PA school is notoriously intense—but what if it didn’t have to feel like drinking from a firehose? The same goes for practicing clinical medicine. It simply doesn’t have to be all consuming. Practicing medicine is an art and a science. Learning to build boundaries while working in medicine is a skill.
In this Episode 326 of The PA Is In, I’m joined by Jono Lippman, emergency medicine PA and founder of PA Guide. Together, we unpack the myths of medical training, the truth about building effective and enforceable boundaries, and what sustainable practice can really look like—even in rural, solo ER shifts.
This episode is for you if you are a student feeling overwhelmed by the volume of information, you are a practicing healthcare professional preparing for board prep, and you feel like a martyr, called to work in medicine, wondering how you can keep going at this pace.
Listen on: iTunes | Spotify | YouTube
Practicing Emergency Medicine Off the Grid
Jono works 24-hour shifts in critical access hospitals in rural Washington, often as the only provider on site. He shares what it’s like to be completely autonomous—stabilizing trauma patients, calling helicopters, and making critical decisions without a backup team. It’s challenging, exhilarating, and yes—still terrifying.
No degree of experience should make us overconfident. We need to know what we don’t know, identify our own limitations, and continue to grow in our clinical knowledge and confidence. But the autonomy of practicing in a critical access setting has helped Jono grow in clinical confidence and adaptability.
Splitting his time between an urban Emergency Department setting and rural Critical Access gives Jono the best of both worlds. Each setting is challenging in it’s own way. He said YES to the opportunity to work in Critical Access after encouragement from a colleague to give it a try!
Boundary-Setting as a Survival Skill
With six kids and a demanding clinical schedule, Jono doesn’t just preach about boundaries—he lives them. Boundaries are not elective. We need healthy, clear and enforceable boundaries. It’s part of learning how to thrive working in healthcare.
Jono states, in no uncertain terms, “No job is going to win in a battle against my marriage, my family or my health.” Getting clear on what you value is an integral part of living a values-based life and the key to unlocking a life that feels great for you and is sustainable long-term!
From walking away from toxic leadership to saying “no” with confidence, he models what it looks like to protect what matters most: family, health, and purpose. He reminds listeners that no employer will respect your boundaries unless you set them clearly, early and often. Simply put, “If you can set boundaries around work, simply saying no, you can create balance.”
The Myth of Work-Life Balance
Both Jono and I agree: “work-life balance” is often a lie. We are sold this lie from the start– that PAs have somehow magically better work-life balance than our physician colleagues. Automatically having better work-life balance as a PA, simply because you are a PA, is a myth. It’s a lie. It’s not true in modern clinical practice.
Instead, we advocate for intentional integration, (because, remember, work-life balance is a myth) and aim for life-work integration instead. Integration means work fits around your life—not the other way around.
You don’t need a good excuse to say no. No, is, in fact, a full sentence. You don’t owe your organization your well-being, your health, your sanity. You and your family come first. Period.
Rethinking the “Firehose” Analogy
Jono believes the popular phrase “PA school is like drinking from a firehose” is not only unhelpful—it’s harmful. Citing the volume of information as overloading and throwing students in the deep end to see if they can swim is a terrible system.
Instead of immersing students into chaos, his PA Guide offers structure, systems, and confidence for learning. Through visual learning, smart preparation, and practical tools, Jono’s helping a generation of PA students rewrite their educational experience.
From Chaos to Clarity: Why PA Guide Works
What started as Jono’s own duct-tape-bound notebooks has now grown into a comprehensive, illustrated Smart Study System. Jono’s materials—now used by students across the U.S. and abroad—help reduce anxiety, improve learning, and prepare students to not only pass their boards but also enjoy the process.
From low tech – handwritten notebooks with comprehensive drawings covering every organ system – to high tech – an AI chat bot that gives you disease specific prompts and walks you through clinical scenarios, Jono and his team have truly thought of everything.
From Surviving to Thriving
If you’ve ever felt like you were barely surviving PA school or clinical practice, episode 326 is your reminder that it doesn’t have to be that way. With the right support, mindset, and systems, you can build a fulfilling, sustainable life in medicine—one that leaves room for growth, family, and joy.
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