 So the very first thing I want to say about this job is I love it. Most people were very happy to have me see them as a PA and even as a brand new PA. Morning guys. Boris the PA back in the rolling studio. On my way to work. Just wanted to give you guys a really quick update about my first week as a physician assistant. So the last few videos I posted was about me getting a job, me passing the pants, how I studied for the pants, all that kind of stuff. And so for the last week I've actually been working as a physician assistant. So last week was technically my second week on the job, but the first week I really only saw patients for a couple of days. Most of the days were like orientation, learning some stuff, watching videos that the SP, the supervising physician, really wanted me to get a handle on. Since he's not only internal medicine, he's an obesity medicine, like medically supervised weight loss specialist. So he really wanted me to get up to date on the latest treatments and research and everything for obesity medicine. And so I did that I was watching videos for a few hours. So that was my first week. So last week was technically my first full week as a physician assistant. That's what I want to tell you about. So the very first thing I want to say about this job is I love it. It's exactly how I envisioned working as a physician assistant would be and should be. The practice is a small private practice. So they don't have all these like bureaucratic rules and everything that a larger hospital system or a larger healthcare system would have, which I absolutely love. And during my clinical year, of course, I had eight rotations, all in different kinds of places. So I saw small practices, large practices, hospitals, standalone practices, things like that. And it really gave me an idea of the kind of place that I wanted to work in, where I think I would be happy and where I probably wouldn't. So I really narrowed it down and I was really selective on where I actually wanted to interview and where I actually saw myself working. And this is exactly the kind of place that I saw myself working. This is exactly what I wanted to do. And I know I've had a few requests on my YouTube comments and just over Instagram and stuff about how to look for a job and then how to pick a job, how to do your resume, all that kind of stuff. Actually, one really quick thing on my website, BorisThePA.com, I actually posted my resume. I took out like personal information, address, phone number and stuff like that. But if you guys really want to just get a template on how to set up your resume, you can go download mine and just fill in where you've worked, fill in your name, update the format any way that you like. But some people who have no idea how to make a resume, just kind of get stuck looking at a blank sheet of paper. So if that helps you out, go ahead, go to BorisThePA.com. I think I called the tap resources. It's like one of the last tabs on my website. So if you want to check out my resume and you want to just use it as a template, it's free. Go ahead and download it. You don't have to sign up for an email list or anything that most people seem to want you to do before they give out free resources. My resources are legitimately free. They're just to help you out. So go ahead, download it, do what you want to do with it. Just wanted to help you out. But I probably will end up making a video on how to apply for jobs, how to ask for interviews, how to build your resume, things like that, as a pre-PA student. Yeah, I really don't want to miss this exit. So what's happening is this place that I'm working has two different offices. One's like 10, 15 minutes away from where I live. The other one is like 25, 30 minutes. And they're both on the east side of Syracuse, but they're kind of in different directions when you get off the highway. So I'm still getting used to how to drive there. Like I'm driving there one day and I think I'm going to one office and then I really end up going to the other office. Still going to take some getting used to. And of course I'm still on the supervising physician schedule. I'm going to be with him for like two, three months, my first two to three months, just basically working off of his schedule. So he's right there when I need him before I kind of go out on my own and have my own schedule. And of course at that time, the days that I'm in either office are going to change. So it's just, it's a lot of adjustment, which is the first thing I really wanted to talk about, about this first week as a PA. It's a lot of adjustment. I mean, there's a lot going on. There's a whole lot more to it than just applying the knowledge that you learned in didactic gear and in clinical year and practicing your skills and all that stuff. There's a lot to it. You got to learn the EMR. And then you have to get all these clearances. And there's like all these organizations that you have to get clearances from, you can send certain medications and you can't send others, you can like send labs, you can't send. It's just, it's a whole lot of stuff that you just really have to get through all these kind of growing pains of being a new provider, which just comes with the territory. So it's like, you want to basically learn how to practice, but then, oh, some things you just can't do at first. And so it's, I don't know, I guess it's a little frustrating, but it just kind of comes with the territory. It's just part of like being in this season of my life as a brand new provider. So it's fine. It is what it is. But the biggest thing I think that I realized as a new provider and no longer a student is like people tell you when you're a student that when you're a provider, like you think about your patients all the time, you can't get work out of your head, at least while you're new, because you're constantly worried about something. And it's kind of true, but not in a bad way. It's like, when you're in school, things matter. You're really trying to really learn things. You're trying to get your knowledge base, see as much as you can, do as much as you can, but you're not really responsible. You're kind of responsible, but you're not really responsible, like your name, your license, everything isn't on the line when you send a medication, for instance, or when you tell a patient even something that seems innocuous. But when you're a provider, even if you're brand new, it's your first day, what you tell every single patient matters. What you send matters. What you write in your note matters. And not to be dramatic, but essentially every single word, every single thing that you write actually can cost you your license if you do it wrong. So what you do, what you say, what you don't say, what you don't do, everything matters. And just that huge weight of all of that, just really, you realize it on your first day. Like unless you're totally oblivious, you really realize it on your first day that like, oh man, I'm actually providing care now. Like this is on me. I'm responsible. And if you have questions, of course, if you have a good supervising physician, which I do, he's amazing. He's the only reason, essentially, that I'm still staying in this area. You know, when I was looking at graduating, I was thinking of moving to a bigger city, maybe Cleveland, back where my parents live, maybe someplace like warmer, like Nashville, Miami, Orlando, like, I don't know, just somewhere a little warmer, a little bigger, more people to meet, that kind of a thing, since I'm kind of starting my life over this year. But I ended up staying here in Syracuse because I met this supervising physician. And I just, I think he's amazing. I really want to learn from him. I think he's going to be the best possible mentor I could really hope for as a new provider. So that's why I'm staying here. And I mean, I like the area enough. But without him, I probably wouldn't have stayed. I would have probably looked elsewhere. So all of that's just to say, he has a really, really good supervising physician. He's an amazing mentor. And he's always there if I need him for help, if I'm ever confused on something. But with that, it doesn't mean that he's holding my hand and that he's doing everything. It's still up to me to recognize when I don't know something, or when I don't know his preferences, or when I don't know, like, how he would word something to make things safe, to protect us, as well as to make it a good quality continuity of care in the chart. So all of that stuff, like it's on me to at least know where the line is. So I have to basically know what I don't know. I don't know if you've heard that before, but that's kind of the biggest thing that a new PA, a new mid-level provider, should really know is know where the line is, know what you don't know, and what you have to ask your supervising physician for help. So that's basically the biggest thing you should know as a new provider. And I've kind of recognized that. So even for instance, if I'm familiar with a disease process that the patient's presenting with, I may not know exactly how to manage them, or I may be able to look it up in medscape or up to date, or just from my notes or my memory from school, I may know what's going on, but I may not know exactly how they should be managed, especially if they have like 15 other medications that they're on and a bunch of other stuff that they're on. So that's really where you just want to have a good relationship with your supervising physician and be able to ask them things. And in my supervising physician's case, he's very open to questions. He's never impatient. He never seems annoyed when I'm asking him questions. He's just really there to take care of the patients and to help me grow as a provider, which I really, really appreciate. So I think that's kind of the biggest thing that I've gotten out of this first week is to really understand what know what you don't know means and how important it is. And also just the gravity of how immense your responsibility is as a provider, even if it's your very first day. So for instance, if you provide care that's suboptimal, you do something that might get a patient hurt, you do something that is not standard of care. People won't care that it's your first day, you're a provider, you're licensed, you took the test, you passed, you know, New York state says that you are a provider. So if you do something wrong, no one's going to care that it's your first day, you still did something wrong. So just kind of realizing that that you are responsible now for everything. That's kind of a big thing that I've really gotten out of this first week. The next thing I've really gotten out of this first week is in a good way, but it's exhausting. It is really freaking exhausting being a provider, like the whole time that you're at the office, eight hours, nine hours, whatever it ends up being, you're working like your brain is engaged the whole time. Even when you take your lunch break, which I mean, the contract says is an hour, but let's be real, like you're catching up on charts, you're catching up on something over that lunch break, you might make a quick phone call for yourself or just like check your email, your own stuff, but you might not. Like you're constantly thinking your brain is constantly engaged the entire time, which even as a grad student, I wasn't used to. Like I might study for an hour at a time, 20 minutes at a time, two hours in a row, like at the most, and then I would take a break five minutes, 20 minutes an hour, whatever the break might be and just not think about the material. But when you're working, you're thinking about the material constantly. If you don't know something, you're looking something up. Like you are just constantly, constantly engaging your brain, your whole brain. And when you get home at the end of the day, it's like, I mean, I think I've said in previous videos, like man, my brain just feels like mashed potatoes. It feels like there's nothing there because I was studying so hard. This is a different level, man. Like this is a whole different level of mashed potatoes. My brain literally felt like it just fell out of my head and there was just nothing there. Like I just couldn't formulate a thought. So for instance, last week, like my friend and I were trying to make dinner plans. We get together for dinner for brunch, like every week, every couple of weeks, just to catch up, you know, talk about what's going on in our lives. He's one of my local friends here in Syracuse and he and him and I were trying to make dinner plans over text. And normally if someone brings up a restaurant they want to go to, or they just say, Hey, let's get together. I'm usually really quick with a plan. Like, okay, I wanted to try this place out. Why don't we go here at seven o'clock? Okay, boom, let's both put it in our Google calendars. Like we have a plan. But this time I just, I could not formulate a thought. I was just like, I got to be honest with you, my brain feels like it's not working at all. All these times and all these restaurants you're bringing up, like they're just going in one ear and out the other. Like I just, I can't think I'm not trying to be mean. I'm not trying to be dramatic. I'm not trying to blow you off. I'm literally just, I cannot think. So can you please just make a decision? Tell me exactly where you want to go. Tell me what time you want to be there after, you know, seven o'clock when I'm definitely free. Just tell me where to go and when and I'll just put it in my calendar and I'll be there. I just, I can't make another decision right now. And I'm usually not like that. I'm almost never like that. I'm usually pretty quick with a decision. But when you spent all week, you know, 40, 50 hours just making hard decisions, every one of which matters, just constantly nonstop, like you're just done. Your brain is just done. And I'm sure you get used to it eventually. Like you get to know a lot of your patients, you already know what's going on with them when you go in the room. So I'm sure practicing does get easier eventually. But as of right now as a new provider, oh my God, you're such a dear in the headlights because every patient is new to me. I don't know anything about them. So every single patient that I see, I spend like 15, 20, 30 minutes just digging through their chart, looking at why they're here, looking at their recent labs, looking at their recent imaging, their specialist consults, if they have a cardiologist, you know, what's going on with them, why they're on every medication that they're on and maybe like why they're not on certain medications that I think they should be. Like if they're total cholesterol is 250 and their LDL is like 170, like why are they not on a statin? And then I have to dig through their last three or four charts that say, oh, on this date, you know, we tried a statin and patient couldn't tolerate it. You know, he had my algeas. So that's why he's not on a statin. That's why he's like on triple anti lipid therapy. That's not including a statin, which is the standard of care. So like, why is this dude not on a statin? Oh, I had to dig through tons and tons of documents before I figured that out. So like when you're a new provider, every single patient you're doing that for and it just takes forever. And it's just a lot of time. So I'm not complaining about it. I probably sound like I'm complaining. But it's just it's the reality of being a brand new provider, not knowing any of your patients because you haven't been taking care of them for years, like the doctor has, you just don't know them. So everybody's brand new, not to mention the EMR, the processes that the office goes through all the staff. Everybody's pretty new to you. Like everything is just new. So you're just absorbing so much knowledge. And you're also like I said, making all those decisions, thinking constantly. So it's just it takes a lot out of your brain. It just it's a lot of effort. So one thing I was joking about actually with my supervising physician last week is that he cured my insomnia. Like for the past at least couple of years, probably longer, I've always had trouble sleeping, even if I'm exhausted, even if I like went to the gym, if I ran that day, like if I'm really tired, doesn't matter. Like a lot of the time I just couldn't fall asleep. My mind's just racing. And so last week, I didn't have that one bit. Even if I woke up in the middle of the night, I was right back to sleep because my brain was just so spent. It was too tired to race. It was too tired to think about things. So I just I was joking with my doctor that like, Hey, thank you, you cured my insomnia with with like how much I'm thinking and how much I'm busy here. So I don't know. I think it's actually kind of a good thing. Like it tells me that I'm in the right profession. Because if I was in a job where I wasn't constantly using my brain, my brain wouldn't have anything to do with itself. And it would just you know, it would prevent me from sleeping and I would be overthinking all the time. And you know, like some people are just more suited to certain jobs. Some people would freaking hate this. Some people would after one day be like, look, I really don't like thinking this much constantly. I like to just kind of get good at something and then just do it mostly the same every single day. And I'm just comfortable with that. And a lot of people are like that. There's nothing wrong with that. I'm just not like that. I need a challenge every single day. I need something to be different. I need to use my brain. And so, man, I guess I got what I what I asked for because I'm really using my brain constantly. And I don't know, like, I guess I'm hoping that maybe in a few weeks, a few months, I don't know, maybe even a few years, however long it takes, like, I just hope that I get to the point where I am using my brain a lot, but it's not like 10 out of 10 every hour of the day. It's like seven out of 10. And then when a patient is complicated, or there's an acute situation, or there's something that I'm not familiar with, maybe then it jumps to 10 out of 10. But like most of the time, it's like a nice comfortable seven out of 10, six out of 10. And then for some diversity, there's some days where it's like three out of 10, you know, all the patients are pretty simple. I know them all. Nothing crazy is going on. So like, I don't know, I guess it's just all new to me. But so that's how my first week went, you know, exhausting, amazing. I love what I'm doing, just like applying this stuff and actually having the authority to order things that you want to order and actually being able to make decisions is really good. Also scary and very like humbling because every single thing you do matters and you understand that from the very first patient you see, unless you're totally oblivious and also just yeah, exhausting, which is awesome. Oh, and one question I see circulating a lot in like PA communities, pre-PA communities, people are always asking, like, what if a patient doesn't want to see you because you're a PA, they want to see the doctor? How often does that happen? What do you do? So that's honestly only happened to me twice. Out of I'm not really sure how many patients I saw last week, maybe a low of five a day, a high of like maybe 15. So I don't know, average of maybe like 50, 60 patients I probably saw, something like that. And out of those 50 or 60, only two of them didn't want to see me as a PA. Most of them were very happy to talk to me. Most of them were happy that I was seeing them. They were happy with how much time I was able to spend with them because they're just not used to that. They were happy that I was listening to them. They're not used to a lot of providers listening to them. So like, most people were very happy to have me see them as a PA and even as a brand new PA. So only two people didn't want to see me. One patient, I said, like, Hey, I'm Boris. I'm a PA. I'm working with Dr. Oh, is it okay that I see you? And she just like very nicely, very genuinely just said, like, no, I really need to see him. I really need to talk to him. And it was like, of course, like it might be a few minutes, but he'll be in to see you. I'm going to tell him that you really want to see him. And that was really it. No harm, no foul. I'm not going to get offended if someone just really wants to see the provider that they've been building a relationship with over like 20 years, you know, he's been in this community for like over 20 years. So of course, I'm not going to take offense to that. And other patient, basically same thing. I said, Hey, I'm Boris. I'm a PA working with Dr. Oh, is it okay that I see you? And he goes, Oh, I made the appointment with Dr. Oh, I said, yeah, he's here. He can pop in and say hi, but I was going to talk to you. And he's just like, no, I need to see him. Okay, no harm, no foul. That one actually hurt a little bit because I spent like 40 minutes reviewing his chart. He had so much going on. And I like really prepped myself and was really ready to go in that room and know what's going on with him. And then, you know, he was like, Oh, I don't want to see you. So that one kind of hurt a little bit. But again, he has every right to choose who he sees as his provider. It might take a little bit longer to see the doctor because the doctor is busier, but still he has every right to do that. It hurt a little bit to me just because I like spent all that effort, but that's going to happen. And that's totally okay. You know, it's definitely not his fault. He has every right to do that. So anyway, I'm here. I'm at the office. I'm ready for another awesome week. Hopefully this one's a little bit easier, mostly just because I'm used to things a little more, but I'm also going to pick up the pace. I'm going to see more patients. I'm going to be more independent just more and more every single week that I'm here as a new provider. So that by the time that time comes that I'm no longer on the doctor's schedule and I'm just on my own schedule. He's only a phone call away. I can still use him anytime I need if I need help, but I'll just be more independent. So by the time that time comes, I want to be much more prepared. I want to feel like I've asked him everything that I need to ask him, at least about common things, how to commonly manage most patients. So anyway, I'm going to have this awesome week. I hope you guys have a great week and I'll see you in the next video.