How to Convert a Clerkship (Rotation) into a job offer

       Ever thought of converting a rotation into a job offer?  Many graduating PA-S II should begin planning their careers while there are still training. Technically speaking, what better time than when you’re rotating through a particular clerkship to make a favorable impression on a would-be employer rather than wait until after your graduate.    

     So why not get a head start now before you’re forgotten and/or lost in the shuffle? It’s easier than most students would think. But you must be willing to implement 6 actions during this time while you’re “apprenticing” as a student; all while uncovering essential information while exercising professionalism & educating yourself as a regular job-hunter would in their job search. Thus, researching the practice, employer early not only will help transition you into your 1st job but also do well in your final grade as well.

           In this article, I will share six tips from an insider that will help get your foot in the door, to land that coveted job of yours, here they are:

 Tip # 1: Be an Invested Mentee:

          Always assure them know with your enthusiastic disposition that you are willing to participate, learn and contribute from all patient presentations even as a student rather than being a passive selective observant. You must build an unforgettable positive picture of yourself by showing a willingness to be actively involved even in the minutiae of any case. Implicitly and explicitly express & remind them of your “availability” even beyond what’s commonly assigned or expected for a student in a clinical rotation. Always maintain a highly visible profile/presence. Conversely don't be a pest or dead wood.

 Tip # 2: Be an open-minded Mentee:

           Even if you think you’re not interested in a particular aspect of the specialty. Let’s say geriatric cases are very appealing to you but not doing lumbar punctures per se, then that could be a minus against you. In other words, you would be sabotaging your chances if this surfaces in the open. This would be tantamount to the “kiss of death” if you were to vocalize such disinterest or infer it to a preceptor during the rotation. Develop the attitude and mindset that you want to learn every skill possible under the sun for that or any other rotation. Minimize disqualifying yourself from potential consideration or from building your skill set early in the game. The more varied your skill set the more marketable you are when faced with competition.

 Tip # 3: Be a Truthfully Humble Mentee:

           Do not be arrogant. The difference in being confident is being aware and assured in your abilities & limitations. Especially when responding to “pimped questions” by the mentor. Even unintended non-malicious deceptiveness never bodes well with hiring potential employers.

 Truthfully, is always best to say you do not know the answer or are unsure, however, you would do your best effort to research the answer to the question posed rather than guess at the answer your preceptor is looking for. Surely you will be more respected if you know and acknowledge your limited knowledge at hand. Not knowing or being a “walking Harrison’s” is not a “crime” nor a sign of “weakness” as sometimes we’re led to believe.

 Tip # 4: Be an Appreciative Mentee:

      Grateful people are remembered fondly; so be mindful and thankful for everyone you met during the rotation including administrative staff, ancillary clinical staff, and housekeepers or operators, etc. Not expressing your gratitude for their time and/or effort in assisting you in your development is not only inconsiderate but downright the surest way to fall out of favor if an opportunity ever presented itself in the form of a job offer. The key here is to have ready and pass a few handwritten thank you cards, or a batch of homemade cookies or brownies. Nothing says “thank you” better than such a selfless gesture and token of consideration in their eyes. 

 Tip # 5 Be a Professional Mentee:

       Nowadays healthcare workers are increasingly hurried –and patients as well. This makes it easy to be abrupt, stressed out, or easily become impatient with others. Remember we’re all humans and occasionally can say or do things that may come across as inconsiderate or at worst, self-centered. The key here is to always take “the high road” when dealing with others. Respectful interactions mean treating others as you would like to be treated yourself. By conducting yourself under this philosophy you are showing your cultural sensitivity and a high degree of maturity that very few can match. In summary, being friendly towards others makes you a standout in the minds of those whose path you crossed even if they meant no ill will towards you.

  Tip # 6: Be an "Investigative" Mentee:

             Always be cognizant of the practice or organizational cultural values, strengths, and weaknesses and see if they match yours as a potential workplace you would like to be part of when starting out of school. It’s perfectly acceptable to express or demonstrate your interest in returning as an “employee”. If that’s the case, covey this during the near end of the rotation to different team members, key preceptors, and/or hiring authorities.

        “Investigate” before leaving by asking if they would consider hiring somebody with your background and personality profile. Go ahead, and submit a resume, but only if they are as interested as you are. You uncover the fact that they would be willing to consider “grooming” you once on board. Be ready with your elevator sales pitch -- to explain in 30 seconds or less your desire to join the group, but more so how would you fit in. Yet, more importantly, how will they benefit from hiring you instead of someone else. For most employers that always seem to loom big in their minds, and/or the biggest hurdle to overcome for newly minted PAs. 

A Profile of the Lawsuit-Prone PA: Could you be one of them?

 

       During PA school, we were repeatedly taught the importance of thorough history taking and physical exams. However, in practice, many PAs, even experienced ones, may be tempted to cut corners, perhaps relying too heavily on diagnostic tests. This overreliance on technology and a decline in clinical thoroughness can have serious consequences, especially if a patient experiences an adverse outcome.

    These shortcuts can expose PAs to significant liability, often without them realizing the risk. Lawsuits frequently arise from negligent acts of either omission (failing to do something necessary) or commission (doing something incorrectly), both often rooted in poor history-taking. This deficiency can stem from a lack of skill, clinical laziness, or perceived time constraints.

    The problem often isn't just what isn't asked, but how it's asked. Failing to probe for specific details about the onset, duration, frequency, and location of a patient's symptoms—in other words, not exploring the temporal characteristics of their illness—is a common pitfall. This often manifests as relying on closed-ended questions instead of open-ended ones that encourage patients to elaborate.

    For example, chest pain can have numerous causes. Without a detailed history and physical exam, a PA's diagnostic process can easily go astray. This can lead to suboptimal patient outcomes, delayed or inadequate treatment, and increased legal risk, particularly in life-threatening situations where a clear clinical picture is crucial.

    Another critical oversight is the failure to document the clinical decision-making process. This includes listing differential diagnoses with their respective probabilities and explaining which diagnostic tests were performed (and why) to either confirm or refute those possibilities. Clear documentation of this thought process is essential for demonstrating sound clinical reasoning.

    In short, prioritizing thorough history taking and physical exams, coupled with meticulous documentation of the clinical decision-making process, is not just good clinical practice—it's crucial for minimizing liability and ensuring optimal patient care.

Physician Assistants: Unsung Presidential-like Healthcare Professionals

            

        When it comes to naming the toughest job on the planet many are quick to point out that being President of The United States is at the top of the list. It’s not difficult to see why and understand this at first glance, but at a closer look, the same could be said about a few other professions too. However, I would submit to you that we [PAs] are about as close as any other ones. How might you say? Literally or metaphorically speaking, we [ PAs] are akin to the president in many respects, to a certain degree & in a general sense the same intense collective challenges, scrutiny & tremendous unrealistic expectations by so many others.

        Much like the president nowadays, facing daily increased pressure with compounding transactional complexities, requiring intense flawless decision-making moves, so do us practicing medicine in a fragmented, chaotic industry notorious for its very unforgiving litigious atmosphere and the ever-increasing world of burdensome regulations.

       Similarly, we’re expected to be assertive, but not domineering in our dealings with others, deliberative, but not appear indecisive all while advocating and empathizing without overpromising when being called to be stewards of the imperfect healthcare system (i.e., money-hungry Big Pharma, profit-making 3^rd party payers, an inefficient tort system and the list goes on).

       Also, historians and political observers agree there has been an increased disdain for the oval office in recent years. For instance, the press media was once considered less sensationalistic in their coverage of our presidents’ limitations like FDR’s wheelchair-bound existence or JKF’s notorious extra-marital affairs. Naturally, we the PA community are all too familiar with this surge of intense inter-professional disrespect in recent years, and the cyclical cyberspace backlash is also part of this malady. The never-ending misguided and misinformed portrayal of the PA community or being devalued in the broadcasting and print media has not gone unnoticed by our community, nor is it new nor will break our spirit. Just like past presidents, who must be balanced true diligent advocates, perpetually being strategic visionaries, in that stance, we similarly embody the positive traits of all our great presidents even though our job may be viewed as nonpresidential. Yet, while we might not sit in the oval office,  our jobs are often times the second or the 3^rd “toughest job in the world”,,,akin to the president's in my view.        

Keeping the Faith despite the stories they tell

      As the year comes to a close & after 34-plus years as a practicing PA and medical educator, I've never seen the level of inter-professional and intrap-rofessional intolerance seen nowadays in the healthcare industry. It has become practically Toxicity on steroids. All boils down to constant daily undermining transactional attacks of one form or another, whether very subtle to openly overtly. I see this daily in how some people and professional groups have made their personal and professional intolerant ideologies an urgent mission to be instilled and implemented @ any cost.

     The PA community, unlike any other group, has taken the brunt of this divisive assault that has become deeply ingrained in the medical profession, and more importantly, the ever-deepening damage it’s doing to all providers and patients alike throughout the western world and our country.

      From the moment the AMA went public minimizing and discrediting our profession, our industry contributions, etc. the opposition has been relentless & fierce. Among the numerous insults and accusations that have been hurled our way by those frightened by our success have been some of the  following:

● We’ve been called “Physicians wanna-be”.

● We’ve been called unsafe providers.

● We’ve been called unqualified deceptive healthcare providers.

     Just to name a few here. The one thing we haven’t been called yet? Probably has been visionary...That is thanks to the tireless work of thousands of our brothers and sisters seeking daily improved quality access to health care along with very few brave supporting physicians who seek to accept our brand & integrate us harmoniously into the very fabric of a fractured flawed industry.

      Fundamentally, I’m proud of them and those who see our adjudicative value.  I’m proud of our community for how hard we fight together for what we believe in despite all the industry naysayers.

       Shouldn't “Do No Harm” be the mantra by which we all measure our individual and collective actions by believing in giving everyone equal access to health care, in upholding the highest standards of medical ethics, and in unleashing a new era of life-saving medical breakthroughs? Shouldn't we also believe in allowing all professional medical providers to practice under the law to the highest scope of their practices thus helping everyone lead a healthier and happier life, regardless of who they are ( DPM, PA, NP, CRNA, OD, etc.)?

        Upon further reflection, I am hoping that we can overcome the forces that threaten the health and well-being of every American. We have a long way to go, and the forces arrayed against us are powerful. Yet, most of our fellow Americans and my fellow medical professionals/comrades realize this. We undoubtedly want a fair leveling playing field in which medical services are provided efficiently and transparently--nothing more nothing less. Is that simple.

        If we could only stop this bickering, finger-pointing we could elevate an industry beyond our imagination for 2023 and the years to come. Thank you for your professional tenacity, pride & hopeful outlook during these turbulent times. Keep the faith...despite the stories they like to tell.

My Pre-PA Journey

      There are many essays and blogs about folks relating to knowing about their early calling in life. For instance, such as: “I have always known that I would be "A" or "B", etc. You know the drill. Well sorry to say or disappoint, but this piece is not one of those stories you see quite often.

     Nor will I use the clichéd stories of how an ill relative or a friend or a close family physician served to be the inspiring force for me when considering a career. In fact, unlike so many other college students’ paths to medicine, mine was truly a circuitous one compared to so many others that I have known or read about. 

       Truthfully, I was never ‘pushed’ nor ‘talked’ into going into medicine by my parents or anyone else either for that matter. However, medicine didn’t cross my mind until I began enjoying my natural science courses as a freshman and sophomore, and junior in college. I felt I would end up pursuing a graduate degree in molecular biology. I even thought about being a bench researcher in the lab after graduating from college or becoming a medical technologist. 

        Basically during this time, I was setting my sights on landing a co-op job experience as a research student @ Argonne National Laboratory--- far from becoming a PA  back then. 

        Halfway into my 3^rd year, I began to feel an affinity for medicine as a potential occupational possibility, so to explore that late interest in a medical career and not with the romantic idea of becoming a doctor I decided to explore employment opportunities in a medical or a hospital setting. In a stroke of luck, I was able to land a job as a Pharmacist Assistant while completing my undergraduate studies. 

        Luckily this particular experience gave me a different perspective, a very insightful one on my desired career path. As I neared graduation, my options became clearer, and my desire to remain in medicine albeit in a different role was cemented; it was clear that my future would require a more definitive game plan from my behalf. For years, I methodically researched in depth about the different allied health careers, from “A” to “Z” and while the infinite options were considered and entertained, no would-be profession back then matched or resonated closely as much as the Physician Assistant Profession did for me.

             And the rest is history as the saying goes…