Interview with an Admiral

This past fall I had a chance to meet with Rear Admiral Epifanio “Epi” Elizondo, Ph.D., PA-C, the Regional Health Administrator for Region 6, Department of Health and Human Services. You can read an excellent article for more on his position and background, and here to see his most recent distinction in the PA world. Since we met in his office (a federal building) I didn't get to video our conversation. I made furious notes the whole time we spoke and, afterwards, had a difficult time putting them into a coherent post. Below are, in no particular order, some thoughts about our conversation. 


Remember where you come from - Admiral Elizondo showed me around his office and pointed out several notable items: a picture with Janet Reno, a flag given to him by the First Lady, several awards for his service and work, etc. We came across a black and white close up photo of a women working in a field. "That's my mother." He told me how he keeps the photo to remember where he came from. His mother worked hard to provide him with opportunity so that now he may help others. It's humbling to remember, and it's important. 


Public Health = Population Perspective - Starting in clinical medicine, Admiral Elizondo worked directly with patients. While he was able to make a great impact on each person, he told me how public health let him reach many people at once. Cleaning up a water supply means a whole population doesn't need to keep making trips to a clinic. For him, it was a chance to have a broader impact and help more people with his time.  


Think Career - As he walked me through his career, he described an incredible amount of intention during each step. Moving from the Air Force to the Public Health Service not only opened up new avenues of practice, but allowed quicker advancement for a new officer his age. Making the most of a position in correctional medicine meant taking on extra projects, but it also let him learn new leadership skills needed to advance. Admiral Elizondo didn't just work hard; he worked wisely to make the most of his career. 


Always another way to help - I had not heard of Operation Lone Star, but in talking I learned of this initiative to address health disparities along the Texas border. I was fascinated to know that a) there was a coordinated effort that occurred regularly to intervene in this massively under served area b) even though I've spent tons of free time trying to learn all the ways to serve locally, I had no idea this existed since 1998.


Take the time, take the opportunity - I emailed the Admiral's office to see if I send a few questions to share on this blog. It was a great surprise to be invited to his office to speak with him in person. Hearing his journey showed me countless times that he learned to make the most of what he was given. Being able to talk one on one with him about his career was an amazing honor and one that I would not have come across if he wasn't eager to help out an aspiring PA. In this field more than any other, I consistently find people who are excited to help anyone interested in the profession. Be sure to take the opportunity and reach out. 

Interview with a PA-C in Neuro

Here's an interview witha PA who works in Neurosurgery. 

1) Why did you become a PA?

I became a PA in a roundabout way.  I suppose the same way a lot of people do.  I already had a Master's degree in Anthropology and was burnt out on academics.  I knew I wanted to do something practical with my training and experience.  Initially, I was taking pre-med prerequisites thinking I'd become a physician, but I met someone who was applying to PA school who was taking a class with me.  I did some investigating and realized that becoming a PA would be a better fit for me over all.  I wasn't wrong.

2) How did you pick BCM? What was your application and interview process like? 

I lived in Louisiana at the time I applied to Baylor College of Medicine in Houston.  Louisiana only had one PA school available and it was a Bachelor's program.  Baylor was relatively close to home and I didn't have to meet any residency requirements to go to Baylor.  I loved it there.  Great school and amazing experiences at the Medical Center there.  The application process was easy.  This was 1998-99 so I think it was an individual application process, not a centralized process.  The application process was enjoyable actually.  We all toured the campus and part of the Med Center.  We were assigned to interview with PAs and MDs.  It was pretty relaxed overall even though we were all stressed out.

3) What was your strategy for succeeding in the didactic phase? How did that change in clinicals?

I learn visually and I just remember reading and re-reading and re-reading and talking things through with classmates.  For me, re-writing my notes was really helpful.  Clinical phase was markedly different.  You learn on your feet, helping take care of patients and then reinforcing what you saw and learned by reading more whenever possible.

4)  What do you do as a neuro PA? What does a normal day/week look like for you?

As a neurosurgery PA I see patient's in my own clinic, assist my physician in his clinics, order and interpret tests, assist in surgeries in hospitals and in our surgery center.  I also take call after hours and round on the weekends as needed.  I also field phone calls from patient's and deal with disability paperwork and refill requests.  I also see patients in pre-op clinic and discuss their upcoming surgery and answer their questions.  A normal day starts at its earliest around 7 am and ends around 4:30-5.  I work Monday through Friday and, if on call, round on Saturdays and Sundays.  Occasionally, we do have emergency surgeries that happen after hours.  Occasionally we have to see patients in the hospital in consultation after hours too.

5) How did you get connected to your current practice? Have you worked in other areas of practice?

I actually interviewed with my current employer 9 years ago but accepted another job offer.  I was looking for a new position several months ago and answered an advertisement for a Neurosurgical PA on the TAPA website.  I have also worked in general orthopedics, neurology, orthopaedic spine and orthopaedic trauma surgery.

6) I've heard that the critical component of any PA position is the relationship with your supervising physician. What do you look for in that relationship?

Finding the right "fit" with your supervising physician is very important.  You have to mesh well intellectually and emotionally.  Working with surgeons means that you have to respect and appreciate that your employer may do things differently from other surgeons, but your employer's way is THE right way when you work for him/her.  You are second fiddle to your boss.  If you can't accept that, don't become a PA!  For me, I need to work with someone who is respectful of me, my life and my opinions, and is honest about the expectations.  Some employers will try to win you over with money and benefits but then have no respect for your time outside of work.  I can take working long hours as long as I know that's what is expected of me.  I've been led down primrose paths before thinking that I would work "normal" hours (ie, 9-5) only to be in clinic until 8pm routinely and in the operating room until 11pm all too often.  With no extra compensation for all that time mind you.  If your employer works as hard as you do that's the exception to the rule.  That's how things are for me now.  Not always.  I used to work with ones who took their dedicated time off during the week but expected you to work your 40 hours and more.  

7) You've been practicing for 10 years now [ed: I think I remember that from our conversation, feel free to correct me] How has the role of a PA evolved in that time? 

I have been a PA in practice since 2002.  Medicine has changed drastically.  I think that US medicine is evolving towards a more centralized system.  Not necessarily toward government centralized but more towards hospital centralized care.  I see more and more private practices having real difficulties because they're competing with other providers who are employed by hospitals.  Imagine that you work for yourself and have employees.  All the income you generate is because of your great reputation and hard work.  Then, right next to your name in the insurance directory is a provider who provides, by appearances at least, all the service you offer but their salary is paid for by a hospital system and that provider is expected to keep all their referrals and testing within that system.  That's what we're going to see more and more of.  Your boss may be a surgeon who is competing with other surgeons who provide the same services, but your boss gets paid based on the work that your practice performs.  A hospital employed surgeon gets paid no matter how much work he/she does because they get a salary from their employers - a hospital.  Your boss may need to do 40 surgeries a month to keep the business going, but that hospital employed surgeon....I'm not sure how hard that surgeon would work since they would get a salary no matter what.  I feel that this trend will affect PAs and NPs and more hospitals will employ mid levels directly.  Might not be a bad direction to consider.

8) Any advice for aspiring PAs?

Study hard.  Ask lots of questions.  Listen to the nurses.  They can teach you a LOT.  Don't take things personally if people look at you like you're "just a PA" and "not a doctor."  I'm amazed daily how few people know what PAs are and what we do.  Don't stop learning.  Most patients just want someone who actually listens to them.  Try to really listen to people rather than just waiting for your time to talk.  Do what you enjoy and enjoy what you do.

Things I did - Choosing a PA school

When I decided I wanted to be a PA, I found out that there was a nearby program that was highly recognized. In the back of my mind I decided that was the school I would go to and focus my efforts on it. A year into the process, I began to meet people from several different programs. I started reading blogs from PA students in other parts of the country. I looked through schools rankings from US News and lists on the AAPA website. I stepped back and realized that I needed a better criteria for selecting a program. I also learned from an admissions committee leader that her program didn't take a candidate seriously if they only applied to one program.

Below are some of the things you will want to consider when deciding which programs to apply to and which to skip.


Cost: There are many ways to offset the expense of PA school, but the amount of debt you accumulate during school will impact you no matter how you address it. If you are choosing between two schools with a noticeable cost difference, ask yourself what does the more expensive school offer that will help me as a practicing PA. Is it worth the added expense?

Family/Support Structure/Commitments: I have a wife and a child, so I can't make a decision about PA school without considering how it will impact them. I talked with my wife (who has her own career) from the start and when application time came around, we selected cities that had programs I liked and opportunities she liked. Consider what commitments you have and what your support structure (friends, family, etc) will look like while in school.

Program Focus: Do you want to go into surgery? Do you want to work in a border town? Many of the programs have unique strengths that become apparent as you get to know them. Look for a program that will prepare you best for what you want to do.

Prerequisites: I have some academic blemishes that have taken work to address since starting back to school. Even with my efforts, there are several programs that will not look at my application. Be sure to carefully read the prerequisites of each program and make sure you meet/exceed each of them. If a program wants a 3.25 overall GPA and you have a 3.1, you may not want to waste the money applying there. You definitely shouldn't get your hopes up.

Culture: As I attended information sessions and heard different program leaders speak, I discovered that I really resonated with a few of the programs. Surprisingly, the ones I thought I would like ended up being the ones that I didn't click with as well. Get to know the programs as best you can. What are their attitudes about school? About students? About the profession? There's not a wrong answer, but make sure you answers match theirs.

PANCE Pass Rates: If a PA program can't prepare you to pass the PANCE then what are you paying them for? Check the pass rates, rates for first time takers and overall rates, look for trends over the last 5 years, look for reasons (good or bad) that the rates are what they are.

Interview with a Surgical PA-C

1)  Why did you choose to be a PA?

I graduated with  BS in biology from Wagner College in Staten Island New York.  For three years after graduation I taught Biology and Chemistry and at a local catholic high school.   As much as I enjoyed it, I wasn’t going to stay there forever.  Since Wagner had a PA program I had a handful of friends who were already practicing PAs.  The more I continued to talk with them the more I decided that becoming a PA would be a great fit for me.

2) How did you pick UMDNJ? What was your interview process like?

My undergraduate GPA was not good.  I want to say it was around a 2.5.  I went back at night to retake some prerequisites and I made sure I had a 4.0 in all of those classes.  With such a low GPA I applied to almost every school I could drive to.  Living between NYC and Philadelphia that was almost 10 schools.
I was surprised to be granted interview at the first two schools I heard from.

The UMDNJ interview was the first one.  I went early and dressed in a suit.  I remember waiting in the outlying room as other candidates went in for their interviews.  I went into the room and sitting behind a small table were probably two faculty members and one or two students.  They asked a lot of questions, but I only remember one.  They asked me what I would do if I were not accepted.  I remember the question because I told the truth and at the time I wasn’t sure that it was a good idea.  I told them that I didn’t know what I would do.  My wife and I were planning on starting a family and we may not want to wait another year.

I heard back from them a week later and I canceled all the rest of my interviews.

3) What strategies worked for you during your program? Did they change when you entered the clinical phase?

I changed study strategies hundreds of times throughout PA school.  I used piles and piles and piles of index cards for anatomy my first year. I wrote test questions and little study guides my second year.  Some classes i focused and took tons of notes.  Others I did crossword puzzles while only half listening.  It depends alot on the class and how much your brain can take.  It is a ton mental work.  It is exhausting and it is a marathon.  I studies in groups and I spent hours alone in a cubicle.  I found I don’t do well for focusing for long periods of time. I prefer the 25 minutes on 5 minutes off technique.  I find my brain works better that way.  In Stephen Covey’s The Seven Habits of Highly Effective People the seventh habit is called sharpen the saw.  The premise is that if you are going to be cutting down trees for a 8 hours you can get a lot more done if you stop and sharpen your saw for at a 4 hours.  If you just keep cutting you will work harder and accomplish less.  I noticed this strongly in PA school and I have brought it into every area of my life.

4) What was your biggest surprise once you started working as a PA-C?

The biggest surprise I had was that people started to trust me immediately.  Nurses would ask me questions as if I knew something.  Scrub techs stopped watching me like a hawk.  Nothing had changed since graduation, but somehow a lot had changed.  Don’t worry when you get there you will be ready for it.

5) What area of practice are you in now? What does a week look like for you?

I currently work for the department of surgery in a small community hospital.  I first assist on any case that a surgeon at our hospital needs help with.  I did a robotic prostate yesterday.  I have lumbar fusion case today.  I have a C-section scheduled for Monday.  I am lucky enough to have the job I went to PA school to get.  I am in the OR 5 days week with a huge variety of cases.  I don’t take call.  I don’t work nights, weekends or holidays.  It really is fantastic place to be

6) You have a great and thorough review website. How did that get started? What are your goals for PA Exam Review?

I got started producing content for Physician Assistant Exam Review because I couldn’t find what I was looking for.  I wasn’t in love with any of the review books out there.  I also really enjoy listening to podcasts and I couldn't find anything on medical review that I could use.  I decided to create what I couldn’t find.

I initially set out to write a review book, but I don’t think that's what I’m doing anymore.  I am building a place where PAs can go to feel like they are not alone when preparing for their exam.  The PANCE is one thing.  You are surrounded by a group of people in the same boat.  When you take the PANRE you are alone. Even if you work with other PAs you are still alone because their cycles likely don’t match up with yours.  So my biggest goal is to create a place for PAs preparing for their exams to feel welcome.

7) Any advice for aspiring PAs?

Get started now.  I put it off for three years debating what to do.  It’s a great job.  You may be worried about the three year commitment, but you will be three years older whether you go to school or not.

Update

Sorry for having such a lull in activity. Its been a busy few months here but with excellent results: I got into PA school! I'm going to start this summer, but that doesn't mean I'm done blogging. Later this week I'll have an interview from a PA-C who also runs a PANCE review website. Stay tuned!