Part two with Brian: autonomy, physicians, and having a life.

We pick up where part one left off. This time Brian Palm gets into how much independence he actually has in the emergency department and what the working relationship with his supervising physicians looks like day to day.

That question comes up constantly from pre-PAs who are worried they'll be looking over their shoulder for permission on everything. The real answer is more nuanced and depends heavily on your experience, your department, and the physicians you work with.

We also talk about the pandemic's effect on emergency medicine, and the ongoing project of keeping a personal life intact while working nights in a demanding job.

What we cover:

• Autonomy and independence for PAs in the ED
• How the collaboration with supervising physicians works
• Emergency medicine during the pandemic
• Protecting family time around a night shift schedule
• What sustains a long career in emergency medicine
• Advice for pre-PAs interested in the ER

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 y'.

All.

This is a part two of Hearing from Brian Palm, Nocturnal ERPA and all about his awesome job.

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 Prepa 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 Future PA 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.

Hey guys, thanks so much for tuning into the Pre PA Club Podcast.

I'm so excited to have you here.

Whether you are thinking about maybe becoming a PA for sure that's what you want to do in PA School or a graduate pa.

This is a great community and I think everyone in it is so awesome and supportive of each other.

So my goal here is just to spread more knowledge about the PA profession and help kind of shed some light on what it looks like in the real world.

So that's what we're doing today with my friend Brian Palm.

He's the creator of MYPA Resource and PA School Prep and he's an ERPA who works at nights or on nights night shift.

I don't know but he's awesome.

A really great friend.

Or if you're new here or just want to hear this one.

Hey, feel free to stick around.

So we'll jump into today's interview and I just wanted to remind you guys.

So check out the PA platform.com if you are looking for anything to do with Pre PA stuff.

We have the PA Program Map which has all of the PA schools in the United States listed with their contact information and links.

So that's a great resource to kind of start figuring out where you might want to apply.

And then we also have the personal statement, two week free interview email course, sorry.

Where you are able to essentially get a draft of your personal statement written in the first two weeks or in two weeks.

So that's if you go to the paplatform.com personal statement.

And I'd love to help you get started.

So if there's ever anything else we can do for you or help you with, please, please feel free to reach out and let me know.

Otherwise, let's jump into our interview with Brian.

Oh, and if you need help with a mock interview, which we are still doing, still interview season right now, or anything else, an assessment.

If you're trying to figure out where you're at and things and what you may need to work on, you can use the code future PA for a discount on any service or product, including the PA school interview guide from the PA platform.

All right, now we'll jump in to hearing from Brian.

I'm gonna.

Can I look at our sheet?

And I'm just gonna like rapid fire some of these.

Yeah.

And I had.

So a lot of the questions I'm seeing.

Okay, there's like two that keep coming up, but one is like, and this is important because we're talking about, like being a pa, but like your autonomy level, your independence level.

Happy with it.

What does that look like?

What does your relationship with the doctors look like?

Is there a doctor there?

Yeah, so there's always a doctor with me and that.

And typically with pas there will be.

Unless you're.

So a guy that I graduated with, he went to go work on like an Indian reservation out in.

Or Native American reservation out in like Arizona or New Mexico or something.

And he was the only provider for like 50 miles or something crazy like that.

The PA, he worked in the ER.

He was it for like 50 miles.

It was insane.

So, like.

But typically in a normal, normal hospital, doesn't make sense.

Like, in your typical error, you usually won't be the only provider around.

So, like, my autonomy here, where I work now again, is different than at the old place.

And so for lower acuity patients, like lacerations, like low complexity lacerations and ankle sprains and stuff, doctors typically aren't involved unless I have a question about an X ray or I ask them, like, hey, would you mind seeing this patient?

Just because I'm not sure what's going on for lower acuity patients, for anything.

So patients, when you come to the ED, are determined in acuity level from 5 being the lowest acuity to 1, which is like dying and.

Or close to dying.

So for five and fours, typically the doctor doesn't have to be involved.

For level three patients, which is your generally middle of the road, abdominal pains, cough and fever, like edema, which is like swelling in your extremities, that's like, not very common, but those are more like middle of the road.

Level three, level twos are like chest pains, shortness of breath, stroke symptoms, and level ones are pretty much reserved for either traumas or coding patients.

So anyway, so on level 5 and 4, doctors typically aren't involved unless I ask them to be.

And then for everybody else, they are.

They see every other one of patients, which is what I want.

I.

At the other facility, like, they kind of determined certain cases where they were required to be involved, but otherwise, like, you could discharge or you could take care of the patients on your own and just kind of ask them for help if you needed it.

And some of the PAs that I work with, like that model where they have more freedom for sicker patients.

And like me, I'm fine with either.

I prefer that the docs see more of my patients than not.

And I think that it's more of an efficient way when they see my patients anyway, because it's efficient and it's, I think, you know, good for patient care, too.

Not saying that, like, not being seen by a doctor is not good, but I think a lot of people now, even they see a PA and they still want to see a doctor if they come to the er, especially like the older generation of patients.

You know, I don't look at myself as a solo provider, as a pa. Like, I am independent.

Like, I feel comfortable with my autonomy.

I still do my own workups.

And if the doctor wants to add something to them, they can, you know, like, they.

But I have the freedom of kind of determining what path of the workup to go down.

And that's kind of what I want.

But that's not for everybody.

Like, a lot of people want independent practice and don't want to have to, you know, have a collaborating or supervising physician, you know, over their shoulder all the time, which, again, is different.

Every facility, like, some.

Some places are going to be, you know, breathing down your neck.

Your doctor that you're working on is going to be breathing down your neck about every workup that you.

That you order.

But, like with me, it's not like that.

Like, I still have autonomy, but the doctors do, you know, still see my patients, which is, again, fine with me.

I'm happy with the relationship and the structure that we have at the hospital, where I'm at now.

Okay.

Okay.

I've highlighted some.

Okay.

I have some rapid fire yes or no questions to throw, so this will knock some out.

If you could do it all over again, would you be a PA again?

100%, Yes.

Okay, we'll come to that.

One last.

I don't know.

And let me just.

Let me.

Can I just.

I know it's rapid fire.

I don't know anybody that wouldn't be a PA Again.

Like, there are people that are like, I've heard of that want to.

They're like, oh, I should have just gone to medical school.

But by and large, I don't know anybody that I have talked to that's like, man, I wish I didn't become a PA for what that's worth.

Like, it's a long road.

It's hard.

But, you know, I don't know.

I would do it again.

Absolutely.

I agree.

Do you have scribes?

Yes.

So for some of the shifts, we use scribes.

I don't use a scribe.

I don't.

I'm not afforded that opportunity.

Would you ever go?

What?

But I would if I. I would use one if I could.

Yeah.

Okay.

Would you ever go Today's.

Yeah, I think so.

Just.

It.

But for right now, it works.

I've got two young kids and it just kind of works right now.

So, yes, I would.

But for now, nights is better, I think.

That's not my boss asking me, I hope.

That's not my boss asking me that.

Trying to.

I doubt it.

Has Covid made you rethink if being in healthcare was still for you?

No.

It's made me, like, disappointed.

Sounds silly.

Disappointed that, like, this is such a problem.

I don't regret going into healthcare and, like, putting myself at risk or, like, working on the front lines, being a frontline healthcare worker.

Savannah.

Um, but.

But no, it's.

It's another challenge that we have.

Like, but even if coronavirus wasn't here, right?

Like, if coronavirus didn't exist, we would have something else that would pop up and, like, cause another mess like this too.

Like, I think personally, to get deep in the coronavirus, this is going to be something that, like, is with us forever.

Like, at least the foreseeable future.

Like, just like flu season.

Like, every year it's just like, oh, we got flu season, you know, here in, like, five years.

Gonna be like, oh, I got the corona.

You know, probably.

I would imagine it's like the back work and all that.

Who knows?

But yes.

Yeah.

All right.

But no, I don't regret it.

What?

I don't regret.

Okay.

Like healthcare or whatever.

Okay.

Do you have your TCLs?

No, I don't know what that is.

Maybe ACLs.

ACLs?

Yeah, I have ACLs.

I don't know if that was what they're asking or not.

Do you participate in codes?

Yes.

So I don't run them.

My involvement in codes, I kind of like my involvement in code.

So, like, I help with compressions.

I help bag if needed.

But during codes, what I focus on is because.

So during the night shift, if there's a code that happens at night, typically it's just me and one other doctor.

Everybody else is at home.

If a code comes in, the doctor's running it.

What I do in codes is before the code comes in, if we have that luxury, we have a warning.

I will talk to the doc and be like, hey, tell me what you need to get done during this code that I can help kind of expedite things along.

We can still take care of patients that aren't involved in the code.

So, like, people aren't just, like, sitting around wondering what the hell is going on?

You know what I mean?

I want to help.

I try to help facilitate flow in the ER during the code.

So can I be involved in the code?

Yeah, sure, I could.

I've intubated before, too.

It just depends on how involved I want to be.

Some places will not allow you to be in codes, period.

They require you to have all the ACLS stuff, but they won't let you be in a code, you know, in the middle of the.

Oh, God.

I haven't even said it yet, but I'll knock on wood.

But, like, if two codes come in, you know, like, it's just me and the doc.

But no, usually in codes.

Thank goodness, because we're a smaller hospital.

Usually it's just one code going on at a time.

I try to help facilitate the flow outside.

And that's what I want.

That's what I want to do.

I want to, like, help people and, like, give them the care that they need.

Again, like, if I can do that while the doc is in a CO doing something else, while they're preoccupied doing something else, then I'll do it.

Okay.

I forgot I was gonna ask you.

Oh.

People wanna know about aggressive and violent patients if you have had them.

Oh, yeah, sure.

So I had this guy.

If you've been assaulted.

I've been verbally.

I get verbally assaulted weekly.

But no, physically assaulted.

I don't think I've been physically assaulted.

At least nothing that, like, I don't have any scars.

It was a few weeks ago.

This guy came in.

He, like, he had been to the ER before.

He had a mental illness, and he was known for being aggressive.

And so he came in and they.

He was placed under the care of the hospital.

They were transferring him to a psych.

A psychiatric facility.

And en route to the psych facility, they, like, brought him back because he was complaining of something or he was too aggressive.

So they brought him back to the hospital after he had already been discharged and transferred over.

They're like, we can't take him here because he needs to be medically, I guess, sedated, medically restrained before we can bring him over there, just because the EMS workers were feeling at risk.

And so I saw him when he got back, and because they brought him back, he thought that he was going to go home, you know, instead of going to the psych facility where he didn't want to go.

And so I had to deliver the news.

Like, you know, I got everybody out of the room.

I closed the curtain.

The door was open.

But we have curtains behind the doors, or, you know, to kind of block so the doors can stay open and you still can't see the patient.

Like, everybody step out.

Let me just talk to this guy.

And so I was talking to him, he's like, listen, man, like, can I go home?

Like, just very frustrated.

I'm like, no, you can't go home.

You're not going home.

You know?

And, like, he went into an absolute.

He was handcuffed.

He went into an absolute rage and, like, stood up from the bed and, like, just started screaming this, like, I mean, just rageful scream.

And it was just me and him in the room.

And, like, so three security guards, like, it was like in a movie, like, pulled the curtain away.

One of them grabbed the guy.

The other one, like, pushed me up against the wall to, like, get me out of the way.

Like, crazy stuff.

Like, it didn't bother me.

Like, it doesn't.

It doesn't bother me for, like, people to get aggressive.

Like, if somebody's gonna be an asshole, like, I'll.

I have no problem being an asshole back.

But, like, unfortunately, people that are acutely psychotic, like, you can't.

You've gotta think about that differently.

Like, you can't be.

You can't treat some people the same as others, right?

So.

So he tried to attack me, I guess.

I don't know.

That's the most Recent case.

There was another case, like, again when I was attacked, where there was a guy that was irate and that took six of us to hold him down.

And it was me on one side of the patient and another tech is a friend of mine on the other side of the patient.

And the patient, like, leaned up to, like, bite my friend, like, on the face or my friend, my coworker.

Oh, he's my friend, you know, pillow friend, I guess, bite him on the face.

And so I, you know, like, held.

I restrained his head back to the bed before he could bite him.

But, you know, like, nurses all the time, they get kicked and, you know, spit on and, you know, yeah, people aren't.

People aren't nice all the time, unfortunately.

But you just gotta, you know, hospitals typically have security that'll help keep you safe if you're ever uncomfortable with a patient.

Even like now with people that are getting healthcare experience hours now.

Like, even if you don't feel comfortable with patient now, like, utilize security and make sure that you're not alone with somebody.

But I've never been punched.

One doc that I've.

That I work with got punched on a shift.

But you just gotta keep your wits about you, you know, don't put yourself in a position to get punched either.

Like, if somebody is.

If somebody.

If somebody is not getting.

If you're not giving them what they want.

Like, if somebody's coming in for, like, narcotics.

Like, just the other day somebody came into the hospital.

He comes in every, like, three days, came into the hospital wanting narcotics.

And I told him, like, no, like, we can't do that.

That's not part of your care plan.

I can't give you narcotics.

And he was like, well, let me talk to your doctor.

So.

I love it when the doc's gonna tell him exactly the same.

Well, yeah.

And for the doc.

So I told the doc, and she's like, oh, God, I don't feel comfortable going in there.

I was like, well, I'll go in with you.

I don't care.

But like she said, last time he was there, she went in alone and he was shouting at her.

And so, like, she felt threatened.

And so I went in there with her.

And, you know, he was frustrated and ended up leaving, but.

But, yeah, it's.

You just can't put yourself in.

She knew, like, she didn't want to put herself in a position to get put in trouble, so.

And you never know.

Like, there was one person that came in, like, that had a gun on him, like, at the old trauma center like they came in for, I think like suicidal thoughts or something and they had a gun in their bag and it's like, holy shit.

Like this, you know, could have been bad for everybody.

Like, you just don't know.

Just gotta be careful.

So it's part of the, part of the job.

But like you, I hate to say that, but like it's, it's a risk.

Like working in the ER is a personal risk.

Working in healthcare in general is a personal risk, but especially the error.

You know, you see on tv, like TV shows where people come into the ER and start shooting up the place.

Like that stuff happens like in, you know, big metro areas, like gang related stuff.

There was when I worked on a ambulance, one of my co workers was telling me a story about how they went out to a call like in a bad part of town.

And they.

It was somebody, it was a person that was found down in a parking lot that had been shot.

And so the ambulance pulls up and like get out of the truck and start giving this guy cpr.

And then a bunch of people were surrounding them and somebody from the crowd was like, are you gonna be able to save them?

And the paramedic was like, yeah, we're doing the best we can.

So then the guy pulled out a gun and shot the guy that was on the ground that had been shot a couple times.

And then so we're like, forget it.

You know, but like healthcare in and of itself is a risk.

Yeah, but like life is a risk.

Like you go to Target one day and get shot, you know, like.

Well, and I mean, like you said, being aware and like that's so like I'm in a room sometimes with patients by myself.

But like, I mean, I always have my cell phone, have my watch, I know where the door is type.

Like there was a derm office in Gainesville, Georgia, where we are, or like a couple hours from where I am that had someone come in and take everyone in their hostage because they were a psychiatric patient having delusions and weren't getting the answers they wanted and were very angry at the office.

And so they came in and, and took, they were able to get all the patients out, but took basically the staff hostage and like, scary.

And it made us like reevaluate some of our procedures and stuff because you just like.

I guess the way I think about it is like, honestly, like, I don't know these people.

Like, you, like, you don't, you don't know.

I never like.

And it's so crazy because, you know, in The ER especially, like, our whole focus is to like, take care of people, you know, like, we like to think of it as a safe place, but like, you know, bad things still happen to er.

There's a statistic about how a certain number of ER patients are victims of trafficking that are there with their, like, you know, what do you call the word?

Like the.

Yeah, well, the trafficker.

Yeah, but like, that's a certain.

That's, that's like a statistic is that like traffickers bring sex trafficked people into the ers and stuff.

And like our whole goal is to take care of patient, like, people the best that we can.

Like, that's why I go to work.

Like, I go to work literally because I want to take care of people, you know, but it's still, there's still risks to it, unfortunately.

But there always be risks.

Like I said, there's risks with everything you do, but just gotta keep your wits about you.

Yeah.

So look at the questions and see.

Yeah, let me.

I'll go through a couple.

Do I recommend an ER residency?

I think so.

All right, so the thing with ER residency is one of my friends did one too.

The thing with residency is that you get more training in the residency.

That's like a year or a year and a half or so.

You get to do things like central lines and intubations more frequently and, you know, more procedures, more workups and stuff.

Like.

Yes, you get to do more hands on things like that.

But even if you do a residency.

So like right now, if I had an ER residency, if I did that and I came to work at my facility, I wouldn't get to do most of the things that I learned in the ER residency anyway.

So, like, at least without going through more like certification through like the hospital and all that, like, just more red tape.

ER residency is a great option.

Like if you get out of school and are having a hard.

You want to work in ER and you're having a hard time finding a job in the er.

It's a great option because it'll kind of set you apart from other new grads that want to go work in the er.

It'll give you a year of ER experience, which a lot of hospitals take as a minimum requirement to work in their error.

Would I have done one?

Am I upset that I didn't do one?

No, I'm glad I didn't do one because I got a job right out of school.

But the reason why I got a job right out of school in the ER is because I Worked there as a tech beforehand.

And so all of you applicants that are working in healthcare now, don't burn your bridges because there's a chance that you might work there when you get out.

They knew who I was and despite me being a new grad, they only take people that have been in the ER for two years.

But they knew who I was, they knew I was a hard worker.

They had some background on me and they took a shot on me.

And I hope they think that it was worth it.

Sure.

People want to know what you think of changing the name of pas.

I really like Praxician, Praxicam or whatever.

No, I don't care either way.

I think the whole, I don't know, just.

I don't care what you call me.

Whatever you want, say yes or no.

My vote is no.

Yeah, I'm fine with not changing it.

If they want to change it, fine.

But I'm fine with not changing.

I don't, I don't get upset about being called a physician assistant.

I'm not me either.

That's what I went to school for.

If somebody like, if I go to work and they're like, oh, you're an assistant?

I'll be like, yeah, yeah.

You know, that's another thing too kind of standing off of that.

What if somebody wants to see a doctor?

Then I haven't see a doctor, like, no, I don't.

That's fine.

It doesn't matter to me.

Yeah, I don't mind it at all.

What else, what procedures do I commonly do?

I do a lot of, like, abscess drainages.

I do a lot of laceration repairs.

I help with fracture reductions and dislocation reductions, which is like displaced bones.

Those procedures.

What else?

Those are the primary ones.

I do aspirations, which is like sucking pus out of our fluid out of a wound.

Those are, I think that's the bulk of the procedures that I do.

What was it like adjusting to nights at first?

Just staying up really late and sleeping during the day.

It's not too bad.

It's just like days.

I mean, you know, you're used now.

Like, if I'm on, if I flip my schedule to days, I feel kind of groggy after 48 hours or so just because my body's like, hey, why are you flipping around?

But if you stay on it, it's not so bad.

You just gotta stay up late and, you know, for a week or two and you'll be alright.

How do I balance family and social life with a night shift schedule?

Well, I don't have a social life because of coronavirus, so.

But now working nights, like I said, I mean, like I.

This is stuff, like, this is so crazy.

This is stuff that I haven't talked about like in a long time.

So I'm glad we're doing this.

We never talk about our jobs.

I know, it's crazy, I know.

But so like my family life, like I see, like I said, I mean, I see my kids, I spend all afternoon with them.

Okay, how about this?

How about we go back to.

You finish your shift at what?

Oh, yeah.

So I finished my shift at 7am yeah.

And then I come home and I usually go to bed, you know, but I'm usually in bed by eight or so unless I stay up and like, you know, if the kids are up or something, or like I'll help with breakfast, but I'll go to bed.

And my wife will usually get up with the kids.

If she's not up by the time I get home, she's up shortly thereafter.

And so we kind of chat about, you know, my night at work for about a half hour or so.

And then she gets up with the kids and is with them until, you know, the early afternoon or so when I get up.

And then we do family things in the afternoon.

So we like do family walks or we go for a drive.

I mean like the things that we do now because of coronavirus are pretty limited.

So we either go on a family walk and, or get in mommy's van and we drive around for a little while and go like pick up takeout or something.

That's pretty much the extent I started taking my little girl to the grocery store with a mask, my four year old.

So that's something to look forward to.

But so we have dinner and then after dinner, you know, we usually, if we have time, we'll, you know, watch an episode of Daniel Tiger or we'll like have a dance party or whatever, like play a little bit.

And then it's bedtime for the girls.

And then when my wife is getting them ready for bed, then I'm usually getting ready for work.

And then I go to work again.

Or if it's my night off, then I'm putting the girls to bed.

So like when I work, my wife, her name is Allison, for all the chat, instead of just saying my wife Allison will.

On nights that I work, Allison will put them to bed.

And my nights off I put the girls to bed.

So we kind of split it up that way.

So I work half the month and so half the work she's putting them to bed, and the other half, I'm putting them to bed and doing the whole bedtime routine and everything.

And then after that, on my nights off, like, we hang out.

Right now we have been really heavy into watching the old show from the 90s, er, because if I'm not working, I might as well just watch er.

But, like, we, you know, whatever.

Like, we do, like, the normal thing that everybody else does, I'm sure, like watch Netflix or movies or whatever.

And that's pretty much the extent.

So, yeah, so I'll get off at 7, go home, sleep, and then I'll be up, you know, early afternoon.

Ish.

Or so usually.

So what else?

What else?

We got the ones that put X's behind the side.

You've kind of answered, but if you want to.

Oh, cool.

Okay.

Tips for getting an ER job after graduation.

So when you're in school, I'm going to take a zip code for this.

So when you're in school, if you know you want to do er, one thing you can do depending on the school and depending on how they do their clinical rotations and stuff.

So preface.

So we at my school, we had like a little brother, big brother or little sister, whatever program.

Like, you are a mentor for the class below you.

So, like the oncoming class, I was assigned a classmate to, like, kind of act as a mentor and like, give them guidance.

And so he told me that he wanted to do er.

And so I told him, well, when you're setting up your rotations or when the school is setting up your rotations, you can suggest or, like, try to find rotations that are more catered to emergency medicine.

So a lot of schools have.

You have eight, you have seven core rotations and then an eighth elective rotation.

And so your core rotations are.

Let me see if I can remember them all.

Family medicine, internal medicine, psych, OB, ER, PEDs.

What's the last one?

Surgery.

General surgery.

Right.

And then you've got a seventh elective rotation.

And so if you know you want to do emergency medicine, you can.

You'll do your ER core rotation, which is usually like six weeks or so.

ER core rotation, you can do an elective emergency medicine, which is another six weeks.

That's 12 weeks of ER.

And then if you do, like, your surgery rotation, if it's got some aspect of trauma surgery, like trauma surgery instead of general surgery, you can do that.

Or you can go work at a pediatric emergency room for your peds rotation too, and get another Six weeks of emergency experience.

This guy, what he did was he did his ER rotation that was required.

He did his elective rotation in the er, and then he did his pediatrics.

What he did, he did his peds rotation in a pediatric emergency room.

And so before he even graduated from school, he had 18 weeks of emergency medicine experience.

And so, like, when he was applying for ER jobs, he was like, hey, like, I know I'm a new grad, but just so you know, like, I've got four and a half, five months of emergency medicine rotations already or emergency medicine experience already.

So I.

Because I know this is what I want to do.

So, like, that's one way, you know, to do it is to get as much experience in school and emergency medicine as you can.

But two, like, if you really.

So when you graduate school, one thing that I was told before I graduated was, you can either, by and large, not for everybody, right?

By and large, you can either pick the.

Pick the specialty that you want to work in, or you can choose your location.

So, like, if you.

So, like, with you, Savannah, like, if you want to work.

I want to be in Augusta.

Like, you can either choose to be in Augusta, like, to live there as a new grad, or you can like, and take any.

Any specialty, or you can take any specialty.

Or, like, if you want to do er, don't count on working and living in Augusta type deal.

You know, like, as a new grad, it's kind of hard to have both luxuries, you know, the specialty that you want to work in and then the location.

So it's hard if you want, huh?

Yeah.

I think for any new.

Well, most new grads, you're probably gonna have to sacrifice somewhere in there.

Yeah, I mean, it's hard.

Like, you know, one thing, if you want to do emergency medicine, you definitely don't want to go.

Like, I don't know, like, it's.

It's so hard now.

And that's another thing we can talk about, like, before we stop or whatever is, like, the job market, everything.

Everybody's worried that, like, it's too saturated for PAs.

But one thing is you don't.

If you want to do emergency medicine, like, you can either keep looking for an emergency medicine job without any experience.

It's going to be hard to get at, like, in, like, a big city.

So you might have to go, like, outside the city limits and work at a more rural hospital.

So one guy I used to work with just graduated PA school and got a job at a rural hospital ER and Like, that's basically what the job was.

They were like, we hire new grads because we know, like, we automatically know that you're only going to be here for like a year or two, and then you, like, they just accept that.

So you can find a job like that.

You can try getting a job at like, an urgent care, but, like, you got to be.

You don't want to get a job in something like ortho or pain management or something where you're going to lose your knowledge and your skills and, like, have a hard time then transferring, transitioning that over to emergency medicine, like, it just makes it a little bit harder, I think.

So, um, it's hard.

You can talk to recruiters and stuff too, and see if they have any openings.

You might have to go and, like, take a locum tenens job, which is like a traveling position somewhere in Iowa or something, for a short contract just to gain experience.

Or, like I said, just work at a smaller county hospital.

I know I was very fortunate I got a job at the place that I used to work at.

But regarding the job market for PAs and stuff, I think it's fine.

Like right now with all this coronavirus mess, like, it has been tough.

There have been PAs that lost their job and, like, got cut hours and everything.

I think it's very, very dependent on, like, the region that you live in.

Some regions have been a lot more affected than others.

You know, another thing is that jobs for PAs aren't always posted on, like, Indeed or, you know, Monster.com, if that still exists.

A lot of jobs that you get as PAs come through, like, word of mouth.

So, like, people that you either went to school with or that you know from like, your healthcare experience or whatever, like, they.

They aren't posted on one of those websites or like, even, you know, because a lot of jobs as PAs are through physician groups, not through hospital groups.

And so, like, unless you know the name of the physician group, like, I'm not a hospital employee, I haven't been a hospital employee.

And so, like, if I went on the hospital website, I wouldn't find a job for a PA in the er, because the ER isn't staffed by the hospital, it's staffed by a physician group.

So.

So, yeah, so just because you don't see a bunch of job openings on, like, the public websites and everything, that doesn't mean they don't exist.

So when you get out another, I'm just going back and forth.

But when you get out two, what you can do is, like, send your Resume out to physician groups.

Like, if you learn.

So, like, big physician groups like Apollo, Kaiser and other big, you know, multi state or national groups, you can send your resume out to them and just, you know, be like, hey, here's my resume.

Or send it to the hospital physician group.

Like, here's my resume.

I'm interested in, you know, joining as a PA or whatever.

That's another way.

If they have an opening that hasn't been posted, you can try and get a job, too.

So.

So, like, my job that I have now wasn't posted publicly.

I heard of it.

I heard about it from somebody that I knew.

So, yeah, I was offered a job on my ER rotation and they weren't, like, publicly hiring.

Right?

Yeah.

Yeah.

Both of the jobs I've had, neither one were posted jobs.

Yeah.

Can we talk about burnout?

Sure.

How much time you got?

Like three more hours.

We might burn out if you take that long.

Yeah.

I think ER burnout is a real thing.

There's a pa, Harrison Reed, that did.

He did an article in, like, JAP or something, didn't he, on burnout?

Does he do er?

No.

Well, he's academic now.

I don't know.

I don't know.

I don't know if he used to.

Yeah, but Harrison Reed, he writes articles for japa, which is the journal for the aapa.

If you're an AAPA member, you'll get the JAPA magazine.

But I think.

I think burnout is very real.

In.

The er and, like, a lot of specialties, too.

Like, a lot is.

Do I. I mean, like, I. Yeah, I experienced when.

I want to know, like, when you felt like you started to feel burnt out.

I think it depends on the day, though.

Like, I'll go.

I'll go through, you know, I'll go in and out, just kind of depending on, like, if I've worked, like, five days in a row.

Like, by the end of that stretch, I'm kind of like, I'm a little less friendly.

Like, at the end of my shift, I'm a lot less cheery than I am at the beginning of my shift, too.

And, like, that's just.

I'm just kind of ready to go home and get out of there.

I feel less burnout now than I did working at the trauma center.

So.

I worked at the trauma center for four years, and it was a great, great job.

I loved it.

I loved everybody that I worked with.

But after seeing, like, so many, like, kind of, like I mentioned before, like, gunshot wounds and, like, stabbings and traumatic car Accidents and, like, kid.

Like, pediatric trauma and arrests and stuff.

Like, that kind of stuff takes a toll on you.

And, like, I'm fine, thanks.

Therapy.

No, no, but seriously, like, that kind of stuff takes a toll on you.

After a while, I didn't feel like I was burned out at the trauma center, but now that I left and kind of looking back on it, I think that I kind of was, like, to a certain extent, like, my personality is totally different, I think, at this new job, or I've been here for two years now or over two years, versus, like, at the end of my job at the other place, just because I don't see that terrible stuff anymore or, you know, nearly as much.

Like, we still get gunshot wounds every once in a while, but it's not every day.

And so.

But I did it before as a tech, too.

You know, as a.

As an ER tech.

I worked in the ER at the trauma center.

And so, like, it was just seeing a lot of that stuff.

And I think that some people, it doesn't bother nearly as much or that doesn't affect them nearly as much.

But even now, I mean, you still have rough shifts now.

Even if it's not trauma, it's just sick, sick freaking people, man.

Like, and it's the burden, I think.

Just healthcare.

Yeah.

Because that's what me.

And I have three, like, best friends from PA school, and two of them are in Durham and one is in.

She was in vascular surgery originally.

Now she's on.

In, like, oncology, like, oncology practice.

And so when we went to AAPA last year, Shelley, who was with me, like, we talked a lot, just about.

And there were a lot of good lectures about burnout there because at that point we were both about five years out of school and, like, really, really, really feeling it.

Yeah.

And I think it's hard, too, like, and not to, like.

Like, I know you're a dad and stuff.

Like, as a mom, like, it's very difficult to feel like you're having to manage a lot of different things.

Sure.

Yeah.

And, like, managing a household and being a good mom and being a good PA and, like, yeah, that was where I was at last summer, where I told my husband.

I was like, I don't feel like I'm doing anything well.

Like, I'm barely doing all of these things and none of them are getting done well.

Like, at work, I'm thinking about home.

At home, I'm thinking about work.

Like, I'm frustrated everywhere.

And so I think, like, switching jobs, like you did, like, that has Helped a lot.

But the PA community is also just very supportive of each other.

And I think that that's very helpful too.

Yeah, I don't think you should go into medicine with like, rose colored glasses thinking it's all easy and great because there's, there's a lot of hard stuff.

Well, I remember, I mean, just like looking back right when, when I first started, I mean, everything was just so cool.

I mean, like, going home and like, talking about what I did in the ER today.

Whereas now you don't get that same feeling.

And that's not burnout, I don't think.

I think it's just you kind of desensitized because you see it all the time.

Yeah, I think burnout is more just like, I don't know, more personal.

Like, kind of along the lines of like, almost like a feeling of frustration and inadequacy, like, to a certain extent, like, I don't know, it's, it's, it's like a snowball effect.

Like, it just, it can keep growing on you.

But I think it's important to be mindful of that regardless of what your job is now.

I mean, even as, you know, pre PAs, working as, like, CNAs or in a, you know, doc's office as an MA or whatever, you can get burned out doing anything.

But it's important to just kind of take a step back and realize, like, how fortunate and lucky you are for having a job, first of all.

But like two, getting to do something where you are able to have an effect on people that you don't know.

Like, people are genuinely, you know, by and large, people are genuinely thankful for the job that you do, both as PAs and like, even beforehand.

I mean, you know, even if they don't say it, you know, I don't remember the last time I was like, thanked, you know, for like, the job that I do.

You know, like, which is fine.

Like, I don't expect that, Like, I don't, I don't go to work, like, expecting me to be thanked, but, like, I know that people are thankful for what me and what everybody at the hospital does.

And even, like I said, I mean, even as pre pas, like, the stuff that that chat is doing right now is like, you're truly making a difference in people's lives, like, what you're doing regardless of what you're doing now.

Hell, you could, you could, like, like I said, I mean, be working as a MA or a CNA or a ophthalmology tech or, you know, physical therapy aide or whatever.

Like, you, at some extent, you're making a difference in somebody's lives.

And that's what's important, like, is keeping that in mind.

And so on days where I get frustrated, like, I had a bad day at work or I go home and like, I don't want to go back to work the next day or whatever, I constantly try to, like, like I said, take a step back and realize, like, how lucky and thankful and fortunate I am to like, be in this position despite my bad day.

Like, everybody has bad days.

But that goes with everything in life too.

Right?

Like, you just got to be as thankful as possible with everything that you're provided with one way or another.

Yeah.

And I think even, like, you're impacting patients lives, but also like the people you work with and your co workers.

That was when the only really thing that kept me going at my old office was my medical assistant.

Just because she was so amazing and so positive and so encouraging that when she saw how frustrated I was with things, she helped me a lot.

And so I think, like, you can look for those opportunities.

A lot of it help, like, and that's, I mean, like, you know, and.

And I also very, very strongly believe after making some changes that if you are not happy somewhere or you're not being valued or worse, you're really being used, it's you.

You can make those changes in your life because it's not worth being completely unhappy.

Right.

Yeah.

I feel like we could literally talk.

For literally talking about burnout forever and just like the problems with medicine and health care and.

Yeah.

Yeah.

Well, maybe we should, so.

But yeah,.

I think I went through all of the.

Or most of the questions.

Yeah,.

I think after listening to this and watching this, people should have a very good understanding of what your job is.

Yeah, I hope so.

And if people, like, have additional questions, like when we could do this again, I wouldn't mind, but like, they can reach out to.

I'm on Instagram at, you know, the MYP resource handle.

If you don't put it in the chat.

Okay, cool.

All right.

Right.

So people can find you.

Okay.

All right, post.

Well, I post your handle a lot.

I'm probably again tonight, but.

Oh, we're going to do the poll.

Do the poll where we figure out if people have applied or if they haven't or if they're applying next year just so we can kind of get an idea of where everybody's at in the process.

People are asking why PA over np?

So when I was going through.

While you're Figuring that out.

I'll answer this question because I've seen a couple.

So I got my degree in microbiology, my undergrad degree in microbiology from the University of Tennessee.

And when I graduated, I didn't really know what I wanted to do.

I thought I wanted to work in a lab, but I didn't.

I hated it.

And so I was trying to figure out.

I knew I wanted to work in healthcare doing something.

I thought I wanted to be a doctor, but I, you know, couldn't because of my grades, which is a whole nother video session.

So I was trying to figure out what I, what I could do.

And so I looked at the nurse practitioner program, Right?

So they have a bridge program.

Some places have bridge programs where people that get their bachelor's degree in any subject can go and take a three year bridge program where you get your, like, I think RN and, or BSN and np.

I don't know if those still exist, but I looked at doing that.

But then I looked at the PA professional like, well, why go?

Why go through that process if I could just be a PA instead?

So the jobs are very different, which I didn't realize back then, or at least not the jobs, but the training is very different.

At least it was back then.

And.

But either way, like, now I work with plenty of NPs and PAs and like, you wouldn't know the difference between, between us working in the er.

So we get to do the same things now.

Yeah.

And in Georgia, PAs and NPs are very similar in what we're able to do.

Yeah.

So it looks like about half are applying now.

And then like 33% next year and then 20 in two to four years.

Gotcha.

Okay, cool.

All good stuff.

Oh, I need to announce the next one.

So people say, you should do a podcast with me.

We did one like two years.

We should do an updated one.

What was the.

Yeah, I think you come on like once a year.

Like it probably is fine though.

So.

Yeah, Brian.

I have a podcast called the Prepa Club and Brian is on it.

Sometimes I forget this Will.

I'll post this on there in the next few months.

Like so people who.

Yeah, listen, but statement one.

And then we did what?

I forget what the second one we did was.

I don't remember either.

We may have done two personal statement one.

Okay.

But I don't.

I don't remember either.

So I'm not sure.

But let me pull up my calendar and grab the link.

So the next.

That is not my calendar.

The next virtual shadowing Event, which I'm very excited about, is with a PA named Tony, who is in Sacramento, California.

And he is.

He went to USC Keck School of Medicine.

He's been a PA for about a year.

He went.

Fun fact.

He went to PA school with his twin brother, which I think is kind of cool.

They're in the same class together, but he does family medicine and street medicine.

So we actually talked today, and he did a podcast interview, which I'll be posting on the podcast next Friday, about his job.

But, like, even I had so many more questions and wanted to know more because it sounds like, number one, his passion for what he does is, like, contagious and so cool.

It's like ours, huh?

It's like ours.

Yeah, like ours.

Nobody.

Like, you are so cool.

So, anyway, so his, like, passion, like, he.

And just his involvement and everything with this organization that he's actually started is so cool.

So he's gonna be talking about that on September 10, which is also a Thursday at 8pm Eastern.

And so I'm gonna post a link.

So we are doing this as a fundraising event for Sacramento street Med.

It's $5 if you want to either watch it live or have the replay.

And all of the proceeds, profits, whatever you want to call it, is going straight to their startup because they are kind of.

I mean, they're.

They're already doing outreach, real talk opportunities, ways to get involved.

But, like, it's.

It's really cool.

And so, like, it's really cool how he talks.

Like, you'll hear if you listen to the podcast or if you come to it, but, like, talks about what he calls people who are experiencing homelessness or people without homes.

Like, oh, yeah, interesting.

People who live outside.

Like, even through this talk, like, I learned so much.

Like, you don't call people homeless people.

Like.

Right, right.

Are.

And just hearing about, you know, I don't know, he got into a bunch of stuff about, like, just kind of the.

The mindset of taking care of.

Of different kinds of populations.

So.

Okay, but let me find that link real quick, and then we will get you all set up, and if anyone wants to do that, and then I'll send out the replay information, too.

So.

This was fun.

Yeah.

It's fun to, like, talk about your job.

Right?

Yeah.

Yeah.

Well, and thanks, everybody, for, like, submitting questions and stuff, because if it weren't for the questions, I would have just rambled on about some nonsense and, you know, which is.

Which probably would have been entertaining anyway, but.

But I appreciate y' all listening and being involved and active in chat.

Yeah, I'll put it up here.

All right, well, y' all are awesome.

If you have any questions, send them to us on social media.

Yeah, follow.

I'm on the at MYPA resource, and Savannah's is at the PA Platform.

Yep.

All right, Thanks, y'.

All.

All right, see you, guys.

Thanks, Brian.

See ya.

Thank you.