Health Care Experience and PA School

Health Care Experience and PA School

Updated: 06/08/2016

Whether you’re new to learning about physician assistants, you’re still not sure if PA is right for you, or you know that you want to go into the medical field, health care experience can be a tricky business. Many application systems out there require you to fill in your experience in a very technical, monotonous way. The CASPA (Central Application Service for Physician Assistants), AMCAS (American Medical College Application Service) and TMDSAS (Texas Medical and Dental Schools Application Service) are the most well-known. So you’re probably wondering what type of health care experience (HCE) you’ll need? Yes, the abbreviation “HCE” stands for health care experience, and you’ll see many students and PAs using it a lot when they talk about admissions requirements. I’ll talk about the different types of experience below and then list a few types under each. Just as a tip, always ensure that your “training” for any profession you list below is not counted in your hours of experience, as schools will not accept any training hours as HCE.

Patient Care Experience

This is experience in which you are directly involved in the patient’s care. 

Part of the value of direct patient care is learning to independently make decisions, acting on these decisions, and living with those choices. The following are people who have had to evaluate patients, make independent decisions, and implement plans without much input from others. These critical thinking skills include: prescribing medications or administering them, performing a procedure, directing a course of treatment, and treating patients (wound care, foley care, etc.). It is not limited, but essentially, this type of experience requires you to make skin-to-skin contact with the patient and making some type of assessment of the patient. If you are unsure, it is ALWAYS recommended you ask the schools you are applying to, NOT CASPA. They’ll tell you what to classify each experience as.

• Certified Nursing Assistant (CNA) - If you’ve ever worked as a tech in any specialty (ICU, Neurology, Orthopaedics, Intermediate Care, Pediatrics, Ob/Gyn, ER, Med/Surg), your experience will probably fall under this category. I can personally attest that this is some of the strongest HCE you can obtain. I’ve worked in the ICU and Neurology units at a hospital before and I learned incredible amounts in the 2 years I worked there. Even if you work “prn,” which means “as needed” you can gain a load of experience working a few nights a week  (7 pm-11 pm) or weekends when it’s busiest. I did this while in school full-time, too! You have the ability to work in a hospital or nursing home as soon as you pass your CNA exam offered by the American Red Cross. Downside is the course for CNA, the cost, and the time (few weeks).
• Patient Care Technician (PCT) - Same position, different title. The difference is usually that these technicians are usually trained on-the-job without any prior experience, while most CNAs are hired from technical schools or straight out of high school.
• Can be involved in a wide range of activities depending on your employer - from feeding, cleaning, and walking patients to collecting urine samples, inserting Foley catheters, taking vitals, ambulating, and deep suctioning.
• Heads Up: If you’re considering getting your EMT certification, you might want to just get your CNA certification. Most hospitals will hire CNA positions with a EMT, CNA, or MA certification. It’s cheaper and quicker.
• Certified Medical Assistant (CMA) - This position requires a course and certification, however, Medical Assistants can be hired with on-the-job (OTJ) training and no experience is necessary. There is nothing wrong with gaining the certification, but make sure it fits into your timeline for PA school. You need to accrue patient care hours outside of your training, so make sure that even if you spend 6-9 months (and $$) gaining your certification, you have time before PA applications to accrue hours! As an MA, you have the ability to work in various specialties and work in different settings (hospitals, clinics, private practices). MA’s usually take vitals, administer medications and injections, record medical records, handle medical instruments and supplies, collect specimens, and can aid PA/physician in procedures. They also have the option to obtain a limited x-ray license.  
• Podiatry Tech - Since podiatry technician’s can assist with surgical procedures, provide wound care and dressing, take vitals and provide patient education, I’ve listed them under MA’s. Most schools should count this as direct patient care experience, but it would be advisable to double check with them.
• Hospital Corpsman (HM) - Hospital Corpsman work in the U.S. Navy and have similar responsibilities as MAs.
• Emergency Medical Technician (EMT-Basic)/Emergency Room Tech (ER Tech)- Also known as the “people who work on the ambulance” (but you can actually opt to work “in house” as well), but if you have trouble finding a job after getting your certification, you can always become an ER tech, CNA, or urgent care technician. EMT’s tend to have higher pay than working in a hospital setting and their training is short (2-3 months) and relatively inexpensive. Here, you’ll learn lots of clinical assessment skills beneficial for PA school. This position gives you a lot of lateral mobility because it allows you to work in clinics, private offices, and in hospitals. Schools tend to love EMTs for their HCE because of the in depth clinical knowledge and skills. I’ve heard before that if you have the opportunity, to go for your EMT-I or EMT-IV certification, because your job will be less restrictive and because the market can sometimes be saturated with EMTs looking for jobs. Because of this, you might consider obtaining your 12-lead EKG, ACLS, AMLS, PHTLS, PALS, NRP, ABLS, WUMP or other additional certifications to make yourself more competitive. Make sure when you fill out your CASPA that you are only listing the “non-wait” time, or simply put, the time you are actually with patients.
• Medics (civilian or military)- Army/Air Force medics are a great way to gain HCE while serving our country. Medics are trained to start IV’s, how to give a basic trauma survey, how to interpret EKGs, and much more. This is a great opportunity for those wishing to go become Emergency Room PAs.
• EMT-Basic - Requires about 110-120 hours of training. Non-invasive skills such as bleeding control, positive pressure ventilation, oropharyngeal airway, nasopharyngeal airway, and splinting.
• EMT-Intermediate - Requires about 200-300 hours of training. Allows more invasive procedures including IV therapy, multi-lumen airway devices (intubation), and enhanced assessment skills.
• EMT-Advanced - Requires 400-500 hours of training. Allows for advanced cardiac monitoring and the administration of pharmaceutical interventions.
• EMT-Paramedics - Requires 1000+ hours of training. Works in ambulance and drops off patients in the ER. Perform medical procedures such as fluid resuscitation, pharmaceutical administration, obtaining IV access, cardiac monitoring, and other advanced procedures and assessments. EMS jobs help with thinking on your feet, making decisions under pressure and sticking with them, formatting a differential diagnosis and not freezing up when it’s make or break time. If you get the chance, it is preferred to become an ER tech due to the amount of exposure you’ll get.
• Nurses (LVN, LPN or RN, ASN, BSN, MSN) - Requires at least a 2-year associates degree or vocational program. Getting a nursing degree prior to beginning PA school can be tricky. If you know you want to be a PA, then maybe nursing school isn’t the route you want to choose. Some schools may question your motives later and ask why you didn’t just pursue becoming a nurse practitioner instead. Although there is no problem with getting a nursing degree before PA school, as this is some of the best HCE you can obtain, some programs may misconstrue your ambition for the “nursing model” of education versus the “medical model” of education, which I will write about in an article soon.
• Respiratory Therapist - Requires a 2-3 year associates degree or diploma in respiratory science. Advanced practice clinicians in airway management; establish and maintain the airway during management of trauma, intensive care, and may administer anaesthesia for surgery or conscious sedation.
• Physical Therapy/Occupational Therapy Aide - Check with individual programs, but most accept (with great appreciation) this type of experience! One of the benefits of this HCE is that most outpatient clinics and inpatient hospitals will train you on-the-job (few months) and no certification is usually required, although you can obtain a 2-year associate’s degree.  
• Chiropractic Assistant/Tech - Performs electrical stimulation, massage, therapeutic ultrasound, etc. Very similar to a physical therapy aide. Contact each individual program for assurance.
• Acupuncturist - Acupuncture practice including performing acupuncture treatment, massage, nutritional and lifestyle counseling, and herbs counts as direct patient care experience at some schools. It would be best to contact all schools you plan on applying to to confirm.
• EKG Technician (Certified EKG Technician) - You’ll learn how to apply a 12 lead EKG to patients, perform stress tests, prepare patients for Holter or ambulatory monitoring, edit and deliver results to providers for analysis. Very inexpensive. Can take as little as 4 weekends to obtain. Click here for more information.
• Pacemaker/ICD Technician (Certified Cardiographic Technician) - Work with patients who require pacemakers to regulate their heartbeats. Have complete knowledge of noninvasive techniques and methods for diagnosing heart and vascular diseases. Great pay and 5 month certification.
• Speech Language Pathologist (Speech therapist) - Requires at least a Master’s degree in speech-language pathology and 400 clinical hours. Evaluate and treat communication disorders and swallowing disorders.
• Athletic Trainer - ATs work directly with patients under the supervision of physicians. They provide preventative services, emergency care, clinical diagnosis, therapeutic intervention, and rehabilitation of injuries and medical conditions. ATs earn at least a  bachelor’s degree from an accredited program and must pass a comprehensive exam to earn the ATC credential. Additionally, more than 70% of certified athletic trainers hold at least a master’s degree.

Other Healthcare Experience

This is experience obtained while working in a health or health-related field, but where you were not directly involved in the patient’s care. For example, filling prescriptions, performing clerical work, delivering food to patient’s rooms, cleaning rooms and making beds, working as a hospital volunteer, etc.

• Mental Health/Psychiatric Facility Technician/Counselor- Any experience where you are working in educational rehabilitation for mental health or psychiatry would fall under this category. This category is very ambiguous, but includes anything from seclusions, applying restraints, auditing charts, facilitating patient group sessions, checking vital signs, and performing suicide checks. If you have any questions about whether your experience counts as direct patient experience, contact the individual schools for a more direct answer.
• Pharmacy Technician (PCTB) - Pharmacy technician experience can count as HCE or “Other HCE” depending on each individual school. You should contact each school for an answer. PCTB board exams can be taken after self-studying using self-study books found online. This is the route many pre-PA students will choose to go. It’s easy to get jobs near your school at a local pharmacy, very manageable work to do while in school, and the pay is pretty appealing too.
• Phlebotomist (CPT) - Phlebotomy certification is relatively easy to obtain and cheap, but you’ll have to check with each individual school to decide whether this is the right HCE for you. Some schools accept it as HCE and some will not. Some count laboratory work (specimen processing, blood bank, microbiology, etc.) as “other HCE,” while actual sticking of patients is considering “HCE.” It all depends on each program. Courses are usually about 1-2 months in length and require an externship at a clinic or hospital. Either way, phlebotomy is usually ranked “lower tier” by most schools in terms of the type of HCE they want you to have. I would not recommend this to be your first choice.
• Sitter/Patient Safety Aide - A caregiver who is usually attentive to a patient at risk due to meeting the criteria and having an order for a 1:1 patient watch. This is a person who makes sure a patient does not get out of bed, pull a line/tube, etc. This does not satisfy the requirement of HCE and should not be your number one HCE of choice.
• Scribe - I’ve talked about scribing before, but basically, scribes chart for physicians during their assessment with patients (complains, history of present illness, family history, review of systems, physical exam, etc.). They keep up with incoming lab/imaging results and overall, provide assistance to the physician/PA to facilitate action in the clinical setting, usually the ER. You are there when patients are admitted or discharged and you’ll learn what labs to order or what symptoms a patient might have. Ultimately, it depends on the schools you are applying to whether or not this will count as HCE or not. Keep in mind that MOST schools will not count this as HCE, but it could be your window of opportunity into another job in health care.
• Scribe America - provides full professional scribe programs to recruit, hire, train, manage, monitor, and deliver medical scribes
• PhysAssist Scribes - First scribe company to form. Hires and trains scribes.
• I Am Scribe
• DocAssist
• ProScribe
• Emergency Scribes Consultants
• Med-Scribe, Inc.
• Physicians Angels
• Scribe Connect
• Medical Interpreter (MI) - Medical interpreters mostly work in the emergency department (ED) interpreting for nurses, physicians, PAs, or patients during triage, assessment, discharge, or trauma. They can also work in other units or remotely for third parties. Occasionally, MI’s are allowed to take vitals, ambulate patients, or perform EKGs, although that experience is rare and contingent upon the hospital needing extra assistance.
• Dental Hygienist/Assistant - This HCE may or may not count as direct patient care experience. You’ll have to check with each individual program. I’ve listed it under “other HCE” because it seems as though most programs would prefer other HCE than this type. While you do plenty of assessment, diagnosis, planning, implementation, and evaluation, you are not treating all systems of the body, which schools want you to have exposure to. If you have some shadowing experience, you might be able to get by. Check with your programs if you want to know more.
• Anesthesia Technician - Most anesthesia technicians are responsible for stocking equipment, cleaning laryngoscope blades, and checking anesthesia machinery (change tanks, change tubing, refill gas, layout intubating equipment, look for fluid leaks, and clean) after surgery, which makes it difficult to count as direct patient care experience. Some anesthesia techs may be allowed to place arterial lines and place hard stick IVs on the floor with ultrasound, but most are only able to handle the equipment. Also, tuition for a program can be costly (up to $30k for one year program) to obtain a certificate.
• Veterinarian Technician/Kennel Tech- Although CASPA does not specify species for HCE, most schools do not accept vet tech experience as direct patient care experience because you’re not directly involved in human related HCE. Schools want to ensure that you are not a veterinarian “reject,” even if you really never were bound for vet school. If you want to list this experience, you can, but try to shadow or obtain as much human HCE as you can before applying. Most vet techs find this in phlebotomy, although phlebotomy may not be the best alternative for direct patient care experience either. Schools want to know that when you become a PA, you’ll be able to treat patients and read their body language for signs and symptoms.
• Transporter - A transporter usually works in large hospitals and ambulates patients from respective floors typically down to imaging, etc.
• Sterile Processor (SPD) - Requires a SPD certification. This HCE does not give you interaction with patients almost entirely. You’re responsible for sterilizing surgical equipment and other healthcare equipment of biological fluids. Cost for certification is inexpensive. Not ideal experience for PA school.
• Food Service - Delivers food from hospital cafeteria rooms to patient rooms. Not ideal for PA school. I would recommend obtaining other healthcare experience.
• Scrub Technician (Surgical technologist) - Scrub technicians are actually facets of CNA’s. They possess knowledge of sterile and aseptic techniques. Requires attendance at a junior college or technical school and many train at military schools. Training can take several years and the goal is for you to be able to anticipate the surgeons next move.
• Radiology/MRI Technician - Requires a 2-year associates degree from a junior, community, or technical college. Average salary is about $27/hour. They perform diagnostic imaging examinations, such as x-rays on patients. MRI technologists operate magnetic resonance imaging scanners to create diagnostic images.
• Laboratory Technician - Laboratory technicians have numerous titles - biomedical scientists, medical laboratory scientists (MLS), clinical laboratory scientists, and medical technologists (MT). This position can be beneficial as a PA for interpreting lab results for making a diagnosis. They perform chemical, hematological, immunologic, microscopic, and bacteriological diagnostic analyses on body fluids. Requires a bachelor’s degree in clinical laboratory science, biomedical science, medical technology, or a certification from an accredited training program. Certified through the American Society for Clinical Pathology (ASCP).
• Medical Lab Technician (MLT) - Perform less complex testing and laboratory procedures than medical technologists (MTs). Usually requires an associates degree from a community or junior college. Work under the supervision of the certified medical technologist.
• Clinical Research Coordinator/Assistant/Specialist - Most programs agree that this is not direct patient care experience, and some would argue that you are better fit with this experience for medical school rather than PA school. This experience has prepared some students well for MPH/MPAS programs.
• Hospital Volunteer - Most hospital volunteers are in charge of restocking medical supplies, answering phones, managing desks at waiting rooms, ambulating patients from their rooms to the front door of the hospital, etc. Occasionally, your supervisor may allow you to assist in feeding patients, turn beds, give sponge baths, and shadow providers under the supervision of others, but this experience should still be listed under “other healthcare experience.”
• Patient Care Assistant (PCA)/Residential Aide/Caregiver - Other names include: Personal Care Attendant, Patient Care Assistant, Personal Support Worker, Home Care Aide. Provides assistance in personal care & hygiene, feeding and meal preparation, maintaining safe and clean environment and providing instruction and guidance. This does not necessarily count as direct patient care experience at schools because they don’t see you making patient assessments like you would in a real hospital or clinic setting. It would be advisable to consult your particular program about your individual experience.  

Healthcare Shadowing

Shadowing is completely different. If you spent time observing a PA, NP, MD/DO or anyone else in the medical field, this is where you would list those types of hours on the CASPA. I’ll write an article soon talking about who you might want to shadow, how long you need to shadow, what you can expect, and more. It’s important to realize this is not considered “HCE” for schools requirements, unless a school has specified they will accept it as such.

Research

Research projects done in addition to classroom work; should NOT appear on a school transcript as credit.

Community Service

Volunteer work done outside the healthcare field

• Judging science projects at a local science fair
• Volunteer for diabetes awareness week
• Habitat for Humanity
• Tutoring children
• Working for a fundraiser walk or blood drive

Other Work Experience

Paid work done outside of the health care field.

• Personal Trainer - Most programs will not accept this as direct patient care experience simply because your “patients” are more than likely “clients.” If they were “patients,” you would have to work in a physical therapy setting or in a cardiac rehabilitation department, rather than at a gym. More than likely this is going to go under your “other work experience,” though you might consider obtaining your National Academy of Sports Medicine (NASM) certification. A wellness coordinator or athletic training coach that develops exercise routines for employees or students/players MAY count as direct patient care experience, but you would need to check with each individual program on your own personal experience. It would be advisable to explain your dedication to training and your own personal achievements to get you where you are (i.e. any degrees in nutrition/kinesiology, physical therapy certifications, CPR certifications, etc.), and your motivation to pursue PA.

A Few Tips:

1. Make sure you keep track of the numbers of hours you accrue for each of these types of experience. You’ll also need contact names and numbers for supervisors, your position, a description of what you did, and the employer you worked for. Keeping an Excel file of all of this information will make your life super easy later when you decide to apply.
2. Make sure you have experience before you plan to apply, as you cannot list experience you are “planning” to have when you are ready to submit.  
3. Don’t let your certifications expire because you won’t be able to list them on your CASPA if they do.
4. Programs want to see that you can work as a team and that you have an idea of what a PA is and what they do. PAs, physicians, and NPs all do things differently, and you'll see things you like and don't like and there is much to learn from almost every provider you get the chance to work with. Just because he/she is a doctor doesn't mean that he/she's smarter than the PA or NP he/she is working with. It was just the route they chose in life. We discuss all areas of medicine, and we all must learn from each other.
5. Health care hours do NOT have to be volunteer hours, and actually paid hours may count for more than volunteer work.
6. If you’re still confused where to start in health care, a good place to start is with the American Heart Association (AHA) to obtain your BCLS (Basic Cardiac Life Support) for Healthcare Providers certification - here. You can search to find a classroom course near you. Once you obtain a certification, you’ll be one leg up on others in the job market and for PA school. Most schools recommend this certification, but just make sure they want it from AHA and not from American Red Cross (ARC). If you still cannot find a job, use this as a resource.

How Many HCE Hours Do I Need?

Most programs only require 300-500+ hours of direct HCE plus any additional shadowing, research, volunteer, and other healthcare experience you may have. If you want to increase the number of programs you are eligible to apply to by about 50-70%, then you’ll need to obtain at least 2000 hours of direct patient care experience. This is equivalent to working for one full year full-time in a job that counts as direct patient care experience.