By Russell Longendorfer BA - PowerPoint Presentation

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By Russell LongendorferBA Clark University 2010MSPA Bay Path University 2017

An introduction to the

physician assistant

profession for undergraduates

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Physician Assistants…Have a master’s degree in Physician Assistant Studies (MPAS) or similar degree (MSPA, MMS, etc.)Are certified nationally by the National Commission for the Certification of Physician Assistants (NCCPA)The Physician Assistant National Certification Exam (PANCE) is taken after graduation to become certifiedThe PANRE recertification exam is taken every 10 years to maintain certificationPA’s must complete 100 hours of Continuing Medical Education (CME) every two years to maintain certificationAre licensed by the state in which they work to practice medicine under the supervision of a physicianTypically, the physician is not actually present when the PA sees patients, and PA “Scope of practice” is different in each state

What is a physician assistant?

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Physician Assistants…Diagnose and treat diseaseOrder lab tests and imaging studiesPrescribe medicationEducate and promote wellnessPerform minor surgical procedures (suturing wounds, collecting biopsies, performing spinal taps, etc)Can perform major surgery up to the level of first assistIn Massachusetts, can be full Primary Care Providers (PCP)Supervise and train medical residentsCan participate in or conduct original researchCan own a private practice

What does a physician assistant do?

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Physician Assistants and Nurse Practitioners can apply for many of the same jobsThey both practice medicine as part of a physician-led teamAlthough NP’s can be “independent providers” in many states, the majority practice in a setting which includes a PhysicianThey both complete a bachelor’s degree, work in the medical field, and then complete an advanced degreeThe majority of PA programs require medical experience, but not allThe average salaries for Physician Assistants and Nurse Practitioners are very similarIn 2010, the difference was $100 in annual salaryPhysician Assistants and Nurse Practitioners often work side by side in the same practice, and have the same duties and skillset

Physician assistants are very similar to nurse practitioners

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Physician Assistants

Are trained in the medical modelRequire a physician supervisor in all statesHas a master’s degree in medicineMust have a bachelor’s in any area before starting programHave a generalist degree

Nurse Practitioners

Are trained in the Nursing modelDo not require a physician supervisor in all statesMay have a master’s or doctorate in nursingMust have a bachelor’s in nursing before starting programMay choose a degree specialty

What is the difference between a pa and a nurse practitioner?

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A Brief history of pa’s

1942: Eugene Stead, Jr. MD develops an accelerated, 3-year medical curriculum at Emory University to train physicians in WWII

1957: Dr. Stead establishes a program for “Advanced Nurse Clinicians” along with Thelma Ingles, RN, at Duke University. The program ultimately fails to become accredited by the National League of Nursing (NLN)1965: Dr. Stead establishes the first “Physician’s Assistant” program at Duke. The program aims to train former Navy corpsmen to practice medicine as part of a physician-led team. Four students are enrolled in the first class1965: Medicare and Medicaid are established in the U.S. The need for medical practitioners rises sharply

Dr. Eugene Stead

Thelma Ingles, RN

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A Brief history of pa’s

1968: The American Association of Physician Assistants (AAPA) is established

1970: California becomes the first state to license Physician Assistants, though they are employed broadly at this point1975: The NCCPA begins certifying Physician Assistants who pass a certifying exam and maintain re-certification standards1986: The Omnibus Budget Reconciliation Act authorizes reimbursement of Physician Assistants under Medicare1997: The Balanced Budget Act recognizes Physician Assistants as covered providers in all medical settings2000: Mississippi becomes the last state to authorize PA practice

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An increasing need for physician assistants

In 2010, President Obama passed the Patient Protection and Affordable Care Act (ACA)

Patients can no longer be denied coverage due to a pre-existing condition

Patients can now purchase health insurance through state-run exchanges, and may qualify for subsidy depending on income

Significant expansion of Medicaid

An estimated 30 Million new patients will now be covered and will seek care

Physician Assistant utilization is increasing rapidly to meet the increased need for medical providers

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There are currently 190 accredited Physician Assistant training programs in the U.S (up from 146 in 2010)There were 95,000 certified Physician Assistants in the U.S at the end of 2013 (up 219% from 43,000 at the end of 2003)Physician Assistant jobs are expected to grow another 30% in the next 10 years (most industries are projected to grow 10%)While PA’s were mostly male in the early days of the profession, two thirds of certified PA’s today are femaleForbes Magazine rated Physician Assistant Studies the best master’s degree for jobs in 2014U.S News and World Report has ranked the PA profession very highly in terms of employment, salary, and job satisfaction

Physician assistants today

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Physician Assistants can work in almost any specialtyNo additional training or certification is required to change specialtyOn average, a PA will change specialties 2-3 times throughout their careerPA’s can work in hospitals, clinics, skilled nursing facilities, home care, and patient-centered medical homes

Where do physician assistants work?

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Physician assistant specialty representation (detail)

Credit: AAPA annual census 2012

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Physician Assistant median salary: $97,500 (Forbes Magazine)Average hours worked per week: 40.57 (NCCPA 2014 statistical report)Average patients seen per week: 70Overall job satisfaction is higher than physiciansPA’s change specialty 2-3 times during their careerOnly 1% of PA’s go to medical school after certification

Physician Assistant Employment facts

Credit: AAPA annual census 2012

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Physician assistant training

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On average, PA training programs last for 24-27 monthsNearly all programs are full-time, including summer semesters and Saturday and evening obligationsMost programs stipulate that you cannot work while at school, or that you may only work at most 6 hours a week with special permissionThe rigor of PA training will not leave you any free time to earn income. You must live off of loans while you’re in schoolPA school consists of two main phases: one year of classroom-based, didactic learning, and one year of clinical rotationsYou will have 6-8 rotations of 6 weeks at different sites where you will explore different specialtiesAt the end you take a certification exam called the PANCE. If you pass, you can begin practicing immediately!

Pa school quick facts

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How long will I be in school?

Credit: PAEA annual report 2012

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Where are the programs?

Credit: PAEA annual report 2012

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Total enrollment and average class size

Credit: PAEA annual report 2012

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Classes will start in January, May, June, August, or September, depending on your programYou will take an average of 20 credits worth of coursework per semester, and complete three semesters within 12-15 monthsThis varies widely by programMost programs include Summer semestersYou may have breaks between semesters or modules which last from 1-4 weeks, depending on the semester and programYou will study a variety of preclinical subjects including Anatomy, Physiology, Pathophysiology, Pharmacology, Clinical Medicine, and Diagnostic SkillsSome programs include courses on professionalism, interview skills, public health, ethics, or issues within the profession

The didactic year

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At most schools, you will rotate to 6-8 clinical sitesRotations last for 4-8 weeksEach rotation will be in a different specialty. You will explore:Family or Internal MedicinePediatricsEmergency MedicineWomen’s HealthSurgeryPsychiatryUp to two elective rotations depending on your schoolClincial sites are generally within an hour radius of your schoolYou will work under an MD, DO, NP, or PA who will act as your preceptor

The clinical year

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Total tuition cost for PA school can be $70,000 - $100,000 depending on your programThis does not include the cost of books, medical supplies, housing, food, or transportation costsApply for federal loans through FAFSAMany students supplement federal loans with private loansMany schools have small grants and scholarships availablePrivate grants and scholarships may also be available from charitable organizations, your hometown, etc. Start looking early!

Financing PA school

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Average tuition cost of pa school

Credit: PAEA annual report 2012

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The National Health Service Corps (NHSC) is a government program which provides financial incentives to candidates who are interested in working in primary care specialties in health care shortage areasNHSC will fund your tuition and provide you with a stipend while you are in schoolIn exchange, you agree to work in a health care shortage area for one year per year you were fundedMaximum of four years, minimum of twoThere are several qualifying sites in Boston, Worcester, and Western MassachusettsLearn more at NHSC.HRSA.gov

National Health service corps

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Applying to PA school

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Research your programsTake prerequisite coursesMaintain a strong GPABegin asking for letters of recommendationJob shadow a Physician AssistantTake the GREObtain good Patient Care ExperienceWrite your personal statement essayApply through CASPA

Pa school application checklist

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The Centralized Application Service for Physician Assistant programs (CASPA) is a common application accepted by the majority of U.S. PA programs. It is administered by the Physician Assistant Education Association (PAEA)CASPA will report your coursework, grades, recommendations, test scores, and personal statement to all participating programs that you apply toMany programs require a supplemental application in addition to your CASPA application

The centralized application

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There are currently 190 programs accredited by ARC-PAA full list of these programs is available at: http://www.arc-pa.org/acc_programs/There are 25 programs which do not participate in CASPAA list of these schools is available here: http://www.mypatraining.com/non-caspa-pa-schoolsIf you choose to apply to any of these schools, you will have to research the program website for application instructionsMany programs have unique requirements for your application. Research some programs now so that you won’t be caught off-guard when you apply

Research your programs

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Academic Performance is a Top Priority

Courses, Grades, and

Gpa

calculations

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Required Courses

Intro Biology 1&2 with labIntro Chemistry 1&2 with labAnatomy & Physiology 1&2 with labBiochemistryStatisticsMicrobiologyPsychology or Behavioral Science CourseEnglish with Composition

Recommended Courses

Organic ChemistryGeneticsNutritionCell BiologyImmunologyMedical EthicsMedical TerminologyPhysicsPathophysiology

Which courses are required?

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Some schools have additional course requirementsBoston University requires three 300-level Biology courses of your choosingBay Path requires a course in EthicsFranklin Pierce recommends Anthropology rather than PsychologyMany schools require that all prerequisite courses be taken within 10 years of applyingIn many cases, a “refresher” course or taking an advanced course in the same subject can substitute for retaking these coursesResearch the programs you might be interested in, and plan your coursework accordinglyYou can’t take every course recommended by every school in the country. Choose programs and course lists which are a good fit for you and your interests!

Program-specific course requirements

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Many schools require a B- or better in all required coursesSome schools require a minimum overall GPA of 2.8, 3.0, or 3.2Competitive applicants will have overall GPAs above 3.4CASPA will report three separate GPA values to your programs:Cumulative undergraduate GPAScience GPANon-science GPAAdditionally, some schools will calculate a “Prerequisite GPA”Every undergraduate level course you’ve ever taken will be included in these calculationsGPA from Masters-level classes will be considered separately

Grades and gpa considerations

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To be a Practitioner, First you Must Practice

Patient care experience

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Besides grades, this is the most important part of your applicationPaid, full-time work experience is preferredThree important criteria are evaluated in determining the quality of patient care experience:History takingTreatment deliveryPhysical contactMost schools require at least 500 - 2,000 hours of patient care experience (2,000 hours = ~one year of full-time work)More experience is betterCompetitive applicants will have experience in both inpatient and outpatient settingsCompetitive applicants will have more complex roles with higher levels of training and responsibility

Patient care experience

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Average health care experience of admitted students

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STRONG patient care experience jobs

NurseEMT / ParamedicUltrasonographerRespiratory TherapistPhysical TherapistMedical AssistantRadiology TechNursing AidePhlebotomist

MODERATE patient care experience jobs

Roles with a limited scope of skills or responsibilityClinical research or any roles where patient care is secondaryRoles which have some but not all of the criteria: assessment, treatment, hands-on contact

Patient care experience

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Roles without direct patient contact are not competitive. Some examples of WEAK patient experience include:Medical ScribeInsurance CounselorMedical Laboratory TechnicianMedical Office ManagerMedical TechnologistMedical Record ManagerMedical software industryMedical devices / sales industryNon-allopathic medical techniques such as acupuncture, reiki, etc.

Patient care experience

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Know the Profession Before You Apply

Physician assistant job shadowing

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Physician Assistant programs want to see that you understand what a PA is and what the job entails on a day-to-day basis.Many programs require a specific number of shadowing hours before applyingRequirements range from 0 (recommended but not required) to 40+ hours, depending on the programCompetitive applicants will shadow for at least several days, and may shadow a second or third PA in another setting or specialtyWorking alongside a PA while working or volunteering is good exposure to the profession, but does not count as job shadowing

Pa job shadowing

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Securing a job shadow can be very difficult. Many clinics don’t allow shadowing at all for safety or patient protection reasons, and PA’s are often busy with their duties. However, most PA’s recognize that shadowing is an essential contribution to the profession, and will try to help if they can. To secure a job shadow opportunity:If you know a PA, reach out to them. Unfortunately, it is not acceptable to job shadow a parent, but family friends are OK.If your PCP is a PA or has a PA that works in the office, reach out to them.Use PAShadowOnline.com to find a registry of PA’s who are willing to shadow. Reach out to them by email.Reach out to a program you’re interested in, and ask if any alumni of that program are willing to let you shadow themCold call clinics or hospitals in your area and ask if they allow job shadowing of providers for prospective students.Small, office-based clinics are more likely to allow job shadowing than major hospitals because of liability concerns

Pa job shadowing

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Get Someone to Vouch for You

Letters of reference

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Schools vary on letter requirements, but in general you should have three letters of referenceAt least one from a science professorAt least one from someone who has supervised your healthcare work experienceYour letters should be from someone who can speak to your work ethic, personality, knowledge of the profession, and whether you are a good fit for the role of PAWhen asking a professor for a letter of recommendation, make sure that you will have worked with them for at least two semestersThe better the professor knows you, the better the letter will beApproach the professor about writing a letter for you while you are still working with themGive the professor ample time (several months) to write the letter before it is due to CASPA

Who to ask for a recommendation

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Whoever directly supervises you at your healthcare job should be your first choice to ask for a recommendationThis person should be able to comment on your professionalism, work ethic, bedside manner, ethics, and personalityYour third letter should come from someone who supervises you, either at work or in school, who knows you well enough to comment on why you’re a good fit for the PA professionHave a few backup letter writers in mind. Not everyone is comfortable writing recommendations, and you don’t want to have to badger someone to write one for you. If you don’t get anywhere with an author after a few weeks, choose another writer and move onDo not write your letters yourself or have a friend or family member write one for youCASPA does not accept committee letters from the pre-med committee. All letters must be submitted directly to CASPA by the author

Who to ask for a recommendation

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GRE, MCAT, and TOEFL

Standardized tests

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The GRE is a standardized, computer-based test which measures your ability to perform at the graduate level academically, and your ability to do well on other standardized testsMany schools require you to take the GRE, but there are also many that don’t require itYou must self-report your scores to CASPA, and send individual test reports from ETS to each program requesting scoresTake the GRE within 5 years of your planned application date

The gre

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Several GRE prep courses are available through Kaplan, Exam Krackers, and Princeton ReviewAllow three months to study for the GRETake several practice exams through ETS. Understanding how to pace yourself through the test will dramatically increase your scoresReview high school level math. The GRE is not knowledge-based, but it uses algebra as a method for testing your problem solving skillsTake an English course and read books for pleasure. Your reading comprehension and writing skills will be tested on the examScores above the 50th percentile are considered competitive

The gre

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Take the MCAT as planned if you are still considering medical schoolA very small number of schools recommend taking the MCAT or reporting your scores to themSome schools will accept the MCAT as a substitute for the GREIf you choose to report your MCAT scores to CASPA, you cannot reverse this choice once your application has been submittedIf you reapply the following year, they will still be thereIf you scores are good, this could be a good thingIf your scores are bad, this can hurt your applicationEither way, be prepared to talk about why you are choosing to apply to PA school and not medical school

The Mcat

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The Test of English as a Foreign Language (TOEFL) evaluates your English speaking skillsIf you are a native English speaker, you do not have to take the TOEFLIf you have graduated from a U.S. or Canadian university, you may be exempt from taking the TOEFLSchools have specific requirements for required TOEFL scoresGenerally, scores above 120 are required for consideration

The toefl

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The Centerpiece of Your Application

The personal statement

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After grades and experience, your Personal Statement is the next important part of your applicationA strong Personal Statement can mean the difference between getting an interview or notA weak Personal Statement can prevent you from getting an interview – even if your grades and experience are strongCASPA requests a 5,000 character Personal Narrative (roughly one page, single-spaced) which describes your motivation or desire to become a Physician AssistantThe CASPA statement is sent to all of your programs – keep it broadMany schools require additional personal statements or essaysGenerally, they’d like to know why their program is right for you, and vice versa

Your personal statement

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Start thinking about why you want to practice medicine right nowDo not settle for “I like science and want to help people.” You need to find a source of motivation that is deeply personal and unique to youThe CASPA personal statement has no specific prompt, but it may be helpful to brainstorm using some common themes:Have you had a difficult experience in your life where a medical professional made an impact on you?Have you overcome some form of adversity, and has that motivated you to achieve?Do you feel a sense of responsibility for the well-being of others? Why?You should address the question of why you want to be a PA and not a doctor, NP, etc. Researching the profession and finding what makes it unique will make this easier

What to write about

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Start early. The more time you give yourself, the more you can develop your ideas and the better your Personal Statement will beAt least 3 months to write is ideal. It’s never too early to start working on your ideasAfter you’ve written a draft, do at least one major re-writeThis will give you the chance to explore different thematic approaches and structuresSave all of your scrapped drafts and ideasYou will be writing many more essays for your supplemental applications. Previous drafts of your PS can be helpful during this processChoose an editor or two, but not too manyDr. T can help make sure your major thematic elements are goodChoose a friend who will be honest with you, but not overly critical, to help iron out the stylistic elements of your essay

When and how to write

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What to do, and When

The application timeline

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The application process takes about one year. Before planning your application date, you should:Have all of your prerequisite classes doneSome schools will allow you to have up to 2 in progress will applyingHave at least six months of solid patient care experienceHave a list of programs you’d like to apply to, and information about themRequest an info packet from schools you’re interested in. Most will send you a brochure and subscribe you to a newsletterAttend some open houses if possible, these can be very valuable experiencesYou don’t have to be done with the GRE yet, but if you take it ahead of time you will be happy you didBe mentally and emotionally ready for a very tough two years of school if you get inIf you need to take a year off, use that time to gain work experience and take some extra classes at night

Before you begin

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January: Enroll in Spring classes. This is the last round of courses that will appear on your CASPA applicationSome schools will not count classes taken after this semesterFebruary: Begin working on your personal statement. Take the GRE if neededMarch: Approach your letter writers about recommendations. Retake the GRE if needed. Order official transcripts for your own useApril: Focus on your personal statement and make sure you are approaching a final version.

The timeline - spring

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April 16th CASPA opens! Create an account. You can now:Send CASPA transcript requests to your undergraduate school(s)Send CASPA requests for letters of recommendation to your letter writersManually enter your coursework and grades using your copy of your transcriptsManually enter your test scores for the GRESend your MCAT scores to CASPAOnly do this if you did well AND you can explain why you’d rather be a PA than a doctorUpload your personal statement to CASPADesignate your programs

The timeline - spring

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When you have finished all the steps in your CASPA application, you can e-submit the applicationAt this point, your statement and self-reported grades and test scores are finalYou do not need to have all letters and transcripts in to CASPA yet. However, they will not report your application until all of your transcripts are inAfter your schools have received your CASPA, many will send you a secondary applicationYou should prioritize the order in which you complete these secondariesBegin with schools with early deadlines and rolling admissionsMake sure that your top choice schools are done well ahead of timeBe prepared to interview at schools with a Winter or Spring start dateRegister for Fall classes. Many schools will accept coursework done in the Fall, some will not

The Timeline - summer

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Interview season generally starts in the early fall and goes well into the winterMake sure you are able to take time off work during this season. Interview invitations usually come a few weeks ahead of time, but they may come on very short noticeBuy a suit, have it tailoredBe prepared to answer common interview questionsTell us about yourselfWhat are you strengths and weaknesses?Have a clear idea of your reasons for wanting to join the profession and be able to present them succinctlyAdmissions decisions may arrive from schools with Winter or Spring start datesFinish your fall coursework

The timeline - fall

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Admissions decisions should arrive from schools with a summer or spring start dateIf you took courses during the fall semester, you must send final transcripts to schools that have accepted you. You may self-report grades to schools that still have you under consideration, but have not offered an acceptance

The timeline - winter

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Don’t Panic

What if I don’t get in?

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You’re in good company!Eugene Stead didn’t succeed in founding the profession on his first attemptPA school admission is very competitiveHighly rated programs may receive more than 20 applications per seatThe GPAs of accepted PA students are comparable to those of accepted medical students

What if I don’t get in?

Dr. Eugene Stead

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You can improve your chances of getting in the second time by planning aheadOn average, most people don’t get in until their late 20’s:The number of accredited programs is increasing rapidly (next slide)You now have a significant life challenge to write about in your personal statement!

Some good news

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The number of programs is growing

Credit: PAEA annual report 2012

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Solicit feedback from your programsMany programs will at least give you a form letter about how to improve your application. Some schools might be willing to comment on your application and how to improve it for next year. Send a friendly email or phone call and be patientTake more classesGo down the list of recommended courses and take as many as possible. A few extra credits can make a big differenceGet more patient care experienceIf possible, begin training for a job that will give you higher-quality clinical experienceIf you’ve just started working, keep at it. Seek opportunities to work in new settings or with new populationsDouble down on your “Soft skills”If your application is marginal, your essay needs to be a slam dunk. Spend some extra time revising and really go for itInterview skills can be learned, and a good interview performance can make the difference. Read up, and practice with mock interviews

What to do next

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Other Masters-level allied health professions:Nurse PractitionerAnesthesiologist AssistantRadiology AssistantPathology AssistantPhysical TherapistNurse AnaesthetistNursing AdministrationPerfusionistRadiation Dosimetry

pa not quite what you’re looking for?

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For a copy of these slides, email me at:Rlongendorfer@gmail.com

Thank you for listening!