health care experience

Getting good health care experience (HCE) is crucial to getting into PA school and to one day becoming a solid PA.

What’s the best form of health care experience (HCE) if you want to get into Physician Assistant School?  To answer this question, you need to know a little history…

How The PA Profession Got It’s Start

Here’s a very very brief history of the birth of the PA profession:

  • 1961: Responding to a nationwide shortage of physicians and medical support personnel, Charles Hudson, MD in the Journal of the American Medical Association, calls for a “mid-level” provider from the ranks of former military corpsmen.  Corpsmen are experienced in providing medicine on the battlefield more or less independently of physicians.
  • 1965: Eugene A. Stead Jr., MD announces the nation’s first “physician assistant” educational program is inaugurated at Duke University. The Program accepts four Navy Medical Corpsmen.
  • 1967: The first class of three PAs, Victor H. Germino, Kenneth F. Ferrell, and Richard J. Scheele, graduates from Duke University on October 6th.
  • In subsequent years, fresh from Vietnam, more military corpsmen return to the US and begin training to become PAs.  This new training allows them to continue to make use of their already extensive medical experience at home in the US.

Notice from this that the first PAs were all medics,  trained in part because they had significant medical experience and had practiced more or less independently already.  There was also no existing profession in the US that would allow war-tested paramedics to continue to practice at their level without graduating from college and medical school.

The Modern Health Care Experience Requirement

Times have definitely changed.  These days, college (at least some of it) is a requirement to train to become a PA.  Soon a bachelor’s degree will become a functional minimum.  Ironically, this means that none of the original PA candidates from the 1960’s would be eligible for PA school today.  Along with the increase in education required to enter the profession, the health experience requirement has softened; you don’t need to be a battle-seasoned medic to be a PA.

There are now many more ways to fill the PA school health care experience requirement.  Although some schools have no firm requirement, most schools now require between 200 and 3000 hours of previous health care experience.  So where do you get that, particularly if you are trying to break into a PA career from another field such as business, education, or stay-at-home parenting?

Here’s what you should strive for.  You may not get all of these, but the more you get, the better:

  1. Working directly with patients.  This means being with them in person, talking to them, touching them.
  2. Assessing these patients medically or psychologically.  What are their problems?  What are their needs?
  3. Providing some form of medical or psychological treatment.  Psychotherapy, CPR, a nutrition plan, administering medication, taking vitals, etc.
  4. Use of your own professional judgement.  This means that you make at least some of the decisions  yourself, as opposed to carrying out only decisions made by others.

Again, not every form of health care experience will give you all 4 of these, but this is your shopping list.

Health Care Experiences Rated

Below are some of the most common forms of HCE that we are asked about.  There are certainly many others.  PA schools have their own preferences, so we can’t be exact.  All ratings are given according to jobs, certifications, and licenses in the United States.  All jobs that require certification are entered by completing an accredited course and passing a certification exam.  The value of each job in terms of PA school applications varies somewhat by the setting in which the work is done.  The jobs below are not listed in any particular order.

CNA (Certified Nurse’s Aid)

CNAs provide nursing support to patients in hospitals, skilled nursing facilities, and sometimes clinics.  Their work allows a registered nurse to do more, follow more patients, and do so more efficiently.  Typical duties include: taking vitals, collecting specimens, helping with patient ADLs (Activities of Daily Living) such as bathing, toileting, eating, shopping, etc.  They also assist with therapeutic activities such as bed exercise, whirlpools, and providing patients with self-administered medications.  Their activities are supervised by a Registered Nurse or Licensed Vocational Nurse.

  • Works Directly with patients: Yes. (A)
  • Performs assessment: Yes – some (B-)
  • Provides treatment: yes, some.  (B-)
  • Uses professional medical judgment: yes – some, but mostly carries out the decisions made by higher medical authorities. (C)
  • Overall Grade: B-

Registered Nurse (RN)

RNs care for patients in clinics, hospitals, and Skilled Nursing Facilities.  They have heavy interaction with patients, monitoring their general condition through assessment of vitals, wounds, mental state, etc.  They start IVs, administer medications by pill, injection, and IV as directed by MDs, PAs, and NPs (Nurse Practitioners).  They make frequent use of professional medical judgment, particularly with regard to assessment.

  • Works directly with patients: Yes (A)
  • Performs assessment: Yes – lots  (A)
  • Provides treatment: Yes – lots, as directed by MDs, NPs, and PAs (A-)
  • Uses professional medical judgement: Yes, particularly in assessment (B-)
  • Overall Grade: B+

Medical Technician/Therapist

This group includes Emergency Medical Technicians (Basic and Paramedic), Cardiology TechniciansRadiology Technicians, and Respiratory Therapists.  EMTs, CT, and RTs provide specialized medical services to patients in acute care settings (hospitals, patient homes, Emergency Rooms, and ambulances).  They are trained in an official program at a community college or universities.  Depending on their area of specialty, medical technicians use advanced medical equipment and often work directly under a physician.

EMT-Bs assess, monitor, and provide basic medical interventions such as oxygen, glucose, and basic airways while “in the field.”  They often transport patients who are in stable condition.  EMT-paramedics do the same, plus provide advanced, emergent care.  They are knowledgeable with EKG rhythm strips, cardiac and respiratory drugs, trauma care, etc.

Cardiology Technicians perform and help interpret 12-lead EKGs, and assist in cardiac procedures, such as cardiac catheterization, treadmill stress testing, and Holter Monitoring.

Radiology Technicians perform x-rays and other forms of advanced imaging such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI).  They also sometimes assist radiologists with interventional radiology procedures, such as vertebroplasty and embolization.  Their knowledge of anatomy is usually extensive.

Respiratory Therapists assess and monitor patient airways, control and monitor ventilator settings, supervise respiratory rehabilitation, and treat patients with chronic lung disease who require oxygen and respiratory medications.  They perform these duties under the supervision of a physician – usually a pulmonologist or intensivist.

  • Works directly with patients: Yes (A)
  • Performs Assessment: Yes (A)
  • Provides Treatment: Yes (A)
  • Uses professional medical judgement: Yes (B+)
  • Overall grade: EMT-B (B), EMT-Paramedic (A), Cardiology Tech (B+), Respiratory Therapist (A-), Radiology Tech (B+ for plain film only, A- for advanced imaging such as ultrasound, MRI, CT, etc.)

Medical Assistant (MA)

Medical Assistant is both an unofficial job title, as well as a formal national certificate.  Becoming certified is not required to obtain job experience as a medical assistant, but it does make the medical training official and therefore may help in getting hired.  The general term of MA (not certified) usually implies that the MA works directly with patients in a medical setting, and are trained on the job.  Responsibilities may include taking vitals, documenting patient information in charts, cleaning and dressing wounds, giving routine immunizations, splinting injuries, performing simple lab tests, calling in prescriptions on behalf of a provider, obtaining EKGs, and helping providers with exams.  This may sound like the ideal job – many responsibilities, no certificate required – but all of an MA’s duties are under the direction of a provider, so there are definite limits.

  • Works directly with patients: Yes (A)
  • Performs assessment: Yes, some (B)
  • Provides treatment: Yes (B-)
  • Uses professional judgment: yes, but limited (C)
  • Overall grade: B- (uncertified), B (certified)

Phlebotomist

Phlebotomists are certified providers of venipuncture, the process of obtaining blood samples.  They typically work in hospitals, since only there are there enough blood draws to support one or more phlebotomists full-time.  Phlebotomy is skill that is perfected only with practice.

  • Works directly with patients: Yes (A)
  • Performs Assessment: limited only (C-)
  • Provides treatment: yes, but very limited (B-)
  • Uses professional medical judgment: limited only (C+)
  • Overall grade: C

Caregiver / Home Health Aid

In the same way that MA can be unofficial or official, so can the job title of Caregiver or Home Health Aid – a course and passage of a certification exam is required for those who work in certified facilities.  The majority of Caregivers and Home Health Aids work in homes with elderly, chronically ill, or disabled persons, where they assist with daily living activities.  These may include bathing, dressing, shopping for, helping to transport, and otherwise assist clients.  Notice here that rather than patients, they work with clients, which is an indication of the limited nature of the medical work they provide.

  • Works directly with patients: although their work is direct, it is with “clients,” not patients (C-).
  • Performs Assessment: limited only (C)
  • Provides Treatment: Yes, but very limited (C)
  • Uses professional judgment: limited only (C)
  • Overall grade: C-

Clinical Lab Technician

Clinical Lab Techs are certified professionals who conduct lab testing with patient specimens.  Duties include running a large array of blood cytology and chemical analysis tests,  viral/bacterial/tissue cultures, microscopy, and tests such as Polymerase Chain Reaction (PCR), Western Blot, and many others.

  • Works directly with patients: No, but we give some credit for knowledge of medical procedures (D)
  • Performs assessment: of specimens, but not patients (C)
  • Provides treatment: No (F)
  • Uses professional medical judgment: again, no, but we offer some credit for medical skills like microscopy, which is relevant to PAs. (C)
  • Overall grade: D

Summary

Obviously, there are many other medical jobs that we just don’t have the time and space to cover here (PT assistant, hospice volunteer, chiropractor, massage therapist, etc.) but if you’ve read the above, you should have a good understanding of how to “rate” these jobs.

Of the jobs listed, the most valuable pre-PA health care experience belongs to paramedics.  Medics were the first to become PAs, and it was for good reason.  Their job requires much direct patient contact, assessment, treatment, and medical professional judgment.  Nurses are a close second.  This isn’t to say that you can’t get excellent HCE in another profession, but work as a paramedic to us is probably the most accepted, unassailable kind to have when applying to PA school.

For more information on obtaining Health Care Experience, visit the topic on our forum, or our other articles.