The Blessing and Burden of Flexibility: A Guide in Choosing Your Specialty as a New Graduate

Sept. 28, 2015

By Verdale Benson, PA-C

While providing mentorship to a PA student, I was asked the question if he should initially pursue a primary care job to solidify his medical foundation before entering a specialty field. I found this to be a great question that I’m sure many soon-to-be graduates are pondering.

While reflecting on the question, I realized how the flexibility of our profession could feel like both a blessing and burden at times.

Bottom line up front: Pursue the specialty you are passionate about.

My advice to new PAs is to get into the specialty you have the most passion for early and rise within it so that you can maximize career time for optimal growth. The knowledge and experience you gain will grow every year and that will increase your market value. It’s very similar to starting a financial savings plan early in life to maximize the effects of compound interest.

Many practicing PAs believe say that your education isn’t nearly over once you graduate from school. As a new graduate in a specialty or even in primary care, you’ll still have to read up on disease states and best treatment practices.  My experience has shown that your supervising physicians will train you to practice as they do, so the sooner you get into the niche, the smarter you’ll become in what you love to do!

I will say that broadening your general medicine roots isn’t a bad move, if that is what you want to do initially. It is how I started my PA career. I would caution that you do it because you genuinely want to practice primary care and not for a potential future benefit. The return on invested time might not be worth it, depending on how you are utilized in a specialty practice.

I was the first to graduate from the Atlanta Veterans Affairs PA residency program, which focuses on primary care. I learned many levels of medicine above what I absorbed in PA school and graduated with a firm foundation of knowledge. I was full of information but found that much of it started to atrophy when I started my orthopedic surgery job. It is the application of knowledge that truly cements it in your mind.

I have recently transitioned to Emergency Medicine and have been able to pull from my general medicine experience. But maybe I would have learned those pearls anyway if I had started out in the specialty.

This debate also takes root in preparation for the PANRE for consistency, consider spelling out this acronym. I have heard stories of specialty PAs failing the boards because they have only practiced in one field. Having to study for the PANRE is a burden that all specialty PAs will have to bear, but general medicine PAs are not immune from the hardship. Even primary practices vary based on population or location, which leads to unseen topics that will require review.

It will behoove every PA to stay abreast of current medical practices so that when the PANRE comes up, you aren’t trying to catch up from years of not applying that information. This is one reason for continuing medical education (CME) activities.

While pondering this debate, I looked at the possible influence from our physician colleagues and their residency training. Physicians who branch into specialties such as cardiology or gastroenterology have to train in internal medicine before attending their fellowship.

This model doesn’t translate exactly into the PA profession. The translation is probably further lost with those entering into surgical specialties. The truth is, most of us forget what we don’t actively practice on the job. That goes for all of us, including physicians! Most PAs likely will have to study before the PANRE regardless of what specialty is practiced. The newer specialty weighted PANRE options have been a great adaptation to help offset this issue, but shouldn’t ever completely yield to one specialty.

Our blessing and burden is that we have the freedom to change specialties, but we will always be held responsible for the knowledge that flexibility entails.

I think this is a great problem to have. I love knowing a lot about many subjects and while I might not be an expert, I can have an intelligent conversation on most medical topics. This is one of my joys and what helped draw me to the PA profession.

So, pursue what you have the most interest in! If that is primary care, then great! If it is urology, then great! Either way, you’ll always have to know a little about everything, so keep your knowledge base up so that when the PANRE comes around, you won’t sweat it.

Verdale Benson, PA-C is a 2012 graduate of the Emory University PA program. He completed a residency in Primary Care with a focus in the Patient Centered Medical Home (PCMH) model. He currently practices Emergency Medicine at Memorial Medical Center and resides in the San Francisco Bay Area. You may contact him at [email protected]