One week of nights on. Two weeks off. That's her whole schedule.

Kristin Burton is an overnight pulmonary and critical care PA, and when she told me her schedule I made her explain it twice. A week of night shifts, then two weeks off. It's a completely different way to structure a career and a life.

We get into what she's actually doing on those nights: the kinds of patients in the unit, and the procedures she performs, including intubations and central lines. This is a high-autonomy role, and she talks honestly about how that independence works alongside a collaborative team.

She also came to critical care from cardiology, which is a good example of the specialty flexibility people talk about but rarely illustrate.

What we cover:

• A one-week-on, two-weeks-off night schedule
• Patients and pathology in pulmonary and critical care
• Procedures like intubation and central line placement
• Autonomy as a critical care PA
• Switching from cardiology to critical care
• What she'd tell students interested in the ICU

Resources:

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

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

PA Program Map: https://www.thepaplatform.com/pa-platform-map

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

Mentioned in this episode:

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Hey guys, Today we're gonna hear from Kristen who is an overnight critical care pa. She has a really cool schedule and she's just really awesome in general and so you're gonna get to hear about her career from when we did our virtual shadowing.

Alright, 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.

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

So my PA 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 Future PA for a discount on any of their service options.

Happy New Year again everyone.

Welcome to the Pre PA Club Podcast.

Since it's a new year, I'll do an introduction.

I am Savannah Perry.

I am a dermatology PA in Georgia and I am the creator of the PA Platform.

Now if you're kinda new here, the PA Platform was a blog I started about five years ago once I was done with PA school and getting started in my job to help other students with figuring out all the ins and outs of the very complicated PA school process.

So it's really been cool to see how it's grown over the past few years into just a really great community.

We are on social media, I'm on Instagram, the PA platform.

I post there all the time on TikTok physician assistant and we have a Facebook group called the Pre PA Club this year.

Something that's new.

Actually haven't really talked about or announced this yet, but I'm going to be posting a lot more videos on YouTube trying to answer more questions and show you guys more things like with CASPA and how to research things.

I just really, I enjoy helping show how to do things and that's sometimes a little bit hard through a podcast or through like a 15 or 30 second video on Instagram.

So be on the lookout for that and go ahead and subscribe.

The link is in the description.

If you're listening to this episode and it's just YouTube.com thepaplatform I may try to put some of that onto the podcast too.

If you're not really like a watch video type persons that you're still getting the information but some of it like walking through CASPA or researching programs will just be easier to show you on a computer or wherever you're watching it.

Or I can do it on the computer.

Sorry, that was confusing.

All right, so if you attended the pre PA conference last weekend, thank you so much.

It was a blast.

Eight hours of intense information, some awesome panels.

I hope that it was helpful to you.

I have a of lot a bunch of questions that came from that to answer.

I'm probably going to devote some podcast episodes coming up to just answering those questions to make sure that we are able to cover it and get everything answered.

But I hope you enjoyed it.

If you did not get to attend but you would like to, that will be up on prepacourses.com where you can get the replays if you did not initially register for the conference.

One thing we announced at the conference is that in April we will be doing a four day CASPA application boot camp.

It will be April 12th through 15th.

In the evenings again there will be replays but I'll tell you more about that as it gets closer so that if you are applying this cycle and want help walking through that application process, we will have that planned out to kind of make sure you're on track.

And that's where we'll really get into like personal statements more and interviews and all that fun stuff.

So today's episode is kind of a flashback to a virtual shadowing I did in October with Kristen Burton.

She is a critical care pa. She only works nights.

Her schedule is really cool.

She works one week on and two weeks off off.

We talk a lot about that, a lot about what she sees and so you're going to hear about that.

This will also be on YouTube if you would rather watch it.

Kristin in her downtime does financial coaching so her Instagram is strive with Kristen and her post if your New Year's resolution is like I need to save money and budget and get my act together, she will make you do it because her posts are so inspiring to put back that shirt you were gonna buy and invest that money instead or save it.

So I definitely recommend following her and all of her information will be in the description of this episode as well.

One last announcement, I think I talked about it last week, but the link to sign up will be in the description as well.

The show notes on January 19th at 8pm, I'm bringing back the monthly webinar series starting with Talking about Experience.

So we'll be talking about personal patient care experience, healthcare experience, shadowing, volunteering, answering questions about that and It'll be, I hope, in a fun format.

It'll be similar to the conference, but I think we'll have it where you can raise your hand to speak and we can have some conversations around that.

And so that will be on January 19, 8pm it is free.

You just have to sign up so that you get emailed everything and then you should be good to go.

But let's jump into hearing from Kristen and I hope you enjoy.

Thanks for tuning in, y'.

All.

I'm very excited to have all of you here and introduce you to Kristen, who I met on Instagram not that long ago.

Yeah.

And we have recorded a podcast that you guys will be able to listen to next week, which is going to be more about financial stuff because she is like a pro and you can learn a lot, which we can get into some of that tonight too.

And she has a really cool.

I mean, I'll let you tell them about it, but a really cool financial course.

Like, I think everyone needs a financial literacy course in their life and we don't really get those.

So don't wait till you are 30 year old.

30 Years old.

Like me to do it.

But we put that in the offer tab for you and I don't know if you want to say more about that.

And then I'll go over some like, housekeeping stuff.

Yeah, sure.

So my name is Kristin Burton.

I'm practicing pulmonary critical care Pack, but I also own a side business.

It's a financial coaching company that sort of was founded out of my horrible situation that I found myself in with student loan debt when I finished PA school.

And I just recently launched an online course.

So in the wake of COVID it's been difficult to meet with people face to face.

So I decided to try the online course approach to meet more people sort of where they're at.

Awesome.

Well, that is in the offers.

And make sure you use that code PA promo to get 20 off of that course.

And it is coming out very soon officially.

It's in like the pre launch right now, so.

All right, I'm gonna go over some housekeeping.

Where's my little thing?

So if you let me know where you found this event, if it was Instagram or who knows where.

I don't even know where else.

The pre PA club on Facebook, maybe YouTube because we posted some of the old ones there.

Tick tock.

Wherever.

Let us know kind of where y' all are coming from.

The email list.

But I'm Savannah.

I am also a pa.

I work in dermatology.

In Georgia, and I do the PA platform, which is my blog that I talk about all things having to do with pooh, pre PA stuff.

So I'm very happy that you guys are here.

Thanks for watching and tuning in.

Also, in the chat, which this is going crazy now, tell me if you are pre PA or about to start PA school or a PA student.

Kind of let me know what stage you're at right now.

Actually, probably the easiest way that would be a poll.

So I'll put a poll up so y' all can tell me.

Yay.

Maybe we even have some PAs in here.

Who knows?

I know that probably doesn't have, like, all the options, but let me know where, where you're coming from.

All right, so.

And if you've been accepted, that counts as PA school.

All right, so as far as what this event, you know, there's been a lot of talk about virtual shadowing, which is kind of what this falls into, because we're going to hear from Kristen a lot about her job and what she does and kind of learn about that, but it's going to be different than if we were actually at her job with her.

So in my mind, you know, this is different than a real shadowing where you are able to get in there and kind of see how PAs interact with patients and other people on the healthcare team.

So I think it's a great information source, but it's not a substitute for shadowing.

So we aren't doing any type of certificates with this because when you really shadow, you don't get any kind of certificate.

We're also not able to validate this as part of far as if we were contacted because we can't say 100% whether someone was here or not or here for the whole time.

And so you can list it on your application.

How you do that and where you do that is up to you.

Some people are doing extracurriculars doing shadowing.

Whether or not the school accepts it is also going to vary.

So I do recommend checking with a school before, before you decide to list virtual shadowing on your application.

But again, just you're gonna hear a lot of information.

So this will be sent as a replay link.

I believe it goes out in 24 hours.

So you will get the link to the replay and then we'll try to get it up so you can watch it too.

All right, so if you stick around to the end, I will tell you about two other events coming up, or I'll probably post them on social media at some point.

But if you want kind of the inside scoop, we'll make sure you get that.

All right, so I think to start, Kristen, let's just hear about kind of what.

What does your job look like?

What do you do?

Yeah, so I work, technically, I work in pulmonary critical care, but I work nights, and I have a schedule that I actually really love.

I work seven nights on and then 14 nights off, 12 hour shifts, which, believe it or not, is actually considered a 1.0 FTE and full time, which sort of feels like it's cheating.

It's a lot of time off work.

So because I work nights and I only work in the hospital, I really don't do a lot of pulmonology.

So I would say, like, probably 85% of my job is just critical care with a little bit of pulmonology sort of sprinkled in.

So I came to this position that I'm in now from the same hospital from doing cardiology, which at that time I was mostly inpatient and a little bit of outpatient.

So it wasn't, you know, a ridiculous transition to go from seeing inpatient cardiology patients to doing inpatient critical care.

Interesting.

Okay.

So that is so different than what I do in my life.

Very different jobs and very different roles.

All right.

And if y' all have any questions, put them in the chat.

We have a list that we gathered ahead of time.

Time.

But we'll try to get to as much as we can.

So in.

So what would a typical night look like at your job if we were really shadowing you?

Okay, so I get there.

I have a colleague who is another pa. She works with me at the same schedule.

We work every shift together.

And then there is a critical care physician who is on backup call.

So they're there in house, in the hospital when we get there from.

They cover, like, a short evening call shift.

So the beginning of my shift is basically getting rapport on incoming patients, who is really sick, etc.

And then the whole shift is cross coverage and new admissions and consults, I guess.

So basically, you know, our whole pulmonary critical care service in the hospital, we have a list of, you know, X amount of patients.

So any question from any nurse on any of the patients gets called to our call pager.

And then any new pulmonary critical care consult or admission in the hospital, we have to do.

So it may come from the er it may just be an ICU admission, or it may come from someone who decompensated on another unit.

But that's essentially the job.

It's Cross coverage, putting out fires and doing new stuff, which is really different from other things I've done before.

And most hospital type of jobs are, which are a lot of rounding.

Like you have a list of patients, you see everyone on your list each day and sort of move them through their hospital stay.

Just because I work nights and not days, my job is actually quite a bit different from that.

Interesting.

Okay, so someone put in the chat.

What is critical care?

Are we talking just like ICU type patients?

So the way that ends up in my hospital is it's really anyone that the internal medicine team feels is critically ill.

So they don't have to be in the icu, they can be in a step down unit.

We don't often have floor patients.

So if you're not familiar with like the hospital hierarchy, there's icu, there's step down, which is progressive care, and then there's the floor, which is like med surg.

So we don't often have med surg patients, but I would say all ICU goes to us and then step down.

Just depends on if internal medicine thinks that they're appropriate or if they think that they should be taken care of by the critical care service.

Okay, cool.

So in a. I don't know if this, if you can even answer this, but on an average shift, how many patients are you taking care of?

So it varies dramatically.

Honestly, summer is slow as compared to like a global pandemic or flu season.

So it wildly varies.

But I would say probably the most new admissions I've gotten at an IDA is 13 or 14.

But when you factor in 50 to 100 pages, occasionally multiple codes, and then 13 admissions of people who are critically ill and may need procedures done, it's actually a lot of work.

Even though 13 maybe doesn't sound like that much for a 12 hour shift.

Yeah, it does sound like a lot of work.

What is your favorite part about your job?

You can say the schedule, because your schedule is really good.

I love the procedures, honestly.

I do a lot of procedures, which is one of my favorite things.

And then honestly, the other thing is probably just like the acuity.

I am kind of an adrenaline junkie, I guess.

So I really like that, like, you know, this patient's massively decompensating right now, we have to intervene.

So I love those moments.

So probably the true blue critical care when it does happen and then that.

And the procedures, what kind of procedures.

Are you typically doing?

So I have privileges for central lines, central venous lines, arterial lines, intubations, chest tubes, thoracentesis Although I do not routinely do thoracentesis at night.

Not really an emergent procedure.

And I do only test tubes in the emergent setting.

You know, in general, all procedures carry risk, so I don't run around at night doing unnecessary things.

But.

So I think probably 85% of my procedures would be central lines, arterial lines, and intubations.

Okay, so are you.

What's your role in, like, a code?

Are you running the code or.

Yeah, yeah.

We don't have.

Like I mentioned, our intensivist is on backup call, so they're not in house.

And occasionally somebody from the internal medicine team or the family medicine team will come to a code, but they tend to defer to us just because we do it much more often than they do.

Okay, what about somebody asked, do you use bedside ultrasound a lot?

Yes, all the time.

Love it.

It's one of my favorite kind of tricks.

So if you are into point of care ultrasound, critical care is a great place to be.

It's becoming really the standard of care to have point of care ultrasound available to you.

And at least where I've worked, both the critical care service and the emergency department tend to use it a ton of nice.

Okay.

There's a lot of, like, just kind of.

Kind of straightforward ones coming through.

But do you.

Somebody asked, do you work closely with respiratory therapists, and if so, what does that look like?

Yeah, so the role of the RT in my experience varies really dramatically depending on the hospital.

I've done moonlighting and worked at smaller outside sort of hospital settings where the respiratory therapist don't do a lot in terms of vent management or airway management.

But at my hospital, they do so especially on vet management and airway stuff.

We work very closely with the rts.

Okay.

And somebody asked, what's the meaning of code?

That's when a patient is not doing well.

Like on tv, when you'd see them, you know, doing CPR and medications, probably the best way to do it.

It's not like it is on tv.

Not like tv.

I get it.

That's probably the only time you've seen decode happen.

Like they call the loudspeaker.

Yeah.

I don't even know if it's blue.

A lot of people want to know why, why you chose this particular specialty and how long have you been in this specialty?

I've been at this job almost two years.

And like I said, I came from cardiology.

I picked this honestly because of a.

The procedural abilities.

My previous job, I like.

I love cardiology med, but wasn't an option for any of their advanced practice providers to do procedures.

So I wanted the procedures.

I felt like in a subspecialty I was losing a little bit of the broad base of knowledge that I sort of had coming out.

So part of it was wanting to get back to just broad medicine.

And then part of it was the schedule.

That schedule.

I was like, it's a lot of time off work, so.

Yeah, that's really nice.

So can you, can you pick up shifts or fill in if you want to?

Yes.

Yeah, there's, there's always day shifts and night shifts available most of the time for moonlighting.

You know, like we're hiring and then we'll be more fully staffed shortly.

But you know, someone's on paternity leave or something.

So there, there's options to pick up, which is nice if you want the increased income.

For whatever reason.

There are some questions about you, asking you, asking, sorry, you working nights and whether, like how you adjust from nights today's, if you switch.

And then also like, is night shift quieter than day shift?

Like, would your job look different if you were on days?

So the first part of the question, it's tough.

And honestly, the only reason I feel like I'm able to do nights is because my shifts are blocked together, which for me that really helps me.

I am like religious about my routine when I'm on nights.

I switch into night shift the same way every time.

I go to bed at the exact same time, wake up at the exact same time.

I exercise when I wake up.

I stop drinking coffee at 3am So I have all these sort of rules that I follow while I'm on nights and it really helps me get adjusted.

But the switching to night shift and the switching back from night shift is the hard part.

So the whole idea of like, you know, working Monday night and then working Wednesday night and then working Saturday night, it wouldn't work for me personally.

But yeah, having a routine and having a lump together is how I do it.

However, lots of people do it, you know, popcorn shifts and they're fine.

I think it just depends, you and your sleep hygiene and all those things.

Yeah, I don't, I couldn't do it.

I just don't think I'm cut out for a night.

Like 9:30.

I'm, I'm about done.

So I just, I don't know that.

And, and my husband's had to do it.

And I'll be honest, he is grumpy.

Like, those switching days are rough, not pleasant.

Those are probably Actually, the most, like, unpleasant days we've ever had in our marriage is like, the two to three days when he's trying to switch and I'm like, you are grumpy.

But it's.

Yeah, that's a weird, weird thing.

Okay.

Do you feel autonomous at your job?

Yeah.

So that's actually one of the reasons that I took this job.

You know, in general, there's a wide variety of levels of autonomy in the PA world.

Probably, honestly, more so than any other job in all of medicine.

Like, if you're a physician, it really doesn't matter where you work.

You're probably going to do the same thing.

If you're a nurse, it doesn't matter.

You're going to do the same thing.

But for PAs, it's super variable.

I knew this group because they came from the same hospital, and I knew that they really valued their PAs and NPs, and I knew that they had them working at kind of that elevated top of their scope of practice, which was one of the big reasons that I wanted to work for the group.

So, yes, I do have a ton of autonomy, probably more than Most PAs or NPs do in a hospital setting that's as big as the hospital that I'm in most of the time.

In a hospital, when an advanced practice provider has a lot of autonomy, it's often in a smaller center where they have fewer providers overall.

So I kind of got lucky.

And again, that was one of the reasons that I took this job.

Yeah.

Okay.

So I know you said there's a doctor who is, like, technically available or on call.

At what point would you maybe need to call him or feel like, yeah, how often do you call him?

I guess.

I don't know.

There's a lot.

There's a wide variety of reasons for me to call, and I.

We have all, like, very close relationships.

They're all extremely supportive and extremely available.

So it's not uncommon for me to call just to run a case by them and make sure that I'm not missing things and that they're in agreement with the care plan without them actually necessarily coming in.

I have had situations that are just disastrous where the physician will come in from backup call to be there in house.

But a lot of times it's something where I can say, here's all the things I'm doing.

I just want to make sure this person's really sick.

Is there anything else that you can think of or that I should be adding on?

So sometimes it's just a kind of a Phone call staff, which works really well.

And honestly, the number of times that I have to call them varies, just depending on sort of what's happening at work.

Like, it's very variable.

I never know what I'll necessarily get.

So there are days where I'll call them two and three times in the same shift, and then two or three days will go by when I won't have to call at all.

So it just depends.

But you couldn't.

Honestly, I don't think you could do the job that I am doing if you didn't have really good physician support and know, like wholeheartedly that if you run into a situation where you're uncomfortable, that they're gonna be available.

Yes.

No, I mean, that's so important.

What is the hardest thing about your job,.

Honestly?

So I get.

I guess I should have said earlier that I just recently got my.

My colleague partner.

That's another pa.

Previous to that, it was just one person.

And so the hardest part of my job was honestly, just straight up stress because I was doing those 13 admissions and the codes and all the procedures all myself, which is a lot of work for one person.

So for a long time, it was just extremely stressful.

You can only do one thing at a time.

So just that the acuity plus the volume was extremely hard.

And then when you factored in Covid, that was a whole new thing.

But now that there's two of us, the job is much more manageable.

Yes.

That's crazy.

I feel like you'd be juggling, like, running, literally.

Yeah, like actually running.

Well, okay, so how did Covid impact your unit or your job?

Yeah, honestly, it was really hard.

The initial sort of beginning of it was probably the worst, just because there is massive uncertainty about, you know, what sort of critical care capacity we would reach and if we would have enough vents and if our providers were all get sick and what we would do if we, you know, ran out of people in the hospital that were intubators or vet managers because, you know, people were infected or whatever.

So I think that really was the worst part of all of it for me.

We did see, you know, initially like a surge, and we had a unit of our hospital that's not normally an ICU sort of converted to critical care, but that was maybe a month.

And then fortunately, things went back to where we could sort of keep it just within our typical ICU capacity setting.

Yeah.

Such weird times.

There are some questions about how you.

How you deal with burnout or stress and whether you've kind of Extended, experienced burnout in your job?

I have.

And I think, honestly, I feel like if you pulled most PAs that have been in practice for several years, there's usually a phase of burnout.

It's not like, you know, constant the whole time, but there are just seasons that are stressful or maybe you have something else going on, like, personally, in addition to work, and it becomes overwhelming.

But, you know, I've always found that if you take a step back and find ways to sort of reduce your stress, everyone has different ways.

I have my, like, you know, five podcasts that I listen to and my bath salts that I like, take whatever.

And, like, you find ways to relax and kind of work through it.

But there are seasons.

Yeah, I feel that, too.

How long have you been practicing?

I feel like some change.

Okay.

Yeah.

Because I'm at six years, and I feel like it was like the, like, year, like around four or five where I was kind of like, oh, man, I'm tired.

Like.

Yeah, it's just a lot to.

I mean, medicine.

Medicine is a lot, Right?

For sure.

So let's see.

Someone asked, are you on call a lot?

I wouldn't think that you would, like, necessarily take call, right?

No, I don't take any call from home when I am at work.

I take call for the service and carry our call pager, but I don't ever have to take call from home.

Okay.

What is one thing you wish people knew about your field of work?

About critical care or about being a PA overall?

Maybe either one.

I guess PA is a little more general versus critical care.

I think the main thing that I did not know about being a PA before I went to PA school that I learned as I graduated was that you have to be super, you know, choosy with your job.

Essentially, like the job.

Like I mentioned, the jobs for PAs are just really variable.

There are places that are incredible to work and you're valued and you're treated like an advanced practice provider, and you bring a lot to the table.

And then there are places where I personally know PAs or NPs that act as scribes, which is kind of ironic because a lot of people do scribe work before they go to PA school to learn a little bit.

So, you know, you just have to.

You have to really dig in, in the interview process and get a really good sense of what your job will look like, because, as I mentioned, it's still a very variable field of medicine, which for me has been something that I've been able to navigate.

It's just a challenge That I didn't know to foresee during my initial, like, going to PA school and first graduating.

Yes, it can definitely.

I agree.

It can vary a ton based on location, state, position.

I mean, all of those things make a huge.

I've never actually thought about it like that.

Like, the way you explain it makes a lot of sense that, like you said, a doctor is going to do what they do pretty much the same job in different places, nurses.

But like, PAs can be definitely very, very different.

Right.

Which is interesting.

This is.

I think this is an interesting question.

When you are, like, when you're done with your work week and you come back for your next set of shifts, do you often have the same patients or usually by then, like, it's completely different.

You know, my hope is that most people are out of the hospital by then because I've been off for two weeks.

But it is unfortunately relatively common that the same people will still be in the icu, especially with COVID that were there the last week that I was working.

So, yeah, I'm really not, but it does happen.

Okay.

Interesting.

There are also a lot of questions about, like, how you ended up doing pa. Like, did you consider Maryland or NP at all?

What was your kind of process there in becoming a pa?

Sure.

So I was a biology undergrad, so nurse practitioner didn't make a ton of sense for me because I would have to go back and redo basically an undergraduate in nursing.

So in order to use the degree that I was already 3/4 of the way done with, I really considered basically, like optometry school, dental school, medical school, or PA school, ultimately decided I didn't want to look at teeth or eyes all the time.

So those were out.

And then I know, like, I don't think I want to do that every day.

So then I was really between medical school and PA school.

And ultimately my sort of counselor at college just helped me go through the pros and cons and the differences between the two jobs.

And at the time, you know, the average number of hours worked for a PA was much less than a physician.

And the sort of ability to laterally move and change subspecialties was really interesting to me, which is harder to do as a physician.

So I ended up choosing pa.

Although, to be honest, I wish I would have known a little bit more before I made my decision.

It's not that I wouldn't have done the same thing.

I just sort of went forward relatively blindly.

I wish I would have had more things like this, you know, to talk practicing PAs and learn a little bit more before jumping in.

What do you wish someone told you or that you would have known?

I guess, you know, it's not really anything in particular.

I just.

I did a little bit of shadowing here and there, but I never really just dove into, like, the nuances and the differences in state legislature and, you know, if you don't want to move.

I lived in Indiana, so if you don't want to move, then what is it like for PAs in Indiana?

That kind of stuff.

The stuff that I gleaned honestly, was just very surface level before I went forward.

Yeah.

Okay.

Are there.

Are there any MPs at your job or no?

Yeah, there are actually a lot of NPs with variable backgrounds.

Some of them are acute care NPS, not all, but we all have essentially the same job and work interchangeably.

Okay, so that's my next question is it's pretty much y' all function the same.

Yes, same way.

Okay, cool.

Do you ever wish you went to med school?

That's the next question coming up.

No.

No, I don't.

And if you want to go to med school, that's great.

But, you know, I work with physicians day in and day out, so I see their job and their day to day, and I'm pleased with my decision that I didn't go.

Yes, very same.

So being on nights, do you end up speaking to a lot of patients, families?

Yes.

Okay.

That can be one of the tougher parts, especially doing, like, a new admission for someone who's critically ill and trying to explain to their family the gravity of the situation so they sort of have a sense of what to expect.

Expect.

It can be.

It can be one of the more emotionally draining aspects of the job.

Honestly, that's hard.

I think I may have missed it or you probably said it, but what are your hours?

Like, what time do you go in and what time do you go home?

I work from 8pm to 8am okay.

Okay.

She may, like, still get to have dinner at home and then.

Yes.

And that's nice.

Do you.

So what would you have there?

Would you call it like breakfast or lunch or.

I have lunch there and then I eat something sort of small, like sort of breakfast, I guess, when everyone else is eating breakfast and then I go to bed.

But I eat like, my husband works a regular schedule.

You know, he gets like, goes in at 7 and gets up 4.

So we have dinner together.

So I have like dinner.

Food for breakfast, basically.

Okay.

That messes with my head.

So how long will you typically sleep?

Like you'll come home.

And I sleep every single day from nine to four.

Okay.

So I, like, literally, I come home, I take a really quick shower, and I'm in bed in, like, 10 minutes.

And I just.

That's what's interesting to me about night shift because, like, when I come home from work, I'm still awake for a good, you know, few hours.

And the, like, night shift, like, that's what my husband do.

Like, he come home and he, like, goes to bed.

It's interesting.

Yeah.

I almost treat it like an evening shift.

Kind of like, where I pretend I'm, like, working till, like, 11, I guess.

I don't know.

Yeah.

And then you, like, come home and go to bed.

Yeah.

Interesting.

Okay, so let's see how weird it's.

Sorry.

So one interesting question.

Do you still get vacation time?

I do not.

But I'm allowed to switch with my colleagues, like, on the other week.

So it's actually a really flexible job.

If there's a, like, thing I need to do on a weekend that I work, I am able to switch shifts around.

Okay.

So that's nice.

I feel like having that type of predictable schedule, you'd be able to plan pretty.

Pretty well, but.

All right, let's see.

I like that one.

It's not good.

Okay.

Do you ever feel scared or have you had any scary situations?

All the time.

All the time.

It's probably, like, every single shift or night.

Yeah, all the time.

Gosh.

What, like, in general, do your patients typically have?

Like, what would their diagnoses be?

I guess.

Sure.

So I'm mostly in the medical icu.

We have a cardiovascular surgical ICU I'm not in very often.

And then we have a cardiac CCU that I'm in some and actually probably feel the most comfortable in from my cardiology background.

But in the medical icu, I would say our predominant diagnoses are probably septic shock and cardiac arrest.

And then in the ccu, it'll be, you know, cardiac arrest, stem is cardiogenic shock.

But I probably, you know, 60% as septic shock, to be honest.

Okay, so just.

I mean, that situation, you're just trying to, like, figure out what's going on, keep them stable, get them better, or, like.

So I guess is your job more like maintenance of the patient overnight versus, like, making decisions in their care?

I don't know if that makes sense.

It just depends.

Like, if they're already there, they're already established.

A lot of times we'll get asked questions, and we'll be making just really minor changes, like changes to their insulin or changes to their pressors.

But then, like, if it's a new admission, then it's a completely unknown diagnosis.

You have to figure out, you know, the appropriate resuscitation, the appropriate pressers, the appropriate antibiotics, the appropriate source control.

So then you're really driving all of their care.

So it really depends kind of on where they're at in their continuum.

But if they're already in the icu, a lot of times it is little stuff.

Okay, do you see any trauma patients?

So we just became a level three trauma center, which has been a whole kind of new world for us.

So I just became ATLS certified, which is all new for me as well.

And we are seeing some low grade trauma stuff.

But realistically, being only a level three trauma center, most real traumas sort of go to a level one center somewhere else.

Okay, so little bit in there.

How do you handle the sad parts of your job?

Whether that's losing a patient or tough cases.

Does that.

Are you able to leave it at work or does that kind of affect you?

That actually varies.

There are some times that I'm able to leave it at work, but there are cases that will bother me at home.

It's just tough.

Fortunately, like, my colleague is extremely supportive, so it helps to talk to her about things.

And she's there with me, so she sees everything.

And really everyone in our group, you know, we all have bad cases and bad situations, so they're all supportive too.

So I try to talk to really the people at work about it and the other physicians and apps in my group, realistically, because they understand better than anyone else can.

I'll talk to my husband a little bit, you know, obviously with no patient identifiers, but it's just different for somebody who's not in the field.

So I, you know, I think the easiest way to sort of navigate it is just to talk it out with somebody who is in a similar position.

Yeah.

Okay.

In this, this role, and I guess it may not be yet, but I think it is.

How long did it take you to feel comfortable or was there like a big adjustment period there with switching specialties?

Yeah, there is a big learning curve with any subspecialty switch, critical care definitely included.

And I, you know, I think that the idea that you're going to just arrive at your job one day and be like, you know, today's the day I feel comfortable.

It's been 12 months.

It just doesn't happen.

Comfortable, the continuum, and you get comfortable with, you know, Maybe certain sets of diagnoses or certain procedures, but then there's still always things that you're still learning and you still can improve on.

So, you know, it's been almost two years, and there are certain things that I feel a lot more comfortable with than I did before, but there are always new things.

There are always things that come up that I'm like, wow, you know, I could do better.

I could learn more, read more.

Yeah.

Do you agree on that?

I do.

And that's what.

Yeah.

So, like, mine, because I went straight into Durham.

I mean, I was.

I think it was like, a good six months before I even ever had a thought of, like, oh, I'm okay.

Like, it was.

I. I was.

I don't know, what's the word?

Like.

Like a little baby horse learning to walk or out.

There's probably a better metaphor.

But I don't, like, just kind of stumbling around and figuring things out, asking lots of questions, studying all the time.

Right.

But it was about, like, six months when I. I kind of remember having feelings of like, okay, I'm understanding.

But even then, like you said, there were things I didn't feel comfortable with.

Like.

Like, at first, I didn't really feel comfortable with psoriasis patients, and then I didn't really feel comfortable with pediatric patients.

So it was kind of these things that I would realize I had less knowledge or, like, a void of knowledge, and then I would really pursue education in those areas to make myself better.

Yeah, I honestly, I think when you start a new job, like, you have to just take such initiative to learn that, like, I think I went to four conferences in the first six months of taking this job, and I spent a ton of time reading and, like, shadowing the other people that worked on nights and loosely learning.

Because, I mean, any.

It's new.

It's not like, you know, you have this huge fellowship that all the positions did before they went into this field.

So there is a knowledge gap, and you have to sort of motivate yourself to overcome it.

Yes.

And that's, I think, just part of being a pa because you don't.

Unless you choose to do a program, you know, get the residency experience where everything is packaged and given to you as far as, like, education, and you're kind of getting.

Getting that organized learning a little bit more.

And I think that's just, yeah, part of being a pa because you come out and you've got to learn a lot.

So, yeah, neither one of us did residencies or official one.

So, yeah,.

These are kind of specific.

Let's see, do you and your colleague work together on the same patients or do you split up?

You know, we mostly split up.

When she first came to Nice, she had been on days before, and it's just a lot.

It's a really different workflow.

So at the very beginning, we did a lot of things together, but now that we've been working together for a while, we usually split patients up.

That being said, if someone's really sick or something is really big as going on with the patient, we usually both go.

And then, honestly, a lot of times I will.

Even if.

And if I don't call a physician and let them know what's going on, I'll ask her, like, hey, I'm doing all these things.

What else can you think of?

It's just, you don't ever practice in a bubble.

And during the day, the whole group that I work for is very cohesive and kind of all sits together in the same room, and they're always bouncing cases off of each other, which was kind of a hard part of working.

Nice to not have that.

So now that I have her there, I tend to do that a lot with her.

So she.

Even though she may not see every patient that I see, she pretty much knows everything about them, because I'll tell her the whole story and tell her all my management and make sure that there's nothing else she can think of.

That's a really good example of, like, the teamwork aspect of healthcare, which I think is so just beneficial to patients, because when you have multiple thoughts and minds involved, you can.

I mean, I think.

I just think that's better.

So that's what made me want to be a pa, was seeing that.

So I think that's a good example of it.

Okay, we have questions on which I think you're the perfect person to ask.

How did you pay off your debt?

Slash, how did you handle your student loans?

So same question.

Asked differently.

But, yeah, what was.

You're, like, very impressive in that field.

So.

I went to a private school for PA school and was fortunate that my parents paid for my undergrad.

So all of my student loan debt was from grad school.

And I had $161,000 when I was done, which for me is above the national average.

And most of mine were private student loans with interest rates like 9, 10%.

So honestly, I was in a tough spot financially when I finished.

And I just decided early on it just wasn't ever on the table for me to take the whole 10, 15 years to pay it off.

My minimum payment was.

I don't remember, but it was like $2,000 a month.

And I just knew that we weren't going to be able to travel, we weren't going to be able to fix up our house or do any of these things that I always wanted to.

I kept this payment around, so I decided to just hustle and work as much as I could and pay it off as fast as I could.

So we.

I was married the whole time, so my husband worked and he.

We bought like a little foreclosure of a house that he could afford to pay on just his income.

And then I worked four or five jobs and every single dollar that I made, we put towards my student loan payment.

So we were able to pay them off in 16 months, which was honestly even faster than I planned on.

But once I got started, it was like this little momentum roller coaster and I just kept going and working and, yeah, got it done in 16 months,.

Which is crazy, but awesome.

What jobs were you working then?

What specialties are those in?

So actually my very first job out of PA school was as a hospitalist PA at a different hospital than where I work now.

And I work seven on, seven off day shift.

So for a while that was really nice for picking up extra shifts and I was just working extra at my primary job.

But then the group that I worked for lost the contract with the hospital and basically my job sort of imploded and I lost my job by proxy, which was very stressful as a new grad, you know, I'd only been out for six months and I already had to find another new job and I just found a job.

So that's when I moved to cardiology.

And then once I did that, I was working Monday through Friday, so it was a little bit harder.

Just, you know, I only had my weekends, but I would work, you know, day shift, night shift, whatever shift I could get on the weekends to make as much money as I possibly could.

Gosh.

Was that hospitalist medicine mainly, or like doctor or urgent cares or.

So it was mostly hospitalist medicine.

I did have one PRN and an urgent care, but, you know, the hospitalist stuff was what I was most familiar with.

That's what I had done.

And even in cardiology, I was working almost entirely in the hospital, so I just felt comfortable there.

And it was, you know, PRNs are great, but you have to be able to pick it up quickly.

Like, no one wants to hire PR and help that needs a bunch of training.

So for me to Sort of stick with what I knew.

Like, worked out the best for me.

Yeah, I mean, it definitely worked out.

Like, I just.

I love your story.

I think it's so impressive.

That's actually made me notice you on social media.

I was like, what is she posting?

Like, what is this?

This is crazy.

But I really.

I mean, I'm very interested in financial stuff, but not nearly as savvy or knowledgeable as you.

So it was a good, like, I'm.

I'm glad.

Glad I found you on Instagram.

But she's on Instagram at Strive with Kristen, if y' all want to follow her, because she goes so many.

So it's all, like, financial tips and tricks and, like, great stuff.

So definitely look at that.

All right, so this is an interesting question.

How much money did you save prior to starting PA school?

And how much would you recommend to save?

You know, I went into PA school with less than $10,000 to my name.

I worked a lot in undergrad, so I had some savings, but not a ton.

And I took out loans for all tuition, so I think I paid for, like, we had to have an iPad, so I think I may have paid for my iPad and some of my initial books and things.

But I would say my savings didn't get me very far.

Honestly, it was all mostly debt.

Yeah, I mean, I think you can save a bunch for PA school.

That's awesome, right?

To give yourself some, like, cushioning or.

I mean, yeah, if you pay for PA school or out the gate, that'd be really cool.

But most.

Most of us in this world need loans, but I will say so.

Just in contrast, I went to a public school, so it was much.

I say affordable, but it's not affordable.

It's still very expensive.

And so I've written on.

On the PA platform in a blog about kind of my experience because I. I paid back mine in about 14 months, but I didn't.

I didn't even have, like, half of what you had.

So I think I ended up paying back around 75,000.

When all was said and done so, so fast.

I mean, I was doing the same thing.

Like, I. I was throwing anything extra at my loans.

I was buying and reselling clothes on Poshmark.

Like, I mean, anything.

I was babysitting, like, anything I could do to get an extra few dollars and then, like, throwing it at my loans.

So I just didn't like them.

Like, I just.

I don't know.

They're like a weight that needed to be gone.

Okay, let's see what Else, we got more about your job.

Did they do any additional on the job training from cardiology to critical care regarding procedures, or did you already kind of feel comfortable?

I guess.

How did they make sure you were ready to go?

So in general, to get.

In order to do any procedure on any patient, you have to have privileges from the hospital.

In order to get privileges for almost anything, you have to show a certain number of procedures for that specific procedure that has been proctored by someone else who already has privileges.

So there was a lot of training.

I went first before I knew I took the job, before I even started.

I went to a conference specifically on procedures, so I knew I could at least have some base knowledge.

And then I was trained by all the other advanced practice providers that were more experienced and had been there longer.

And they proctored me.

So they, like, taught me their way of doing it, monitored me doing it, checked off my forms that I did everything appropriately, and then I had to have those forms all submitted to the hospital.

The credentialing committee reviewed them all, and then I was granted privileges.

So in general, you have to have training or something.

The hospital is not going to allow you to just go around, like, poke.

Patients, which is a good thing.

Yeah.

Okay, so what did somebody ask?

I lost the question.

Hold on.

That was a great question.

Oh, no.

Somebody just commented that nobody really talks about financial stuff a lot, which is true.

And that's why I think, like, I mean, I think it's good to be transparent and stuff.

And then someone else said, would it be possible to hear a chat or panel about the financial side of PA school in the future?

And you can do that.

So Kristen and I already talked and recorded a podcast episode that will be up next Friday.

And then in her course, you can hear all about finances in general and apply them to things about PA school.

And I think we'll definitely continue talking about things like that in the future as well.

See, people want to know what your patient care hours were before PA school.

I was a cna.

I worked in a memory care unit.

And, you know, it wasn't something I wanted to do forever, but I loved it, actually, at the time.

That's interesting.

I was a cna and it was like a whole rehab hospital, but the memory care unit was my favorite section.

I really enjoyed that part of the hospital, for sure.

So let's see, when you interview for.

Okay, these kind of go together.

When you interview for PA jobs, what questions should you be asking?

And there's some questions about, like, what should a job Pay for as far as like insurance liability, health care insurance.

Like what are your thoughts on some of that?

Good question.

So honestly, you have to come to your interview with a very long list of questions.

And then also I feel very, you should never take a job without actually spending like a full day with a practicing app that works there already.

So I would ask like what do you do during the day?

I would specifically ask, you know, autonomy.

One way that I found that is an easier way to gauge autonomy than outright asking is to ask about the billing.

So like some groups won't allow their advanced practice providers to bill at all.

So then you automatically know your autonomy is going to be on the lower end.

So that, that's kind of been a secret weapon question I've asked before to try to navigate that because sometimes people aren't forthcoming.

I would ask, you can tell little things like when you're asking them about PAs, if they say physician's assistant with an apostrophe or if they are still saying like mid level provider, you can kind of gauge that maybe they're not a routine employer of apps or maybe they're not up to date on the latest legislature.

So they may not be sort of on the forefront as far as scope of practice.

So I would try to find out things like that.

Obviously you need to know things like how much you're going to be paid and your CME and all those things.

So that kind of leads into the second part.

Most jobs have a CME budget which honestly I probably wouldn't take a full time job that didn't have one.

You have to learn and those conferences are expensive.

So cme, they should pay your medical liability coverage and it should include tail coverage.

And if they don't include tail coverage, I would highly reconsider, honestly, because you have to have tail coverage and it's extremely expensive.

So that should be covered.

Most places will cover your license.

If you prescribe controlled substances, they'll pay for your CSR and dea.

And if they don't, you may, you may.

I don't know if you shouldn't take the job, but you need to have a salary that accounts for that because those things are very expensive.

And if you are not factoring that in when comparing jobs, you're going to be out multiple thousands of dollars.

Yes.

And all the, it's like the little things add up to your kind of total package that you have to look at.

And so I think, yeah, like definitely look at all of those different benefits.

Tail coverage is like a very, is a Specific, like, malpractice thing.

Like, if you left a job, you'd still be covered.

So at my previous job, I actually ended up having to buy tail coverage because.

Yeah.

And it wasn't so bad.

Like, basically, I'd been told I had it, but then our practice merged with another one and our insurance policy changed.

And then I was not told that from that point forward, I was not covered.

Wow.

So it wasn't, like, for the whole time I was there, but even then, I think, like, two.

So it was a nice little unexpected expense, Right?

Yeah.

So, I mean, I think that, like, definitely, again, something to talk about.

And, like, I.

And I always say have a written contract because, yeah, I have some friends who work in jobs where they don't have a written contract, and I'm like, that's a really easy, great way to get screwed over.

Like, yeah, just have it written down.

Like, even if it's a Word document, like, have it written down.

So, anyway, okay.

I think this will be a nice question to kind of wrap up with.

What are your goals for the rest of your PA medical career?

And somebody else kind of asks, like, do you ever see yourself going back to day shift or what?

What do you kind of see as your PA future?

Gosh, Honestly, I'm not entirely sure.

I do know I will not work nights forever just because there are health implications.

And it's hard to sort of keep a healthy lifestyle while working night shifts.

So for now, it's great.

But that part of it, you know, at some point, I'll absolutely go back to some version of a day job, I guess.

And, you know, right now I'm affiliate faculty at the place that I went to PA school at and do some lectures for them and precept students.

So at some point, I'd probably like to do some version of academia, whether it's full time or part time, I'm not sure.

But that's the nice part about being a pa, right?

There's endless options.

And I could do dermatology next if I felt like it.

Highly recommend.

Okay, so to wrap up here, I wanted to tell y' all about a couple events coming up.

So if y' all go in the chat, number one, thank Kristen for her time and then go follow her on Instagram and just check out her blog.

So if you go to that offer tab and click to check out her course, it'll take you to her website so you can learn more.

And there are a lot of really great blog posts on there.

I've kind of like binged them so it's all good.

But I'm like so interested in that and get so confused by financial stuff.

So like when you make it easy for me, it's great and so much easier.

So.

All right, our next day in the life event will be with two PAs who both work in infectious disease.

Non who is one of our pre PA coaches and she's on Instagram @AmpersandPA.

So y' all may have seen her on there, but she is she works more inpatient infectious disease.

And then we're going to have Joshua Watts who is also infectious disease but works more outpatient.

So they are going to be talking about and comparing their positions which will be really interesting especially I think amid all the COVID which has affected everyone's job so strangely.

But so that'll be on October 20th.

Let me say this right, 22nd is what I want to say.

It's a Thursday.

Yeah, October 22nd at 8pm Eastern.

So we will in your replay link there will be a replay email.

There will be a link to sign up for that next one.

If you want to watch that, it will be posting as well.

The other thing I wanted to tell you about is that on and we've decided we're gonna announce it like later in the week on Instagram.

But I was talking to my friend Brian and he's like go ahead and tell them.

So on January 2nd, if you want to mark your calendars, that's going to be our next pre PA virtual conference.

I don't know if anyone attended last time in May.

If you did, let me know.

But we're going to do another one that's going to be a little kind of same topics but a little more geared to if you maybe aren't quite applying yet or like to help you improve your like entire application versus right before you apply when you can't really, you know, do too much more stuff.

So we're gonna have a lot of great speakers.

It's gonna be an all day event like it was last time.

But if you go to prepayconference.com you can go ahead and pre register for that and we've set up the code future PA for you to get $5 off of that.

So check it out and I hope you we see you there on January 2nd.

So.

All right, well thanks everyone for watching and tuning in, y'.

All.

Great.

Thank you guys.

I appreciate your time.

Thanks for having me.

Final words, I hope, I hope you go check out this course if you have questions about kind of just how to get your money on track and what you should be doing, even as a media social student before you have a job, this course will have all your answers.

And there's a promo code for $20 off in the offers tab, so make sure you check that.

So that, yeah, it's PA promo.

And I definitely, like, like somebody said, like, it's not something people talk about a lot.

And it's not something you'll learn about in PA school, either.

Maybe some PA schools do, but not mine.

So we and so we'll be talking more about that on the podcast episode, too.

But, yeah, definitely, definitely check it out.

And then if you have any questions, let us know.

Absolutely.

Thanks, guys.

Bye, guys.