprint. In order to live and work in a way that’s sustainable, you’ll need to find ways to take care of yourself while in the midst of taking care of everyone else! 

See episode 191 on 7 ways to complete the stress cycle. Exercise ranks high on that list! Find a way to move and fuel your body so you can keep on healing others.

Start today to take care of yourself. Remember to put your own oxygen mask on first. Fill your own cup. Be as diligent about the care you are providing others.

7. Networking Matters

Be intentional and focused on cultivating a network of strong relationships. This network extends beyond other PAs in your office, hospital system, or town. Be on the lookout to pour into connections with other physicians, NPs, and other professionals that you work with regularly. 

I always tell my PA students that it costs them nothing to be kind. Being kind and cultivating positive relationships with those around you is so important.

When someone calls you with a question – be gracious.

When they consult you in the afternoon and you’re bummed was ordered – be kind.

When they come to you for a favor – be generous.

These things will serve you well in your career and they will also enhance your professional growth and improve your patient care. 

My kiddos love to say that teamwork makes the dream work and this is true – inside the team that is clearly yours and working with those who are working alongside you on other teams as well. 

Patients win when we have strong networks and positive relationships with those around us. It’s a big benefit to your career but not entirely self serving to cultivate strong relationships inside of medicine – in your specialty and with others.

8. Seek Mentorship Relationships

This podcast is a great resource, if I may say so myself, but it cannot replace a true mentor who is a part of your life and can give you feedback as you navigate this career in medicine. 

Those who have been around the block, who are more experienced in your specialty or in medicine at large, have the ability to share their wisdom with you. They can offer insights and share their experiences.

You can stand on the shoulders of the mentors that you cultivate relationships with.

Be on the lookout for mentors within your workplace, at your state organization, through the AAPA mentorship program, or through in person networking opportunities. 

These relationships can be rich, give you meaning, and you can leverage your mentors’ experience to help you have a long and wonderful career. 

9. Focus on Your Patients

It can be pretty easy to get swept up in the ancillary activities of practicing medicine. Reviewing labs, charting, keeping up on your in basket, there are tons of ancillary and administrative tasks that are involved in taking care of patients.

These tasks can distract you from the reason that you are here in the first place: your patient. You are that patient’s most capable and most passionate advocate.

Make sure that you are intentional about focusing on patients. Be diligent about continuing to be empathetic, compassionate and caring.

As the newest members of the medical team, you are likely the person who has the most cultural sensitivity. The longer we work in medicine, the more jaded we can become. 

Work to use your evidence-based medicine to make medical decisions that are in the best interests of your patient. Include your patient in that decision-making when at all possible. 

Just as you are going to relish in the autonomy that you now get to appreciate as a provider, help patients maintain that autonomy as much as possible. 

Be an active listener who cares about your patients. Even on busy days and stressful times, focus on your patients.

Remember that they are people who deserve to be treated with respect and kindness. 

10. Be Agile and Adaptable

It’s not going to look like you think it is. The path through your career isn’t going to be linear. Circumstances are going to change. There are going to be unexpected twists and turns along the way.

Be agile. Tune in to what you enjoy. Have a finger on the pulse of what’s going well for you at work and what is not. 

Be prepared to pivot early and often. Look for opportunities for growth within your department and specialty and outside of it.

PAs are doing incredible things in leadership, in industry, in research, if clinical medicine doesn’t feel like it’s working keep those opportunities in the back of your mind. 

Welcome, my friend, to the profession. We are so happy to have you. You’ll do great things.

Remember to follow your heart, stay true to your morals, and take care of yourself along the way!

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