Working :)

Wow, I didn't realize how long it had been since I last blogged.  Since that last notice, I have obtained my full credentialing (happened in October), and have been working.  The office I am working in is a great fit for me.  It's family practice with 1 (now 2!) provider, and a mix of patients from ages 7 to geriatric.  We accept 1 HMO and many PPOs. We take care of a lot of chronic conditions, acute illnesses, etc.  We don't do OB.  Not a lot of procedures.  It's good!  I like it a lot!

The only problem right now is lack of patients... going from 1 provider to 2 means we need to double our patient load in order to pay the bills.  That is slow going.  I'm hoping maybe when 2014 starts we will get more patients.  In the meantime, I'm only working part time (mostly on days that are busy), and finances are rather strained at home.

Here's to hoping 2014 is super busy with lots of patients!

Credentialing process!

I am now the owner of a PA license, an NPI number, a DEA license number, and just recently took the "controlled substances class" which will allow me to prescribe scheduled drugs without prior approval from my supervising physician.

I've accepted a position in family practice, working for my previous boss, and it's going to be a beautiful relationship!  

Now, the hold up seems to be the "credentialing process" that no one ever warned me about!  This is the process, after you are hired, of sending all your information to insurance companies.  They, in turn, agree to reimburse you for seeing patients.  Without this approval, you really don't want to be seeing patients, else you might not get paid for them at all!  My work understands this, but wants me to have the chance to get "back in the groove" with the EMR and workflow, so they are allowing  me to come in part time and refill prescriptions, answer phone notes, review lab results.... mostly paperwork.  In addition, last week we started with me going in to see patients, getting a history, physical, coming up with a plan, etc, then communicating this info with the doctor, who in turn goes in to see the patient for an abbreviated visit and confirms these things, so he can bill it under his name rather than me signing the note.  I thought this would take a lot of time with both of us seeing the patients, but it really doesn't, as he is free to go work on his paperwork while I see the patient, and his time with the patient is abbreviated from normal since he doesn't have to get the whole history, etc.  Hopefully this will work until the "credentialing" process is done.

Licensed!

Everything is proceeding quite well!  My license number was issued the Monday after the PANCE scores were released (haven't received it in the mail yet, though).  Applied for my NPI and got that the same day.  Now need to apply for my DEA... which is $732 for 3 years, yikes!  And then need to take the controlled substances course, which is another $180.

Can't wait to start work and MAKE money instead of spending it!

Passed the PANCE!

Well, I received notification today that I passed the certification exam (PANCE).  Now I await my license. :)

DONE!

Well, here we are.  Graduation is tomorrow.  After that, I plan on giving myself a few weeks to rest and study, then take the PANCE in September.  My master's degree is finished as well.

On to bigger and better things!

Time is nigh!

Wow, less than 2 weeks left!  Three days left of rotations.  It's so close!  Unbelievable how fast the time has gone, though it seemed so slow during.

I'm scheduled to take my PANCE exam the first part of September.  I'm nervous about that.  I just want to get done and start working.  I will be working in a family practice office in Bakersfield.  I worked there before as a medical assistant before PA school.  So excited!

Five months left!

Our last day is August 16th, so we have FIVE MONTHS left of rotations!  Only FIVE!  Yay!

PACKRAT and Clinical year

Wow, I didn't realize it had been so long since I had blogged.  I started the clinical year in August 2012.  I've been through 3 rotations so far.... internal med outpatient, internal med inpatient, and mental health.  I'm about to head into my elective rotation... advanced mental health.  So far, the rotations have been tough at times, but very enjoyable at times.  Patients have touched my heart and I hopefully have touched some of theirs.

We took the PACKRAT (Physician Assistant Clinical Knowledge Rating and Assessment Tool) a few days ago.  It's supposed to have a correlation on how we will do on the certifying exam, the PANCE.  This time was our first time taking the PACKRAT, and I believe we take it again a little further on in the year as well. You basically get a raw score number, and then there is some formula that translates to what you would get on the PANCE.  For instance, I got a 161 this time, which apparently converts to a 636 on the PANCE.  Passing score on the PANCE is a 350, which is around a 111 on the PACKRAT.  Anyway, this time doesn't mean so much... it's more for us to know which areas we are weak in and should concentrate on.  My highest was GI and my lowest was neurology, so I especially need to be studying neuro in my spare time.  And then hopefully on the next PACKRAT I can bring up my neuro area, and also be better able to answer the questions on the PANCE after I graduate.  :)

Two weeks of first year left!

I got my first choice on order of rotations! I will be starting internal medicine (hospital clinic first, then on the floors) on August 20th!!! 

Last Didactic Semester!

So, we are a week into our summer semester.  It's a bit more laid back, but also is integrating us more with the hospital.  We are also learning clinical skills like how to dress for the OR, gyne exams, suturing, etc.

I want this fall to get here soon, but I'm a little anxious too.  Fear of the unknown... not knowing how rough the pimping will be from the docs, etc.  We should be requesting our rotations soon, then I will find out which one I will be starting with.

A year and 2 months from now, I'll (hopefully) be done with the program!!!!  Time dragged on some days, but overall it seems to have flown.

Summer is coming!

Wow, time really is flying!  We are nearing the end of spring semester... our finals are just a couple of weeks away!  We had oral exams (rubrics) the other day.  We were all pretty scared, as we had been told that many people do not pass them.  This year, though, they provided us with rubric workshops, so hopefully that will give us a better result than previous years.  We don't have our grades back yet, so I can't really say.

Summer is supposed to be a bit different, with more practical skills included like suturing, IVs, etc.  We also have pediatrics and ob/gyn, nutrition, ER and geriatrics.  Should be interesting!  Crazy to think I'm only a semester away from rotations!!!

I also applied to Saint Francis University for their MMS online program.  Got my acceptance letter the other day.  I hope I can handle doing both it and my 2nd year at PA school!  It's a program made for this kind of situation, though, so many people have done it before I have.  It will be really nice to get my Masters at the same time as my PA-C next year, especially if we move to states that require it.

Fun day with ophthalmology

Today we had a lecture from a local ophthalmologist, then we went to his office.  At his office, we each had an eye dilated and were allowed to look into each other's dilated eyes with our ophthalmoscopes and with the slit lamps, as well as checking each other's vision.  This was really neat, because we have been trying to use our ophthalmoscopes with undilated eyes up until now, and the pupils have been so small we had a hard time seeing much at a time.

One of the other ophthalmologists in the office invited us to come watch an upper eyelid repair on a patient who had droopy (ptotic) lids, so several of us took turns watching.  That was pretty neat as well.

Spring semester

We indeed got spoiled over winter semester!  I feel so busy this semester that I have a hard time finding time to actually study!  The first section was not as bad... endocrinology... because there was no physical exam to learn along with it.  Neurology is tough in itself, but trying to remember all the parts of a neuro physical exam is hard! Add to that the fact that we are in class longer, and it makes my free time nil.  We now have pharmacology added to our Tuesday schedule in the evening, making for some very long days when we start class at 8 am and end at 9 pm.  Pharmacology is interesting, though.... we have some pharmacists from the hospital teaching us what we need to know.  That is nice that not only are they directing us towards how we can best do rotations later, but also giving us a few more familiar friendly faces when we do our rotations!

So, today I have my neuro physical exam.  Then Monday we have the neuro anatomy exam and neuro medicine science exam.  Monday we also start ophthalmology!  Of course, ophthalmology will also have a physical exam component to it.

I've also been warned to be afraid of rubrics... also known as orals.  Those will be coming soon as well.  The best I understand, they give you a case and you walk through it to the diagnosis and treatment, but you get points for certain things...asking about this symptom, doing this kind of exam, listing these as a differential diagnosis, etc.  Supposedly many students fail the first mock rubric. Yikes.

We also need community service hours.  We had only a few events last semester so we are all scrambling to get our hours in.  We have 2 events coming up on March 31st, so that's good.

Okay, back to studying for that physical exam.

End of winter semester

So, we are nearing the end of winter mini-semester.  We had 6 weeks of EKG interpretation and radiology.  It has been interesting and fun, and kind of relaxing.  We have had short days, and no class on Fridays.  I've gotten so used to it; it will be hard to get back to a normal semester when spring starts (February 13th).  In the spring, we will have the same classes as the fall, plus add in pharmacology and genetics.  Whew.  Anyway, that will be our last "normal" didactic semester.  Summer will be practical: learning procedures, etc.  Then in the fall, we will be in our clinical year in the hospital!  I can't believe it is coming so soon!  Exciting and scary!

Finals

Well, the first semester is almost over.  It seems like we've had hundreds of tests along the way... some written, some where we examine a patient (usually a classmate).  I *think* I did okay, but it remains to be seen until after the finals are over.

We've lost a few students along the way.  Some because of family obligations, finances, health situations, and some just had too many other obligations to study effectively, and had difficulty keeping up their grades because of it.  It's sad... it's like losing a member of the family.

Speaking of losing people, our program director is retiring.  Not only does this mean losing our director and an instructor but could mean changes in the program... hopefully not too many since she will still be with us on a part-time basis.

Onward and forward!

How PA school works

So, it's been a month now.  We have seen an autopsy, had class pictures taken, had a couple of medicine science tests, a couple of physical exam tests, and a lab test so far.

We have some very fun parts of school... Problem Oriented History and Physical, and Problem Based Learning.  These 2 are group learning activities, where we solve cases in small groups and learn all kinds of things in the process.  We also have lectures, physical exam workshops and other types of classes.

Most of our structured learning occurs outside of class, which is different from most programs.  Our classes help to make what we study relevant, but if you don't study, it does nothing for you.  Just paying attention in class will not work.  There are many things on our objectives that are never brought up in class.  We spend many hours outside of class learning from many different books the topics that are on our objectives.

Am I enjoying school?  I honestly don't know.  I'm enjoying knowing more, but the learning process is a bit painful.  Mostly, I just want to get done with the program and start seeing patients, but I realize I need to know a lot more in order to do a good job.

Class

We have started to get more into our classes now.  I'm being reminded of things I had forgotten, being clarified on things I thought were clear, and being taught many  new things.  We have some excellent professors.  Today we had 2 speakers we had not yet heard... both awesome in their own way.  I was just left feeling so blessed with being able to learn more about God's creatures, and humbled that He is arranging it for me to actually have a part in treating them.  What made me feel so blessed?  I'm not sure.  Part of it was just being reminded how tremendously complex our brain is.  Part of it was feeling so happy that God has given us good professors who care about the profession, the patients, and us.  Whatever it was, let's just say it was a good day at school.

First Day of Class

So, today was our first day of class.  Just the basic introduction to the program, where the faculty let us know what they expect of us, and what to expect from them.  Then, we received more information about the program. So far, it sounds hard, but doable.

My classmates all seem very nice.  We all come from such a variety of backgrounds, but all have the same common goal, so that closes a lot of gaps.

Down to the wire

So, things have fallen into place.  I have a place to stay.  I have my books and some of my equipment.  I have my lab coats.  I have plans to meet with some classmates this weekend.  Classes start Monday!  Our dermatology test was cancelled.  Whew!

I also had a strange thing happen yesterday.  I went to the Moreno Valley mall.  I decided to get a haircut, and the beautician I had started asking me questions about me and my husband.  Come to find out, we are both from the same baptist association, and her dad pastors a local church!  So, I intend to visit her church this coming Sunday.  Very non-coincidental! :)

Books -done!

Okay, so today we were given the final book list for fall semester.  I got them on Amazon and most of them should be here by next week.  Final cost less than $800, and many of the books will also used for succeeding semesters.  Not bad, I think.

Housing plans go awry

So, I turned in my PA school physical today and called the landlord I would be renting from. She reports that she lost the house, so I am back to square one. I checked out a few places in my price range, but didn't find any that would totally fit my needs.

Leaving my job to start a new career

I officially have only 4 weeks left of work, and 5 until school starts.  I'm nervous and anxious about school, and really pretty sad about leaving my job.  I've worked as a back office medical assistant and scribe for the past 3.5 years.  I've seen and learned some awesome things, worked with some awesome people, and met some awesome patients.  I will miss all these things.

My office manager, who, incidentally, is married to the doctor, informed me yesterday that they would pay for part of my equipment as a going away present, so she actually bought my otoscope kit for me!  This is a huge part of the cost, so now I will just need to buy the less expensive items, in addition to my books.  My doctor and his wife have been such a blessing to me over these years... much like family.  They have been with me through some really hard times... infertility, my personal cancer diagnoses, other issues.  It's hard to realize I won't be seeing them every day as I do now.  We, of course, do plan on keeping in touch, through facebook, phone calls, and text (even the doctor has begun texting).

There have been hints of possibly bringing me back to the office as Doctor's first PA, if financially feasible.  I would like that.  And our patients have mentioned that they would not mind seeing me in a PA capacity, either, since I already know them and their stories.

Well, wherever God has planned for me to go after school, I'm game.  He's given me a great life already.  Now, I just need Him to help me through these next 2 years.

Physical... check!

Okay, so I have my immunizations updated and titers done, 2 PPDs done, and now the physical.  I will drive to Moreno Valley on Monday and drop them off in person.... especially important since it's so close to the deadline.  I'm hoping to make sure they have everything they need from me.

The same day, I also plan on checking out the possible room I have planned to rent.

Tdap... a little stinger!

I'm required by school to have a Tdap booster... that's the new Tetanus, diphtheria and pertussis (whooping cough) booster advised once for everyone over age 11 or 12.  I was already up to date on my Td, but due to the school requirement, went to have my Tdap last Friday.  I had it done at the county health clinic, paid my $13, and was on my way.  No pain.  I didn't expect any, as I've had the Td in the past with no pain, either.  (Shots don't generally bother me).  What surprised me was the achy deltoid for 4-5 days afterward!  It's now Wednesday, and my right deltoid still doesn't feel the same as my left.  I also woke up Saturday very hot and sweaty... kind of feverish.  I know these things CAN come from immunizations, but I've usually had no problems in the past from the Td.  It must be the pertussis component.  Oh well, enough whining.  :)

Background check ... finally okay!

Well, a few days ago I got my notice from my background check that there was a discrepancy in my employment involving a former employer.  This included wrong dates, wrong title.... I was so worried that this would ruin my chances of PA school, as I was accepted based on my information.  So, I disputed the claim, and they called the employer back, who cleared up the discrepancy. Whew, such a relief!  One more hurdle overcome.

Titer update

Okay, I got the correct polio titer test back.  So, now I'm immune to everything I'm supposed to be immune to.  That's nice.  Now I need a Tdap booster, 2 sets of TB skin tests, and a physical.

Titers

Well, it's been a while since I posted.  I had my titers drawn last week... those are tests to determine if you are immune to certain diseases, via vaccination or the actual disease.  All came back ok, except that we did one wrong test.  We were supposed to get a Polio titer, but the only options at the lab were "CF antibodies" or "antibody neutralization".  We gambled, went with the CF one.... and basically I had to go back a few days later to get the neutralization one.  Oh well. 

We have the class picnic this weekend, with my class and previous year's class.  Should be great fun to meet everyone!

Cost of Equipment

So, I totaled the cost of equipment from Welch Allyn, with my student discount:  http://www.pamelajeanwhiteley.com/WelchAllyn.pdf

It's almost $1150, not including tax and shipping.  I wonder if we get any better discounts if we wait until Welch Allyn sends a representative to our school?

Yes, we do get discounts.  Here is a link to that:
http://www.pamelajeanwhiteley.com/WelchAllyn.jpg

Book list

I have my book list updated as a "wish list" on Amazon.... it ends up costing between $750-$926, depending on which books have used versions available.  http://amzn.com/w/2PVTPLE0ZIQIX

I have yet to price the "equipment"... otoscope, ophthalmoscope, BP cuffs, different stethoscope, etc.  I'm sure they will be quite pricey as well.

PA Orientation

Yesterday was orientation for PA school.  We were given a list of items and books we will need, instructed in financial aid, welcomed to the program, and was pretty much threatened with how hard the program will be.  I know it will be difficult.  They told us about the attendance policies, the severe studying and testing needed.  Am I scared?   I'm a little frightened, yes, but also very excited.  I just need to make sure my ducks are in a row before I go, then I can just concentrate on the program.  You can make it through 2 years of almost anything; I can do this!  Last year's class is hosting a picnic for us in June to get to know them and each other.  It should be exciting.

Beginnings and endings

Today, I will be travelling to probably my last CSMA (California Society of Medical Assistants) meeting... at least in this capacity.  For the past 2 years, I have been the Webmaster of the CSMA website. http://www.csma-medassist.org/  This weekend, I will give up my position, and attend a few CEU meetings.  I'll also get to "hang out" with some of my friends that I don't see very often, which will be nice.  I will likely not renew my CMA (AAMA) certification, unless perhaps one more round.  I won't need it as a PA, obviously.  This whole weekend is just another reminder of the upcoming changes in my life.  I'm extremely excited about the changes, but a little nostalgic for what I'm leaving behind, as well.  Perhaps I will drop in at another CSMA meeting in the future to visit for a few minutes.

Tuesday, I will have my orientation meeting for PA school. :)

How did I choose which PA schools to apply to?

There were several things to consider..... price, location, time frame involved, prerequisites, etc.  I first narrowed down my search to my state.  Then I checked prerequisites required... some are the same for almost all PA schools:  anatomy and physiology, general chemistry, microbiology, algebra, cultural anthropology or sociology.  Some schools also require additional classes such as physics, statistics, genetics  or others.  I started taking the "common" prerequisites while I searched for schools, and saved the additional ones for the end, so that I could start applying earlier than otherwise.  Incidentally, I had already taken physics my freshman year of college, so I could throw that class in my "done" category, just as I could the algebra.  Then I looked at the list of schools requiring just the common prerequisites (plus physics), and narrowed it down to just those. 
Next, I compared length of programs to their cost per year to figure out overall cost.  Some schools cost more overall, but had shorter programs, which would essentially let me get out and work sooner.
Then, I looked at individual advantages to some programs... Stanford would allow me to live at home much of the program, which was an advantage, but there would be a significant amount of driving and cost involved.  It also had a shorter program, which is why I applied to it my first year trying.  I ended up applying just to Stanford that year.
The next year, I applied to 2 schools.  Oddly enough, Stanford was no longer my top choice, as their program had extended, taking away one of the advantages.  I was accepted by my top choice school, RCC, during that second year.  It is closer to home (well, 3.5 hours from home), MUCH less expensive, and has an overall feel that I like.
Oh, yes, the "feel"... one thing I left out.  Walk on the campus if you can, go to information sessions about the program.  You will begin to get a "feel" for the program.  In my interview with Stanford, they felt a little, well, snooty.  I could deal with it, but really felt a little like a fish out of water.  RCC did not require an interview, but attending the information session was priceless.  It felt very comfortable, like I could fit in there.  People were smart but friendly.  Even driving around town, I could "see myself" there.  I hoped I would be accepted, and was.  I think God was leading me there, giving me an excitement and a sincere like of the community itself.
So, those were the main things involved in my choosing a program.  Other people may have other things they need to consider.  My GPA was rather high, so I did not need to worry about the minimum requirements.  I did not take the GRE, so only considered schools that did not require it.  Could you apply to many schools?  Yes, but you may spend a lot of time taking extra prerequisites, plus filling out long applications and paying application fees.  It's best to narrow it down somewhat.