Who wants more?!!

Hey everyone!

        I know, I know... its been a while! 

Surgery has kept me very busy...

      I've received a lot of feedback that pre-PA and PA students alike have found my blog very helpful and continue to utilize its content. 

So in light of this knowledge I'm reaching out to see who is interested in more?

• More content and a website
• More info 
• More stories
• More of what its like to go through the process of becoming a PA from the start to practice. 
• Life after a fellowship/residency
• And MUCH more! 

Place YOUR vote in the poll above and get ready for more to come!

The post-graduate fellowship experience

It has been a while since I posted i know... but Mayo Clinic kept me very busy as a PA fellow. Now I am completely finished and it has gone by so quickly!

What can I say to relay such an amazing, challenging, difficult, rewarding, beneficial experience?! 

First off, lets say I have gained a lot more confidence as a PA during my time as a PA fellow. I have also rubbed shoulders with some amazing PAs who have shown me examples of what its like to be a professional. Its hard to teach that in school, and its hard to learn that as a student. It is best learned while being on the job and actually getting your hands dirty doing the work. 

It has been nice to be able to make small mistakes and have PA colleagues there to help me see my mistakes and how to correct them before I could make really large mistakes. A fellowship is a unique learning ground to nurture fresh PAs to take on the HUGE role as a provider. It is a support structure to push you and teach you in an environment where you can develop strong roots to be a better, more confident, and smarter PA in such a short period of time. 

Sure a fellowship is not for everyone... but it can really make a fresh PA become more confident, a better learner, a better provider, and much better at knowing how best to care for patients in a short amount of time. Fellowship training accelerates training that would otherwise take many years of on the job training. Not only does it make one a better PA, but it serves as an adjunct to help get a competitive job! A fellowship will not only help you to land the job you want, but also get a better salary for your extra training.

Lets go over a few questions that those might consider when contemplating if a post-graduate fellowship is the right choice for them:

Is a fellowship right for me?
                That depends on your long-term goals. I looked to a fellowship because I was unable to get a job in a specialty where they wanted PAs with experience. I didn't want to go out and get any job just to gain experience in an area where I ultimately didn't want to work. 

Will it be worth the cut in pay?
                 Most of the pay cut you will take for doing a fellowship will be made up within the next few years after landing a job with higher pay secondary to your new training. Plus its not always about pay, when you work to get a job you love that has the schedule, benefits, and aspects of the job you love, you'll find it is very much worth any cut in pay for a year. 

What will it really do for my career as a PA?
                 A fellowship can do wonders to make you a better, competent, and confident PA. You will think about things with your patients that you never knew to think about because of your extra training and experience. You will learn about more challenging and involved areas of medicine that go beyond the foundation knowledge you learned in school. And if you have a more advanced knowledge in the area, it will build upon that knowledge. Fellowship training also gives you a leg up over competition when it comes to applying for a job, and negotiating a salary. You will stand out and will be more likely to get the job you really want because of your unique experience and exposure.

What is life like as a PA fellow?
              Life as a PA fellow can vary widely depending on the fellowship. Expect to be busy and work a lot. You'll have many training and education lectures, tons of patient exposure, and constantly be pushed beyond your comfort zone (in a good way). Expect to learn things by being exposed to them over and over again and to become comfortable handling them easily on your own. Its an experience that's hard to gain any other way.

First rotation as a PA Fellow

As a PA fellow, much like a second year PA student, I have different rotations in all areas of ENT. My first rotation was in general outpatient ENT. I saw many ENT pathologies including: benign paroxysmal vertigo, dysphonia, epistaxis, cerumen impaction, acute hearing loss, nasal polyps, sinusitis, laryngitis, vocal nodules, and so much more. I learned a ton during this rotation, but I will continue to be part of the ENT clinic throughout my year, so I kind of got an introduction here. 

My second rotation was Head and Neck surgery. This included me seeing patients in clinic for pre and post op follow ups, assisting in the OR, and rounding on patients admitted to our service every morning. I learned SO much during this first rotation. We had some very long surgeries.... like 14 hours. But they are some of the most amazing surgeries I have every seen. 

An example of a flap reconstruction of the right cheek

We work with a lot of head and neck cancer, and utilize flaps for head & neck reconstruction. These flaps typically are harvested from the anterior lateral thigh, radial forearm, or fibula and lateral leg. As part of the process the flap, along with an artery and vein, is harvested and reanastomosed with an artery and vein in the neck. This new flap is what repairs the defect made by resection of cancer.
 This is truly life changing, as it can affect how the patient eats, swallow, smells, and especially how they look. I am always humbled when I get the opportunity to be part of these surgeries. 


My third rotation was rhinology. I got to be part of some amazing surgeries during this rotation. I learned so much about nasal anatomy, and nasal obstruction. I got to see patients in clinic, and assist in the OR. We performed lots of different types of surgeries including: Septoplasty, turbinectomy, frontal sinus entrostomy, ethmoidectomy, resection of polyps, nasal valve surgery, rhinoplasty. I had no clue how much an individual's nose effects the look of their entire face. I learned to respect the ENT surgeons who are part of this sub-specialty as it is truly an art form. Most of our patients left home from the hospital as outpatient surgeries. However, we would have a patient every once in a while that would have to stay a night or two. In which case me and the resident would round on them, and make sure they had all their progress notes and orders in daily.

One great thing about being part of a fellowship is it has allowed me to learn how to do the little things like putting in orders, or how to dictate a note, honing my interviewing skills, and getting better at what questions to ask patients. The fellowship is allowing me to gain confidence in myself and my recommendations to patients. Each rotation builds on the next, and I feel I understand the principles of ENT a little bit better and more thorough than before. I have also got the chance to practice common ENT procedures including flexible nasopharyngoscopys, ridged rhinoscopys, trach replacements, prosthetic speaking valves, and microscopic cerumen impaction removal. 

An example of flexible nasopharyngoscopy

An example of ridged rhinoscopy
(notice the straight long scope vs the flexible scope in the above picture)

As part of the fellowship I go to weekly "core curriculum conferences" along with the residents. These conferences cover topics in ENT and help to serve as a foundation for ENT anatomy, pathology, and treatment plans. Surgical modalities, difficulties, and common mistakes are discussed. I always learn so much during these conferences. I also attend Sim lab trainings with the other PA fellow in the ENT program and PA fellows in the internal med program. These are always helpful, as they give us the chance to learn in a safe environment and learn from each other.

I also share first call about 4-5 times per month. It can be really taxing at times as you get calls all night, and sometimes get very little sleep. However it always provides some great learning experiences.

My next rotation is Oral Maxillofacial Surgery, then general outpatient ENT, followed by pediatric ENT. I cant believe how fast everything is going. I feel like I just started, but with all i've learned it feels like i've been here for years! 

Graduation and First day at Mayo Clinic

I thought I would have more time during my "time off" after graduation and starting my job... lets just say I was wrong! 

I have been very busy getting settled that I haven't had a chance to update my experience with my final rotation and graduation... So lets summarize quickly to catch up.

My last rotation was at a VERY busy trauma center in Portland. I worked 6 days/wk 14hr shifts... I basically lived and breathed there. It was a great experience and I had the opportunity to do a lot, and get a lot of great exposure. The PAs there work very hard, and they have a lot of knowledge. Needless to say I was happy to be done with the crazy shifts, but I learned a lot and it did go by fast at the same time. 

Graduation snuck up on me very quickly... Before I knew it we were saying the PA Oath and getting our graduation certificates and Masters degrees! It all went by in such a blur... It was such a strange feeling to know that was it; Last week I was a student, and now i'm a PA... Sure I still had to study and pass my PANCE, but school was officially done! It was a love/hate relationship, I already miss my classmates. Its fun to see where they are working, and get excited for the awesome opportunities that they are getting.

I am thinking of dedicating an entire post to PANCE prep and taking the test... It wasn't as bad as I thought it would be, and although I didn't feel 100% prepared (not sure if anyone does) I passed and performed just fine. Waiting for the results was the hardest part I think... just a constant worry all the time! 

Today was my first day and orientation day for Mayo Clinic... what an AWESOME opportunity. It is crazy to think that I am now a PA-C and will no longer be the "student". I will still have a learner role as a fellow... but I am no longer simply a spectator from the sidelines, its time to get my hands dirty! Basically today was just orientation and computer training for the EMR. I have a feeling that things will pick up very quickly... We do have rotations in different specialties in ENT, i'll update the blog when I get my schedule. In the meantime... i'm just trying to get adjusted to the new hospital, schedule, staff... just everything! Great things are coming though... I can feel it. 

PA-C!

I thought I would update everyone that I am now officially a PA-C! I just found out this morning that I passed the PANCE. I will post an update on my final rotation of PA school and preparation for the PANCE in the upcoming weeks. 

Thanks everyone for following along with me during this long journey!