If you are a future or practicing PA and you don’t know about The PA Blueprint Book yet, you must!
Allow me to introduce you to Shayne Foley, PA-C & Jordan Fisher, PA-C.
These two amazing PAs pack 15+ years of collective experience in the PA profession, while also teaching, precepting, and writing books. Pretty impressive.
What I love the most about them is that they saw a pretty big blind spot in the education of PA's & went ahead and created an excellent resource to fill that gap.
This educational blind spot pertains to all the really important stuff about life, finances & navigating the world as a PA inside and outside of work. More importantly how to have all of that without going insane.
As the authors of The PA Blueprint Book, they have created a priceless resource that helps to unlock all the secrets of crafting your ideal PA career, without having to go to the school of hard knocks yourself.
You know, all the important stuff that school didn’t teach you about finding balance & actually thriving in the PA profession.
They address super important topics like compensation negotiation, discerning between a garbage contract & benefits package & a good one, the path to wealth through investing, maintaining sustainable work/life balance, student loan repayment, navigating the workplace, avoiding burnout, and even where to get CME.
This book is truly the guide that every PA wishes they got as a graduation gift.
I highly recommend you get or gift your own copy at www.thepablueprint.com
PA students take note: You may ask that your school get Shayne and Jordan to come speak at your School!
I did an interview as a guest on their blog a little while back called Real Talk with Karen Calcano & the questions they asked me on this interview-esque blog post were way too good for me not to turn around and ask them the exact same set of questions!
Shayne & Jordan did not disappoint! As I expected I delivered gold and many nuggets of wisdom that I just know you will find just as valuable as I did.
1). IF YOU COULD GO DO IT ALL OVER AGAIN, WOULD YOU STILL CHOOSE TO BECOME A PA FOR YOUR CAREER?
The short answer: YES. I’m not sure I would’ve answered that way within my first few years of practice, but now I feel confident in saying yes. Here are my reasons:
At the end of the day, the career is rewarding and I genuinely love connecting with and helping my patients.
Right now, having nearly 10 years and a variety of experiences to draw on, as well as having a great personal life setup, really makes the work much easier to handle. I think I’ve found just about the optimal life-work balance.
What we are allotted in our careers, from our salaries to benefits to career opportunities, are very generous and can easily assist us in pursuing our goals and dreams.
I would if I could decrease the cost. One of my biggest qualms with the PA profession (and any healthcare profession for that matter) is the cost.
PA school admission is so competitive that most students must put finances aside and just go where they get in. Often this is a private school with high tuition costs. I don't think any career should start $100,000+ in debt and cost $5k+ to just apply. New applicants should always try to keep tuition costs in mind, especially if they are lucky enough to have options.
Besides this, the PA profession has a lot to offer and is a wonderful career to consider.
2). WHAT IS ONE OF THE BIGGEST CAREER MISTAKES THAT YOU'VE MADE SINCE BEING A PA?
Having made just about every financial mistake since starting practice, my answer is not having a better understanding of budgeting, student loans, and investing at the start of my career. If I had all my financial ducks in a row from day #1 until now, being nearly 10 years into my career, I can confidently say that I’d be close to financial independence already.
Instead, up until 2020 when I decided that I could no longer remain financially ignorant, I probably checked every box in the “Basic financial mistakes” category. It looked something like this:
Spend more than you earn.
Don’t invest in 401k/403b, Roth IRA, and brokerage account options.
Pay excessive amounts of money to a financial advisor.
It was a painful and expensive 8 years of trial and error, and I realize now that I could’ve just spent less than $100 on books (including The PA Blueprint), read some free blogs, and taken a few hours to learn the basics and get on a much more prosperous path. Given that I now know enough to figure this stuff out, my financial naivety up until 2020 cost me hundreds of thousands of dollars and years until retirement, and that thought is a real punch to the gut. But, on the flip side, I am also ecstatic to report that I’ve saved “future us” at least $500,000, and we are on track to meet our goals of financial independence within 10-15 years!
I don't know if it is a mistake as much as a regret.
I had a job offer at a hospitalist practice that I signed roughly 2 months before I graduated. Once I graduated and started the credentialing process I was pretty much forgotten about. I didn't hear from anyone for 4+ months as I was burning through my savings and growing increasingly anxious. Then the job changed, and I was getting set up at a different hospital with a different team, unbeknownst to me. These all seemed like red flags, so I ended up taking another position.
In hindsight, I wonder if I should have stuck with it. I left the other job after a year and wonder if the hospitalist experience would have served me better.
The moral of the story is to choose a job where you will feel supported and valued, especially right out of school when you are in need of extra guidance.
3). TELL US ABOUT A TIME THAT YOU WERE BURNED OUT, INCLUDING WHAT YOU DID TO IMPROVE THINGS.
A few years back while working in Urgent Care, I was fried. I had over-committed with full-time practice, working as an adjunct faculty member, precepting, and trying to work extra shifts in order to earn more money.
The slow creep of saying yes to too many things, in addition to the demands of 12-hour shifts, really was too much. I found myself running on cortisol, needing days to recover from consecutive shifts, frequently eating junk food, and feeling depressed.
It took a long time to realize that the demands of working in Urgent Care were the biggest contributor to my burnout, so I knew that that specialty wasn’t one that was ever going to be sustainable for me.
My wife was also feeling burned out, so we hashed out a plan to take a sabbatical year (as discussed on PA The FI Way podcast), and just the exercise of doing that was enough to relieve some of the burnout feelings. With each extra shift and commitment now serving a purpose (saving enough money to fund a sabbatical), along with having a defined end-point, these burdens no longer felt so heavy. My thinking is that creating, planning, and executing on the sabbatical forced us to focus more on our personal life, realigning ourselves with our goal to “Work to live, not live to work.”
That would be now! The pandemic has been difficult, especially in the emergency medicine and urgent care settings, which has led me to experience a degree of burnout.
I have been focusing on mindfulness, taking more time off, working on my side hustles, and looking into other specialties to try to combat burnout (not to mention all the other great tips in The PA Blueprint!).
This is a genuinely difficult time to be in medicine and I think a large portion of healthcare workers are experiencing a degree of burnout. Make sure you are taking the time to self-reflect and see if you are experiencing burnout.
4). WHAT FRUSTRATES YOU MOST ABOUT WORKING IN MEDICINE?
I’m actually going to say two things: Bureaucracy and the lack of a proactive approach to the well-being of healthcare workers (HCW). These two things do go hand-in-hand, as oftentimes good ideas, including how to “heal the healers”, wind up dying on the vine via “death by committee.”
I see bureaucracies as like aircraft carriers, meaning they have a lot of weight and power behind them when employed, but are lacking in the agility often needed in modern medicine. It seems all too predictable that good ideas will reach a point where a committee or task force will inevitably be created, wherein a conglomerate of already overworked professionals will meet monthly to discuss (often at the expense of action being taken) the idea, and at a glacial pace decide on how to best take actions. By the time the plan is set to be executed, there are often other issues at hand, and the delayed response has allowed the problem, such as healthcare workers’ burnout, to reach a point where the proposed solutions are no longer commensurate with the level of the problem. I know that this may just make me sound cynical and jaded, but I’ve seen it play out where it took 6+ months to roll out a survey on burnout, at a critical time when action, and not just data collection, were needed STAT!
In regards to HCW feeling that our own well-being is ignored, I’ve written about this Hippocratic Hypocrisy on KevinMD.com previously. It frustrates me that there isn’t more being done by our own employers to help us with our financial, mental, physical, and career well-being. Too often, we need to settle for “Hang in there” messaging, pizza party or donut delivery, outsourced solution, or something else that just seems superficial, disingenuous, missing the mark or that puts the onus back onto us to navigate our work-related problems alone (Yeah, I’m looking at you “Mindfulness” webinars).
In order to decrease burnout, improve employee job satisfaction and retention, and improve HCWs’ ability to provide optimal care to their patients, the medical field as a whole needs to do even more than they currently are.
Health insurance. Our system is broken, and it is frustrating how much a patient's health insurance can dictate the care they receive. It is something I run across multiple times every shift. It is even expensive and confusing for me, as a provider, to be seen at my own hospital for a simple physical!
5). WHAT IS ONE THING THAT YOU WISH THAT PA PROGRAMS WOULD DO A BETTER JOB WITH?
I’d love to see more lectures on subjects outside of just learning medicine, which was the impetus for creating The PA Blueprint with Jordan. I realize that the demands of PA school are already incredible, but couldn’t we consider foregoing having to learn outdated practical skills in exchange for basic career skills?
Throughout PA school, we try to drink from the proverbial fire-hydrant in learning about medicine, but don’t even learn enough about subjects like employment contracts, job searches, 401k investing, student loan repayment, etc. to wet our lips.
The resources to assist with clinical practice, such as Up-to-Date, are readily available to help us practice evidence-based medicine, but the best resources to help us get on the optimal career path had not been available until resources like The PA Blueprint were created. From what we’ve seen from delivering presentations to PA students and working with practicing PAs, people are hungry to learn more about the career itself, so we’d like to see PA programs do more in this realm. Fortunately, PA programs now have the option of booking us to deliver presentations on the career, and we look forward to working with more and more programs each year.
Career education. PA school is short, and time is limited. The focus is understandably on training students to pass the PANCE. However, just as important is training students how to get a job as a physician assistant.
Programs need to institute career education to assist students in the competitive and ever-changing PA market. Career education has become one of the main missions of The PA Blueprint.
We have been lucky enough to lecture at 15+ universities on topics related to career education and hope to continue educating students at schools around the country.
6). WHAT IS ONE OF THE MOST CANDID PIECES OF ADVICE THAT YOU WOULD GIVE A PA SCHOOL APPLICANT?
If you think that your life will be smooth sailing once you become a PA, you are mistaken.
There are many challenges in preparing for, applying, getting accepted, and graduating from PA school, don’t get me wrong. PA school was one of the hardest things I’ve ever done. Working in clinical practice has a whole new set of challenges and pressures, especially for those where this may be the beginning of their careers or first “real” job. The first few years can feel rough. Overall, I wouldn’t call working in clinical practice worse or better, but just different. The stress of taking and passing exams becomes infrequent (ie PANRE), but often is replaced by a whole new set of rules, regulations, nuances, policies (all the way from government down to your individual practice), laws, educational opportunities, etc.
My feeling is that some individuals struggle with having less structure and more freedom, causing some to not adapt well to their new reality, stunting their career growth. The structure and guidance that is in place throughout our education drops off sharply after graduation, and it can feel like mentorship opportunities are few and far between. Fortunately, you don’t need to rely on yourself or your employer to help guide you on to the best path forward, as resources like The PA Blueprint are filling in those educational gaps.
Make sure you have somewhat of an understanding of the medical world before you apply. As you gain your patient care hours, learn from your environment. Picture yourself as the practitioner. Do you see yourself being happy? Fulfilled? If you have any hesitation in your answer, then you need to make sure that being a PA is really what you want. Otherwise, you are committing 4+ years (patient care hours, application, and school) of your life to start a job that you may not love. Make sure this is the right career for you, and once you do, you will love it!
7). WHAT WAS YOUR MOST REWARDING DAY AT WORK, OR A POSITIVE EXPERIENCE YOU KEEP IN YOUR MIND?
My vision of an optimal workday would look something like this:
Quick pre-charting to prepare for my day
Something from my self-care routine
Optimal workday circumstances:
Moderate-heavy patient schedule
Variety of complaints -- acute/chronic issues, a spectrum of ages, a combination of physicals and follow-ups
Working with an efficient nurse/MA
All patients show up on time
Limited BTWs (eg “I’ve also been having chest pain”)
Deeply and genuinely connect with at least one patient
Leave work on time with all charts completed
Have dinner with my wife and dog
Wind down with a show on Netflix (currently watching “Great British Baking Show”) or some reading
Head to bed, hopefully, to rinse and repeat the following workday
I try to look for the most rewarding part of every day. Whether that is a laugh I have with a patient, a case where I went above and beyond, or just a patient saying thank you for placing a hand on them while I listen to their heart. For me, it is more important to focus on the everyday little things rather than one or two big events.
8). KNOWING WHAT YOU KNOW NOW, WHERE DO YOU SEE YOURSELF IN 5 YEARS CAREER-WISE?
In 5 years, I envision that The PA Blueprint will continue with our mission to become one of the premier resources for all things PA. Jordan and I will continue to do presentations to PA programs, produce more high-quality content, work as mentors/coaches and continue growing as demands change. In regards to my “day job” as a practicing PA, I envision myself still practicing Family Medicine in Vermont, continuing to precept, and working on eventually decreasing clinical practice time in exchange for maximizing the time spent on things I am most passionate about. Who knows, maybe in 5 years we will be living out our dream to take a sabbatical in a European country, immersing ourselves in the culture and exploring our temporary home away?
At this point, I have found that for me the team matters more than the medicine. I want to be part of a small, cohesive team, making differences in patients' lives every day. Hopefully, I will have found that environment. I also plan on continuing to grow The PA Blueprint. Shayne and I hope to one day be a career education hub that every PA can utilize to optimize their career and universities can hire to educate their students on the PA career.
Special Thanks to Shayne and Jordan for stopping by and imparting their much-needed wisdom, especially in this era in Medicine.
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