HCE

Patient Care Career Alternatives: Respiratory Therapy

Sponsored by Jacksonville University 

One of the best parts of working in medicine is collaborating with other healthcare professionals to provide the best patient care possible! As future medical professionals, we often have the same end goal - helping people. It sounds cliche, but medicine is a great way to achieve this goal while improving the quality of life for many. Becoming a physician assistant is a great choice, but it’s not the only allied health option that allows you to get one-on-one time with patients. I’ve teamed up with Jacksonville University’s (JU) Master of Science in Respiratory Care (MSRC) program to share some insights into the respiratory therapist (RT) healthcare career track. The goal of The PA Platform has always been to provide exposure to possible healthcare career paths; respiratory therapy is a great option for anyone who wants to make an impact on patients (in a way just as important as breathing)!

What is a Respiratory Therapist? 

A respiratory therapist (RT) is a healthcare practitioner with advanced knowledge of the cardiopulmonary system: how it works, the diseases that affect this system, how to treat these diseases, and more. If you’ve been in the hospital for any reason, you’ve likely seen an RT at work without knowing it. Respiratory therapists perform a range of duties including providing oxygen and aerosol therapy (breathing treatments), performing physical exams, and managing mechanical ventilators and other life support machines.

“Intubation” has been a popular word over the last few years, but you may have not realized that in many cases, RTs are the personnel responsible for these important procedures. Respiratory therapists are expected to display high levels of critical thinking, interpersonal communication, and clinical assessment skills as they oftentimes work in high-pressure situations.

Where can Respiratory Therapists work?

Respiratory therapists can work in a variety of locations including outpatient settings such as home care, physicians’ offices, clinical research facilities, pulmonary rehab, or polysomnography labs (sleep lab) or in all extents of the hospital. Some of the areas at a hospital where you’ll see an RT are the emergency department, floor therapy, intensive care units, pre-operative and post-operative units, and neonatal and pediatric units. When I had my daughter, I remember the RTs were in the corner ready to go in case of an emergency during my C-section. There was a respiratory therapist for both me and my daughter and I spotted the tiniest endotracheal tube for babies, which was not much bigger than a straw, that, thankfully, we didn’t need.

Respiratory therapists can also enjoy the flexibility of becoming travel therapists or seek excitement by becoming transport therapists. There are also academic and leadership opportunities, and having an advanced degree like a master’s in respiratory therapy opens more doors for growth; non-practicing RTs can become simulation educators, teachers in higher education institutions, or even ventilation specialists. A graduate-level degree in respiratory care allows an individual's options to go beyond the emergency room or critical care units.

How to Become a Respiratory Therapist?

Much like a physician assistant, RTs are in high demand. The profession is expected to see a 23% increase in job growth by 2030, per the U.S. Bureau of Labor and Statistics. Jacksonville University is one of only nine programs in the country that offer a graduate program in respiratory care. While there are associate and bachelor respiratory therapy programs, a graduate degree is becoming the future hiring standard for respiratory therapists. 

The MSRC program at Jacksonville University shares similar admissions requirements as PA school due to its competitive nature; you will need to have completed your bachelor’s degree prior to admission, write a statement of intent, obtain a letter of recommendation, and interview for the program. Like PA school, you can receive your bachelor’s in any desired area that fulfills the required prerequisites (many are shared with PA school as well). Prerequisite classes include algebra, chemistry, human anatomy and physiology, microbiology, physics, psychology, and statistics.  

What can you expect from a Respiratory Care program?

Using the Jacksonville University MSRC program as an example, the program provides students with both the knowledge and skillset to ensure that graduates are prepared for a successful career in respiratory therapy. Jacksonville University has partnered with Rush University, a Chicago-based university widely known for its success in credentialing certified respiratory therapists and registered respiratory therapists, to create a program that combines high-quality academic learning with hands-on clinical placement in local top-tier health systems. 

Last week on The Pre-PA Club Podcast, JU MSRC Program Director, Amanda Dexter, emphasized how evidence-based medicine is used to develop and implement patient care plans specific to the cardiopulmonary system. Programs like Jacksonville University’s MSRC teach patient education on acute and chronic lung diseases, learn how to run disease management programs for specific diseases, and prepare graduates for the careers ahead of them. Like any other allied health program, you want to feel confident in your knowledge and training, especially when performing life-saving procedures.

This two-year program is broken up into didactic and clinical sections, another similarity to PA programs. In the first year of an RT program, students can expect to learn the fundamentals of identifying, preventing, and treating acute and chronic cardiopulmonary dysfunctions. By going in-depth into the anatomy and physiology of the cardiopulmonary system and the pathophysiology of respiratory disturbances and diseases, you’ll get a solid understanding of how to help future patients. PA programs typically only spend a few weeks on these specific topics.

First-year curricular content for respiratory therapy includes pharmacology, gas laws/theorems, principles of mechanical ventilation (and maintenance), how to identify and correct acid-base disruptions, and fundamentals of performing a full respiratory assessment in the Jacksonville University Healthcare Simulation Center. PA school barely touches on this information, but this is the mainstay of respiratory therapy practice. The foundation of your education will continue to build in the second year during clinical rotations. 

The second year of the program focuses on the development of strong clinical skills and prepares graduates for national board exams and state licensure. Clinicals are the fun part of education – you get to apply the knowledge and practices you’ve gained while learning from experienced practitioners. Students will become familiar with administering oxygen or aerosol therapy, obtaining blood gas samples for analysis, performing secretion removal maneuvers, as well as initiating, maintaining, and removing mechanical ventilation or artificial airways. Lots of hands-on experience!

I hope this gives you a good inside look into the respiratory therapy profession and maybe a new option to put on your list of career choices. If you have any questions or are seeking guidance into the field, please reach out to Jacksonville University at graduateadmissions@ju.edu, and any RTs you know! 


Mission Trips as a Physician Assistant - with Hands of Esperanza, a PA-run Non-Profit

I’m so excited to share today’s episode because it has personally inspired me to consider what we, as PAs, can do to serve patients and people more. I'm chatting with Eryn and Ashley from @handsofesperanza, a non-profit providing healthcare to rural areas of Guatemala. Listen to the story of how this organization was born out of a PA school mission trip, but has become such an asset to the Guatemalan community. If you’ve been curious about global health or medical missions, we have some great ways for you to consider getting involved. Learn more at https://www.handsofesperanza.org/.

This blog post can also be listened to as a podcast episode on The Pre-PA Club Podcast. Listen to it here!

Ashley: I’m Ashley, I’m a physician assistant in Atlanta. We all went to PA school in Nova Southeastern University in Orlando, FL. I went into surgery, and had a couple of different experiences but I currently work in transplant and hepatobiliary surgical-oncology, which is a mouthful, but that's where I practice now. And today, we want to talk about our mission work and our nonprofit in Guatemala.

Eryn: My name is Eryn, I live in Tampa, Florida, and I currently work in the emergency room as a PA, a little easier to say haha. I also went to Nova Southeastern University in Orlando, and I'm also working on the same mission with Hands of Esperanza! 

Savanna: Great! So when did y'all graduate? 

Hands of Esperanza: We graduated in 2016 and 2018. 

Savanna: Okay, and I was ’14, awesome! Can one of you give me the mission of Hands of Esperanza, and how it got started.

Ashley: Sure! So we have been kind of a group collectively for the past five and a half years. We started this mission trip my very first year in PA school in 2014, because when we all came to NOVA, we didn't have a mission trip. A lot of us felt very passionately that we wanted to do something and were interested in global health, at least in when we had more free time during divided breaks in between semesters. We were like, this is something that we would like to create and make a legacy at our program. So we started brainstorming, and we had a few very trusted advisors at the program at the time. One of our professors there she said they do medical work in Guatemala with her church, we trust the people there, and we have an organization that we work with, if that’s where you guys would like to go. So that's where it all started. So we took our first mission trip there in 2015, after we finished our first didactic year. We had about 20 students go. We had one PA and one nurse who went with us. So we did three days of remote rural clinics, and then we did a few days of volunteering in hospitals, seeing the local orphanage there. Immediately after we went, a handful of us said that this is not something that we can walk away from, never come back to. This is something that we felt like would be part of our lives for forever, to be quite honest. So the next year, that class overwhelmingly was like, we want to go back to where you guys went. Let's make this a legacy. Eryn’s class was the third class that went. 

Fast forward to June 2019, we were able to form our own non-profit, which is called Hands of Esperanza. We did that because we are fundraising for our largest project in Guatemala, which is to build a multi-specialty medical and surgical center within the community that we serve that will allow us to provide more sustainable access to health care for the patients that we treat. Because right now, we hike to the villages. We carry all of our medical supplies, and we do this because we're young and healthy right now, but some of us are turning a little older, and our patients are a little older too! One of our oldest patients is 80, and it's very difficult for them. They do this every day, when they need to get somewhere, but we would like to be able to provide them with the opportunity to come and see us in a more accessible environment year round when our groups like ours are unable to be there. And I'll let Aaron talk a little more about it too because she has been involved since pretty much the beginning of the organization. 

Eryn: Yeah. It's actually really crazy one of the reasons I went to PA school was so I could do global medicine, start going on mission trips, and make an impact, not only in the United States, but in other countries as well. And I remember Ashley came and presented to our class trying to promote the mission trip, and I was so amazed! And PA school gets so crazy, we’ve all done it, I was like, “how will I fit in this mission trip?!” on top of all of this studying and everything. So I originally decided not to go. I was thinking about it for weeks, and I was like, “I can’t not go; this is why I went into medicine.” And then once I saw Guatemala and saw the work that they were doing over there, I have not been able to leave it. So, that's how my role got started. Once I went for the first time, I just knew I couldn’t not go back. So I went back last year, and the year before that as well. 

Savanna: So how many times a year are y’all going to Guatemala? 

Hands of Esperanza: Right now, just once a year. Every August we go for like 10 days, but probably with the clinic, we will start going more often because we'll have more opportunities and a stable set-up. We actually have the infrastructure to be able to do that. It's difficult for us to be able to bring groups that can do a little bit less with their mobility; we're asking them to bring in all this equipment to do more advanced things that require more surgical equipment and things like that. We have a cleft palate group that comes right now, and that's obviously not something that you can bring to a very remote area. It requires a lot of equipment, a lot of anesthesia, things like that. So when we're able to actually bring groups into the clinic, we'll have more groups coming more times of the year  that will be able to provide more specialty care. In addition, we actually have people in Guatemala; we have local doctors and nurses that have offered to provide services at the clinic for free or reduced prices at no cost to patients. And so that's something that we're really excited about too! We really want to go more than 10 days out of the year, but that’s just not possible haha. 

Savanna: So what happens on your mission trips? I've been on a couple; I went to Kenya and El Salvador. And it’s hard to explain exactly like what to expect, but what's kind of the breakdown of the trip? 

Hands of Esperanza: Great question, so ours is pretty unique. We've already touched a little bit on the remoteness of the clinics and how we set up. But for us, what we really wanted to do was offer the PA students an opportunity to be able to see patients and kind of use this as their first clinical experience because they're doing this in between their didactic here and their clinical year. So, they've learned everything right? You studied everything; you know how hard PA school has been and how many books you've read. And so this is really their first opportunity to use all those physical diagnostic skills and everything. 

The first day we get there, we hike to a remote village. It depends on the length, but usually the Guatemalans take about half the time that it takes us haha. So we get there, unpack, set up rooms, try to triage patients into an area they need. We have primary care, pediatric care, and an OBGYN room. And we go from there. We typically see me around 200 to 300 patients a day, depending on how many show up. It’s not a steady flow; it’s usually these bursts of people because they're walking from different villages and it takes them like three to four hours to walk there. And sometimes people are waiting for us when we get there first thing in the morning. So it can also be kind of chaotic! 

Once the students kind of get the hang of things, over the course of the week, it does become more organized. We are able to do 4 of these days. We are most often at a school that is pretty rudimentary; it is 4 walls with open air, a dirt or concrete floor. We set up exam stations on desks the students normally use. If we are lucky, they will have tables and chairs. And we tell students, you know, you're not going to have lab values, you're not going to have x-rays, you're going to have to go based on a lot of your history-taking ability and your diagnostic skills. So, that's really a good learning experience for them there. 

Then after those 4 days, we actually have a full day where we go volunteer at a hospital. And so they get to participate in emergency room triage and acute care, participate in labor and delivery, and scrub into some surgeries! One of our members got to scrub into a surgery, and she actually went into surgery as a PA, which I don’t know if that’s why, but it was actually really cool. They also get to see the inpatient side of things; they'll participate in rounds and stuff like that. For the most part, that's the actual mission work that our students are able to do. 

We also do some stuff while we're in the villages, as well. So, our main focus is medicine, but one of our other focuses is actually building stoves. We see a ton of respiratory problems! Because their only option right now is to cook on an open flame, and they're constantly breathing in smoke. So one of our projects is building these stoves that have actual chimneys and allow the smoke to escape from the house. We built 25 stoves last year, and we have been there for 4 or 5 years, so we have definitely made an impact in this way. And then we'll also paint the school, really just do whatever they need help with in the village with our extra manpower we have. We've also built some water filtration systems because a lot of them have worms or different illnesses stemming from the water because they don’t understand that boiling the water is healthier. So we built this filtration systems, and those will last for about 20 years. And once we are able to install it, then we educate them on how to use it. And I'm glad Eryn brought that up because we try to give them preventative and public health education, which is really important! And these patients don't actually speak Spanish; most of them speak a Mayan dialect called Poqomchiʼ. So, this adds to the complexity of what we're doing there. Going from 95% of our volunteers only speaking English, so we go from English to Spanish to Poqomchiʼ. There are also 2 other languages spoken there! So, if you get one of those stations, you have to find an even more unique translator. But it’s a very unique experience. Our students come back from this trip saying, “Oh my gosh, how is this even something we are allowed to do? This is so cool; we really think this is a mission trip we haven’t been on before, and we don’t see with other programs.” So we're very thankful that we found it and provide the opportunity to continue going! 

Savanna: Yeah, I'm super impressed by just how organized everything seems, like the logistics. This is way cooler than I even thought. And you answered my next question about language barriers too! So i the clinics, what do you all see as far as medical need, like what medical conditions do you see most commonly and how are you actually able to help them from a medical standpoint?  

Hands of Esperanza: Like I mentioned before, with respiratory problems, we are able to bring a nebulizer and breathing treatments, which helps a lot. We also see a lot of worms from the water, so we bring deworming medication. And then really one of our main jobs is education. So we are not just handling them medicine, a breathing treatment, and telling them to go on their way. We explain to them why they are feeling that way, teach them they need to boil their water to get rid of worms, and things like that. We also see scabies, and we can’t just treat one person in the family for scabies, so we need the whole family there. We explain you need to boil your sheets and things like that. In summary, a lot of upper respiratory issues, GI issues, lots of aches and pains since they're doing a lot of manual labor. I've never seen someone so happy to just receive Tylenol and a lidocaine patch in my entire life! I’m sure we will touch on it later, but it really speaks to the gratitude of this patient population when you see them smile. 

We also take care of some things that require a bit of procedures. We have drained abscesses, removed very superficial lipomas, keeping into consideration where they are going back to as well. We removed someone’s Nexplanon this year too. We have also removed foreign bodies that have caused them a lot of pain while walking and stuff like that. There are a lot of foreign bodies in ears, usually insects. 

Savanna: Oh no! 

Hands of Esperanza: Yeah! We also have some things you wouldn’t normally see. We had a machinery murmur last year, and all the students came around and listened. So, lots of very interesting things, but most of the stuff is pretty basic. I think the biggest barrier that we encounter is the nutritional problems. We are not going to be able to fix all of that. This is a poverty stricken area; about 83% of the population lives below the poverty line of Guatemala. So telling them they need to eat a healthy diet, stop doing things that are causing you to have GERD, stuff like that, is very simple because they only eat what they have, and they eat very little of it. 

Something else that is cool is that I also spend a lot of time in the OBGYN clinic. And we've seen a lot of STDs, and the number of people with STDs are dramatically dropped since we started going there. Because we started treating them and educating them on how they're transmitted. This year, by far, was the least amount of STDs we have had. STD, worms, and URIs we saw a lot less this year! From the time we started five years ago to this year, because it’s a public health initiative and public health education, I do think it’s really made an impact. We will also bring toothbrushes and teach them how to brush their teeth, or we also bring reading glasses. It’s amazing when someone wears a pair of reading glasses, and they haven’t been able to see well in years. They put one on and they will be amazed.

Savanna: That is so cool! Wow. So I’m going to just ask you guys questions I get all the time about mission trips. So what can a PA do on a mission trip? Do you still have to have a supervising or collaborating physician? Are there any just limitations?

Hands of Esperanza: That’s a good question! The barriers we encounter the most with that is when we are in the U.S. ordering medications to take with us. We have to have a physician prescriber sign off and have it delivered to their office, which we do. After we get to Guatemala, we are not required to have a physician accompany us. 

We actually have all of our medical licenses registered with the Ministry of Health there, so what we are doing is very kosher. We are not just going into their country and saying, “I’m going to treat you now. My name is so-and-so, and I’m your doctor.” We do not tell them anything that is not true; we tell them what we are, and they understand they are seeing students who are being supervised. The organization we work with there actually takes our licenses and does all of that for us. They make sure the country and the Ministry of Health know we are there. 

It’s a little bit different if you are going for a surgery trip obviously; a surgeon and an anesthesiologist or CRNA will probably be required. But for us to practice basic primary care medicine, they do not have any laws requiring a physician there. It’s obviously based on country, but for us it is not. 

I don't ever feel like we're lacking in the department; we have so many specialties across the 15 PAs that we have. We have ICU, pediatrics, a  lot of ER, a lot of surgery. Everyone is kind of spread out, and we have have people with some background before PA school that helps too. So

We have a wide breadth there. And then we also have physicians that come with us on a trip, but they're usually volunteers. They do add a lot to the trips, but we don’t feel like we rely on them to tell us what to do. 

Savanna: Okay great, so are there any opportunities for other students like pre-PAs, undergrads, PA students from other schools, to get involved? I'm already brainstorming all these different ways through fundraising and collecting supplies – I love that this is a PA organization, and what are some practical ways people can help? 

Hands of Esperanza: There are so many ways! Honestly, the first way is that people just listen to what we have to say, and they help us spread awareness about our mission. The second way is donation. That could be financial donation, supplies donation, or donation of your time as a volunteer. On our website, we have a list of commonly used over the counter medications and supplies. If you have a question, you can reach out and contact us. You can send us an email to handsofesperanza@gmail.com, very easy to remember. A third way is volunteering time. The organization we work with in Guatemala is called Living to Serve, and they support trips year round. We may be going on medical trips, but they have groups all the time that have different focuses. For example, they have high school students come from churches. It doesn’t matter what your ages are, what your level is, and so on. They don’t necessarily hike to these same villages, so the ability to hike doesn’t have to be there either. There's tons of opportunities, and if people are interested in setting up a trip where they maybe build stoves or water filtration systems, or a volunteer at an orphanage or the local nursing home there. There is a lot of opportunity. If you are pre-PA, and you want to do something with public health education, that is certainly somewhere you could get involved. We can always talk to Rudy with Living to Serve and see if there is an opportunity there. But there are lots and lots and lots of opportunities and we're always happy to field any inquiries if you have one! And honestly Rudy is the nicest human in the whole world, and anybody who wants to help in any way he will find a way to get you there and get a group going! 

Savanna: Okay awesome, so definitely spreading awareness which we can do. So how much does it cost to build or install a stove?

Hands of Esperanza: Around $200-250 per stove. They have done research in countries –when people who receive these donations have something invested in the project, they’re more likely to use it. They did this project with mosquito nets in Africa. They just gave our mosquito nets, and when they came back, the residents were using them for all different purposes. They were using them as shopping bags to carry groceries, using them for fishing, using them for all kinds of things, even though they were provided with education and these life saving mosquito nets. So then they asked them to contribute 5% of the cost of the mosquito nets, and suddenly, the use of these nets completely changed. When they came back, the mosquito nets were all being used for their intended purpose. 

So that’s one thing about this community – they are incentivized to use the stoves. They are asked to contribute a very small amount, like we said the poverty line is very high here, but they contribute to the stoves, come and pick up the stove material, deliver them to their houses. But the stoves are pretty rudimentary, and they're basically cinder blocks that get stacked. There's a place where you can put the wood, light it, and it heats up. There is a large metal slab on top that has little burners. The area where the wood heats up in the center has an outlet that's a very thin piece of metal, and it goes out of the roots. And then there's a protective wire on the outside. So that’s it! And a lot of the money that the students raise for their mission trip every year contributes to that.

Savanna: How much are y'all anticipating the clinic will cost? 

Hands of Esperanza: A conservative cost right now for a two level, multi-specialty clinic, including a surgery center, would be $450,000. We've already purchased the land, and we've already started construction on the perimeter wall. So that was a large chunk of money. Land in Guatemala is not cheap. We have collected $50,000 so far, and we are fortunate that we have a company that wants to double match our donations. So we are very close to our goal in order to double match to get the $450,000. We've got about $100,000.

Savanna: Wow. That is awesome! Oh yeah and that brings up another limitation. So a lot of people worry about the finances of going on a trip like this. Do y'all have any thoughts or advice on how much a trip would cost to go on, and how people can make it happen? 

Hands of Esperanza: So ours isn’t that expensive compared to other mission trips. We charge $1,100, including the flight, all the main meals excluding snacks, so everything included! When I was in PA school, I funded that through GoFundMe. Family members and I raised the money pretty quick because when people hear about what we are doing over there, they get pretty excited. But compared to other mission trips I’ve heard about, the price is usually double that. And the fact that everything is included I think justifies this overall. If you're going to go somewhere like Africa or India where there is a longer flight, that is obviously a higher cost. But for us, this was the lowest cost. 

Savanna: Alright, so you all said that this is something you see yourselves participating n for life. What do you see as kind of the future for Hands of Esperanza?  

Hands of Esperanza: The clinic is in the forefront of everyone's mind right now. That's what we're really focused on. Once we have the clinic, I would love to be able to provide more specialty care for people. We have seen crazy things that we just don’t have the providers to provide for. Maybe it’s something surgically advanced, like a head and neck surgery. We saw child last year who needed craniofacial specialist, and those things are just not accessible in the area. The area we are in is 6 hours away from Guatemala City. There are certain labs that their main hospital is not able to do, it has to be sent to Guatemala City. A TSH result for instance takes 2 weeks. We want to help bridge that gap, whether lab work or bringing specialty care. Those are some long-term goals. We also want to be able to provide sustainable healthcare, preventative care, and screenings. There is a very high rate of death from cervical cancer in this population of women; if we could offer something as simple as free cervical cancer screening, that would be something that could dramatically impact these women. Big long term goals there! 

We are also focused on the sustainable products as well just because that's one of my major roles. I was talking to somebody who was brought up in Guatemala when we were there last year, and she made us aware that there are a lot of kids in villages who pass away simply because they won’t latch onto their mothers. So they have no way to feed; they don’t have any formula. So stuff like that would be so simple for us to contribute to. We are looking to get breast pumps donated to help the mothers feed their children who have trouble latching. 

Also in the future, we would love to bring more groups of students, especially from other programs. Where I am at in Georgia, there are programs where you can do your OBGYN in Peru. I think that’s incredible and it that offers so much insight. And you are so limited if you only do rotations in America, in your little city in America. Maybe you are like us in Orlando where there are a lot of other programs competing for rotations, so if you are able to broaden what you see and what you are exposed to, maybe that will change who you are as a provider and allow you to think a bit more about what type of patient you are treating. I’m sure Eryn has in the ER in Tampa, but I know for sure in my job in all the areas I have worked in, you have patients that come in who only speak Spanish from Central America. And there’s a piece of me that understands that patient better. I’m not going to be one of those providers that is going to talk over them because I don’t speak Spanish, and they only speak Spanish, and I just go get the translator but we are going to breeze over them. That’s never the kind of provider I want to be. It’s so easy to do that though, if you don’t have that exposure. So long story short, we would love more opportunities for PA students to be exposed to that population! Yeah and PAs too! I just know I’m a completely different provider than I would have been if I was never over there. You just see so much. 

Savanna: What is one tip you would give to someone who has never been on a mission trip? I’ll say mine too. 

Hands of Esperanza: I would say my biggest thing is just being flexible. 

Savanna: Shoot that’s mine too! Hahaha.

Hands of Esperanza: Yeah you literally think you have a certain role, and it’s never that role. We’ll get to the clinic and a triage is just not going to work that day due to the set up of the clinic. We will throw you into a provider role, or throw you into playing with kids that day because there are a lot of kids that day. So just being flexible. And honestly, that’s what being a PA is. 

And very similar to that – go into a mission trip being very open minded and not having an expectation. Every mission trip I've been on, this will be my 6th year going on this trip, but I’ve been to other mission trips to other countries, and Guatemala was really different from Ecuador from the Dominican Republic and so on. So just go into it with an open mind, allow it to change you and shape you. I think people will have a really awesome opportunity.

Savanna: Yeah and they’ll probably get more out of it. Mine is along those lines. When I went to Kenya, it was a derm specific trip. Out of the 12 of us, I was the only one who brought a stethoscope. Everyone was like, “we are just seeing derm stuff!” And I was like, “No we are not” haha I can guarantee that. It turned into more of a multi-specialty clinic for those few days, with one stethoscope. All right, well, where can everyone get more information and contact you and all those fun things?

Hands of Esperanza: Yeah our website is https://www.handsofesperanza.org/ Those of you who are not bilingual, Esparanza means hope. We are not necessarily the hands of hope; we think hope is a two way street. When we are there, we hope we give our patients hope, but we also get that from our patients. They give us a renewed sense of faith in what we're doing and how we're practicing medicine. You can find ways to donate and find ways to get involved. There is also a contact button on there. You can email us at handsofesperanza@gmail.com, and our Instagram is @handsofesperanza. We frequently update and would love to have you guys follow. Eryn will be updating as well, so follow along! 
Savanna: Well thank y’all so much! 


Direct Patient Care Jobs for PA School: What is PCE and How to Get Certified?

Direct Patient Care Jobs for PA School What is PCE and How to Get Certified.png

Today’s post is sponsored by Advanced eClinical Training!

One of the most important aspects of a physician assistant school application is direct patient care experience (PCE). As the process of applying to PA school has become more complicated with an increase in requirements and more competition, the quality of PCE is even more important than ever. While there are still positions that may not require a certification, investing in extra education and training is one way to stand out when trying to land a high quality patient care experience.

What is direct Patient Care Experience (PCE) and what “counts”?

Before diving into becoming a PA, it’s a good idea to make sure you like the daily responsibilities of taking care of patients. Working in a healthcare setting doesn’t always allow for patient interactions, which would be considered “healthcare experience.” These types of jobs include receptionist, front office or insurance work, pharmacy technician, and patient transporter just to name a few.

For a position to be considered “direct PCE” you are expected to have involvement in a patient’s care plan. Typically, you’ll be more hands-on with tasks such as taking vitals, phlebotomy, assisting with procedures, starting IVs, or administering medications. (This is not an exhaustive list, but just a few examples.) Many of these jobs will require additional training or certifications before you are hired into these types of positions, and some roles to search for include medical assistant (MA), certified nursing assistant (CNA), patient care technician (PCT), and emergency medical technicians (EMTs). 

When considering what type of position to take, there are two main factors to look at - what your programs prefer and what you’ll actually be doing. Job descriptions can vary, so look beyond the title to what your daily roles and responsibilities would look like. 

What kind of training, certifications, and qualifications are needed to work in a direct PCE job?

Obtaining healthcare care experience before PA school can be a difficult and stressful process.  When I was looking for clinical certification programs, it was nearly impossible finding a program that met my needs for time, affordability, and flexibility. To become a CNA for my job at a rehab hospital, I ended up driving 1.5 hours each way every Saturday for 3 months and giving up spring break for clinicals. It was the closest option I could find that fit my schedule, but wasn’t ideal while balancing a full-load of science courses at UGA. There are places that may hire and train without a certification, but this will depend on your state and position. It will be more difficult to find a hospital or larger facility that is willing to hire without a certification. 

Fortunately, Advanced eClinical Training (IG: @advancedclinicaltraining) is now offering fully online Allied Health certification courses designed specifically for Pre-PA students.

The certification training programs they offer are:  

  • Certified Clinical Medical Assistant (CCMA) 

  • Certified Patient Care Technician (CPCT)

  • Certified Pharmacy Technician (CPhT) 

The training programs can be completed in little as 8-12 weeks, but are completely self-paced with no due dates or time restrictions!  Their programs consist of innovative learning modules including interactive assignments, real-life clinic simulations, classmate discussions, expert video lectures, and constant support/feedback from course instructors who are board-certified medical providers!  Upon successfully completing the online training, students will sit for their program's certification exam to obtain nationally accredited clinical certifications and be credentialed to work in the diverse clinic and hospital settings! 

 After speaking with students who have completed the program, they were very happy with the program and stated they are quick to respond and approve submissions. By volunteering for in person experiences, you can put what you learn into practice. Definitely reach out and contact Advanced eClinical Training if you have any questions about the program. 

Advanced eClinical Training is currently enrolling Pre-PA students for all of their online certification training courses! Use code PAPLATFORM to get $100 off and start gaining valuable clinical training before PA school! 

How can I find a direct PCE position? 

Once you’ve completed your certification, it’s time for the fun part, but finding a job and getting credentialed can take a little while. When deciding on a certification, look to see what types of jobs and requirements are most common for your area to make it easier when you start to look.

Most hospital websites and large facilities will have job postings at all times. Apply widely until you secure a position because you never know how long it will take to hear back. Cold-calling smaller offices or sending out a resume with a letter of intent is another great strategy as many places love to hire pre-health students.

Don’t forget the power of networking, and use any connections you have. Even if none of your family is in medicine, you never know if you tell your neighbor about your ambitions who they may know who can help you out. My rehab hospital CNA job was actually the result of one of my dad’s co-workers who had a connection and knew they were hiring extra help for the summer. 

For more information on how you can complete an online certification to land a direct patient care job, visit Advanced eClinical Training

My Thoughts on CASPA's Changes to Healthcare and Patient Care Definitions

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First of all, take a deep breath.  It will all be alright.  

This past week right before CASPA reopened for the 2017 cycle, there was a lot of buzz around some recent changes to the recommendations on how to classify experience on applications, and whether it should be categorized as healthcare experience (HCE) or patient care experience (PCE).  In the past, HCE was defined as working in a medical setting, but without directly interacting with patients in a way that involved their care (receptionist, billing, transport, etc.).  PCE was defined as any job in which there is direct patient interaction and care, such as nursing, EMT, paramedic, CNA, MA, etc.  These were more of roles where you were performing skills and had more responsibility.  Scribe has always fallen somewhere in between.  

Moving on to the new definitions. Here is a screenshot from the site, but you can see more here. 

CASPA's Healthcare and Patient Care Experience Definitions

CASPA's Healthcare and Patient Care Experience Definitions

This made a lot of people angry.  CASPA basically changed it so that CNA and MA are categorized as HCE instead of PCE, according to their guidelines.  The idea is proposed that a role is only PCE if you are more responsible for a patient's care and contributing to decisions about a patient's care.  CASPA also stated that these changes were made based on feedback from PA programs.  Obviously, this has many people who have worked hard for their hours feeling like they've wasted their time.  

I get it.  I worked as a CNA, and it's no joke.  I work with MAs all day long, and there is no denying that they are very involved in patient care.  But this may not be the case for all positions deemed CNA or MA, and I think that has been part of the problem.  If you work as an MA, but you're usually in the front office answering phones or working on prior authorizations and paperwork, that is more accurately HCE.  If you're taking vitals, performing venipuncture, and counseling patients, that's more PCE.  

Let's talk about why this will all be ok.  The final decision is up to each program, and unless they decide to change requirements last minute, all of the experience you've accrued should be fine.  CASPA gives you some discretion with statements like these: 

  • "Please review the definitions below, consider the duties which you performed during your experience, and use your best judgment to determine which category your experience falls into."

  • "CASPA advises applicants who have prerequisite requirements to confer with their individual programs if they are unsure how these programs will consider their experience."

  • "If you have any questions in regards to your experiences fulfilling an individual school’s requirements, you should inquire with that school directly."

Healthcare and Shadowing Experience Log Download

It's essential that you keep great records of your healthcare and shadowing hours. Use this Excel form to have all of your information organized and ready to go for CASPA!

Ultimately, you can decide where you feel like the experience should.  If it were me, I would list the experience where it was recommended based on CASPA's preferences.  But I would be very thorough in describing what my experience entailed and what my responsibilities included.  Make it clear to the programs how involved you are in patient care, but as always, be honest.  

If you're unsure about how a program will categorize your experience, the first step is to check the website and see if it's listed.  If you are unable to find an answer, consider contacting your top few programs to clarify.  Just keep in mind that they are probably getting a lot of these calls right now, so be patient.  

I hope this gives you some clarity, and if you have any questions, I'll do my best to answer or find an answer. CASPA is complicated (and confusing) at times, and I do my best to keep up, but I am not the final say!  It's also convenient that I planned for the May webinar to cover HCE and PCE (before CASPA even changed anything!).  Make sure to mark May 24th at 8 PM on your calendar so you don't miss out.  Comment below with your questions! 


Guest Post: 10 Tips to be the Best Medical Assistant (MA)

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Taylor's back guys!  I have to admit that Taylor is the best MA I have ever worked with because she does all of these things she's listed and more.  I know it can be a busy and exhausting job, but if your goal is to become a PA, you want to make the best impression possible and secure that amazing letter of recommendation.  If you missed Taylor's first post about why she's decided to go back to school to become a PA, then check it out here.  


  1. Know your provider. - I have worked with the same PA for over two years, and with that time comes a knowledge of how she practices. I can quote verbatim the side effects of many drugs and know which medications she likes to prescribe and how she likes the flow of her schedule to run. While this takes time to learn, I have found it is very helpful for staying on schedule and running a smooth clinic
     
  2. Always be willing to pitch in - In the practice where I work, each provider only has one medical assistant assigned to them. During down times when the PA does not have patients, I am asked to help other providers out when I can. I always try to do this with a smile on my face because teamwork makes the dream work.
     
  3. Time Management - I like to make the most of my quiet mornings before patients get in, as well as my lunch break, to keep up with my PA’s schedule and check and make sure that patients are scheduled correctly and that our exam rooms are fully stocked.
     
  4. Take advantage of learning opportunities  - At the practice where I work, we have been given the opportunity to train in many different procedures such as laser and photodynamic therapy, as well as chemical peels. Any chance to learn more, go for it (and actually pay attention). I love going to drug rep dinners with the PA I work with and getting to learn exactly how the medications we prescribed work. You are never too old to learn!
     
  5. Don’t think that you are above or below any task- When I was first starting off in the medical field, I thought some tasks I was given were pretty mundane and menial. I have come to learn this is not a reflection of my intelligence, but is necessary. The simplest task I have at work is to assemble shave biopsy kits, which any fifth grader could do. But without these kits, the providers would be unable to do one of the most important procedures that allow for the diagnosis of skin cancer. These shave kits could potentially be saving someone’s life!
     
  6. Don’t let one patient ruin your entire day - One of the most exciting things about working in the medical field, as well as one of the most stressful, is that you can never predict exactly how the day will go. There is always the one complicated patient that takes a little longer then you have allotted, and needs a little more TLC or hand holding than others. This can often throw off your schedule and can at time cause tempers to rise. Always remember to take a deep breath and take your day one patient at a time.
     
  7. Be Organized - Any type of career in the medical field requires some degree of organization. It is difficult to manage around 30 patients a day, as well as answering phone calls, and keeping up with pathology, without having a system. I do not like to leave things undone, so the best feeling for me is leaving work at the end of the day with an empty inbox. The combination of organization and time management can be the most helpful in running a smooth clinic.
     
  8. Evaluate Often - If something is not working, never be afraid to ask why and be willing to seek out ways to make your practice and office better. Savanna and I have had several conversations after certain crazy days to evaluate what is working and what is not working.
     
  9. Always Be Attentive - One of the most valuable assets to being a great MA is the ability to be one step ahead of your provider. Being able to predict what they might need for a procedure or what samples a patient would benefit from keeps your schedule running smoothly. I feel like I am the biggest help to my provider when they don’t even have to ask me for things that they might need.     
     
  10. Have a good attitude. - This may sound simple and obvious, but makes the biggest difference in your work environment. Just a simple smile and a willingness to serve others can brighten someone’s day and allow for unity and less drama in the workplace. 

These tips can translate to many other healthcare positions besides medical assistants.  I hope they've been good reminders that you can take with you into work.  I love Taylor's positivity and commitment to the patients we see.  I can't even pick a favorite because I like all of her tips so much.  What tips would you add for being the best medical assistant? 


Guest Post: Why I Decided to Go Back to School

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Hey Everyone!  I'm so excited to bring you a guest post from someone I spend more time with than my husband, and who keeps me sane - the medical assistant I love the most, Taylor.  I'm really lucky to work with someone who is also one of my best friends, and we have SO much fun.  She also is one of the most positive people I've ever met, and she puts up with my (occasional) stress and negativity so well.  I'm so proud (and sad) that she's decided to pursue becoming a PA, and I think you'll gain a ton of knowledge by following her journey here!  


This one time we dressed the same for the Christmas party completely on accident!

This one time we dressed the same for the Christmas party completely on accident!

    Hey there! My name is Taylor and I work with Savanna. I have been working in the medical field for almost six years now, and as a Medical Assistant for four years. If you were to ask me in high school what I wanted to be when I grew up, the answer was always the next Katie Couric. Friends actually signed my senior yearbook with “Can’t wait to see you on The Today Show!”  I come from a family with zero medical backgrounds, and honestly I was never interested in medicine. Flash forward to my senior year of college in 2010, and realized I really don’t see myself having a career in PR. I was one semester away from graduating and wasn’t sure what I wanted to do with my life. 

    I moved to a new city and started to look for PR jobs with non-profits. After several months on the job search, and a quick stent at my favorite quick-service restaurant (let’s just say ‘my pleasure’ is forever engrained in my head), I came home to my roommate telling me I had a job interview with a local dermatologist. This is just one example of one of the most valuable lessons that I have learned post-college - networking is everything. This roommate worked at a hair salon where my new boss had her hair done, and mentioned that she was looking for a new hire since her receptionist just got into PA school. Always be on the lookout for opportunities to network! 

    I asked my roommate what the job entailed, and she had no idea. All I knew is it sounded somewhat interesting, and I knew I wanted a change of scenery. I went into the interview, and the first question they asked was “Are you okay with blood?” I responded with a cautious “Sure?”  The office manager proceeded to tell me the different responsibilities of the job, and the tasks I would be doing. I started off mostly as a front desk receptionist, and worked with the physician one morning a week so her medical assistant had time to do paperwork and catch up on other tasks. After a few months on the job, I could see that being in back with patients, interacting with them, and learning about dermatology, was the most enjoyable part of my job. 

    A few years later, we hired a Physician Assistant and I became her full time medical assistant. This was as far as I could move up the ‘totem pole’ at my job, and for several months was satisfied with where I was. For someone who had no experience in the medical field, I found it very intriguing and could see why people would want this career. When I first started this job, I knew being an MA was not something I could see myself doing my entire life. For several years I thought about possibly going back to school, but to be honest, it scared me, and I thought it would be too much. One of my greatest weaknesses is my love of comfort. I was comfortable with where I was. I knew what was expected of me and knew my job and could do it well. 

    This year, I finally decided it was time. I never wanted to look back in five years, and regret the fact that I wasn’t willing to take a leap into the unknown. I am single, don’t have children, and thankfully did not have student loans, so what was I waiting for? I was quite nervous when I first decided to go back to school. I have been out of college for six years, the only science classes I took were 10 years ago, and I am working full time. How was I going to juggle all this?! One step at a time, that’s how. So in September, I began. I am two classes down of the eight I need to apply for PA school, and guess what? I’m still alive! It has taken a lot of time management (Hello Kate Spade Planner for the win), saying no to dinners with friends and weekends away, and knowing that “This too shall pass.” 

    For all of you college students out there wanting to go to PA school straight after graduation, I am kind of jealous. I have thought recently how nice it would have been to graduate with a degree and know exactly what you wanted to do for a career. But do I have any regrets about waiting? No.  I have learned some valuable lessons in my twenties. I have learned what it means to live on my own, that the real world is not as easy at it seems, that time management is very important, and that it really is never too late to chase a dream. All it takes is one little step, and that first step is usually the hardest, but is always worth it. I do not know where this road the Lord has me on is headed, but I am going to trust that “there are far better things ahead than anything we leave behind.”


If you're struggling with deciding if this is something you can do, i hope Taylor's story and insights have provided some encouragement to keep pursuing your dreams!  Leave any comments or questions for Taylor below!  And if there's anything else you would like to hear her perspective on, leave a comment! 


International Healthcare Experience

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Who doesn't love to travel??  International healthcare trips can give you the opportunity to both travel and get the HCE that you need for PA school.  I think if you have the opportunity (aka - time and financial means) to get some experience abroad you should go for it!  These trips give you a cultural outlook on healthcare and the chance to see conditions that you might not encounter frequently in the United States.  Many times the medications and treatment options are more limited when you are in the field, which means you learn more about specific treatments and what they are useful for.  These trips can be a way to get a lot of hours as well.  If you're doing clinic for 10 hours a day for 5 days, that's going to get you 50 hours in 1 week!  It also gives you awesome subject matter for your interviews.  And amazing views like below (La Romana, Dominican Republic).

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There are some cautions you should take before deciding to go on an international healthcare trip.  You do want to choose an area where you will be safe, and you want to travel with a group that is well-established.  These trips can be quite expensive, and you don't want to waste your time or money.  While on a trip, you also want to be cautious to only practice to a level you feel comfortable.  Sometimes countries have standards that are slightly different, and although you are learning, I would recommend not doing anything that you shouldn't be doing as a student or have no training to do, basically anything you wouldn't do in the States.  I've heard of people actually getting turned away from medical programs because they mentioned doing procedures during interviews that they probably should not have been doing (circumcisions, tooth extractions, etc.) and that was considered unethical.

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Sometimes your bus might get stuck in a ditch on the way to clinic ^^^, and then all you can see for miles are fields (see below).
 

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Financially, international trips can be expensive between the trip cost, flights, and spending money.  You could always work to raise this money, ask for funds as Christmas or birthday presents from family and friends, or even try a Kickstarter or FundMe.  Many people questions why you would spend thousands of dollars when there are plenty of people to help here in America.  Well, after one trip you'll be hooked.  It's so worth it to see how appreciative the patients are and how much it means to them that you would travel so far to help them.  It also opens your eyes to the needs of others in a whole new way when you are seeing people who don't have all of the material items and distractions that we have daily.  My biggest take home point was that no matter where you live or what you have, we all have the same healthcare issues.  It's very unifying.

The biggest thing to know and prepare for before you go on a trip is to BE FLEXIBLE!  After being on a few different mission trips, I have learned that it is rare for everything to go perfectly, and it's a lot easier if you accept that before you go.  As part of my internal medicine rotation, I was able to go for a week to the Dominican Republic on a trip with a few of the medical students at MCG (including my husband).  We had sent money ahead of time so they would have supplies and medications for us to use during clinic, but when we got there, we had nothing!  How were we supposed to hold clinics with no medications?  By the grace of God, another team at our base had miraculously ended up with over twice as many supplies as they needed and they were so kind to share with us.  Everything worked out!  But it was a little dicey for a little while there.

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So the majority of these trips operate in similar ways.  You have a home base in whatever country you are going to, and from there you go to different areas to set up clinics each day. At these clinics, patients show up and wait to see a provider.  Sometimes there may be stations for vaccines or de-worming of children.  There can be hundreds of patients in a clinic during one day, but other days may be much slower.  At one of our sites, all of the men were out in the fields, so we only saw women, children, and the elderly.  There's usually a "free day" as well where you get to explore or do something fun.

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This picture is of the first time I ever tried lobster, which was amazingly fresh and delicious, and on the beach seen in the title pic.    This was on our day off in the DR and we took a boat trip all around different islands and had a surf and turf BBQ on the beach.  Lots of sunburns, but totally worth it.

Here are some of the reputable organizations I'm aware of, but there are tons out there!

Rahab's Rope - This is a group out of Athens, GA that focuses on getting women out of sex trafficking in India.  They do 1-2 medically based trips a year.  The founder of this organization spoke to a group I was in while I was in college at UGA and I was just so impressed by their mission and the work they have done so far.  It's one of my goals to go on a trip with them at some point.

Flying Doctors of America - This is an organization that takes trips all over the world!  One of the leader's daughters was in my PA class so he came to speak to us and explain a little about what they do.  The trips seem to be very well organized, and they work hard to make sure the accommodations are safe and comfortable.

Rivers of the World - This is the group that my trip to the Dominican Republic was organized through, and even though we had some bumps in the road, I would still recommend it!  The leaders know what they're doing and the sites are very well established.

And if you aren't able to go on a trip before you start school, there's the chance you can go during rotations!  If this is something you might be interested, be sure to ask the schools you are looking at.  People from my class went to Peru, and the most recent classes have been going to Uganda!  You also want to ask and make sure that these hours will be accepted as direct patient-care experience.

Where have you been on mission trips and what are your tips?


Healthcare Experience for PA School

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Healthcare experience (HCE) has become one of the biggest factors that PA schools look at, and some of the requirements are pretty high. For most programs, you're going to need "direct patient-care experience."  This usually does not include shadowing or volunteering, although some require these types of hours as well. It is not uncommon for programs to want at least 1,000 HCE hours.  About 1 year of full-time work will be about 2,000 hours just as a reference.

Before you decide to spend some money and time on any kind of training to get HCE, check with the programs you are interested in to be sure it will count.  There will occasionally be occlusions of certain jobs that you think would possibly count, or the opposite can be true as well.  The program I attended (Georgia Regents) actually accepted hospice volunteering hours as direct patient care, which was nice because it was free.

To become more competitive, I recommend doing some kind of formal training, unless you are able to find a position where they are willing to train you on the job. Occasionally, you can be trained as a medical assistant, scribe, or patient care assistant, but more often than not, you will have a better chance at getting a job if you are certified.  My high school offered an awesome program where you could become a CNA (Certified Nurse Assistant), and unfortunately I did not take advantage of this.  If you are starting out early, good for you! And take advantages of any training you can get as soon as possible.

Being that I still needed some experience, I decided to enroll in a CNA program.  These typically will be either condensed over a few weeks during the day or at night or spread out to accommodate different schedules.   I attended the program every Saturday for 3 months during my sophomore year of college, and did the clinical week during my Spring Break.  Not my favorite Spring Break, but totally worth it in the long run. It was a few hundred dollars unfortunately, but I made it back working full-time during the next summer.  I got a job as a CNA in a rehabilitation hospital and it was a great experience.

Looking back on that experience, it's made me question why PA programs would want you to have any healthcare experience, let alone thousands of hours.  My husband is a 4th year medical student and he didn't have to do anything like that at all!  I think by doing tasks that are sometimes not the most fun, it reinforces the teamwork aspect of being a physician assistant.  Once you are practicing, you will have such a greater appreciation and respect for the CNAs, medical assistants, EMTs and nurses because you have been in that position yourself and you realize how important they are.  I remember working as a CNA and the physician coming to find me to ask if I had noticed any changes in a certain patient because I spent so much more time with the patients than the actual providers.  And that's ok because they have a lot of people to take care of, but it really opened my eyes to just how much better healthcare can be if you approach it as a team effort.

Here are some of the fields that are typically accepted by most programs:

  • EMT or paramedic
  • Registered nurse (RN), BSN, LPN
  • CNA (sometimes called a patient care assistant)
  • Medical assistant
  • Respiratory therapist
  • Dietician
  • Phlebotomist
  • International healthcare based mission trips

Here is a great blog post with examples of what actual students did for healthcare experience before starting PA school.  

What are you doing to get your healthcare experience and how many hours are you applying with?