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- [00:00]
A
Foreign welcome back to the JAPA Podcast. This episode will be associated with CME Credit. To receive CME Credit and access your certificate, you must complete the post test and evaluation in AAPA's learning central@cme.aapa.org this is free for AAPA members and available to non members for a small fee. I'm going to pass it on to.
- [00:25]
B
Kim, so go online and check out the available cme@cme.aapa.org in this episode we'll be exploring PA Career Flexibility when deciding to become PAs. I think we were all attracted by the ability to switch specialties. While career flexibility is unique to PAs, there has been little research surrounding the experience of these PAs and their employers. To better understand the lived experience of PAs who have switched specialties, we'll be discussing a study recently published in JAPA on PA career flexibility. Three of the authors, Eliana, Claire and Jay, are joining us to discuss their work. Eliana, Claire and Jay, welcome to the podcast. To start, can you introduce yourselves, tell us a little bit about your journey, how you became a PA and where you work currently. And since we're talking about career flexibility, if you weren't a pa, can you tell us what profession you would be in? Eliana, I'll pass it off to you.
- [01:19]
C
Great. So I actually came a little bit on a winding road to get here. I originally studied physics and computer science in college and then worked as a management consultant when I graduated college. After that I took a job at a public health startup that was trying to use data from thermometers to track infectious diseases spread, but really wanted to work more with people one on one and was kind of always interested in medicine. And at some point when I was working at the startup I discovered the existence of the PA profession, which I had never been aware of previously, started looking into it and really just everyone I talked to was so happy with their career decision and said such wonderful things about being a PA and convinced me that this was something I was interested in. So I took some prerequisite courses, applied and got into PA school and here I am. So I think if I were not going to be a PA when I was deciding whether or not to go to PA school, the other thing I was really interested in, which actually relates in some ways to the paper that we wrote, was kind of organizational management and I was really involved in onboarding at the startup that I worked at and I was interested potentially in helping companies with their organizational management and onboarding more smoothly and getting things done more effectively. So I Think that's probably what I would have ended up doing.
- [02:49]
B
That's awesome. Thank you for sharing. Jay, can you tell us a little bit about your journey?
- [02:53]
D
Sure, Kim. So my name is Jay Navoa. I graduated from my PA school about 21 years ago in New York City. And I was intrigued by. After I met a PA during my junior year of high school and I just asked him about his profession and he allowed me to shadow him in the or. And I felt that this was an awesome job to look into because I was thinking originally I would go through the. Through the physician route, but then after meeting him and seeing how his engagement with other nursing staff and people in the OR and then what he was able to do in the or, I thought it was an awesome job to look into. So I started my career as a PA in neurosurgery and neurocritical care. I actually did try two other services during my career and found myself back in neuro before. I am now currently in my position at Stanford. I am the Director of Advanced Practice for Inpatient Services and Strategy. Really excited about my role in advancing other PAs and EVPs in their different service lines. And if I was, if I did not become a pa, I think there was probably two routes I was always thinking about. More recently, I think I would be something more like a professional development coach or something where I can actually talk to people and engage and get people to enjoy what they do and enjoy life and be able to find enjoyment in their careers. The other route, I always thought of starting a business like a sports complex or something where kids and families can do things. That's kind of the, who knows, maybe the business side. One day I'll hand it over to Claire.
- [04:29]
E
Hi everyone. My name is Claire Kriakos. Currently I'm the Chief Advanced Practice Officer at Stanford Health Care. So in my current role, I help support PAs and other APRNs in our organization to some of what Eliana was saying in regards to onboarding, practice management and providing the clinical support and resources they need for the team. I've been a PA now for 16 years from the same PA program that Jay graduated from, so. So we have a little connection back there. As a pa, you know, I started my career in clinical practice, but pretty early on, you know, I was one of the first PAs on my first on the team that I was, I joined, I was one of the first PAs there. And so there were informal leadership opportunities to talk about the role, start carving out what the function would be. And those leadership opportunities has helped really just inspire my to continue in healthcare administration. And so I just looked at different opportunities to pursue an MBA after my PA program and think about how I can continue contributing as a PA in the broader healthcare landscape. And so that's where I kind of fell into this advanced practice leadership role and really excited to be part of this publication where we learned so much about how that PA journey really is onboarding and transition to practice. And if I guess I would say if I wasn't a pa, I would be an entrepreneur and business owner. That's actually one of the reasons I went to school is I have a dance school. I used to have a Bollywood dance school and that was something that I was doing very actively and I wanted a career that I could still do, continue my dance school in. And as a pa, I was able to continue running my business for about 10 years and that's because of the flexibility and and the support that the PA profession offered. So really grateful for this profession.
- [06:30]
B
Oh, amazing stories. Thank you all for sharing and thank you for your leadership and we can see how your past experiences aligns with your research study. So to get really into the meat of the article, I wanted to share some background with our listeners. PAs can change specialties without additional training A study of PAs who graduated between 1978 and 1998 found that 75% changed specialties at least once during during their career. More than 90% of PAs rated this flexibility as being important, combating burnout or attrition. While thousands of PAs have changed specialties, little is known about the experience. Eliana, can you tell us what inspired you to do this research?
- [07:10]
C
Happy to. I think when I was considering PA school and talking to people about why I should consider being a pa, the flexibility to change specialties was often top of the list of advantages of being a PA over other healthcare professions. But there's also so much advice that as PA students or pre PAs, we get on what do you need to do if you want to be able to change specialties in the future? That people were telling me that I needed to do primary care or I needed to do something that was really broad or I needed to work at a large institution academic medical center, if I wanted the opportunity to change specialties in the future, which was one of the things that interested me in the PA profession and it really got me thinking that is there really a reason behind this advice? Is it true that if you want to be able to change specialties in the future that I needed to go into primary care? Or were there Other ways that as somebody who wants that option in the future, I should be approaching my career choices. So I figured if I had these questions, other people also probably had them and it would be helpful to answer them in a slightly more rigorous manner.
- [08:20]
D
If I can chime in after that as well. I was really excited when I heard about the research that Eliana wanted to start because once again, I think going into the PA profession was. It's the flexibility that really was something that was drawing us into the profession. As Eliana had mentioned, I am one who started in neurosurgery and went to the critical care realm and then went to cardiothoracic surgery and then thoracic surgery and then back to neurosurgery. So it kind of went full circle in my career. And then now as a hiring manager, I think we start to think about, you know, should we hire a new grad versus someone who has experience as a PA but now wants to change specialties. So a lot of this goes into our thought processes when we are offered before we offer a position. So I thought this was amazing thing to look at, especially since it hasn't been fully researched on for PAs in general.
- [09:13]
A
That was very interesting. And this research kind of highlighted a lot of things for me. In my personal experience, it was different. Actually when I was going to the peer profession, I didn't think about switching specialties because my background, if you guys know, I'm a foreign medical graduate, so I've only known the physician way. And when I went to medical school, my specialty was pediatrics. I did a whole internship in pediatrics in Europe, in Belgium for a year and all that stuff. So when I went to PA school, I'm like, okay, I'll just work in pediatrics. I just knew I could choose my specialty. I did my first job out of PA school was in pediatrics. I did the training part. Then I did and I found out, no, that's not what I want. Because the parents were very demanding, not really accepting, asking me questions. I felt pressured because I had just moved to this country as well. I'm like, no, forget this, I can't do this. I went ahead and I did urgent care for a little bit. I. There was no tie, so that was good for me. I was just practicing my skills. And then I did I take cardiology actually as one of my first full time jobs. And then from now on I switched to internal medicine. I did outpatient and that's when I, oh my God, I can switch specialties. I can actually explore other things. And I found, guess what? I never went back to pediatrics and I did hospital medicine for seven to eight years. I loved it. And I wanted to change medicine, my schedule, because of my kids. My kids are getting older now they're elementary school age. I was missing practices. My husband could not handle all the taking them on time, working seven to seven, I can't be there to some of their recitals or presentations or things that are happening, doing even in the afternoon because I'm finishing at seven, I'm like, I need a switch in my schedule. So the main reason I switched back to cardiology was because of the schedule. I was able to work Monday to Friday, 7:30 to 4. I have time to pick up kids at school. I have my weekends off because I only have two weekends off. So I'm like, that's wonderful. That's so great. But I didn't go into PA knowing that I was going to switch specialties. So that was just my personal experience I was sharing. You guys shared in your literature review that there were two studies surrounding the experience of APRNs switching specialties. And these studies indicated that a structured onboarding program correlated with a positive experience for the APRNs. We know that education programs for PAs are different from training programs for APRNs. However, the APRNs and PAs often fill the same roles. So how did the research surrounding APRNs switching specialties inform your research question?
- [11:47]
C
I can start. I was really looking for myself for research on the topic of PA switching specialties and what that experience looked like. And when I didn't find it, I found, as you mentioned, these two articles about APRN switching specialties. And then I did find a series of articles on onboarding new PAs to new jobs. And I think I looked very carefully at the way that the questions that those three studies asked in informing how I made the interview guide or how we made the interview guides that we were asking of our hiring managers and PAs and actually specifically pulled from those studies some onboarding strategies that they discussed to ask people in the interviews whether that was part of their onboarding and how they thought about incorporating those strategies for this particular population.
- [12:36]
E
I think in Eliana, to maybe add on, I think from my experience, I do feel like even though school program education is different for APRNs and P, that transition to practice is very similar. Right. As far as that scope the responsibility, being a clinician, an ordering provider. And so I think we've all seen in the industry more transition to practice clinical fellowship programs or residency programs, depending on what the organization may call it those are some other common practices that are helping with those with that initial transition to a specialty. I know some focus on that new graduate NP or new graduate pa, but there are others who focus on a new specialty. Even if you have been an experienced provider but you're starting a new specialty, you may qualify for a fellowship program in that specialty. So I think that's been a great resource that many apps and PAS specifically can use when transitioning to specialty. Different specialties as well.
- [13:45]
A
That was very interesting. And you're right. I'm pretty sure the experience is the same as a new grad. No matter what specialty. Right. No matter what profession, you still need that transitioning, that onboarding. And I think onboarding is very important. If you miss that mark, you miss it. And I know that a lot of institutions have been working on their onboarding program to ensure that the process would be successful for their clinicians. As part of your study, you contacted 225 PAs and 60 PA NAPRN team leaders and asked recipients to self identify as fitting the study criteria and to volunteer for an interview. From what I understand, you then interviewed 11 PAs and seven hiring managers. Why did you select to interview both PAS and their hiring managers? And what questions did you ask the PAs and NP and pennagers?
- [14:37]
D
Well, maybe I can get started first and then I'll hand it over to Eliana. But I think when we were doing some of the research and looking at the publications that were already there, I think a lot of it focused on the transition to practice and the experiences of RN to apps or APRNs and to transitioning to a new role. But I think there hasn't been much talking about the hiring process that I think was valuable and a little bit different on our publication. So we started to focus a little bit on both. And I think that is why we decided to take the approach of interviewing both PAS and hiring managers, just to get both perspectives in this for flexibility for PAs. And maybe Eliana, would you like to go into a little further about the exact questions we asked our interviewers?
- [15:25]
C
Happy to. I think as Jay was saying, I was really or we were really interested in both the perspective from the hiring managers of kind of what are you doing? How do you feel like it's going? How are you thinking about this? But then also the perspective from the people who've gone through this process of what was your experience? What do you think went well? What do you think didn't go so well. And so that's why we chose to interview both populations. The Questions we asked kind of centered around a couple of different buckets. For the PAs, we were really asking some of the questions that Martine answered earlier. So kind of why did you choose to switch specialties? How did you go about the process of looking for a new job? What do you think contributed to your success in that process? And then what was your experience starting that new job? What aspects of your onboarding were helpful versus maybe challenging hiring managers? We asked the flip side of those questions. So when you're looking at a pool of candidates, how do you think about those candidates? Specifically, if you're looking at somebody who's trying to switch specialties, what makes you more interested in that candidate or less interested in that candidate? And then once you've hired somebody who switched specialties, how do you think about making that onboarding experience smooth? Do you think about it differently than somebody who's a new grad or somebody who has same specialty experience? And then what kind of long term has been the outcome of those hiring of people switching specialties?
- [16:49]
A
I like the fact that you guys got both perspectives. It was eye opening for me as well. It was interesting mostly to see what the hiring managers were looking for, especially when people were switching specials. I was like, so it can give you kind of some tips if you want to be successful in that switch, what you should really look for or how you should present yourself. And I think most of the points they made kind of made sense. And I'm pretty sure if you can convince your hiring manager that this new schedule is what really. Because they know schedule is one thing that's very important for providers. If you're willing to commit to that schedule, you find it perfect with your lifestyle, they're going to be like, you're a go. So I find it interesting because you never know really that point of view. Right. And after your interviews, now we're going to go into really how you analyze the content. You had hours of content to analyze. And not many of us have experience with research, let alone quality qualitative research. So we are curious to know how you analyze your data. And did anything surprise you doing your data analysis?
- [17:56]
C
I think one of the interesting things about this process was I did all of these interviews, so I sat through them the first time and had thoughts about what I thought I was going to find in the data. Just having participated in the interviews and then going back and, and looking at the transcript, sometimes I found what I thought I was going to find, but sometimes I didn't. And it's, it was kind of an interesting reflection on all of the times you have conversations with people. You know, even this podcast where we're chatting, that sometimes I'm sure if we went back and read the transcript, it would read a little differently than what we remember in our minds. One of the things, not necessarily that surprised me in the analysis process, but overall that surprised me is I really went in coming from my. This. This position in the tech world where I've been thinking a lot about onboarding and onboarding strategies and asked a lot of these very detailed onboarding strategy questions, and almost everyone I talked to was just not thinking at that level. That there. That I think, please chime in, Jay and Claire, because you have more experience in this. But I think that the app world is still pretty nascent in its process of really thinking about onboarding. And in a way that the tech world, which is where I came from, has had to deal with people switching from very different jobs for a much longer time, and so is actually has thought a lot more about how do you take somebody who has a lot of past skills and experience and quickly get them to the point that they're able to contribute to a new organization where there's different knowledge required and different processes and kind of how do you streamline that process? And so I was really surprised in my interviews that when I would ask these questions, I wasn't getting answers from people that. That a lot of people were like, oh, I've never thought about that as a specific population. That's not a question that I've. I've thought about the answer to. And so I think I shifted from my initial plan was to write this paper on this is how people are onboarding this population to much more of like, this is the experience. And these are some of the gaps that we can fulfill as we move forward.
- [20:01]
E
Eliana, I really appreciate that. I think you're. You nailed it in that onboarding is a gap in a evolution as far as how organizations are really structuring that transition for APRNs and PAs. And it's almost a little scary, right, because as a new grad, you may have at least the team will understand you are a new graduate. But if you're an experienced PA but now transitioning to a new specialty, but the expectation of you is, you know, as an experienced provider that can really create some, you know, expectation management performance issues and just overall burnout and lack of fulfillment. So I think that clarity in that as far as managing that onboarding and orientation to the skill level and expertise of the provider is so important, I.
- [20:58]
D
Think, if there's anything I would add is that, you know, while we were coding the responses and we found, I think the common themes is what is always interesting to hear from hiring managers, even from the PAs who have switched specialties, but from the hiring managers, it's multifactorial, not only for orientation, the bandwidth to train a newer provider, whether it's a new grad or in someone who's new to the specialty. So those are things that you have to take into consideration and then think about what process will I get to to make sure I can get this person up to speed as quickly as possible to meet the needs of the service without putting them in a scenario where they're feeling stressed or burnt out or feeling anxious about moving into this new role. So a lot of that comes into play when you're trying to hire a new individual or someone new to that specialty.
- [21:49]
B
So many important themes to dive into here. Question about the NPNPA hiring manager's decision. When you talk to these hiring managers, did they perceive having prior experience in a different field as a positive or negative attribute when they were looking at candidates to fill the position?
- [22:05]
C
I was really surprised that I talked to hiring managers on totally different places in that spectrum, that there were people I talked to who are saying any experience is really helpful and I would far prefer to hire somebody who knows how to talk to patients, who knows how to work on a medical team, that there are a lot of transferable skills and that they felt they could really teach the specifics of the medicine. And then I talked to other people who said people get bad habits from other roles, that honestly, I would take a new grad any day. I can train them exactly the way I want and I don't have to worry that somebody's going to think that they have more abilities than they do or even fall into practices from an old role that don't apply here. So totally different sides of that spectrum.
- [22:52]
E
I think one of the other elements to that or a wild card is the hiring manager's ability to invest time in that new hire? Right. So maybe they have a preference of having some experience or having zero experience. But I think it's also where is that team at? Are they understaffed? Are we recruiting for like four new people today? So maybe it won't make sense to hire four new grads. Right. To think about the complement the team structure. So I can, I can imagine the preferences of the hiring manager evolving based on the current state of the team as well.
- [23:31]
B
That insight is so valuable. There's definitely more to when you see the job postings and they say five years of experience too, in specialty preferred, what that actually means. It's interesting that you identified that networking professional connections were associated with hiring PAs and experience in other specialties. Did the PAs and hiring managers share how they met each other prior to the open position? And what do you think that organizations can learn from this trend?
- [23:55]
C
One thing that was interesting to me is when I asked people to reflect a little bit on how their prior experience helped them get a job in a new specialty. This was something people would come back to in almost every interview that they felt that being a PA gave them these networking opportunities to meet people who work in other specialties, to find out about job openings, to have those relationships with people. One thing that I think is interesting, and I imagine Jay and Claire can actually speak more to, is that Stanford has a structure for apps meeting each other. And I talked to a couple of people who had met hiring managers or team members from a team that they would later work on at some structured Stanford Advanced Practice provider networking event, and that that allowed them to form these somewhat informal professional connections that then when there was a job opening, they remembered that they had met this person who was interested in it and that was able to develop naturally out of those opportunities.
- [24:55]
D
I think if I was going to just add on, I think the networking is key. And that's because for our hiring managers and when we have people on our teams, we sometimes really want to know about them and feel like what can we do to make them more successful. And sometimes you might just realize that this ABP is an amazing individual or this PA is doing great. But I think their passion might be in this specialty. And then they might actually, when they hear that there's a specialty open, I think we're all in the business of trying to make sure the patients are cared for in the best way they possibly can. And when you have an engaged provider who is able to deliver that care, we're all more than happy to say, hey, I believe this. My app right now would be great on your service. And it looks like you have an open position. And then I think so that kind of networking is important. But some of that is, as Elian had mentioned, is through some of our activities where you get to meet other PAs and try to learn about each other and what really drives them. And I think through that we're able to refer each other and I think other organizations can learn to do more activities where we're open for services to intermingle and learn from each other. And it's not about, you know, stealing from one to go to the other. It's really just where can we provide the best care and utilize the PA's strengths and be able to advance them in their career?
- [26:12]
E
Yeah, I love that, Jay. And I think, Martine, you touched up, touched on this earlier and recognizing that based on where you are in your life, you're, you know, you're the needs of your staff, your schedule may change. Right. Young kids to older kids to taking care of parents. And so having that understanding or having an organization recognize that you may be a clinical expert, but just that that type of role just doesn't work well for you. Surgical or 6am Type of role may work, may not work when you have a different type of lifestyle. And so I think, to Jay and Eliana's point, having that networking and opportunity to network internally within the organization has allowed for that. But one thing we have to be mindful of is internal turnover that is unnecessary or that could be avoidable. And so I always think about how organizations should look at equitable standards across the board. So you don't have people jumping specialties for extrinsic motivating factors. Rather, it's truly these intrinsic motivating factors of passion and what connects well with you in that stage of life that you're in.
- [27:24]
B
I love that call on that point. You want to encourage the employers to look at the overall setting to make sure that the apps are happy, but then also if they're looking at a different clinical area to enable that as well for their own growth. So question for all of you as someone who has switched specialties. My first job was in urology, and then I moved to hospital medicine. I remember when, you know, when I first started my first job, I was told it took one to two years to get comfortable. And I had this onboarding program. Exactly. That y' all have hinted on. But when I transitioned from urology to hospital medicine, I didn't get any guidance.
- [27:54]
D
On what to expect.
- [27:55]
B
So when you interviewed the PAs, when did they start to indicate that they were feeling more comfortable in their new roles?
- [28:01]
C
I think, as you mentioned, one of the things that we found in our research was people talked about not having expectations for how long it was going to take. And on both the hiring manager side and the PA side, or sometimes that one person would have a very different expectation than the other person and that causing a lot of tension. Honestly, I think this is something that varied a lot on a case by case basis. And, you know, it varied with some of the other factors we talk about in the paper, that if the two specialties are more similar or the settings are more similar, or even a number of the people we interviewed stayed within an institution and they talked about the fact that understanding how the institution operated or knowing how EPIC worked at that particular institution really allowed them to feel more comfortable more quickly. But one of the interesting things, as a new grad PA myself, starting a role soon and talking to people is that what that line of comfort is, is not a black and white. Like today, I'm not comfortable. Today I am comfortable. And a lot of people talked about that in their first job as a new grad pa, that there was this real sense of discomfort coming in day one, and that at some point, probably one to two years down the line, they reflected and realized, actually now I'm a comfortable pa and that it's a little bit blurrier in the switching of specialties. And that people talked about that some patient encounters or types of things in their job might be much more similar to things they had done previously and actually feel comfortable on week two, whereas some things might be uncomfortable for that full one to two years. And that the most successful experiences were really where people were clear with that expectation with their hiring manager and worked together to figure out kind of where are the opportunities for somebody to very quickly shine in this new role and then where are places where they're going to need support for that year's timeline?
- [30:00]
D
Yeah. And just to add, I think that exactly what Eliana had mentioned, I think setting expectations is probably what is key for a lot of our PAs. When they start a new position for themselves. They shouldn't expect that they'll become a pro at this service within the two weeks of their orientation. Or is it the two months of their orientation? We know that before someone really becomes more proficient and feeling even close to comfortable, I would say in about a year or so, it's still expectation needs to be. You're not going to know everything after a year into your new position, whether it's a new grad position or in the new specialty. And you should be able to continue to learn and want to learn and be able to do that. So set an expectation from the PA themself as well as a hiring manager, to the physicians they're going to work with, to the nursing staff, just everyone to set expectations and maybe milestones during their orientation so that everyone is clear as to what we're trying to get to. And the ultimate Goal once again to be able to care for our patients in the best way possible.
- [31:03]
E
And I think one of the theories Patricia Fenner has the theory a novice to expert. And I feel like although that's really a nursing sign science theory, it does apply in this case, really going from that novice to competent, advanced beginner to competent to proficient, to Jay, what you were saying to expert. And depending, of course, depending on your experience and skills. That timeline may vary. But I think it is important for us to realize there's so many steps before you really become even proficient in expert. Thinking about that advanced novice to advanced beginner, to content competent before you become proficient. And in my experience, at least in some of the programs that we have implemented in our institution, we've used five years as kind of our minimum expectation for proficiency. And sometimes it may even take a little longer to truly be proficient, let alone expertise may even take longer.
- [32:00]
A
This is very important and I guess you guys touched on this. It makes sense that PAs moving between specialties would take take time to begin to feel comfortable. And again, I'm going to share personal experience because I've switched specialties part of being a kid for 14 years. I kind of have a lot of experience with this. I remember. So I just switched. I just realized it's two years now. It felt like yesterday when I switched specialty in 2022 from hospital medicine to cardiology. I had been a PA for 12 years already. So the expectation of the new employers was, oh, you're being a PA for 12 years, so just jump into it. I go to the hospital to round. They were asking me what's taking you so long? You've been working in the hospital. But I was not doing cardiology. So whole specialty. When I did cardiology more 10 years ago, some drugs didn't even exist. Some procedures were not even being done. The new guidelines for heart failure and stuff like that, they are new. I, I never learned them. So I had to take it on me to do webinars, to do classes, to buy to. I had to really train myself because the expectation is you've been a PA for 12 years, right? You were doing hospital medicine. Okay, I, I saw the consults from the cardiologist, but I was not invested in that. I was not really writing it. So they were all. They found that I was slow. I'm like, I just started, give me time. Now you won't even talk about it. I feel so comfortable now and I've learned so much. I can see my growth. But this is true when you've been when you are already, they don't know what to do with the people or experience. Right. When you have 10, 12 years of experience in a different specialty, they don't know how to really onboard you to. Even though I use my skills that I had in hospital medicine, but it's not the same same thing. I was being trained to put loops in. I did two or three. Okay, are you ready to do them on your own? No, I need to do more with the physician being there if something goes wrong, I'm not comfortable. I had to advocate for myself and say that, okay, how many do you need? I need to do at least 10. When I'm comfortable, I'll let you know. When I'm comfortable to be on my own, I'll let you know. But not after three. I've never done this. It's a procedure. I don't want bad outcomes. So you really have to advocate for yourself. Same thing. When I was transitioning from outpatient to hospital medicine, something happened my first week I was supposed to work in a hospital with another PA and I also was out support. Oh, the physician is out. We have a problem. You have to go to the hospital. Here's the Cisco phone. Here's the pager. Good luck. So they dropped me in the hospital by myself with a Cisco phone. Thankfully, I had a medical background. I had. I did seven years of medical school, PA school, master's degree. So I had a lot of things that I have done that kind of helped me in that role. But this just dropped me my first inpatient role. That was the first time I was going to work in a hospital system. I was transitioning from outpatient. So I totally understand how important this is to understand how to train to onboard experienced APRNs and PAs. Did you find any common onboarding practices for PA switching specialties? And also were there any trends between specialties that transferred between. I'm pretty sure they'll follow these ones. Some of them are closely related and PAs might feel more comfortable switching between certain specialties. Did you find those trends?
- [35:09]
C
I can talk a little bit about what we found, but I think, you know that these interviews were done two years ago and I think that things have changed even since then and improved. So if Jay and Claire want to give a little bit of an update after. I'm very curious. To me, it seemed like there was a spectrum of hiring managers from and I really. I didn't talk to any hiring managers who were at the point of. It sounds like what your experience was Martine, of this person is experience. I don't care that it's a different specialty. Let's just throw them in. But I did talk to people who that had been their experience when they joined five, six years prior. You know, I think the next step in that spectrum is saying we recognize that all PAs have some onboarding needs and that might have different time requirements, but that we're going to put everyone through an onboarding program. And most of the, the hiring managers that I talk to were in that stage of thinking where they were saying, okay, you know, we'll have them do some shadowing, we'll have them do some supported shifts where they're being, you know, watched with procedures and walked through things. To me, the last stage of that is somebody who's really thinking about, you know, what skills does this person bring with their background and how do we leverage those skills in this onboarding program. So, again, going to your example, Martine, it sounds like when you were transitioning from being a hospitalist back to cardiology, that there's, there was a lot of new things that you didn't know, but you had a lot of places where you were already competent or proficient and that you figured out yourself how to leverage those places and build up your. Your skill set in the places that you needed more help. But it would be really great if that's something where you could work together with your hiring manager and have a little bit more of a structured program to both highlight the strengths that you bring from this past expertise, but then also fill up those gaps without you necessarily needing to spend all of your free time doing webinars and training yourself. And my sense from the interviews was that people are kind of slowly moving down this continuum of realizing that this is a gap and something that we.
- [37:17]
D
Need to work on just to add for that part. And thank you, Eliana and Martine, for your insight there. I do think that when you mentioned common areas, I think a lot of times it also, more recently I've noticed that it's based on acuity is a little bit more of what is a similar theme. So if there was someone who's used to inpatient work, sometimes moving the specialty, learning the medicine in that specialty is one thing, but knowing how to treat in the hospital, patients in the hospital, working up different things, learning the, you know, your resources is something that is actually important there as well. So maybe not necessarily the specific this service is related to this one, but more the acuity and the type of patients that they're going to be used to seeing.
- [38:00]
B
Yeah, thank you for that little insider knowledge about the. The trends that you're noticing between fishing specialties. So one last question for your team, for everyone who is currently in PA school. And they're probably thinking, you know, I want to get my first job, and then what happens after that? What advice would you tell them about preparing for a possible career switch?
- [38:19]
E
I'll start, I think, if some. As a PA student, I think one of the. Like we all have been saying, this is an. I mean, being a PA is so exciting because of all the opportunities that are in front of you and through PA school, it's really hard to maybe identify that exact specialty that you want to spend your whole life in, and that's the beauty of this role. But I feel like you could try your best in trying to understand where your passions align in today's state of where you are in life as we talked about, and recognize that we have that opportunity and that flexibility to change specialties if needed. And so that's always an option, but sometimes you have to take that initial risk and choose the specialty of choice based on your passion, but also the opportunities that arise in keeping your clinical skills as proficient as possible so you can continue to transition in your career as a pa.
- [39:19]
C
I think that's great advice. And as somebody who just graduated and was going through a job search process, part of the way that this research influenced the way I've been thinking about my job search is I didn't focus only on the way that you have to think about it as a medical student. So I'm not. I wasn't like, do I want to work in surgery or medicine or pediatrics or ophthalmology? Instead, I focused on what are aspects of my rotations that I really liked, that I want to be part of my practice environment. So, personally, I realized very quickly that I liked the inpatient environment and I wanted to work inpatient. And so I focus my job search on inpatient services. And it was informed by this research, because my sense is that that means that later, if I say, hey, this actually isn't the medicine that I'm the most interested in, I want to do some other medicine, that I will have a much easier time switching within the inpatient setting than I would even potentially go. I mean, that. That sometime it could be harder to even go from inpatient to outpatient in the same specialty as a PA than it would to kind of stay in that setting. And that. That having that in common between roles and really learning how to thrive in that environment will help me in my future career, assuming that that stays the same. You know, I think things can change. And another thing that I found very comforting in this research is it I talked to people with totally different backgrounds who had done totally different things, and it didn't seem like there was only one recipe that you have to follow if you want to switch specialties. And that, you know, I think for almost everyone I talked to, and there was some bias because I talked to people who were successful, but it worked out in the end. And there was this sense of, you know, that if you're persistent and you pay attention to what you're interested in and you network and you are good at your job and use your reference as well, that you will end up getting that job that you're excited about and it will work out. Just comforting.
- [41:13]
D
And thank you, Eliana. I think that's great advice for practicing PAs. And I think the only thing I would add is for PA programs in general. I love speaking at the PA schools just to kind of share my experience as someone who has been in the profession for quite some time and for those who are starting out, but just to keep an open mind, kind of understanding that you might go into something that you felt was the, your interest during our rotations, which, as we know, you get four or five weeks to try to learn a specialty and then you're on to the next one. And that's what PA school has been like. But I think knowing that you know you're going to try your best in your first position, that's what I would probably say to all of our PA students. Don't think that you're going to be in your final job right away, but you should try your best because you might realize that maybe this is actually where I'll end up finishing my career. So just keeping that open mind on your first job, do everything you can, learn the specialty, but keeping that open mind that maybe this isn't the end all for me and maybe I will move from the ICU to an ambulatory position later on just because for all the reasons we mentioned earlier for work, life balance and making sure that we improve our burnout and sometimes critical care areas can be something that contributes to our stresses in life. So maybe at some point we just have to let our PAs and PA students know that. Keep an open mind and be willing to take that jump if you feel that it's time to do so.
- [42:38]
A
Well, thank you so much, Juliana, Claire and Jay, as always, please be sure that you are following JAPA on social mediaonline that's spelled out. And don't forget, listeners can now earn CME by listening to the podcast. To receive your CME credit and access your certificate, you just listen to the podcast and complete the post test and evaluation in AAPA's Learning Central at cme.aapa.org. let us know your thoughts about the topics went over today and until next time.