How I Chose the Profession

I’d initially been interested in becoming a medical doctor, but while learning in yeshivah and college at Lander College for Men, I realized I was uncomfortable with some of the challenges involved in becoming a doctor. Firstly, the path to becoming an MD is long and arduous. Aside from the four years of rigorous schooling, the residency period afterward can extend for many years, depending on the specialty, and leaves you with very little personal or family time. In neurosurgery, for example, it can take over ten years of residency before one is qualified to become an independently practicing neurosurgeon. Additionally, while there are accepted, practical methods to handle working on Shabbos, I wasn’t interested in having my Shabbos so curtailed on a regular basis. And lastly, the path to becoming an MD is almost prohibitively expensive; the typical cost after residency is over $200,000.

While shadowing a neurosurgeon as part of the necessary prerequisites to apply to medical school, I met some of the PAs who worked with one. I had never met or heard of a PA before, but I was blown away with what they were able to do. They explained to me the scope of their practice: their ability to assist in the OR, to make clinical decisions independently, and to work autonomously within the field of their choosing. Best of all, they told me that PA school was only two to three years, was significantly more affordable than medical school (at the time only $90,000 to $100,000) and, most importantly, that a PA’s work schedule is much more flexible than a doctor’s. Most inpatient PAs (who work in a hospital setting) do shift work, similar to a nurse. If an employer is amenable, it’s possible to avoid working on Shabbos while still working a full schedule. It was definitely a fortuitous discovery, and after speaking to them, I was determined to become a PA.

The schooling is not so different from what you learn in medical school; it’s just a more condensed version, with one year of very concentrated courses on all different fields of medicine (e.g., cardiology, neurology, pulmonology), learning how to give physical exams, and learning the necessary deductive skills to be a clinician. The final year is spent on clinical rotations in a variety of specialties, after which you can determine which one you would like to work in.

The schooling was very arduous (especially since our first baby was born during my didactic year!) but ultimately very rewarding.

How I Chose My Specialty

Initially I considered cardiology, but the professor who taught our neurology course was a neurosurgery PA, and when she described what she did, I was immediately intrigued. That is so cool! I thought. It’s been the best field to work in; after spending several years in neurosurgery, I can’t even imagine working in a nonsurgical field.

What I Love Most about the Field

Being a PA affords me the opportunity to practice medicine at a clinician’s level, while at the same time enjoying a much better work-life balance and still earning a significant salary.

I feel specifically fortunate that I have the opportunity to work in the field of neurosurgery. The brain is the biological organ that most expresses our intrinsic self, our neshamah. When we treat patients with severe brain trauma or debilitating brain tumors, we are helping them recover the most central aspects of their personhood. We are caring for people at their most vulnerable, and there’s nothing more meaningful than giving someone expert and compassionate help when they need it most. I also enjoy the adrenaline rush that comes with working in trauma. The patient is coming in a critical state; his injuries have to be triaged and life-and-death decisions made in an instant. Working through such intense situations, and quickly deciding, acting and working to save someone’s life is extremely exhilarating.

What I Find Most Challenging about the Field

Shift work is grueling. While part of my motivation in becoming a PA was to have an easier schedule and more time with my family, the hospital shifts do take away from family time.

I’ll Never Forget When

We once had a patient who had been wrongfully convicted of murder and had sat in jail for over 20 years before evidence came to light to prove he was innocent. He was invited to Columbia to speak about his experiences, but on the way to the lecture, he suffered a severe traumatic brain injury. His injuries were so bad that he stayed in the ICU for over a month. We all felt particularly determined to heal this man. Although he experienced many challenges and setbacks while in the hospital, he ultimately walked out on his own two feet — and announced that he was ready to give his speech. I was so inspired by this man’s resilience despite his unimaginable life challenges.

Something I Wish People Knew About Physician Assistants

We can prescribe medications.

My Advice for People Starting Out

If you really want to be a PA, make sure you’re okay with serving in a mid-level role. Ultimately, you’re there to assist the attending doctor, not be the attending doctor yourself. If you want to be in the driver’s seat, then the PA role might not be for you. On the other hand, PAs can amass a lot of knowledge and experience, and with time, can be seen by the doctors as genuine colleagues.

TAMAR MERMELSTEIN: Clifton, N.J.

Physician Assistant, Advanced Dermatology PC, Paramus, N.J.

Graduated from: Touro College of Health Sciences, M.A., Physician Assistant Studies

Years in Field: 5

My Typical Day at Work

As a PA who specializes in dermatology, I diagnose and treat a wide variety of conditions. This ranges from treating medical conditions like acne, rashes, and warts, to performing cosmetic procedures using lasers (i.e., laser hair removal) and injectables (i.e., Botox). We also perform preventative skin cancer screenings in which we diagnose, treat and prevent potentially life-threatening cancers.

On a typical day, my responsibilities range from giving skin care advice all the way to performing surgical procedures to remove skin cancerous lesions, atypical moles, cysts, and lipomas.

I manage my own patients, under the supervision of the doctor. A PA can treat everything that a doctor can, as long as the supervisor feels comfortable with it. Personally, I’m fortunate that the doctor I work with gives me a lot of autonomy, while at the same time is always available to help me if I have any questions.  Many PAs I know have supervisors who don’t feel comfortable allowing them to do anything more than follow-up appointments, medication refills, and wound checks. Then there are other PAs I know who see their own patients from start to finish without even consulting with their supervisors. The scope of work and amount of independence a PA has is very field- and job-dependent.

How I Chose the Profession

I wanted to be in a field of work where I could help people, and I wanted a job with a good work-life balance. Becoming a PA fit both of these qualifications.

One of the other really big perks for me was that as a PA, you don’t have to commit to any one specific field of medicine.  As long as you have a physician willing to train you, you can be trained in any specialty while on the job, which offers you huge flexibility and job opportunity.

The schooling required varies based on the program. There is a central hub for applications (CASPA) where you can find each PA program’s requirements. I personally chose Touro’s joint bachelor’s-master’s program because I liked the fact that I didn’t have to worry about missing classes or exams due to Jewish holidays, and I heard that they set up students on great rotations.

How I Chose My Specialty

I fell in love with dermatology care while doing my school rotation, in which I was fortunate to be trained by a wonderful PA. The relationship that we developed during that five weeks’ rotation ultimately got me a job offer at the very same practice.

Since then, I’ve continued to build on that relationship, which has led to even more opportunities. The reasonable hours and good work-life balance combined with the competitive salaries offered in dermatology compared to other fields were big factors as well.

PAs don’t have a standard “residency” training, so the initial training period when you start a new job is essential. Just like doctors come out of medical school with a lot of knowledge but not as much clinical experience, PAs also need this time to learn how to apply their medical knowledge to practice.

Since there’s no standardized training protocol, the nature of the training is very job-specific, including factors such as the length of the training and whether or not you get paid during training. Personally, I first went through a training period in which I observed a provider. After this initial observation stage, I started seeing patients with simple diagnoses like acne or warts, and performing laser hair removal. As I became more comfortable with the basic diagnoses, I added a larger variety of conditions to my repertoire.

What I Love Most about the Field

There is continuity of care in this field, so you really get to establish a relationship with patients. I love meeting people from all sorts of backgrounds. Of course, the most satisfying part of my job is when I’m able to heal my patients and improve their quality of life.

What I Find Most Challenging about the Field

Medicine is rapidly evolving, so keeping up with the best practices requires constant training. I’m always learning something, whether it’s about a new medicine on the market or updated guidelines for best patient care.

I’ll Never Forget When

Just recently, a patient came to consult me about a scaly patch on her face that was bothering her. I told her that this spot was benign, but while examining her, I saw a different spot on her face that looked suspicious. This spot turned out to be a melanoma. She had come to the office about something benign, but that appointment ended up saving her life!

Something I Wish People Knew About Physician Assistants

Although the profession is considered one that offers a good work-life balance, you do need to put in a lot of time and effort in order to be successful.

My Advice for People Starting Out

Realize that whatever you put into the profession is what you’ll get out of it. If you’re willing to work hard in the beginning, you’ll reap the rewards. The skills and habits that you form at the beginning of your career will stick with you forever.

Another piece of advice I would give a new grad, based on my own difficult experience, is to take your time to explore different job options before accepting an offer. I was so desperate to start work when I finished PA school that I accepted the first offer that came my way. This led to a “live and learn” experience (lesson being that when you’re picking up on red flags in your employer, trust your instincts!). I wish I had been more persistent and explored more opportunities first.

SHIRA WEIN

Bergenfield, N.J.

Physician Assistant, OB-GYN & Infertility Services of Northern NJ, LLC Clifton, N.J.

Graduated from: CUNY York College P.A. Program, Queens, N.Y.

Years in Field: 1

My Typical Day at Work

I work at an outpatient OB-GYN office, where I see approximately 25 to 30 patients a day. My patients present with a wide range of gynecologic issues. Some come for their annual exams, others have specific complaints, and a large portion of my caseload is obstetrical patients, whom I treat throughout their prenatal and postpartum care, including performing basic ultrasounds. Our prenatal care is individualized for each person, factoring in underlying medical conditions, risk factors, and medical/pregnancy histories. We see a fair number of high-risk pregnancies at the office.

For the average patient, I basically perform the same services as the doctor, and I often see these patients in his place. The doctor does all of the in-office procedures such as the endometrial biopsies and colposcopies. I’ll also consult with him when it comes to specific high-risk prenatal cases, such as managing gestational diabetes and deciding if the patient needs medication or insulin, or determining different treatment options for patients with histories of preterm labor. The doctor manages the patients with ongoing gynecologic issues, like fibroids or endometriosis. These are things that, with more experience, I could be doing as well, but it takes a lot of experience to be able to manage such medical care appropriately, and as someone new in the field, I certainly don’t have this yet.

In addition to the OB-GYN patients, I occasionally counsel patients for simple primary care issues such as new-onset diabetes, high cholesterol, and thyroid disorder. When I’m not busy seeing patients, I spend time in the office reviewing lab results, filling in patients’ charts, and responding to questions or requests that patients submit to the office throughout the day.

How I Chose the Profession

I always had a passion for biology and the way the human body works, and I also knew I wanted to work in a fulfilling profession in which I could interact with people on a regular basis.

The PA field was particularly appealing to me because it would allow me to care for patients in a medical setting, after a relatively short training period. My master’s program included a year and a half of didactic classroom study, followed by a year of clinical rotations in nine different fields of medicine.

How I Chose My Specialty

In my current job, I specialize in women’s health. As a young woman, I’ve always felt a connection to the field of women’s health. I’m able to personally relate to what so many of my patients are experiencing, and I can appreciate from my own experience how important it is to receive good, professional care.

What I Love Most about the Field

It’s such a privilege and pleasure to go through the nine-month journey of pregnancy with our patients. Due to both the frequency of their visits over a short period of time and the intense emotions of pregnancy and childbirth, I get to develop a real bond with my patients, which I love! There aren’t many fields of medicine which inspire as much happiness and excitement as obstetrical care.

I also love the variety of patients that I see in our clinic. Since we’re located in Clifton, a large portion of our patients are frum women, spanning the gamut from Modern Orthodox to chassidish. Our patients come from the Passaic area and Teaneck, and also from Lakewood, Monsey, and Monroe, and it’s such a pleasure interacting with so many women from different walks of frum life.

What I Find Most Challenging about the Field

Since I’m a recent graduate, I’m still learning more every day. It can be daunting to realize how much clinical information is out there — information that is constantly being updated — and how much there is for me to learn and incorporate into my daily work.

Something I Wish People Knew About Physician Assistants

Despite the prevalence of PAs today, some patients are still confused about what exactly the role of the PA is. I’m often asked, “Are you the doctor or the nurse?” or “Will I be seeing a doctor today, too?” On the other hand, many patients often think that I am a doctor. For many patients, the role of the mid-level practitioner is still unfamiliar, and I try to do my best to explain the physician assistant field to them.

My Advice for People Starting Out

As PA positions are becoming more and more widespread in the Tristate area, there are so many options, in a variety of settings. Of course, every job comes with its own sacrifices, but don’t settle for the first opening that you see. Make sure you’re in a specialty field and work setting that you enjoy and one that makes you feel fulfilled!

(Originally featured in Mishpacha, Issue 936)