Shadowing shut down, so I brought you into my clinic instead.

Nobody could get shadowing hours in 2020, so I recorded this to give you the closest thing I could. This is part one of a walkthrough of what I actually do as a dermatology PA all day.

I go through the flow of a clinic day, what my patient interactions look like, the procedures I'm doing, and the parts of derm that surprise people. Efficiency is a much bigger deal than students expect, and I talk about how you balance moving quickly with actually taking care of somebody well.

I also answered a bunch of listener questions about the specialty and about becoming a PA in general.

What I cover:

• What a full day in a dermatology clinic looks like
• Patient interactions and how visits are structured
• Procedures I do regularly in derm
• Balancing efficiency with thorough patient care
• The parts of dermatology people don't expect
• Your questions about derm and the PA path

Resources:

Free Application Timeline: https://www.thepaplatform.com/services/free-application-timeline

Free Resume Download: https://www.thepaplatform.com/services/free-resume-download

Pre-PA Counseling: https://www.thepaplatform.com/services/pre-pa-counseling

Pre-PA Academy: https://prepaclub.thepaplatform.com/landing/academy

Mentioned in this episode:

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If you've ever had questions about what my job is like as a dermatology pa, this episode is for you.

This is a part one of two and two will be coming next month, but diving in.

Here we go.

Welcome to the Pre PA Club Podcast.

If you want to learn how to become a physician assistant, you're in the right place.

I'm your host, Savannah Perry.

Let's get to it.

I want to thank mypa Resource and PA School Prep for sponsoring the Pre PA Club Podcast.

So mypa Resource is a personal statement editing service that edits only PA school essays, only edited by PAs.

And most of us have admissions experience, so I am one of the editors.

Definitely check them out if you need help with your content, grammar, flow, making sure that you are on track for turning in your application.

And you can use the code futurepa for a discount on any of their service options.

PA School Prep is an online course that focuses on the anatomy, physiology and med terms that you'll need for PA School to make sure you feel confident going into that first semester and that you are able to handle what PA school throws at you.

So check that [email protected] and also use the code futurepa for a discount there.

All right, guys, welcome.

I'm so excited to have you listening.

So today's podcast is an event, I guess you could say that I did a couple months ago with Archana.

She's one of our Pre PA coaches who does mock interviews.

But she lives in Hawaii, which is so cool.

And if you ever do a mock interview with her, the background is beautiful.

Well, the one that she talked to me on was.

And it was literally her like the beach of Hawaii is her backyard and her view out her window.

So anyway, she is awesome, but she has been holding virtual shadowing events for the past few months.

And so she asked me to come on and talk about my job as a dermatology pa.

So that's what I did.

And I recorded the audio for you guys so you could hear that.

And this session, I would say it's mostly a Q Q A type session.

I talk a little bit of just about my job and what it looks like and then a lot of question and answers.

So I think it should be very helpful to anyone who's interested in dermatology and in just being a PA and what that's like.

So this was very ended up being like an hour and a half or two hours and we had some technical difficulties.

It was the only time that my power has ever gone out and so it might be a little choppy in places because we had to make a quick switch to a different platform and all this stuff.

But I hope it's helpful to you to just hear more about that.

So.

And you know, I'm always sharing on instagram at the PA platform about my job as a derm PA.

I've started sharing a lot on TikTok.

My name there's at physician assistant.

And so those are places you can find me other than this podcast as well as on the PA platform.com and that's, you know, all of our pre PA information.

But if you've made it this far listening and haven't given up on me yet, I wanted to let you guys know about an event that is coming up that I am doing.

Personally, I'm not technically calling it virtual shadowing.

Let me go ahead and give my disclaimer about this.

So right now there's a lot of these virtual shadowing sessions happening and I've watched a few, I've been in a few.

And today, to be honest, they're very similar to what we do on the podcast where we interview a PA and hear about what they do.

And so you can't.

I don't know if that technically really counts as shadowing.

You're not seeing that patient interaction with the PA and what that looks like on a daily basis.

And so I've talked to some schools.

Some schools are considering virtual shadowing as shadowing hours, some schools are not.

That's something that you would definitely need to check on.

So for my event, I'm calling it A Day in the Life We're Going to Start With.

Again, I'll be talking about being a derm pa, but I'm going to do it a little different.

I'll explain that there will not be a certificate or anything, but I would love for you to join me.

It's going to be this Thursday, August 13th at 8pm Eastern.

There will be a replay sent out if you aren't able to make it live.

But I will.

I'll put that link in the description and then I'll be posting it on social media of course as well.

So make sure you kind of check into that if that's something you're interested in watching.

I'll be putting a question box up on Instagram for you to go ahead and send me your questions.

You'll be able to ask questions during the session.

And then to make it a little bit different than this session, what I'm actually going to do is I'M going to bring my schedule from next week from the patients I see on Monday and Tuesday and we're going to talk through kind of what I actually did and saw every single, with every single patient obviously being HIPAA compliant, not talking about specific patient things, but just general, you know, conditions I see and what that's like.

So I think it should be fun.

It should be, you know, a great time for us to all connect and.

Yeah.

So I hope to see you Thursday, but for now you can enjoy this talk from me and Arjuna.

Now, if you are still like, I just want to throw this out there.

If you are in the waiting period and you have not heard back from school schools, I know it's frustrating.

You're probably seeing a lot of people who are getting interviews, getting acceptances.

Just know that it is not too late, it is still early in the cycle and I feel like I have to say this every year, but like, I just want to make sure you know that there are schools that are not interviewing yet and have not contacted anyone yet.

And so don't be stressed out if you feel like you haven't heard anything.

Just keep on going, keep working on your application, then just hang in there.

And so we have all kinds of resources on the PA platform.

You know, you can go ahead and start your interview prep.

We have the free interview worksheet downloads if you go to pa platform.com, sorry thepaplatform.com downloads.

We also have the PA School Interview Guide, the book, and Amazon's actually been running that on special a good bit lately, so you can check on that.

And then whenever you do get an interview invite, we're gonna be so excited for you and we can help you out with the mock interview if you need one.

So, all right, let's get into my discussion with Archna and like I said, this is part one, so be on the lookout for part two coming next month.

I've got a few interviews coming up after this that you'll get in the next few weeks and then we'll do part two of this in September.

Alright, thanks for listening, guys.

And if you haven't left a review yet, I would love a review on itunes.

Let me know what you think about the podcast and I'm here for you guys.

I did enjoy the majority of my rotations and so surgery was my favorite rotation and that is parallel to dermatology a little bit just because, I mean, you're not in an OR in derm, but I'm still doing procedures a lot and so Then I ended up getting my job as a dermatology PA right out of school and sticking with it as far as kind of like, like, what a day in the life looks like as a dermatology PA right now.

When I first started, my schedule was Monday through Thursday.

And then after a while, I went to adding a half day on Fridays.

And then now I work right now two days a week.

It was supposed to be two and a half days a week, but with COVID changing things, we've kind of backed down on our schedules a little bit.

But so right now I work Mondays and Tuesdays.

I've always had a schedule of basically 8 to 5.

Usually my first patient is there at like, 8:15.

So that gives me time to get to work.

And when I walk in the door, always kind of sitting on my desk or my area, there is a folder of pathology.

So any procedures I've done from the previous week, whether it was a biopsy or an excision, I think it just started pouring rain at my house.

But all of that is sitting there in a folder for me to go through and decide if anything needs to be done, what needs to be done with it, and schedule it.

I have a dedicated medical assistant who works with me.

Is anyone a med medical assistant in dermatology or shadowed in derm?

Y' all let me know if you have, because I think it gives you definitely great experience and an interesting perspective.

But so we work together.

I kind of pass that along to her to set up, and then also in there be, like, lab results.

So if I did a culture on anything, any infections, if I ran blood work for either Accutane, which is a medicine we give for acne, or what else we earned labs for hair loss.

People on biologics will get labs done.

All that will be in there for me to go through.

And so then I start seeing patients.

Derm is very, very fast.

And I think that's something that people don't realize when they say they want to go into derm is to work in this field, you've got to be able to make decisions very, very quickly and move, like, move very fast.

Being in my new practice actually kind of slowed down a little bit, because at my first job, I had gotten to the point where I'd built up a really great patient base, and I was seeing around 30 to 35 patients a day in my job.

Now I'm up to about 20 to 25.

And then with COVID that made that less, and we're back up to that number now.

And so as I build up that patient population and continue that, I expect it to get back to that kind of 30 to 35 number.

And that can be a mix of all ages.

We see babies and kids and then all the way up to, you know, elderly people.

I've had patients who are over 100, which is really cool.

And then we see all different stuff.

So my appointment times are.

At my old office, they were 15 minutes.

At this office, they're 10 minutes.

And depending on kind of what it is, if it's like a new patient, it may be a longer appointment and just depending.

But I kind of get to control how my schedule is set up.

So, like, if I want, you know, a procedure at a certain time or all cosmetics at a certain time, I can dictate that a little bit with our scheduler.

And then we.

So, yeah, so what comes in the door?

Medical stuff.

So that's like your acne, eczema, psoriasis, mole checks, skin cancer, follow ups, pre cancer spots, which are called actinic keratosis.

Any kind of rash, any kind of just funky place.

We see hives.

What else?

Hair loss, nail stuff, toenail stuff, cysts, good old, like, Dr. Pimple Popper stuff, but all kinds of things coming in.

And then we have our surgical or procedural side where I'm taking out cyst, I'm taking out skin cancers, doing biopsies, freezing warts, extracting milia.

What else do I do?

All kinds of things.

So pretty much anything, anything I feel comfortable with, I can do.

And then we have cosmetics.

So on the cosmetic side, I'm doing Botox, filler, chemical peels, laser.

That's pretty much it.

Talking about cosmetic things as well.

So I have a pretty good mix of those I save.

I like to have my procedures at the end of either my morning or afternoon to give me time in case those go long.

Last week, I guess it was last week.

On Tuesday, I had a surgery that took, like, way longer than I was expecting.

It was a basal cell in the arm, but the patient.

Oh, I lost power for a second.

Are y' all there?

I guess my.

You're talking about your basal cell.

Oh, yeah.

Okay.

So, yeah, Tuesday.

So for anyone new here, I was talking about my job.

You may have missed some stuff, but.

So, yeah, I was cutting a basal cell out of this guy's arm, and he was on aspirin, and he started bleeding like crazy.

Like, it was, like, cool, which is.

I don't know.

So it was cool because I could, like, actually see the vessel that I Kept, like, kind of nicking, but it was so superficial that to get the skin cancer out, there was, like, no way I could avoid it.

So I basically just had to, like, keep tying it off.

But anyway, so it, like, took way longer than I was expecting.

Usually I try to, like, my procedures take, like, 30 minutes or so, and this one took, like, almost an hour.

And so that's why I like to schedule them kind of at the end of the morning or the end of the afternoon.

I'm, like, really, really big on schedule and efficiency and, like, trying to stay on time as much as possible.

The other thing with kind of my schedule, how it is, is I. I can choose, like, if there's something I want to cut out or if I don't.

So if I don't feel comfortable, if it's too.

Too big or in a bad spot, I can ask if my supervising physician wants to do it.

And if she doesn't, then we'll send out to plastics or general surgery.

But some of the questions.

So am I able to see patients on my own?

I see patients completely on my own.

So I have my own schedule, my own clinic.

For the most part, the physician is there most of the time, but if she's not, like, I can always contact her.

I've had two different main physicians that I worked with, and both of them have been awesome.

Like, really supportive, really great teachers, really great at kind of being there when I need them, but also pushing me a little bit.

So especially when I was learning to do surgeries, the first physician I trained with, you know, she would.

I would be like, oh, I don't know if I can sew it or not.

And she would kind of be like, yes, you can.

I.

There was a. I remember one of ours was, like, a skin cancer right here, and it was, like, in the crevice of the clavicle.

And she was like, you can do this.

Like, you can sew it up.

And I got to, like, the end of the suture.

And she was like, you can do it.

You don't need more suture.

And so just kind of teaching me, with supervision at the time, how to handle different challenges.

So the reason I knew how to tie off a vessel was because I had seen her do it, and she had taught me how to do it.

Can you guys hear me?

But, yeah, as far as how autonomous I am, I. I don't.

Like, I may be.

I don't know.

It depends.

Like, there'll be some weeks I don't ask for help with my supervising physician.

At all.

And then there are other weeks where I feel.

And, like, I'll joke with her.

I'm like, I'm so needy right now.

I'm like a needy PA because it seems like when all the weird stuff comes, it comes at the same time.

But, like, my.

Everyone I've worked with and the physician I work with now, like, she's really cool in the fact that she, like, loves the weird stuff, too, the same way, like, I do.

But what happens in this kind of specialty setting is I get to see all the new patients and the triages where she's seen a lot of the skin checks.

So if someone has something weird going on, it's gonna come to me.

And she's always like, I'm so jealous.

Like, you get to see all the fun stuff.

And so if.

If something is weird or different, I do try to pull her in.

Especially, like, I think in our setting, because it's me and another PA and the doctor.

If something, like, really weird is coming in, that may have to be seen more in follow up, since I'm only there on Mondays and Tuesdays.

I also just want to want other eyes on it so that in case they have to follow up with that patient, they know what they're looking at or what to expect.

And.

And our.

We all kind of do that.

So if something is coming in that it's like, okay, this is a little different.

We're probably gonna have to see you, you know, fairly often.

Or if you have a flare of something, we're gonna have to, like, work together on this.

I want.

We all want to be on the same page, but as far as, like, going in every room with me, definitely not.

Actually on Tuesday, when I had that patient, that was difficult.

We were all supposed to be going to lunch together, and everybody else had already left.

So, like, I got to lunch really late, and they had just ordered food for me, and my daughter's like, oh, you were still there.

I didn't know where you went.

I thought you went home.

And so it's just funny.

But, yeah, we all kind of do our own thing.

Can you start your endurance practice?

PA practice?

And if so, how?

That's dependent on the state.

In Georgia, you as a pa, you cannot start or own your own practice as a PA in other states, like Florida and California.

Erin Jensen with the treatment, owns her own, like, cosmetic practice in California, and there are a few in Florida with that.

You do still have to have, like, a supervising physician overseeing things as, like, a medical director.

But that doesn't Again mean that they're necessarily like in the office with you all the time.

So that's not something that I'm at all interested in.

What are some challenges that you face day to day?

Are there patients that give you a hard time by saying they want to see physician instead?

Okay, so the second part.

Sometimes, not often.

I mean, I can maybe, I've been there since September and I can maybe think of like two patients who didn't want to see me.

And a lot of times, you know, they've already seen the doctor before.

Or what I always say is, you know, if somebody has a bad experience with a pa, they're never going to see a PA again.

If they have a bad experience with the doctor, they'll go find another doctor.

And so it is kind of up to us to make sure that we are doing the best we can and, you know, trying to help patients to understand what PAs do.

But yeah, and I don't, I don't really care.

I don't get offended.

If they want to see me, that's fine.

Or they want to give me a chance, that's fine.

If they don't, if the doctor's there, they're welcome to wait for, for her, which will probably be a very long wait.

But she is great about like making sure she sees anyone who wants to be seen or rescheduling to be with her.

And, and both of those things have happened.

So, yeah, not a big deal as far as day to day challenges.

No, I mean, I think I, I feel fairly at this point after six years, like confident in my practice, but I think staying on time.

Somebody commented on the last one I saw there, like 10 minute appointments, which does sound crazy.

But you have to think like in Durham we do get people who come in who are like, I want my whole body checked and I want to talk about skincare regimens.

And then sometimes I get this rash and my foot itches and so like that's going to take more than 10 minutes.

But then we also have the patient who is literally like, what is this spot on my arm?

And I tell them it's nothing, it's benign, it's fine.

They're like, okay, bye.

And so those things even each other out a good bit.

But yeah, so what am I challenging is staying on time, trying to keep a positive attitude throughout work.

There's always going to be kind of complications at work or, you know, people who don't always get along or, I don't know, I don't really get involved in any of That I just go to do my job, you know, medicines.

I think that is challenging.

Trying to figure out where to get the cheapest medicine and what insurance is going to cover, what's not going to cover.

Like, I feel like we're constantly double checking all of that and then half the time we think we did it right or what they're going to cover.

And then it changed yesterday.

Now it's something new.

And so that gets a little frustrating.

But that's in, I think probably all of medicine that happens.

It's just kind of how the system is.

It's very frustrating when a patient can't get a medicine that they really need because insurance dictates it.

And that's very frustrating.

And then I think the other thing about derm that people need to realize is there's a lot of things that we take care of of and we see that there's no cure for.

So like, if somebody comes in with eczema and they want to know, why do I have this now?

Can you tell me where I got it from?

Or is it ever going away?

So a lot of things I can't cure.

It's never going away.

I can make it better, but I can't make it go away.

And then also I can't tell you why you have it.

It just for whatever reason your body changed, you're not the same as you were even six months ago.

And so your skin is not the same either.

That can be, I think, frustrating to patients to hear because they want an answer.

And skin's a little different because you can see it.

You can see what's happening on your skin versus like blood pressure.

You don't see that happening or you may not even know it's a problem.

So that's kind of unique to skin.

Right now I'm seeing around 20 to 25 patients a day.

I learned, I guess you would say I learned my skills and procedures on the job.

I did a lot on my surgery rotation.

That's where I really learned to suture.

And my surgery preceptor is the one who actually got me my job in dermatology.

And I don't think he would have made that recommendation if he didn't think I was doing a good job.

And he actually gave me a good bit of freedom.

So we did a lot of breast cancer surgery on that rotation.

So a lot of times, like we would work on one side and do what we needed to do and then he would let me close and like finish up and suture after like a mastectomy, and he would go and start on the other side.

So that was pretty cool that I really did get that kind of first assist experience.

And I do feel like I learned a lot of skills on that rotation emergency medicine.

I got to do some procedures and learn and practice some skills there.

And then I did my last two electives at my first derm job.

So I did a lot of training there as well.

But I will say, like, when I started, after about six months, I told my supervising physician.

I was like, listen, I really want to be able to step into, like, a surgical role and do more surgeries.

I want to feel comfortable with that.

And she was pregnant at the time and going out on maternity leave in the fall.

So I was like, it would be helpful if I'm able to do some of these surgeries versus when you are out for three or four months, having like a ton to do when you get back.

And so for a good six months, we blocked my schedule when she had surgery so that I could be in the surgeries with her and really get that hands on experience.

To make sure that we both felt comfortable with that.

I also learned Botox and filler on the job.

They brought in trainers.

The company will send trainers out to practice with you.

And we'd have patients come in.

Usually my mom, she did not necessarily appreciate that as much as she should have, but I was.

You know, I remember the very first time I learned filler, I was poking her so many times, and the trainer was like, okay, put a needle in.

Okay, take it out.

Put the needle in, take it out, put the needle.

And like, I mean, I probably stuck her like a hundred times, and she was all bruised and it was bad.

I'm a lot better now.

But that first, first experience, she looks like, I'm not telling anyone to do this, but she.

I like to have her as my guinea pig.

Okay.

What do you find challenging or struggled with about derm?

So, I mean, coming out of school, I did not get a lot of derm practice at all.

So we had two weeks of derm in clinic, then that was it.

And so it was a lot of, like, on the job, on my own learning.

And then I think at first there have been different things I struggled with.

So I struggled with pediatric skin.

And I would say I still kind of struggle with that.

I struggle with skin of color, but I feel pretty confident in that now just with what I've kind of taken initiative to learn on my own.

And then psoriasis was really hard for me at the Beginning too.

But again, I feel like I feel comfortable with that now and it's just how much you see things and then again taking that time to ask about it and learn about it and research it.

And derm conferences are great.

Like they, especially the derm PA ones, I mean they focus on pearls, focus on like really good applicable information.

So I went to a bunch of those at the beginning that were really, really helpful.

I.

Okay.

Do you feel like in order to get into a certain specialty like Derm, somebody needs to have derm experience prior to being a derm pa?

I don't necessarily think that.

I mean my only experience was shadowing in derm.

I don't think I would say that that helped me very much except for being able to show that I was interested in it.

It's more, you know, location, timing.

I was able to step into a role of a PA who was leaving.

If you're in a bigger city, it's going to be more difficult because that area is more saturated with experienced PAs, whereas I'm in like a suburban area.

So it's a little bit easier.

There's a lot of factors, but the jobs are out there and you just have to find someone also who's willing to train.

Whereas know, my first job, they were willing to train me and take me on as a new grad versus my second job.

The doctor I'm with now, she did not want a new grad.

She wanted somebody who was ready to go, who's experienced.

So it was very different when I moved into that job.

I, I mean, I think I shadowed her for like a week or like three days.

And then we started like filling my schedule with patients versus the six month training that I had at my first job and slowly kind of letting me go.

And of course she reviews my notes and she, I mean, would kind of write notes if she had any recommendations.

But it was kind of cool after, I guess I'd been there a few weeks, a month and started to really see patients.

She was like, you're well trained.

Like I feel confident and like she knows the doctor I worked with.

So she knew that I had good training.

But like seeing it in my notes, she was like, you, you're knowledgeable.

I feel comfortable with what you're doing.

So if you, and like you're asking appropriate questions, all that stuff.

Okay, the transition between PA school and starting work.

And were you lost when you first started working?

Absolutely.

So it was like.

And I don't know how you felt.

Arjuna.

Like I, I was exhausted, like I would go to work and study all day and learn and stuff.

I would come home and I would sit on the couch and say some more and I would fall asleep.

Like, if I.

The second I sat down on the couch, I did not get up.

And so I just was so tired.

Like, my brain was tired.

And that was, that was like a good six months and just like learning so much so quickly.

And then I, after about six months, I started to feel a little more comfortable and like got into my groove and started to feel kind of confident in my knowledge too.

So that was, was more helpful.

So.

Same here.

It was, I think the transition between like, PA, school and work is.

It's just a weird one because you're so used to being guided and you come out of rotation.

So you know that whatever you do, if you screw up, somebody's going to pick up after you.

Like, you kind of have that safety net.

And not to say that when you work as a pa, you don't.

But you definitely, I mean, you, you shouldn't work with this assumed safety net as a PA because you are often the only one you're ever going to see.

Yeah.

I mean, some people, like, when I was working in my sleep clinic, they didn't even know their supervising physician.

Like my supervising physician, because she doesn't see patients in the clinic.

She doesn't even live on this island.

So, like, that was one thing that I struggled with when I first started working was learning to transition from being the student to being the provider.

Like, you have the final say.

What you say affects the.

This person's life directly.

And it's a lot of pressure to put on yourself, but it is what it is.

I mean, you're a PA at that point, so.

Yeah.

And then, yeah, of course, like coming home and learning to like, I don't even know to how long it was horrible.

And then in between patients, you're also studying in between patients because you're like, oh, yeah, I remember this one thing from Pants Prep Pearls.

My school never touched on it.

So let me go back and review it, you know?

Yes.

I'll tell like a really embarrassing story.

Like my.

This is so embarrassing.

My doctor, like, when we were learning, when I was learning, she kept saying things like when we were in rooms and stuff, and she'd come out and say, you know, this could be lichen planus or lichen sclerosis.

And I was like, okay, those are good things.

Like, I'll look them up, blah, blah.

And it took me a probably a good month before I realized that she wasn't saying, like, in sclerosis, like, L, I, K E space, I n. But like, the word lichen is a derm word.

L, I, C, H, e, N. Like, she was describing a disease called lichen planus.

And I thought she was just talking about something called planus.

And I realized, I told her I was like, I'm so dumb.

I'm so sorry.

And.

But I mean, it was funny, but it wasn't funny.

So.

Yeah.

I mean, you're just like, coming out of school, you're just kind of dumb.

And it's okay as long as you know what, know your limitations.

And that's really important.

Yeah.

And even now, like, I mean, I'm six years out, and sometimes I.

So when I bring my doctor into the room, it's not like I'm bringing her in.

Like, I have no idea.

I'm bringing her in like, okay, this is what I'm thinking.

This is where I think I need to.

To do next.

I just want your thoughts on it.

And, you know, so like, even recently, I had a patient who had this, like, weird crusting on the side of her face and a history of skin cancer.

And so I had biopsied it once and it came back negative, but it just kept getting bigger.

And so, I mean, if something's not going away and keeps going bigger, we automatically think cancer.

So I was like, I just need you to look at this.

Like, I feel like I've treated appropriately.

I don't know what's going on.

I don't want to keep cutting on her unnecessarily.

So she came in and looked at, and she was like, no, I think it's cancer too.

But, like, we need to do another biopsy.

But I was like, I have this other thought.

I've seen one time.

It's called erosive pustular dermatosis.

Do you think it could be that?

And she was like, I don't think so, but, like, maybe.

And so we biopsy, and that's actually what it came back as.

And so, like, that felt really good to me that I identified something that is fairly rare and maybe see it once a year, if that.

And so, like, we, like, we just.

It's better to have conversations about things.

And I just would always rather her look at.

And she would too.

And she tells me, and my supervising position is also really cool because she'll say, like, I don't expect you to make the same kind of decisions I would make.

Like, she is maybe sometimes willing to take More risk.

Or, like, treat something without biopsying it because she has more experience, and she can do that, but she doesn't expect me to do that.

She expects me to use my judgment.

Yeah.

And doctor, recognizing that, like, we're not.

We're not on the same level, you know, the training does differ.

And, you know, I think, like, I don't know.

Do you, like, have conversations with your husband when you come home, like, about treatment plans?

Like, I do, too, and yours is a.

Your husband's a hospitalist.

Right, Right.

And that's what I was gonna say.

Like, we probably have a different view, because I think there are PAs out there who are like, oh, it's the same as med school, just quicker.

And it's not.

It's not.

It's not.

It's different training.

It's a different job.

Yes, we do a lot of the same things, but it's different.

It is.

It's different.

But, yeah, I have to agree, like, knowing your limitations is huge because you don't want to be, like, a rogue pa, Especially when you first start.

Like, you don't want to be that PA, you know, and.

And you'll meet PAs who are, you know, and they're brilliant, and they're great at what they do.

But it.

A lot of that comes with, like, practice.

Like, I don't have the full confidence yet that I feel like, you know, when I'm six years in, like, Savannah, like, that confidence builds.

I'm two years in, you know, and so there's a lot as far as confidence that I just don't have.

But you have to know your limitations.

Like, I'm not afraid to call my supervising physician ever.

You know, and some specialties just with, like, doing, you know, working in different specialties, like sleep medicine.

I never call my supervising physician.

Like, when I say never, I mean.

I mean, like, once every six months, maybe.

Like, never.

You know, I mean, it's.

It's cut and dry.

It's straightforward.

You see the same, like, four types of patients, but, like, urgent care.

Yeah.

I mean, I.

You want to make sure you don't miss something.

And I've, like, shared my stories with you guys before, but, yeah, you just want to make sure you don't miss anything, so.

And they appreciate that, too, because their license is also on the line when you're practicing under them, so.

Yeah, they do appreciate it, too.

Yeah.

Yeah.

No, I completely agree.

Okay.

I'm gonna keep going through the chat.

Okay.

Oh, how do you handle patients that speak a different language?

I'm in Georgia.

Thankfully, my supervising physician is fluent in Spanish, so she takes all the Spanish patients, which I am so appreciative of because my Spanish is extremely rusty.

But if it's someone else, like.

So I've had a few patients who speak languages other than Spanish.

We just do the best we can.

A lot of our patients are good at bringing someone along to kind of translate for them, which is helpful.

I've used Google Translate, writing things down, making sure they have, you know, handouts to look things up so the skin I can see it.

So even if I can't explain or they don't understand exactly what I'm saying, I can provide, you know, written information.

Usually if they point to what they have, I can figure out what it is and then provide them information to go look up and like write out instructions, what we need to do.

And then they may have someone at home who can translate or they can go use a translator app or something to look it up.

Do I think I'll only work in Derm?

I don't know.

I like derm.

I don't plan on changing it.

Someone, the next question is, if you were to change your field of split specialty tomorrow, what would it be and why?

I think I would still try to do something like surgical or procedural.

I love the or and I would not mind getting back in the or, but a lot of times the schedule that comes with that is not favorable.

And I have a two year old and so I do like to be home and able to see her.

And so yeah, I think I would change it.

It was nice, you know, the ability to change specialties.

When my husband was applying for residency because we maybe would have had to move and if we did, I really wasn't worried about it.

I knew I could find a job somewhere else even if it wasn't Durham.

So that was kind of a nice little perk.

Do you do surgical things on often?

Yes, like a lot.

I just, I. Yeah, I do them pretty much every day.

Do I ever wish I went to medical school instead?

Not medical school.

I can't say I've ever wish I went to medical school.

But there have been a couple times where I wish I had the residency experience.

Like I remember a few cases with where something weird came in.

I went and got the doc and she came in and she was like, oh my gosh.

I saw this one time during residency and it made me go, oh my gosh, I wish I had residency.

But like when I really think about it and think about kind of the Years out and everything.

I guess I kind of considered like those first few years as a residency where I was definitely.

And even now like still learning and still seeing new things.

So it's kind of more of a self driven thing.

But yeah, that was really, that's really the main thing.

But as far as like being a doctor, I, I really don't wish that, especially now that I have chosen to have a more flexible schedule and be part time.

I think even making that decision with being a PA and everything that's invested was difficult.

But I think if I had gone to like medical school and residency, first of all, I'd only been out for like I year versus six years and I think I would feel somewhat guilty and that I needed to, you know, work more and more and more.

So luckily I don't feel that way.

Has there ever been a time that you felt uncomfortable or the patient felt uncomfortable when the problem is in a personal area and you have to take a look.

What did you do?

Yes, I mean, we have to look at everything everywhere.

And I wouldn't say that I feel uncomfortable just because I'm so used to it.

And sometimes I actually have to remember, like, oh, this patient, you know, probably feels uncomfortable because I am used to looking at different stuff and like the naked people, like all day long.

And so we give them a gown, we try and make them as comfortable as possible.

But ultimately, like I explained to the patient, I can't if it, if it's on your skin, like, I can't tell you what's going on if I can't see it.

Because they'll want to say, well, there's, there's bumps and it's itchy and it's red.

I'm like, okay, well, like, I really need to see it.

There's a lot of things that have bumps and are itchy and red.

And so like, if they, you know, refuse or don't want me to look, that's fine.

But I can't make a diagnosis on something I can't see.

But yeah, I'm sure pretty, pretty used to having to look everywhere.

That's a good question.

Have you experienced any burnout?

Whether in PA school or practicing now?

How do you stay positive and motivated?

This is something actually me and one of my good friends who is in my class who's a pa, we're talking about last year because she went to AAPA with me in a kind of a hot topic there.

It was also right before I kind of made the switch to part time and we both at that time, which was like last May, felt like we were experiencing some burnout.

But burnout, I feel like, can encompass a lot of different things.

And it's not always necessarily the job itself.

Sometimes it can be more of a job setting.

And I think in any job, you're gonna have frustrations and stuff, but ultimately, like, if you're not happy or not feeling valued in a position, it may be time to leave.

I really loved my first job.

I loved the doctor I worked with.

My ma was my best friend, and it was great.

But over time, I started to feel some.

Some of that way, like, just not.

Not as connected, not as.

As heard when issues came up.

And part of that came from, like, growth of the practice too.

And so that led to me kind of feeling more stress and more overwhelm and frustration.

And also my medical assistant at the time, if you follow me on Instagram, you've heard me talk about our Taylor.

She got into PA school, and so she was leaving, and she was like, part of what made me love my job because we had so much fun together.

And I was scared to leave because I did like it so much, and I wasn't sure if I could find another job.

But when I decided to go part time, they weren't able to accommodate that schedule for me.

And so I did have to make the decision, you know, my family or this job, knowing that I may not be able to stay in Durham.

And ultimately I chose my family.

But it was.

It was pretty cool because I turned in my resignation on a Thursday, and by Friday at 1pm I had a new job at this new office where they are awesome.

They.

The doctor we met, we interviewed, and she said, you know, you have a great reputation in town, and we would love to have you.

You make your schedule, you tell us when you want to work, which was like a godsend, like, exactly what I was looking for.

And really, really, really cool.

So that goes to show you that, like, having experience is very valuable as a pa and like Archena said, like, you don't want to be that rogue PA with a terrible reputation.

Like, we all, like, you probably have people in your mind.

I have people in my mind.

Like, you don't want to be that person.

And every specialty, like, just with, like, your case, Savannah, you know, every specialty has a niche.

So if you've, like, created this image of yourself and your pa, your patients speak volumes.

Like, those are your biggest advocates or your patients, right, who have had a good experience with you.

And if you.

If you're able to Share that.

I mean, word gets around.

Like Savannah, you know, this new office, new of Savannah.

I mean, how does that happen when you're at it?

This is a competing office, right?

So how does that happen?

It happens from, from doing what you do and doing your best at it.

And the burnout thing.

Yes, I second you on that, Savannah, is that it is like for me, as a lot of you guys know from previous sessions, like me leaving my sleep center job was.

And it's not even leaving.

Like I say that I haven't fully left yet.

I'm having a hard time with it, but I am.

There is going to be an end date.

I don't know when, but it's happening.

But it's burnout.

It really is.

It's a lack of appreciation.

You know, it wasn't always like this.

You know, I think another thing is to be careful is I've mentioned this before.

You guys have to, you have to know your value as a pa, right?

Like just because you're not a physician, you're not worth less than them.

Like you're more affordable.

But that doesn't make you worth less, if that makes sense.

Like you're just as valuable to a practice.

They're gonna make more money if they have you, as opposed to a physician that's doing the same thing as you.

I mean, there's a lot that you bring to the table and you have to know your worth.

And with, for me, I think they knew my worth before and you know, in the beginning.

And I think over time you get comfortable and you forget that this person really is doing, doing everything without me.

There is no provider on Oahu for this place, you know, for this practice.

And so you have to know when, when it's time.

And it was time when I would come home angry every day or like crying every day.

Like it's time and it's, it's not a high stress specialty.

That's the biggest thing you have to think about, like, am I working in like, you know, I'm not doing trauma, I'm not doing er, I'm not doing oncology.

Like, I'm not doing these big like emotionally taxing things, you know, on a day to day.

And so why am I stressed over sleep medicine?

You know, there's really no emergency.

So that's when I recognized it.

And clearly I'm having a hard time saying no, but it's gonna happen.

Well, I, I wanted to leave or do something different for a year.

It took me a whole year to decide.

Yeah, but yeah, And I, like, I'm completely with you there.

I mean, you feel.

So this is what I learned.

You feel.

What's the word?

Like, dedicated to a place.

I think, like, you feel.

Yeah, like, you feel dedicated to your patience, to the place, to everything.

And I guess, kind of, like, indebted, but that doesn't mean they necessarily feel that way about you.

So.

And I learned that, you know, I thought, you know, I'm irreplaceable, but I was very replaceable in a matter of two weeks.

And so, like, that is just.

I. I just don't think you necessarily should stay somewhere that.

That you feel that way because.

And.

And I was, like, you, like, coming home, very frustrated all the time.

And it was like.

It clicked for me that this was, like, a really great decision.

When a couple months in, my husband was like, you don't complain anymore.

Like, even if you're, like, working with a different medical assistant.

Like, I was like, oh, my medical assistant's out.

He's like, but.

But you're not complaining.

Like, you're not upset about.

I'm like, yeah, it's different.

And so, you know, just.

Yeah, when other people notice, that to me, is like, a big deal, because I'm all about, like, having fun at work.

Like, I don't think work should be a stressful thing.

Yeah, you do.

You know, you have to love the environment you're putting yourself in.

Every day you're spending.

Most of your day is spent in that environment.

So if it gets.

I mean, mine became toxic, like, to say the least, you know, it's hard.

I mean, it's really hard.

I will say for you guys who don't know much about telemedicine, telemedicine also helps with.

With this.

Like, I'm doing what I love right now, and that's probably why it's harder to leave, because I am doing it from home.

So I'm out of that physical environment.

And I think mentally it's made a big difference.

It has.

I'm still seeing my patients, still doing something I love.

But with urgent care, now it's just getting too busy, you know?

Now life is just getting too busy.

Yeah.

Too much going on.