Transition from PA-S to PA to PA-C with ease: Part One

The Long Space between leaving PA school and practicing as a PA-C

If I could get a dollar for every time Iโ€™ve been asked โ€œdo you have a job?โ€ or โ€œhave you started working yet?โ€, Iโ€™m positive itโ€™d help pay off some of the interest accruing on my loans. While these questions are asked out of interest, it is frustrating to explain the long process it takes. This post is the first of two part that will include how to prepare if youโ€™re finishing up PA School and what to expect after you become a PA-C.

Within 60 days of your last day of PA School:

  1. Register for your PANCE as soon as you can. You can take your PANCE 7 days after your official last day of school, but you can register for it from when your program gives you the okay (my school was at least 60days before we finished). https://www.nccpa.net/pance-registration
  2. Create a resume and cover letter.
  3. Start applying for jobs.
  4. Make a schedule for how you want to tackle your PANCE.
  5. Take your BLS/ACLS/PALS course training if you donโ€™t have them or will be needing them in the specialty of your choice.

Officially a PA.

  1. Study hard and PASS your PANCE as soon as you possibly can. Check outย How to PASS the PANCE
  2. Continue to apply for jobs.

Officially a PA-C.

  1. Apply for jobs if you are still searching.
  2. Send in your state registration application. There are usually multiple steps for state registration, read the instructions carefully and pay the required fees. You can start this process while studying for your PANCE. In New York, it cost $115 and you can begin the application prior taking your exam and release your scores after youโ€™ve passed. http://www.op.nysed.gov/prof/med/rpaforms.htm
  3. Sign up for your NPI. The easiest of all things youโ€™d have to do. https://nppes.cms.hhs.gov/#/
  4. Apply for your DEA โ€“ (optional). If your job requires (as most do), your practice may pay for this or waived if working for a state institution. It cost $731 and most people reluctantly pay for this out of pocket. It can take up to 6weeks (Although it has taken less from what I hear) https://apps.deadiversion.usdoj.gov/webforms/
  5. If youโ€™ve secured a job prior to finishing school or while studying for your PANCE, then you continue to start the credential process with your job. Private practices take less time to complete as opposed to hospital settings where average time is 3-4 months.

The delay is mainly due to credentialing. Iโ€™m speaking specifically for NYC here, make sure to keep in contact with the credentialing specialist assigned to you. There is a medical board that must review your credentials and to my knowledge, they meet once or twice a month and if your documents are not in order, you will not be presented and must wait for the next round. After accepting a job offer, youโ€™ll have to complete a series of request. You must be proactive to email, ask for updates and complete all required tasks on time, otherwise, it will delay how soon you can start working.

Each company requirement for credential varies but you can expect the following plus more:

  1. Complete job application
  2. Medical clearance
  3. Recommendation from program director and clinical supervisors
  4. Background check
  5. HIPPA training and other training related to your job
  6. BLS/ACLS/ATLS/PALS etc as needed.

If you have not secured a job, continue to search, apply and interview.

Completing these steps are dependent on the individual, position and company. This is my experience and will be sharing the part two, which will include details on finding a job, deciding and more.

 

 

How to PASS the PANCE

I started this blog post several weeks ago, where I added things, removed some and debated if it was worth sharing with the world. This topic is universal and very subjective because Iโ€™m only a recent graduate who is sharing her one-time experience with the PANCE. The rest of the post will be very informal, so judge very lightly.

These are my views on the topic and everything I wrote about is not going to apply to every student.

Was the test hard? Yes, it was. ย Probably one of the most challenging exams I’ll ever take.

What study tools did I use? I used Pance Prep Pearls and Rosh Rapid Review e-text as my text resource. Hippo education, PPP question book, Smarty Pance and Rosh Review were my resources for questions. In hindsight, I probably couldโ€™ve benefited from an additional study guide, but I am a person who doesnโ€™t like too many sources. Once something works, rarely do I ever want to change it.

  • Rosh: I did all the body system questions, the family, internal, surgery and emergency medicine EORs. I also completed the Mock PANCE to replicate the PANCE in a 5 hour sit down. This was done 7 days before my exam.
  • Hippo: I completed at least 4x 200+ random question per practice exam. I reviewed mostly the questions I got wrong and allowed HIPPO to pick my questions based on my weak areas.
  • Smarty Pance: I did 3 of the comprehensive 225 questions exam during the first 2 weeks of my studying. I didnโ€™t return to use Smarty Pance because it wasnโ€™t as tough as the remaining resources.
  • PPP question book: I only did 160 question out of the whole 600 question book. I was short on time and simply preferred computerized practice question. Although if I had more time, Iโ€™d have done more of these questions because they helped.

Tutor or Exam mode while doing questions? I believe that tutor mode makes me lazy as it helps answer future questions. Simply put, I didn’t do any tutor mode. I timed myself for every exam to build up my stamina. Youโ€™re going to be taking an exam, so start stimulating that and youโ€™ll be ready. Sidebar, I had about 8-10 min in each section of my PANCE to review my exam and news from fellow classmates was how they were running out of time.

Did I take the NCCPA Pretest? ย Yes, I did and totally worth the $50 investment. Honestly, this is the only test that is very similar to the actual test and helps to show where you stand among your peers whoโ€™ve taken it. Do not take the pretest until you’ve reviewed all the topics and at least 10-14 before your exam date. It has a way of unnerving even the calmest students, so prepare for it because you donโ€™t want to waste your money or time taking it when youโ€™re not ready.

What were my weak areas? Pulm, Msk, OBGYN & GU were my weak points. I did terrible on reproductive system because I did not review those topics before taking the pretest. Therefore, it is important to finish reviewing all materials before taking it. TRUST ME.

How long did I study? PANCE is an individual race. You must know where you’re as a student and know what works best for you. I took my exam exactly 6 weeks after my first board review. I put in about 10 hours x 4 days a week consistently in the library and a about 6 hours here and there on days I wasnโ€™t in the library. ย I needed the structure of the library and no distraction to complete what I needed to do. While this worked for me, it can be different for you. I know a lot of people say you’re studying for PANCE while in clinical rotation, but that time is not the same because you’re still focused on passing an EOR & graduating. There must be time set apart to focus on solely studying for the PANCE and that time varies. Average recommended time is 4-8 weeks depending on who youโ€™re. Some students will take it within 2 weeks, while some will take 10 weeks or more. Its all up to where you stand.

2019-09-06 01.32.27 1.jpg

How much time is too much time? Just as you don’t want to take the exam unprepared, don’t take forever either. You can be ready objectively but subjectively you may feel not ready and willing to keep pushing off the test. If your practice scores show that you’re doing well, your pretest places you in the green and you know your stuff, don’t take forever waiting. Because life will be happening around you, which can affect how well you study if you are weeks to far into it.

What topics needs extra attention? The main heavy hitters to know are cardio, pulm and GI. BUT, reproductive health, GU, and professional practice are content areas not usually given much thoughts to and I’d recommend paying closer attention to them. Personally, I treated reproductive health as a topic that โ€œI should know alreadyโ€ but it turns out that I needed to read and put in more effort. ย Do not sleep on professional practice content areas.

Was I anxious? I had a lot of anxiety leading up to my exam and even until the morning I got my result. I was blessed to receive so many great news that morning- my niece was born that morning as well. I believe that being mentally prepared for the exam was just as important as studying for the actual blueprint. We know the material but learning to be a test taker and not doubting yourself is vital. After my exam, I felt like such a weight was lifted and that I could have passed. While thinking about that, I tried to quell my eagerness because you just never know. That was the hardest part and the waiting was bad. Thank God for great friends who will adjust their plans to keep you company after taking that exam!

Does your score matter? I simply have no idea. To me it doesnโ€™t matter if you pass at 350 or 750, because youโ€™re both a PA-C. Your test score doesnโ€™t determine what type of practitioner youโ€™ll be. While studying, ask your faculty what numbers are ideal to be scoring. If you reach out to me personally, I will share what numbers I think can tell you where you stand. I have only my knowledge and other classmates to use as my source for it, which is why I do not feel comfortable sharing it here.

Test taking tips… Do not change the question asked. Answer what you’re given, as it is given. Do not think like a clinician, think exactly like the textbook. Read the last line first and then start from the beginning to help focus. Review questions you answered wrong then find out why you answered it the way you did and learn from it.

Group study or no? I did one group study session with my friends and it was only on cardiology. While it was helpful, we found that we were all at different points and wasnโ€™t going to be productive to keep meeting up. We stayed in touch via video chat, group text and phone call whenever someone had a question, which was very often!

My support system wasโ€ฆ My three closest friends in the program were the people I spoke with the most. I shared everything from my anxiety, study techniques, stress and tips with them and vice versa. I limited the amount of people who had access to me during my study time because I didnโ€™t want to interrupt the energy I had cultivated. My state of mind during those 6 weeks were fragile and life was happening all around me and I had to block a lot of it out. You must do what you have to do sis!

If youโ€™ve made it this far, I hope you learned something and will share my experience with the 2019 PANCE with others. It was an exam that put my 27 months in the program to test, to see if I had what it takes to practice. I am blessed to have family and friends who supported me because it was a tough 6 weeks. No one else will be able to understand what youโ€™re feeling, except for your classmates, so it is okay to take however long you need to be ready. If I remember more helpful information, Iโ€™ll update this post as needed.

B.

p.s: be mentally prepared by learning how to control your anxiety.

p.s.s: If you are a borderline student or struggled while taking your EORs, PACKRAT etc, then I’d recommend taking your time to evaluate your weak areas and strengthen them. Those areas do not disappear just because you’re done with school. The PANCE is too important and expensive to just “go take it”. There are students who don’t pass or do well, thatโ€™s the sad reality of it. It doesnโ€™t mean theyโ€™re not smart, they just must adjust to taking a test. Do yourself a great service and do whatโ€™s best for you. Check how youโ€™re scoring on your practice test; find patterns in questions you get wrong and alter your studying appropriately.

p.s.s.s: the passing score of 350 from last year exam will not yield a 350 this year according to the information regarding the 2019 PANCE. That means the PANCE was harder this year, which has put alot of people on edge. It is neccessary to stress, because you want that “C” bad, but don’t let the stress stop you from effectively studying and learning to be a better tester.

The 2019 PANCE was a real one, from my experience and the passing rate nationwide.

 

Why Diversity Matters

With every opportunity, I recommend my school to anyone who will listen long enough for me to boast. There are positive qualities and areas where the program can improve upon, but one factor that makes them different from most Physician Assistant (PA) program is how diverse each cohort is. Each class is an example of what the world looks like, with students from various ethnicities, beliefs and practices. Unfortunately when I talk or see students from other programs, there is a lack of diversity among the cohort.

It is important to have diversity. Numerous research has conclude that quality of care for racial/ethnic minority patients improve tremendously when they share a ethnic, language or even religious similarity with their provider. Also, it is known that health care experience and outcome for minorities are much more different than the results of their counterparts in both medical and surgical specialties.

In 2017, less than 20% of PAs were minorities and less than 4% were Black. Attending my school, I often forget that students from other programs do not look like my classmates. There is usually just one or two Black students among the cohort. There are many reasons why minorities make up such a small amount of the percentage and it is up to us -the current students and clinicians- to change those numbers.

Processed with VSCO with a5 preset
Diversity Matter T-shirt fromย The PAC

How do we start?


ADVOCATE. We must encourage others and create a future where we matter. We must also take up positions as administrators when opportunity presents. Use social media as a tool. Social media is much more than a pretty collection of our best looks, it is a place that can inspire the next generation to believe in themselves. It is important to note that you don’t have to be Black or a minority to advocate for diversity. We all share responsibility in creating what we hope to achieve.

So each day going forward, do your part to diversify the field of medicine.

B.

Dear NICU….

A change. I may or may not have prepared for it, but it wasn’t waiting for me to get it together. My body has become the vessel for a new being and I was elated, scared, anxious and whatever other feelings I could feel. I imagined who you’re going to be, how the delivery would go and what type of mother I’d be. The whole months that passed by, I heard congratulations, advice, appointments and the whole village was awaiting your presence.

But oh no…….

A declaration was made. My deceleration were wild, my membrane ruptured too early, the amniotic fluid was very little, the cord was wrapped around you, who knows what, it all sounded like jargon and they must bring you out immediately. Wait, I didn’t finish your crib, I wanted a home birth, I don’t want a csection, the baby shower is still weeks away, I didnt even get to push!

But you’re here now……

Way earlier than we planned and whisked from my stretched & tattered flesh into the arms of strangers. I didn’t hear your cries, someone said you’re all blue, no movement as I lay not feeling my lower body. Everyone in the room springs into action. I wasn’t your first hug or your first touch. You’re suctioned, probed, masked, pricked, infused with various drugs/fluids and placed in an incubator, secluded from my warmth, my touch, my heart beat.

Away from me….

Seeing the world but without my touch or my voice along side you. The team is now with you all day. Some stranger who earned a MD NP, PA, RN, RT behind their name spend more time with you than I can. The updates are sporadic, late phone calls to bring breastmilk, to keep pumping, lines all hooked up to you, the stares, audience when I’m forced to bond with you in front of people who doesn’t know me. Some will see me, smile, try to accommodate while hoping I don’t ask too much questions. They’re waiting for me to abide by their requests and not flinch when asked for permissions to continue probing you. The slightest frown or repeated question got a raised brow from them. All just wondering why I just don’t get it and be okay with everything.

How can I be okay….

Do they not know that I can see them? Hear their whispers about me and my baby? Can’t they see how I feel? The anxiety, the shame, the energy it takes to walk out and not leave with you in my arms? Have they placed their feet in my shoes? Didn’t they dream of the perfect baby like I did? Don’t they hurt when days turn to weeks then into months in the hospital and only allowed to visit my own child during visiting hours?

They must know….

They consoled when there was no progress, when you lost weight and nothing could stop the cries, my defeated walk out of the door, my frustration trying to get you latched onto my breast… or at least some of them knew. They smiled and laughed during discharged . They joked about my lack of sleep from here on out, couldn’t wait til I visit & show them how beautiful he/she would look. Or atleast that’s what we was all hoping for. Some didn’t get the luxury of going home with the baby. Prayer was a constant factor with hope that we got to take you home to help you grow some more into a beautiful member of the society.

And you do grow...

You grew before my eyes because of their help. I praised the strangers who became family during the stay. They brought you to a state a I couldn’t. I smiled, thanked them for their efforts and appreciated each one because I knew with certainty I was walking out with you in my arms. I accepted that I may have overreacted when they called one or few times, I took out my frustration on them when I shouldn’t and we both weren’t perfect. They were doing their job. One they must love and care. So I apologized to the team about their difficult jobs but to understand where I was coming from.

This experience was new, unlike what I planned for and each day was not guaranteed. I was only human. With that, I smiled then waved goodbye knowing that the true journey has just begun.

—————————————————————–

p.s: I am not a mother, I’m simply an observer. This piece is not to insult families who have had to go through NICU, not to disrespect the staff that works tirelessly to help or to ridicule the fragile state everyone is in during their stay. I just wanted to write again, to dig into the other part of myself I often neglect. And I appreciate you for reading this far.

B.

Get Comfortable being Uncomfortable as a Pre-Pa

In everything that you do, be it as a student, volunteer or liscensed professional, do it with grace. I have had the opportunity to be each one in my short life and while each role has different responsibilities, I always try to give do my best. While you’re applying to schools, you’ll have to be a volunteer shadowing a PA/MD. Your responsibilities are very limited and the day may seem to drag. It can be tempting to not pay attention to what is going on because your job may seem meniscal to that of the preceptor but it isnt.

Use the time in the clinic/hospital start learning your History & Physical skills. Get comfortable with asking questions, performing physicals and learning how to evaluate the lab results. Some people are not as social as others and struggle with this. It takes a few tries to really know how to direct a question and get the information you need from your patients. I’m still learning how to take a great history and I’ve been doing this for a while. You’ll still go over these skills in school but knowing how to interact with your patient is a skill that takes time. Starting early only gives you a great advantage and gets you out of that awkward few encounters

Primary Care Study Tips : Dermatology Module

Hey everyone, this post is about how I’m passing my major course this semester.ย  This semester we’re taking a 8 credit course that focuses on Primary Medicine with various systems of the body getting tested every couple of weeks along with the rest of my classes.

If that sounded overwhelming, it feels like it!ย 

We started with GI and Infectious Disease in January, then Hematology and Pulmonary and we are finishing up Renal and Dermatology now so I’ll begin writing this journey with Derm.

How do you prepare for Derm?

  • Pictures! If you have time, begin by making your flashcards because if you cut the pictures and write it out, you’re learning as you do this. My friend did this and it was very effective. It allows you to be able to work on the go. If you don’t want to write it, do it via quizlett or an app on your phone.
  • Use your Google Drive: drop all the pictures into a file on the drive and make another documents with the answers. You will go through each of the pictures,ย  write down your answer and check your answers once you’re done. This technique work best after you’ve learned the material.
  • Look for written exams online to guide you with what type questions you may see on your exam.

How do you know what questions to ask yourself?

Derm is detailed oriented. Most disorder have a hallmarkย  sign that helps to differentiate the skin disorder. So you’ll ask yourself key factors like:

  • What type of workup will you order for a Pt presenting with small, grouped erythematous papules around the mouth and gentirals (Tzanck Prep). Take it a step further and ask what type of cells will you see if you order an Tzanck Prep?
  • What disorders will present with erythamous rash across the cheeks and nose? And how do you rule each one out?
  • What age group commonly has bullous pemphigoid, and how would you treat?
  • What are the different stages of decubitis ulcers?

Repetition is Major Key.ย 

You have to review the materials several times. Grab a classmate, a friend, your girl/boyfriend or mom and ask them to quiz you. Tell them to ask you the disorder hallmarks, dx, sx , tx and keep repeating it. Try it different ways.

I always learn by first reviewing things alone then in a group. When I talk about things outloud, I retain more and I’m able to explain why my amswer is right.ย  Thats when I know I’m comfortable with the material.

And most importantly, always trust your instinct.

Leave a comment if you’re trying these methods out or if you have any other method that are helpful .