HCE

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."

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?