EXPLORING AND UNDERSTANDING THE PA PROFESSION AND HEALTH CARE WORLD
The two very important things you need to initially focus on are the following:
- Find a PA to shadow. With HIPAA regulations, it can be very hard to find a PA and practice willing to let you spend time with patients. I contacted about ten local PAs and was turned down by each, with the most common reason being the practice doesn't allow it. However, the two PAs that I were able to shadow were through connections I had via friends and neighbors. Talk to everyone you know, see if they see a PA or their docs have a PA. It's harder than you think! You should also seriously consider shadowing a nurse practitioner and doctor as well, as more likely than not, you will be asked why you chose to become a PA instead of other health care professions in your PA school interview. You will hold more credibility to ADCOMs (admissions committees) if you have personal experiences to base your career decisions off of!
Shadowing is also the best way to fully understand what a PA does. Don't go by the definition on the AAPA (American Association of Physician Assistants) website! There are some myths out there about the PA profession, so shadowing should help dispel them. Check out this website for a discussion about PA myths.
- Get direct health care experience. The PA profession was created as a second career for those already established in the health care field. While there is a movement of schools accepting younger applicants with fewer hours of health care experience, it is in your best interest to get 1000 hours at the very least, but shoot for 2000 hours (that's one year of full time work). PA school admission is extremely competitive, and is more competitive than some med schools. Having 2000 hours will put you on the map amongst other applicants.
Remember, however, that the point of DHCE is not to gain admission to PA school, but to acclimate yourself to the health care environment. Health care is messy (both literally and in the legal/business/administrative side of things), and you will be working with people who are sick and therefore probably not in the best of moods. At the end of the day, how are you going to deal with demanding patients and cranky coworkers, vomit/urine/blood etc? PA school is also extremely intense, so if you already know a certain aspect of health care and are comfortable with common procedures, your life will be that much easier. I was rejected by all PA schools my first year applying, which was a hidden blessing because I was able to more than double my DHCE. I feel ten times better (more comfortable) about working with patients in a stressful environment, and understanding the bigger picture concepts of health care.
The most common routes for gaining DHCE are to become an EMT, Certified Nursing Assistant, Medical Assistant, or Respiratory Therapist. These are classes that you can take at a local community college, and some hospitals will even pay for your CNA licensing if you commit to working at their facility. Sometimes you can find a PT aide or rehab tech position that don't require formal training, but those are few and far between. There is a difference between health care experience and direct health care experience, and DHCE is more highly favored than plain old HCE. DHCE is any position where you are directly caring for a patient, whereas HCE positions involve a more peripheral role (secretary in an ED, ER scribe, shadowing, etc). Make sure the job you have is allowing you to get up close and personal with patients.
In fact, here is some info from the Northeastern University Physician Assistant Program admissions page, that is a perfect indication of what most schools are looking for:
"We are looking for candidates with a high level of maturity and an understanding of patient care. For this reason, we require that applicants have completed approximately one year (2,000 hours) of direct patient care experience (hands-on experience with the physical care of patients) prior to applying. We will consider part-time equivalency if it totals approximately 2,000 hours, but this is not as competitive as full-time employment carried out after completing your baccalaureate degree. This level of understanding of patient care makes the classroom experience richer because you bring a deeper knowledge and a personal history of care into the discussions. We will consider experience that you have gained through work in positions such as:
- certified nurse's assistant
- medical assistant
- medical corpsman
- nurse
- physical therapy aide
- emergency medical technician doing more than patient transfer
- paramedic
- physical therapist
- respiratory therapist
- ER technician
Once you have started focusing on the above two aspects, I highly suggest setting up an account at www.physicianassistantforum.com. There you will find hundreds of physician assistants, PA students, and pre-PAs sharing a plethora of information about this career. Do yourself and everyone else a favor and READ THE FAQ sections of each sub-forum, as more likely than not your questions will be answered there. If not, search for the topic you are looking for and 95% of the time, you will find your answer.
Additionally, the book Getting into the Physician Assistant School of Your Choice by Andrew Rodican is considered the Bible of PA school admissions. It has EVERYTHING in there that you could possibly want to know and is considered a must if you want to be a competitive applicant. The PA Forum does have and expand upon all info found in this book, but the book makes everything easier to find. Hands down the best ~$15 you will spend during your PA admissions journey.FINDING A PA PROGRAM TO ATTEND
The next logistical aspect of applying to PA schools is to figure out which schools you would like to apply for. You first need to make sure you satisfy all the academic requirements of your school.
ALL schools (with very few exceptions) require the following classes:
- Anatomy and Physiology I and II
- Biology I and II
- Inorganic (or General) Chemistry I and II
- English/Writing/Psych classes
- Organic chemistry
- Biochemistry
- Statistics
- Medical terminology
- Microbiology
- Immunology
- Pathophysiology
- Genetics
- Upper level bio classes
Schools need to be assured that you can handle a tough course schedule, so by taking the classes mentioned above and doing well you are able to best promote your academic ability to ADCOMs.
What GPA should you have before applying? Well that depends. If you have at least a 3.5 you can be pretty comfortable in terms of being a competitive applicant. Almost all schools require a minimum of 3.0. The lower the GPA you have, the better you are in making up for it with DHCE hours. Always contact your school if you have a question or want a better feel for how competitive of an applicant you might be. Some schools will favor older applicants with greater hours of experience, while some might favor younger students with high GPAs. Attending programs' open houses is a good way to get a feel for what kind of class they are looking for.
Onto selecting programs to apply to. Here are some criteria to think about:
- Location. Are you tied down to a certain geographic area? Do you like certain climates better than others? Do you prefer to be in a big city/suburban/rural setting? Here is a website that lists PA programs by state.
- Cost. PA school ain't cheap. Plan on investing anywhere from $60,000-150,000 in your studies. Many students have to take out loans to live off of, so this number might not be as high if you can live with a relative or off of savings. It can also be lower by attending a school that awards a BS or certificate, as opposed to a masters program. However, those programs often have specific mission statements in mind (more on this later), and a couple of states now require PAs to have a master's degree (Mississippi and Ohio if I recall correctly).
- Family obligations. Do you have kids or are you single with no ties? If you do have a family, what kind of support system will you have to help take care of them while you are in class/studying? It is very hard for people with young children to go through a PA program, but it can be very doable depending on the help they have around them.
- Mission/Goal of the program. Some schools focus on providing health care providers to rural areas, and are therefore looking from A) people from those areas and B) people willing to serve in rural areas. Read your school's mission statement and see if your career goals are in line with their objectives. Most certificate programs only accept very local (ie, county) students, and other programs only accept residents, so plan accordingly when applying.
- Do you want to do a 3 year program or 2?
- Where will you be doing your clinicals?
- Do they have opportunities to do clinicals overseas?
- What is the school's first time PANCE rate? (Passing the PANCE is how you get the -C behind PA in your name). You should be somewhat hesitant with any school whose first-time PANCE pass rate is <95%,
I dedicated a whole morning to going to each school's website and first seeing if I met their admissions requirements, and then whittled down my list based on cost and other requirements. It was painstaking and time consuming, but it was worth it! Making a spreadsheet helped me make my decisions.
APPLYING TO PA PROGRAMS
APPLY EARLY!
The most time consuming process of CASPA is entering in each class that you have taken and the grade you got for that class. They require every grade from every college level class you have taken, even if you didn't graduate from that school, or had to withdraw from that class. Do yourself a favor and get an unofficial transcript from each university you have attended. Also, you are going to have to send official transcripts from every school you have attended into CASPA, so be prepared to fill out lots of forms and fork up $$ if your school requires it. I have spent well over $50 having my transcripts sent out (I've taken classes at five schools), so be prepared for that expense.
APPLY EARLY!
You will also have to get three letters of recommendation sent to CASPA, and that has the potential for being a big pain depending on the writer's schedule. Find three people who know you well, include at least one PA (or doctor), and a science professor and employer in a health care setting couldn't hurt as well. Some people have experience problems having their LOR writers get everything in on time, so make sure you ask early. Also, (BIG TIP!!!!!), if you are graduating undergrad and are not entering directly into a PA program, have people write LORs for you and then hold them. It is way easier for professors to write LORs when you are fresh in their mind, and you will get a much stronger LOR out of it. They will email the LOR directly to CASPA, who will then send them to the programs you apply to, so you will not have to worry about that aspect of things.
Another potentially time consuming aspect of CASPA is writing your narrative (admissions essay) and then whittling it down to the maximum character requirement. You'll have to find a way to distinguish yourself from other applicants, and Rodican's book that I mentioned above is a great place to start.
APPLY EARLY!
You may have noticed that I have written APPLY EARLY three times in increasingly bigger fonts. I cannot stress how important that is. If you apply in September to a program with an October deadline, you will have an 8% chance of getting in to any school with rolling admissions. Ok, I made that statistic up, but that's how important applying early is. CASPA opens in April, and this past cycle they sent out the first applications in June. Don't wait until April to ask for LORs, ask for them in Jan or Feb. That way you give the writers plenty of time to write them and they will be ready to go when you are able to start filling out your CASPA.
CASPA has to calculate your GPA from every single class you take and compare what you entered in for coursework to your transcripts, and that takes time. If you apply early it's only a matter of days. If you are applying in August and September, those days turn into costly weeks. Rolling admissions means that as soon as a school receives your application, they set up a time to interview you (if they feel you are competitive) and then make a decision regarding acceptance. You can either be interviewing in September for 50 open seats, or you can be interviewing in December for 10 open seats. Most schools interview around 200 people from well over 1000 applications, so it's not that hard to see how applying early works in your advantage. Each school will list their deadlines and usually mention if they have rolling admissions or not (look for key sentences such as "Applicants are encouraged to apply early," so pay attention to those dates.
CASPA calculates your overall GPA, your science GPA, and your GPA for each year that you have been taking classes. This could work in your favor. If you have a 3.2 overall, but in your last 2 years of taking pre-reqs you've gotten a 3.7, the ADCOMs will see that, so don't let a low GPA dishearten you if it reflects some not so great early years of being a student.
To recap, DO YOURSELF A FAVOR and focus on these tasks in the Jan/Feb/March of the year you are applying:
- Finding 3 people (including at least 1 PA/MD) to write a LOR for you, and having them written by April 1
- Get unofficial transcripts from every school you have attended so you can fill in data about schools
- Start writing a personal statement, refer to the Rodican book, and have people proofread and give you comments
- Figure out dates and hours for any volunteer/work experience you have
Another helpful thing for your application is to become a member of the AAPA, and any local chapters you may have. Being a member of the AAPA, you will get newsletters about what is going on in the PA profession nationally, daily emails about health news, and other benefits. It is a good way for you to understand more what PAs are about (and a good way for ADCOMs to see that you are serious too).
Oh! Your CASPA application will cost you money depending on how many programs you apply to. Plan on at least $130 if you are only doing a couple of programs, 5 or 6ish will be over $160, and so on. There is a fee table on the CASPA website that has the exact numbers.
INTERVIEWING AT A PA PROGRAM
If you are selected to interview at a PA program, the most important thing to understand is this: YOU HAVE ALREADY BEEN DEEMED A WORTHY STUDENT FOR THEIR SCHOOL. You are already good enough. The ADCOM thinks you can do well based on your credentials. They would like to have you. Your goal in the interview is to distinguish yourself from other students, show how you would be a great addition to the program, and let the ADCOM know that you don't have any serious social handicaps that would prohibit you from being a PA (saying that you don't like taking orders from people or that you always HAVE to be in charge are example indications that being a PA might not be a good fit for you).
The best thing you can do is peruse the PA Forum and Rodican book for examples of questions you may be asked and details about your interview experience. Asking for specific questions from each program is considered bad form by many patrons though, as it gives you an unfair advantage. You without a doubt however should be able to go into any interview knowing these three things: 1) the history of the PA profession, 2) why you want to be a PA as opposed to an NP or MD (which means you need to know the details of each of those professions as well), and 3), why their program is a good fit for you (and vice-versa). I would also suggestion educating yourself about health care reform and legislature (which shouldn't be so hard with everything that is currently going on!). Go onto Time or CNN or any reputable website and they will lay out the basics of the health care reform debate. Read the newspaper. Watch the news.
Every interview I had was not hard, meaning the interviewers weren't trying to trick me or stress me out. Their priorities were making sure that I understood the PA profession, and then getting to know more about me as a person. I had two ethical questions asked of me, and as long as you don't say something completely ridiculous, you can give whatever answer you feel is best AS LONG AS you can create an argument and stick to it. That is their focus, that you can stand by what you say, do, and believe. All my interviews were very enjoyable, and it was great getting to see the other applicants. I've heard stories about med school interviews were interviewees were very competitive/hostile to each other, but that never happened at my interviews. Every question I was asked I found on the PA forum or Rodican book, so if you do your research you will be fine.
These forums are funny reads for those about to interview. The first is about med students' most bizarre interview moments, and the second is about worst interview answers. Some of the funniest things I have ever heard of are written in them. At one of my interviews my fly was down the entire time, and I was still accepted. You just have to relax and laugh minor things like that off or you will go crazy. Being extremely nervous about your interview, while understandable, won't do you big favors if it inhibits your ability to showcase yourself. Be confident in who you are and what you have done in your life. This doesn't mean making yourself sound like God's gift to this earth, but it does mean be able to speak up and not have a quavery voice when you are asked a question. Talk about your strengths and your weaknesses, and understand there is no such thing as a perfect person/applicant. Once you fully believe the first things I wrote in this section, you are almost guaranteed a good interview experience.
Lastly, be prepared to wait. Wait for CASPA to calculate your GPAs. Wait to hear for your interview dates. Wait to hear your admissions status. If you have to, schedule something to keep you busy around the time when the mail comes in so you don't go crazy each day waiting for a letter. My correspondence with schools though was 50% snail mail, 50% email, which does help in diminishing wait times, and I feel like there is a push to make everything electronic. All my acceptance letters were through the mail though. If it's a thick envelope, remember, they won't take 5 pages to tell you that you are rejected!
GETTING AND REACTING TO A DECISION
If you were like me for my first year and got denied everywhere, DON'T LOSE HEART. Being admitted to a PA program is very, very hard, and many successful PAs didn't make it in their first round. Take some time off to clear your mind from the PA process, and then start implementing your plan B, which hopefully you had in place before you started applying. Maybe this means getting more health care experience, or taking classes to raise your GPA. Most programs will allow you to ask them why you weren't admitted and your weak areas, so do take advantage of that. The great news is that you now have one more year to make yourself a stronger applicant, so your next year should be much easier to get into a school, granted you have made the best use of your time.
If you do get in, celebrate! Finish strong in whatever you are doing (don't mentally check out on your coworkers/classes), but try to plan a vacation before school starts. I haven't started school yet, but every student I have talked to has said to take a vacation because once you start in your program your free time is used up. Start connecting with your classmates through Facebook or the PA Forum to work out housing. Make a budget---most schools will have spreadsheets to help with that. Spend time with your loved ones. There is a great thread on the PA Forum called Between Acceptance and Matriculation, so check that out as well!
SUCCEEDING IN PA SCHOOL
I haven't started yet, so this section will have to be TBD. :) There are tons of threads on the PA Forum and also SDN (medical students version of the PA Forum), so until I graduate you will have to rely on the wisdom of those students.
CONCLUSION
I have written out the basics of my PA application process throughout the past three years. Hopefully, between this, the PA Forum and the Rodican book, I can help you succeed in becoming a PA! If you have any questions or would like to point out errors or things to be included, please email me a paflame@gmail.com.
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