TAPA 2013 Video Interview #1

Here's the first of several video interviews I did at this year's TAPA conference. Eric Martinez is working with TAPA and recently completed his EM residency at BCM.

PA-C running a business

Here's a unique interview: a PA who, after praticing clinically, started a health care related business: Medelita.

1) What made you interested in health care? Why did you become a PA? 

I was actually pre-nursing at Emory University (undergrad) and after volunteering extensively at Grady Hospital (the big, inner-city hospital in Atlanta) I realized that I wanted to be more a part of the clinical decision making process and that my personality was best suited for a clinical role.  I knew that I also wanted to someday be a mother, and I needed flexibility in my profession to allow me to do that.  And I was dead set on working in Emergency Medicine, and PA s have always had a strong, respected presence in ER.  I thought it was a great fit. 
 I wrote a recent blog post here that describes my first day of ER rotation with Larry Herman, president elect AAPA.


2) Tell me about your time in clinical practice. What did you like? 

My first job was at Mary Immaculate Hospital working in the Pediatric ER and Fast Track.  It was an inner-city hospital in Jamaica Queens (NY) and has since been shut down.  It was one of the best places in the country (perhaps I'm biased) to learn clinically at lightning speed with zero competition for good cases.  It was my number one goal to work in that ER under the direction of Larry Herman, RPA-C.  Only the brightest, most reputable and capable PA s worked in this ER.  The ultimate honor.  And it was the most difficult job I've ever had in my entire life.  There was very little (if any, honestly) physician support.  I would sometimes go to the main ER to ask for help and the response would be something along the lines of "look at me.  How could I leave this area now?"  It's not how the PA profession was designed to work, but I'm telling you – it is absolutely a great way to learn, for someone with the right clinical sense and drive.  The mentality of not being dependent on others in a very risky environment makes you learn super quickly, to say the least. 

It was wildly clinically challenging, in the oddest ways.  We were the receiving hospital for JFK airport, so we would regularly get people sent from other countries who were told "We cannot help you here.  Get on a plane to the US and they can help you with this medical problem."  So in the middle of the night I would see severe gigantism, uncontrolled seizures from head trauma (months prior) from a mounted water dispenser falling 2 stories onto my patient's head, etc.  Hmm . . .  It was always very interesting.  My very first patient as an employee/non-student was a seizing 2 year old coming in by ambulance as a "scoop and run", and while I was calculating the valium dose, I asked my nurse to put in a line.  She said "I don't put IV's in kids under 5."  So I said "well who does?"  And she said you do.  Ok . . . Well then I better get it on my first try.  Lots of miracles happened while I was working in that ER.  Getting lines in an actively seizing 2 year old just being one of them. 

I worked happily in that ER for 4 years, and then decided to move closer to family/re-prioritize my life after 9/11.  So I moved to Southern CA, without a job, in the summer of 2002.  My parents drove me to an interview a couple of days later in Mission Viejo, CA, and after 3 months of convincing them that I was the right hire – I got the job.  I worked at Mission Hospital/CHOC at Mission for 3 years, until I decided to get serious about Medelita.  My strengths clinically were anything related to Peds ER (most ER docs prefer not to deal with the parents, so I got really good at it), any ER procedure, especially complex suturing, and perhaps my biggest strength was my patience and skill at listening in combination with good clinical judgment.  Larry always said that the patient gives you the diagnosis 90% of the time, and I never forgot that.  It's so true, especially with children and parents.  A patient never complained about me, that I know of, in my entire clinical practice, and I feel really good about that.  My personality is such that I really do care, and I think people can feel/sense that.  It's common to lose that trait working in Emergency Medicine for a long time, but I was lucky not to.  It didn't mean I was especially popular amongst colleagues, or that I was the fastest at seeing patients.  I was just thorough and I listened, and could go home at the end of each day feeling good about my contributions.


3) What led you to transition to your new role founding Medelita? 

I'm not a fashionista or anything.  I just felt like I couldn't be the only female clinician that hated wearing boxy, frumpy, shapeless lab coats and scrubs that were absolutely not made for the female figure.  I simply bothered to brush my teeth, fix my hair, put on a tad of makeup before my shift, and why in the world would I want to put on something of lesser quality than cheap pajamas?  It just didn't make sense and seemed to be an issue, completely overlooked.  All other professionals of similar education and/or stature wore in upwards of $1000 business suits and carried expensive bags. But medical professionals should be stuck in horrendous quality ill-fitting garments, and expect to gain respect and trust in a matter of seconds?  Still to this day it baffles me that people are willing to accept this traditional norm.  Medelita is definitely changing that.  The original idea was based on fit/styling only, but I decided to combine the trend of using applicable performance fabrics, in a similar way that companies like Patagonia, Lululemon, Athleta, etc. have been doing to appeal to the buyer and improve the buyer experience and functionality of the garments.


4) Medelita has been in business for 4 years now. How has your experience as a PA informed the direction your business has taken? 

I think it's a HUGE advantage.  It gives us credibility and a level of understanding of our customers/colleagues that is unmatched in the medical apparel industry.  Everything that is written on the web site and/or guided by our customer service team, is catered toward the needs and personal attention of our clinician based customer base.  Almost all the other similar companies out there have focused on nurses, and surprisingly forgot about the growing clinician force – including physicians, physician assistants, nurse practitioners, dentists, veterinarians, chiropractors, podiatrists, etc.  This population has very different medical apparel needs v. nurses, and Medelita caters to their specific requirements for appearance, length of garments, quality of garments, and professional logos. 

Also, if you take a look at all of the professional organization logos that we offer, and the professional affiliations that we hold, it is testament to Medelita being a clinician owned and operated business.  It is a tremendous honor to have the trust from these extremely reputable, prestigious organizations, such as AAPA, ISAPS, and ASAPS, among others. 


5) Do you still work clinically?

Do you plan to re-certify when you license expires?
I'm not working clinically but I miss it terribly.  The combination of working (more than) full time and having a 2.5 year old daughter, as well as being almost 6 months pregnant with twins, would make it challenging for me to work right now.  I absolutely stay up to date by reading multiple journals and earning CME mainly at highly reputable conferences throughout the year.  Since we exhibit at the very best conferences in the country, it's been easier to travel with the conference team and attend CME lectures as well as help out in the booth when needed.  Main conferences we attend include AAPA, ACEP, AAD, ASRM, CAPA, etc.   My license is up to date and I have never lapsed in re-certification, after graduating in 1999.


6) What do you want to do next with Medelita? 

We are still very much in the beginning stages of the business.  So from that perspective, I simply want to do everything possible to help the business grow and to improve brand awareness to our target audience.  By hitting certain targets of growth, we will then be able to introduce new lab coat styles, new scrub colors, introduce additional sizing, and sponsor additional medically related events that show close unity to Medelita.  We also want to be at the forefront of fabric performance technology and being certain that we are testing and (in the future) utilizing the very best available technologies that are applicable to the wearer.  We do that now, but absolutely need to stay on top of developments and it is a very expensive, time consuming task. 

Interview with a PA-C

Here's an interview with a PA-C who has worked extensively in the Emergency Department.


1) Why did you choose to be a PA?

The experiences I had with PA's prior to becoming one was that they universally seemed to be more down-to-earth, common sense professionals, which fit more in line with how I was raised. It seemed also like a natural extension from my prior career as an EMT.


2) What was your application process like (how many schools, how many interviews, how did you choose)?

I applied to schools in Texas only, since that is where I lived, and Texas is an absolute bargain for higher education. I applied to all state public schools except for UT Pan Am, was granted interviews at 4 of them. One of the schools I was offered was Texas Tech, but the date they offered was right in the middle of a trip to Las Vegas. I gambled (no pun intended) on getting accepted somewhere else, and thusly turned down the Tech interview. Thankfully I DID get in somewhere else, and I don't recommend doing what I did :)

The interview process at each school was very different. The most comfortable I felt was at UNT in Fort Worth, which is where I ultimately was accepted and chose to go to school. UT San Antonio was by far the hardest, and lasted all day from 8-5: an impromptu essay writing, followed by four individual interviews (with an impromptu spanish-language thrown in additionally), and ended with a panel interview with 4 different PA's.


3) Since graduating, what areas have you worked in?

I have only worked in emergency medicine since graduating, and at the original place I began working after becoming certified. I took a bit different course after PA school though, as I immediately entered a residency program in ER for PA's, which was 18 months in duration. I was hired on as staff at the same hospital after completing the residency, and have been there ever since. I don't see myself going into any other specialty in the near future.


4) What has surprised you about being a practicing PA so far?

What has surprised me the most is how much I was able to learn and absorb simply by being in the PA residency out of school- the first year after graduating is definitely an experience in exponential learning potential. Before PA school, I never thought I could have done medical school if I wanted to. After having gone through that, as well as training alongside emergency medicine physician residents, I know that I could do it if I wanted to....but I have no desire to go beyond being a PA.

On another note, it has shocked me at how many of my classmates switched jobs within a year after graduating from PA school. There's only a very small handful of us, myself included, who are still at our original jobs. But then, this is the uniqueness of being a PA- the ability to move into another field if you so desire.


5) You've done some research on emergency medical practices and PA roles there. I know that a PA will do very different things in one Emergency department versus another. How has that role evolved and where is it heading?


In general, there has been a trend towards more autonomy for the PA in the emergency department. We have several in our specialty who are running rural ER's on their own, although this will likely continue to be the exception rather than the rule. I am thankful that in my own practice, that the physician whom I work with on any particular day and I will just trade off who is seeing which patient- there is no defined limitation on which patients I am able to see or not see.

Because of this trend towards more autonomy, there has been a measured push towards more formalized training for PA's in emergency medicine. Just in the three years since I graduated PA school, we have gone from 3-4 PA residencies in the ER to approximately 10 (with more in the pipeline), and the first standardized test for PA's in emergency medicine- the CAQ exam. While residencies and specialized testing is still optional, it would not surprise me that in the distant future you would not be able to switch specialties without at least passing a CAQ exam, if not also completing some sort of post-graduate training. At the very least, the emergency physicians (ACEP) advocate for us to acquire additional training specific to the ER in whatever form that may take, and there are plenty of options out there other than a formalized residency program.


6) You trained in Texas and now practice in a different state. How are the regulations different in your current state? What was the licensing process like for someone from an out of state school?

Pennsylvania is definitely unique in that there are actually two boards of medicine- one for allopathic and one for osteopathic. As a PA, you choose one or the other based on your supervising physician (although you are not limited to one or the other based on who your substitute supervising physicians are). PA's in Pennsylvania are also able to write for DEA combination Schedule II opiate medications, whereas in Texas you are limited to Schedule III and lower. There is also a bill currently going through the legislature that will take away the requirement for all PA charts to be co-signed by a physician.

The licensing process was actually very painless- it's always easier to get your initial license than it is to acquire an additional one after practicing for a few years. Most states enable you to acquire a temporary license that's valid just as soon as you graduate from an accredited PA program, and last until you pass the PANCE (when it automatically rolls over to a permanent license). So as soon as I graduated from PA school, I had my program director sign my license application and sent it straight to Pennsylvania, and within a week I had a temporary license. Unlike in Texas, there is no additional exam such as the Jurisprudence exam that needs to be passed in order to acquire a permanent license.


7) Besides shadowing and good grades, what advice would you give future applicants?

*PRACTICE INTERVIEWING! It will truly make you more relaxed when you're in that one-on-one situation come crunch time.

Other than that, there is a vast wealth of information at the PA Forum to help future applicants. It's helped me and countless other PA's get to where we are today.

Interview with a PA-C

Here's an interview from a PA that works in the Emergency Department at my hospital.

1) Why did you choose the PA profession?

I was thinking about med school and optometry school at first. Decided optometry was going to be too boring. Chose PA school after speaking with counselor at UT. Didn't know anything about it at the time. It was more of a time/length of school factor for me.

2) Tell me about your preparation for application to a PA program.

Really just looking at the pre-req's ad concentrating on my grades, especially in my core classes (sciences)

3) What was your most challenging period as a PA-S?

Most challenging periods were the in-patient clinicals with call schedules. I think they have changed/limited the number of hours now, but at the time, I would be at the hospital for 30-40 hours straight on those days.

4) What areas of practice have you worked in as a PA-C?

Only emergency medicine so far

5) How do you think the role of a PA will change in the future?

I hope to think it will only get stronger. Our value seems to be our best asset.

6) What advice would you give an aspiring PA?

Concentrate on grades in school. It is pretty competitive, so don't slack on studying. Also, I think now they are wanting some type of experience/exposure, so volunteer, work or shadow when you can.

Interview with a PA-C

Here is an interview with TAPA board member Amanda Reynado. If you're not a PrePA member of TAPA, I highly recommend it.

1) Why did you choose the PA profession?
I wanted a profession that allowed me to practice medicine, learn in-depth science and its clinical implications, and work as a provider patients can relate to – all while still maintaining my personal life. The PA profession allows me to practice an autonomous career in medicine that involves diagnosing and treating, practice independently yet be part of a team, and have personal relationships with patients as their provider. My first interest in the becoming a PA was due to all of the PAs I had met being absolute cheerleaders for their career.

2) Tell me about your preparation for application to a PA program.
After college, I worked in research for 4 years as a lab manager. After I realized that a lifelong career in research was not for me, I began to research the requirements to get into PA school, went back to school at night to get the 3 classes I was missing, and also shadowed multiple PAs for over a year. After shadowing I was positive this career was for me. I then applied to PA school very early (submitted my application 5 days after it opened), and got in that year.

3) What was your most challenging period as a PA-S?
I was in the “Hurricane Class” at UTMB during Hurricane Ike. I had just started my first semester in PA school, was not 3 weeks into classes when the hurricane hit and destroyed our campus. We lost our cadaver lab, our building, and half my class lost everything they owned. We missed 5 weeks of school, and returned to a make-shift site with a crammed schedule. PA school is stressful and high-paced enough without a condensed schedule. We did not even have a library or coffee shop where we could study, but most of my class made it through the first semester. It was all uphill from there!

4) What has surprised you since you’ve become a PA-C
My first surprise was that they trusted my education and personal preparation to start working independently my first day. It was absolutely nerve-wracking but that’s how PAs learn – baptism by fire. Once I grasped my medical confidence, I had to discover and explain my role as a PA in a large emergency department. We still are a new career field to many people, therefore it is always necessary to provide information and set examples for who we are and what we can do.

5) What areas of practice have you worked in as a PA-C?
I am a new PA-C, and have only worked for 1 year. My only job has been in Emergency Medicine and this was my dream field while I was in school. I love my field!

6) How did you first get involved with TAPA?
One of the PAs I shadowed before school was coincidentally a TAPA officer. Once in school, I was elected to be my class TAPA representative during our 3 years. I served on multiple committees and helped get my program re-involved with TAPA during my office. Now I am the PR committee chair and sit on the general board of TAPA. I find every experience of representing PAs extremely rewarding.

7) How has participating in TAPA benefited you?
TAPA has helped me in multiple dimensions. Firstly, they donated multiple truck loads of goods from around the country during my program’s time of need after Hurricane Ike. Second, by sitting as a student board member, I realized exactly how much they represent and provide for PAs in the state. It also educated me on PA functionality, politics, and how to assert myself as a PA in a new work environment. Thirdly, I got my first job in a very competitive field from connections I made in TAPA.

8) How do you think the role of a PA will change in the future?
We are already seeing a large delegation of work to PAs in hospitals and highly populated areas. Physicians and administrators are realizing in every field that hiring a PA allows efficiency and betterment of the flow of care. Also, with the introduction of socialized medicine in our near future, this type of delegation and team work will only be broadened.

9) What advice would you give an aspiring PA?
Besides the obvious (study hard, good GPA, average GRE score) keep a well-rounded life. PA programs want to see that you get along with people in any scenario (family, work, volunteerism) because, after all, PAs serve as a midlevel provider and come into contact with everyone. Schools also want to see you have extracurricular activities that help you balance the stressors of school and our demanding career.
Shadow shadow shadow. You need to know what a PA does, how we function in the field, and it is a “requirement” on CASPA. If you don’t have shadow hours, you have less likelihood of getting an interview. Know why you want to be a PA and not a nurse or physician.
Use people who know you well for your letters of recommendation. I used a physician from my past with whom I worked, an old research mentor, and my boss at the time of application. All of them could truly speak of my personality, nature, and work ethic. I would not advise getting all college professors. We have all been to college, and we all know that one does not really experience a lot of one-on-one and close-knit relationships with professors.

Please follow TAPA on Facebook and Twitter by logging onto www.TAPA.org and clicking
their icons. You can also become a pre-PA member for cheap to prove to schools that
you really are committed. Contact me with questions at amandamcgreynado@gmail.com.