The Path to become a Physician Assistant

I have talked about this before. It is very important to know the prerequisites of the programs to which you will apply. When I looked at just the top 25 teams, it took me 50 hours to extract 25 different items per program onto an Excel spreadsheet. I make that Excel file available to you in the program "Everything You need to know to get Accepted to PA School". Until you purchase that program, let me talk about this issue.

Rule number one is to exceed the minimum. Just barely qualifying won't get you accepted. The top 25 programs receive about 15+ applications per seat. Duke gets 700-800 for 70-75 seats. Emory reports similar stats and Iowa, ranked #1, only has 30 seats in its program. You have to get noticed by your academic record first and they look at how many courses you have taken, how heavy your load was (PA school is intense and you need to show you can do it) and what kind of grades you made. A 3.0 overall GPA is the cut-off for most schools. For your last 60 hours, you need more than a 3.0.

What courses do you need? Think about Anatomy and Physiology with labs, Microbiology with labs, Inorganic and Organic Chemistry with labs, Statistics, Cell Biology, Genetics and advanced courses in Psychology plus Medical Terminology. Think about Embryology and Immunology also. Almost all the top 25 programs require a degree for acceptance to their program. In the 2010-11 application cycle, St. Francis University in Loretto, PA did not have a place for anyone outside their pre-PA program. This is not the norm but could be as more and more students choose the PA profession as their first choice.

Then there is the GRE. Most Masters degree programs require it. You have to send it directly to the program and not through CASPA. You don't need a course if you will prepare for the GRE mindset with a book. Elizabeth writes about this in her tips in the PDF that is part of our "Everything You need to know to get Accepted to PA school". Click on my picture to go to the site to look at the information mentioned.

I have been asked in the comment section of my blog www.thePAPath.com recently about the amount and type of experience needed to get into a quality PA Program. The exact answer to this is answered on the admissions requirements page of the website for the program you want to attend.

Most programs want 1000 hours of really high quality experience. This amounts to 10 hours per week for 2 years. Usually volunteer experience is not enough. and many kinds of experience that are paid do not qualify like Pharmaceutical Company Sales Rep, Life Guard, Candy Stripper, etc... Duke's admissions site (listed below)covers all the things they will not accept in detail and it is probably representative of all top 10 or top 20 schools.

My advice is to become either a CNA or a basic EMT early on. Then you can arrange to volunteer in the ER to gain experience. As a basic EMT you would be able to do chest compressions in a typical "code", take blood pressures and other vital signs and bandage wounds after minor procedures done by a PA or MD. CNAs in small hospitals could do much the same things. You would be asked to do some of the routine work also and if you make the right nurses life easier she or he will help you get into situations that will help you learn, and get you exposed to people that can write you a good recommendation.

Other routes are to become an Army Medic or Navy Corpsman in the reserves. You will get called up in times of "national emergency" but the experience is unbeatable and you would be eligible to apply to the Armed Forces PA program which is a top 20 school and get paid to go to school.

If you need the real scoop, consult the school. Go to an open house and ask the administrators for the school,"What experience do you need?".

According to the Bureau of Labor (http://www.bls.gov/oco/ocos081.htm)
Physician Assistants in 2005 graduated from 135 different accredited programs. After passing the national certifying exam (NCCPA) they were able to practice. 90 programs give masters degrees on graduation and the other 45 give either a bachelors or associates degree.
In 2004 the median annual income was $69410. For new graduates it was $64536. The lowest 10% earned <$37320 and the highest >$94880. The middle 50% were between $57000-$83500.
Those working in hospitals had median income in 2004 of $70310, those in physician offices and outpatient clinics $69210.
In 2004 there were 62000 PA jobs. There were more jobs than PAs to fill them as many PAs held more than one job. Employment in physician offices accounted for 50% of all PA employment. Hospitals accounted for another 25% and outpatient care centers in HMOs, colleges and universities, prisons, professional schools and self-employment accounting for the remaining 25%.

I received an e-mail through Squidoo from a visitor to this site. He was wondering about PAs and NPs and the pros and cons of being a PA. I sent him a brief reply and decided to add this module.

I have enjoyed being a PA and find these items to be the PROs.
When I went to PA school no degree was required to get in. It was a two year program and if you qualified, you were also awarded a bachelors. I have made a good living and had a great opportunity with a two year education.
-The pay over the years went from so-so to excellent
-Acceptance and understanding of the profession is very good and has made being a PA very pleasant
-The working conditions are great and you get to work with the best and the brightest most of the time
-The work is challenging everyday, although some of it is routine, the responsibility never is
-I get thanked for what I do much more than 10% of the time (remember the story of the 10 lepers)
-I am delegated as much responsibility as I can accept. I have worked in the clinical end of medicine my entire career.
-There is a great deal of flexibility in what a PA can do. It is generally not hard to find a place to work if you choose to relocate. Even in Great Britan, American PAs are sought after.
Cons:
-I have to get at least 50 hours of CME a year. You can get high quality or junk. It takes time and money to get high quality CME if you stay in rural areas like I have much of my career
-You will never be independent. A PA by definition is a dependent practicioner. Even if you "own the business" an MD will always have to over see your clinical duties. It does not always have to be over-the-shoulder but it has to comply with your state laws and regulations.
-You need skills as good as any clinician but will always be paid less than an MD in most cases no matter how good you are. (That does not bother me now but it used to.)
-You have to take and pass a certifying exam every 6 years. That may change but for my entire career it has been the standard. I have passed it 5 times now.

For a look at NPs visit "NPs Save Lives" here on Squidoo. The lensmaster posted a link to that lens on my guest book.

Each year US News ranks graduate schools all across the nation. It causes many to really jump through hoops to keep their rankings high.

For 2008 the top 3 PA programs of the 80 US News ranked were:
1. Duke
2. Iowa
3. University of Utah
4. Emory

Literally tenths of a point separated the rankings of these three. Duke and Emory have been top choices for years but Iowa has risen to the top.
I wrote a review of Iowa recently on the blog
www.thepapath.com You can visit The PA Path for reviews of the programs, their rankings, and information about how you can get on your own PA Path.

Bureau of Labor and is expected to increase 27% through 2014.  There are over 149 different PA programs where PAs earn degrees from associates to masters with the majority of programs offering a masters degree.

Income is excellent, as are working conditions.  Physician Assistant Salaries range from the high 30's to the low six figures for experienced specialty Physician assiatants.  Physician Assistants work in ERs, hospitals, clinics, prisons, long-term care facilities, Private solo and group physician practices, Rural Health Clinics and many other public and private areas.

It hasn't always been such a bright future but many of my contemporary PAs have used their time, labor and money in an effort to improve our ability to practice in every state, prescribe medications and do more for every patient as well as our own careers.  I wanted to help anyone interested in the PA profession to find information quickly.  So here is my lens on the PA profession with links to important sites, products and services for PAs and those wanting to be PAs. It is a work in progress.  Let me know what you think it needs. LIKES of this lense are really appreciated as are comments and questions.

Squidoo allows me to use 10,000 characters here, but I will try to only use 5000 as that is all CASPA allows you.
The most important thing to remember is emotional impact! You want to connect on an emotional level. Think about why you cheer for your favorite sports teams. It isn't the stats, it is the emotional impact. You love the team, you root and cheer and celebrate when they do well and grumble, moan and act disgusted when they don't.
Connect with the reader emotionally. The readers are mainly PA's. They have been where you are and wanted what you want. Don't talk about what PA's do, they know! Talk about why getting to do it is important to you. You have 500-600 words. Tell 3 150 word stories.
What words not to use:
-I
- an, the, or other articles
- adverbs, your verbs should be strong, present tense action verbs

You need a hook. The first 150 words should make the reader want to read more. Each sentence should pull them to the next one. You will use these stories as sound bites during your interview to renew that emotional connection. To turn on that light in the interviewers brain - this is THAT Applicant!

You have a story. You just have to organize it succinctly and effectively. It has to reflect you and your personality. The tendency is to allow the inner voice that says - you don't have anything to say, you are not special, forget it who want to know about you - to be dominant and freeze you from taking effective action.

You should spend about 10 hours writing this essay. Begin by writing all about your interest in medicine from as far back as you can remember until now. Write 250+ words about "When I first remember knowing what a doctor was." "Malapropisms I used before I knew much about medicine" "A significant experience I had as a patient" "How I became aware of the PA profession" "The PA's I know best their influence on me" "When I first knew I wanted to be a PA" "10 reasons I want to be a PA" "Why I don't want to be a Doctor(or a Nurse or PT or Chiropractor)" "What I want to accomplish as a PA and why"
You see what I am having you do? Sweep up every idea, solidify your ideas and thinking, give you sound bites for your interview, and material to write your supplemental essays. You will need to really know the program and tailor your supplemental essay toward the programs mission and goals. Once you have written 10-15 essays on the above or similar topics, you need to pull out the bullet points and put them in lists.
For the essay "10 reasons why I want to be a PA" or for me why I keep doing it after 33 years
- It is a good living and I still enjoy seeing patients daily
- I want to influence patients to think and act preventatively and proactively
- I want to teach people to use and renew their Physical, Mental, Emotional and Spiritual Energy
- I want to help people locate and use accurate information
- I want to continue to be a patient advocate in the medical community

OK, now you take those bullet points and select the 3 best, most powerful groups. Which area of writing fired you and energized you? You will use those to ell your story, by example, if possible.
When I went to PA school I had met some students in the Utah Medex program, I had seen a Duke catalog and I had read an article in the paper about the relationship of one PA with his Doctor and how much the Doctor trusted and depended on the PA. I needed to go through a less expensive and shorter training program than MD for my wife's mental health. I had been an Army Medic and done things many residents in training did not do. I was licensed as an LPN but hated the work, it was too restrictive. I needed more autonomy to be professionally satisfied. So,I applied, first just to the Medex program - first alternate, Next year to several Eastern PA programs - accepted everywhere. The rest is history.

You need to write your history in a way you emotionally connect to the reader. Being open, honest and transparent are ways to do this. Tell stories from your health care experience, your own health experience with a PA, how you make decisions. Tell unique vignettes from your point of view. Use the exercises and advice from above to refine it and make it the pure essence of you and your desire to be a PA.
If you really feel the need for help, I have a coaching program on my site www.thepapath.com
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You want to be a PA. You want a smooth path to PA school. You want "The Ultimate Guide to Getting into Physician Assistant School". Andy Rodican wrote that and I prominently recommend it in two places on this lens. Rodican has a coaching program too. It costs 250-600 dollars. He is a savvy guy and worth the money. I think I can do it better for less and allow you to get most of my services free. Before I ask you for a decision let me give you some free advice. Free advice is all over the internet and the 9% of you that apply to and get into PA school will know soon enough that the advice you patients get on the internet is of various age and quality. So is the advice of those giving it for free. Here is some of the best I can tell you.
First thing that you have to have to get accepted are good grades in more than the minimum prerequisite courses. It is a given that every top applicant will have good grades. I am asked often "What can I do to make myself a better candidate?" When I look at their Resume, I often see a less than 3.0 over all and barely a 3.0 science GPA. That will not get you into a top 25 program. Neither will the minimum number of courses. Taking all the prerequisites isn't done. You take as many courses as possible. There are the required ones and then those that are "recommended". Take as many as possible and get a 3.0 or better in every course. You need a GPA in science greater than 3.5 to be a top candidate. No one can take the courses for you, but get a tutor and do what it takes.
Second, prepare for the GRE. We have a bunch of tips in the membership program written by Elizabeth Murray now a PA-C herself. The most important thing you can do as an undergrad is expand your vocabulary. Learn a couple of new words a week for 4 years and you have 400 words. Use them in an email or in conversation or in a paper to lock them away.
Third, begin to think about medical experience as soon as you start college. There are plenty of programs that don't require it but they weight it heavily. If you apply and get an interview, all things being equal, the person with the most and best experience is going to be offered a seat. You need to get some kind of certification like MA or EMT in the summer before college or between your freshman and sophomore years. To be a PA you have to get a large solid foundation before you ever set foot in the program. Most of your experience can be obtained after you graduate from college while you are applying. 1000 hours of experience is 40 hours a week for 6 months. Easy if you got a certification and were doing some volunteering with your medical training during college.
Fourth, prepare to get some great references. Often a professor is approved to give you one and then you are going to want two from health care providers. Preferably one or both should be PA's and if they graduated from programs to which you are applying, so much the better. You can begin to get some experience by shadowing a PA. Before you even ask one to do so, get a professional name tag made with your picture, name and in large letters below you name the word Student. Wear it on you right upper chest to that anyone with whom you shake hands can see both your name and status. Second, take a medical terminology course. You can buy a good book, I recommend some here, and learn the basics so you understand what you are hearing. You can then ask questions not about patients, but about how the PA knows or suspects "that" was the problem. I will give you your first hint - the suffix ITIS means inflammation so appendicitis is inflammation of the appendix, diverticulitis is inflammation of a diverticulum etc... Get one of those black moleskine cahier books and keep it in your pocket. Write down hint, tips and new information like words, diagnosis etc... that you learn. I think a person who takes notes on new stuff is ambitious. Get a medical dictionary app for your iPhone, iPod touch or Android phone. Look up stuff. You can start finding shadowing opportunities by checking with the PA's that work in student health, your own doctor's office and at the local health department. Also shadow a nurse and a doctor. Then you can have a response to "Why do you want to be a PA?" that begins, after I shadowed a PA, Doc and Nurse I realized that....answer in no more than 4 sentences or 20-30 seconds. Know why you feel that way and then look them in the eye and tell them. There are ways to get a good reference. A bad one is the number one App Killer. I will tell you what to do in week 10 of my membership program.
Fifth, get ready for the essay. Get out that moleskine. What did you learn during work, shadowing and taking terminology etc... What makes you special. How do you meet the mission of the program you want to accept you. Can you tell them in 500 words? You need a strategy for speaking and wrting these facts. You need to be able to draw out from your preparatio, examples that will connect you emotionally to the reader. They need to not be able to resist meeting you as a result. This is a 500 word description of your brand. How does your brand solve the problems the PA program has? You have years of college to think this over. You can communicate with admissions faculty and staff about preparation and ask what they think about certain things you are doing to prepare for admission. Take Laura Phelan's advice and send them a thank you note after every contact. Know the program's address, get the person's name you talk to and write a simple thank you right after the call. Keep a folder on each program and record who you talked to in one line and if you sent a note. It will help you explain why you chose them - they were friendly each time you called or emailed especially so-and-so etc...
Last, get prepared for the interview. This is where an experienced interviewer can help you. Behavioral questions are asked more and more by both employers and admissions committees. You have to be ready to answer them and you need a strategy. My coaching program can help you with that. You can hire me as needed for 30-60 minutes at time. You could hire Andy Rodican, but his program is $250 self study and $600 if you want his help. One of the things he does is edit your essay. This can get you in trouble if your GRE writing score is low, you have a dynamite CASPA essay and then bomb the essay they have you write at your interview. Better to have a little essay writing practice in college and then have a strategy that suits you that will help you think write and speak clearly and from a position of strength and preparedness. I am ready to help you. Just click on the link to the right Link-The PA Path
One last thing, a list of what kept people from being accepted is linked to the pic of the Iowa PA program headquarters. Just click on the picture to see the list.

Getting into PA school is a series of steps that begin with a realization that the Physician Assistant profession exists and that you like some things about it. You are reading this because you are interested in the profession and you think this article might help you. Great! The first thing you need to know is why you want to be a PA. What are the benefits to you? Do you know them or is it just exciting to think about. Do you get excited because you really want to be a Doctor but don't want to pay that price? Or - have you been treated by a PA and liked them better than the Doctor? Have you seen a PA do things you thought were cool and that you would like to do too? What was it that got your attention and how will paying the price to do that benefit you? This is important because over and over you are going to be asked why do you want to be a PA? People who you are friends with will ask you, people you want to shadow will ask, people you want a reference from will ask. CASPA will ask you to submit an essay on the subject when you apply and you will write supplemental essays and answer interview questions on the topic. You need to know the benefits to you. Features of the PA profession are shorter training time, less costly training usually, more professional flexibility, lots of jobs, good professional recognition, etc... The benefit to you though is less time from decision to application, less loan repayment, able to find professional opportunity almost anywhere you might need to move ... You should be catching on to this idea now. Write a list of these benefits now. Come back here when you are done.
Next, you need to think about the benefit of admitting you for the programs that interest you. They publish mission statements. How will having you as a PA student benefit them? You should be able to point to 5 reasons over time. Begin working on this.
Last, how will you benefit an employer? Most PA programs want you to commit to primary care. Now within their institution there are PA's teaching, some in specialty clinics far from the front lines. That is a given, but as an applicant you need to show How you will benefit them in their stated mission to practice primary care, especially to under-served populations. Look at the mission statements to the programs in your state or for the programs in states where you think you want to be a PA. What is the benefits to primary care employers to hiring you?
Now you should have 3 lists, one for you - Why I want to be a PA, the benefits to me. The benefits to the school and to the potential employer.
I would love to discuss these with you, either in the comment section here or through my coaching program on ThePAPath.com Let me know how I could benefit you.

There are factors that combined get you and interview to PA programs you want to attend. Grades are first. Everyone who gets accepted has great grades. It is a given that you will. Do first things first, get good grades. I get lots of questions from people who have a GPA less than 3.0 on a 4.0 scale about, "How do I improve my chances?" My answer is get some A's in tough science subjects while carrying at least 15 hours in one semester. Next is a good GRE score for schools that require it. Prepare for this the way Elizabet Murray recommends in "Everything you need to Know" on http://www.thepapath.com Your CASPA and supplemental essays are very important. You need correct grammer and spelling but more important you need and essay strategy that extends to the interview process. Experience counts even where it is not required. Get some good experience! This is where you will likely meet the people who can give you a strong recommendation. If everything else is equal, a strong recommendation from a PA will put you into the interview category. What do you do to get one?
I have written only 5 recommendations over my entire career. Four of them have been in the last 4 years for people working with me as medical assistants and Spanish translators. Things I am looking for in a good candidate are the ability to use correction constructively. Example- the first day Laura Phelan translated for me, she did not know Spanish medical terminology. I understand most of what Spanish patients say and can follow the conversation. I just an not fluent in conjugation. Laura translated a phrase I said incorrectly. I told her, "That is not what I said." She got a dictionary and blank booklet for her pocket. She looked up terms, learned what I needed to know for common conditions and by the time she asked for a recommendation, I knew she was great material for PA school and I wanted her to get in, so I really worked hard on my recommendation. You might ask someone you want a recommendation from - What are you looking for in a Pre-PA candidate to the program you graduated from? Ask to buy them a coffee or something and pick their brain a few times. Keep track of things they corrected that you now do correctly and any comments you get from patients, other staff and the person you want to recommend you. When you ask for a recommendation, create a file of bullet points like this:
-learned to do a dip stick urinalysis
- learned to do vital signs
- you corrected me about *****, and never had to do it again
- I learned and can speak in medical terms - I personally respect this
- I learned the names of 100(?) drugs and can spell them and know what they are used for
etc...
You get the picture here. First you do a good job. Find out how they like things done, make notes on specifics, ask good questions, take correction without making an alibi, excuse or laughing or getting angry. Just listen, ask to be sure you understand and then make the change. If the person is angry because they can be, forget them as a reference. Learn how not to be from them. Just be sure you know your scope and stay in it. Reminding the person giving you an order you aren't trained or authorized to do about your status is important. This is usually a no-brainer but just in case, you are officially reminded.
I have been doing this for over 30 years and my supervisor still "corrects" me. He sometimes just needs me to do it his way to make him comfortable. I don't do anything wrong, but I still need to change. It is part of the process.
Be on-time, be professional in your dress, talk, and at work behavior. Let the person you want a recommendation from you are going to need one and create a conversation with them - get them to mentor you some, then they will be invested in your success. When the time comes, remind them verbally and give them your bullet points and deadline. Ask if they want to do it online or on paper? Then get their info, make sure you are in the correct submission period (Laura had me write her recommendation only to find out is was too early and I had to do it again. We were friends by then so no big deal but you might not be friends so get the details right.) and submit their info thru CASPA or in the way the program recommends if it is not a CASPA participant.
Recommendations are an important part of the over-all process and vital to getting an interview.

To apply to the Duke PA Program you must use the CASPA or Centralized Application Service. After you have finished that application and submitted it, Duke will send you an e-mail that gives you authorization to access the Duke supplemental application. In adddition you must have 1000 hours of direct patient care experience. Duke is very specific about what this means so read their website linked in a module here to be sure you have met that qualification. You will need three recommendations, one of which must come from someone who has seen you provide patient care.

For the 2008 year you must complete CASPA and the Duke supplemental applications after May 1 and before Oct 1, 2006. The Supplemental form by 15 Nov 2007.

The class that entered Duke in 2007 were chosen from 570 applications and had the following group qualifications.

Over all GPA 3.1 - 3.5
Natural Science GPA 3.0 - 3.5
Total Natural Science Credits 42-68
GRE General test scores
Verbal 460-570
Quantitative 550-670
Analytical Writing 4.0-5.0

Months of full time patient care experience 10-34

Go to the Duke PA Program (paprogram.mc.duke.edu) site and check out the admissions process. These stats are from the general information from that site.
43 States have at least one traing program for PAs as well as Washington D.C. and the uniformed services. New York has 19 PA programs and California 10. Alaska, Delaware, Hawaii, Mississippi, Rhode Island, Vermont and Wyoming have zero programs to train PAs.

The Alumni Hall of fame for Duke University PA program is located on the Duke PA Program website here Duke Alumni Hall of Fame

The Hall of Fame was established in 2002 to honor alumni who have achieved success in their lives and careers. The first inductees include alumni who have received the distinguished alumnus of the year award since its establishment in 1985. They were inducted on October 6, 2002 during PA Day ceremonies held at the Duke University Medical Center.
My class, 1978, has 5 persons inducted into the Hall of Fame, tied for most from any class with the class of 1968. There are also honorary PA's inducted and I want you to read about Margaret Schmidt and Mildred Woody if you don't look at anyone else. One special person is Reginald Carter '78. He was the Program director for many years and finished his rotations in time to graduate with my class. He was educated with many classes and served as a guiding beacon for the PA program before he retired and took over the PA history responsibilities at Duke.

Visit the site. I unaware of other programs that have such recognition but if they do, please let me know.