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How to Overcome Overload at Each Phase of Becoming a PA

The stress that comes with becoming a PA starts years before you get into PA school, and it doesn't stop once you begin work as a PA, as demonstrated in my recent feature article on PA burnout.

However, the factors that contribute to stress change over time. The pressures you feel when you're just starting on your pre-PA path are vastly different than those you'll encounter as a new grad in your first PA job.

Often, as you live through these changing phases, they blend together. Consequently, working toward becoming a PA can seem like a never-ending parade of tension with new anxieties encountered along the way.

But, if you view each stage separately, you'll better understand the most common contributor to anxiety at each step. And when you see the phases as distinct from one another, you'll be able to adjust your strategy to adapt to each one. Additionally, you'll also gain insight into how long you can expect the "stress peak" to persist in each stage.

This last part is essential because nearly anything can be made tolerable for short periods. But learning how long it will take you to trudge through something unpleasant, like overwhelming stress, is what makes it bearable.

PHASE 1: PRE-PA

Most common stressor: Not enough time "left" to do x.

If I were to consider all of the questions I field about PA school, I'd speculate that about 90% fall into one of two categories: "how to..." and "how could I possibly..."

The first, the "how to," is a practical question. It comes when a future PA is trying to figure out how to find someone to shadow or decide which patient care experience might be a good fit for them. Once someone gets their answer to a "how to" question, they can go implement.

There's no doubt preparing for PA school is a lot of work, but that's not where I see most people struggle. Once they have a plan down, there's no mystery around what they should do to prepare.

The real stress comes from the "how could I possibly" questions, the ones that are emotionally charged. Those like:

What if I don't have enough patient care experience?

Is my GPA every going to be good enough?

Am I applying too late in the CASPA cycle?

These kinds of questions imply that there's an ultimate deadline for your pre-PA plan. And there's not.

Yes, programs have application deadlines each cycle. And maybe a few of your prereqs might "expire" soon. Or it might take another three semesters to bring up your GPA to a competitive level.

But working around all of these issues is possible—with time.

Managing Stress Before, During, and After PA SchoollBe a Physician Assistant

What stresses pre-PA students out the most is not the amount of prep that's needed for PA school or how long it might take. It's feeling as if they'll miss a deadline that they've created in their head.

You can apply to PA school whenever you are ready, and you can take as long as you need or like to get prepared.

If you're determined to become a PA, getting ready may take you a bit more time than you initially planned. It may take more than one application cycle to gain the experience you need to become competitive.

Don't let an arbitrary deadline deter you from continuing to make progress. The biggest stressor at this stage will only last as long as you allow it to. You're in full control to let it go.

PHASE 2: PA STUDENT

Most common stressor: The sheer volume of work.

Unlike the pre-PA phase, no mindset shift will immediately remove the most significant stressor of being a PA student. There's an undeniable amount of work you'll encounter in PA school, and it's not going anywhere.

And, the stress of this seemingly unending volume of material will last for the entirety of PA school. (My condolences in advance.)

However, acknowledging that you've got a tough couple of years ahead of you is not the same thing as assuming there's nothing you can do about stress in PA school.

Along with the volume of work, PA students tend to pile on the stress by feeling guilty over what they aren't accomplishing. You can devote the entire day to studying and still feel you came up short because you didn't absorb the material well enough or didn't get to the other subject you intended to cover.

So, instead of spending an entire day studying, I've got a radical proposition: limit your study blocks. Have a planned start time and end time. Work in 60-90 minute stretches for no longer than 4 hours at a time.

Does this sound like way too little? I'm sure it does. But, this is how super productive people work.

When you place a limit on how long you have to work on something, you'll have greater focus, and the self-imposed pressure can light a fire under you. If you have only 2 hours to commit knee anatomy and exam techniques to memory, you're more likely to do it.

But it requires that you eliminate distraction. No checking for replies to an earlier text or updating social media about how hard you're studying. PA school is a great time to adopt the motto, "Be where your feet are."

Along those lines, you've got to support all of the work you're doing to learn but not forgoing sleep and exercise. Stay with me, because these are not just general health guidelines.

When you're spending most of your day attempting to cram in as much knowledge as you can, sleep and exercise are the first "non-essential" parts of your day to get infringed upon.

I won't use the argument about how skimping on either will throw off your physical and mental health because I know that's not enough to convince a crazed PA student to walk away from the books.

Instead, think about how sleep and exercise have a direct impact on amplifying your study efforts. Regular exercise has been proven to change your brain and improve memory.

Additionally, it seems a several-hour gap between studying and exercise helps with recall of the subject you're trying to absorb. So, science says that a break followed by exercise will make you a better student.

Likewise, sleep has a consolidating effect on memory — it makes your memories stable. Sleep solidifies both the "what" and "how to" of things you learned during your waking hours.

Consolidation happens during slow wave sleep, aka deep sleep, which only accounts for a portion of your overall sleeping time. You've got to sleep a normal-human amount, not an adjusted PA-student amount, to get the benefits. As you might imagine, not being exhausted will also help with your next study session.

So, as an overwrought PA student, don't use sleep and exercise only as ways to keep your sanity, but as strategic moves to amplify your studying efforts.

PHASE 3: EARLY-CAREER PA

Most common stressor: Feeling out of your depth.

If, during PA school, you ever found yourself rubbing the crease out of your cheek from falling asleep on your pile of highlighters, crying from no discernible cause other than exhaustion, or appearing to listen to someone while secretly imagining the distribution of their cranial nerve anatomy so that you didn't lose precious study time, beginning work as a PA can feel like you're entering a life-long vacation.

But while the long white coat and salary suggest that you're a "real" PA now, it can be some time until it feels like you are.

Starting as a brand new PA is stressful. It's like week one of every clinical rotation you had but prolonged and with way more responsibility and self-doubt.

Managing Stress Before, During, and After PA SchoollBe a Physician Assistant

As a new, legit PA, you'll feel as if you should have more answers than you do.

You'll wonder if you're possibly an idiot who didn't learn enough in PA school and how you're going to make it through an entire career without anyone finding out.

The two most important things to know about this stressful stage are that: 1) feelings of inadequacy are completely normal, and 2) this is temporary.

The learning curve at the early part of your PA career is the steepest you'll ever encounter. Even if you change to a completely different specialty, it will never be as hard again.

Your skills in managing patients and working with colleagues will grow tremendously in 6 months. And you'll feel pretty cozy in a year. You just need to ride the wave.

However, there are a few guidelines to follow during this stage that will help you in the future.

Be curious.
If you were hired as a brand new PA, your employer knows what they signed up for. Your colleagues know you're new, and they're willing to help. Ask about what you don't know and work to gain the knowledge that will make you more independent in the future.

Work hard, but don't live there.
You'll feel less frenzied if you go in a bit early and leave a little later than what's required for the first few months. The extra time will help you get your bearings. But do not stay hours beyond what you have to.

In these early days, you're setting a precedent for what can be expected from you. It's okay to be seen as a hard worker but not as someone who's continuously available.

Undoing this pattern is much harder than avoiding it in the first place. If you need to read up on something you saw that shift, do it from home. Your future self will hate you if you do this wrong and create a work world where you're always accessible.

Delegate even though you really don't want to.
Similar to the idea of not living at work, as an early career PA, it's important to delegate what you should delegate. Sure, it's okay to send a fax or take vitals to move things along once in a while.

But, you shouldn't be spending your time doing something only because you feel bad/bossy/guilty over asking someone else to do it. This is a slippery slope as an early career PA, and it's even harder to break out of than working endless hours.

As you gain experience, you'll be more useful at work, and you'll be wasting your employer's money and your sanity if you consistently spend time not working at the full capacity of your training and licensing.

Other than that, just hang in there for the first few months. You'll be amazed at how quickly you grow in your new role. As everything becomes more routine in your first PA job, the stress of feeling like you don't know what you're doing will be a thing of the past.


No phase of becoming a PA, or the stress that can come along with it, lasts forever. And the things that can cause stress early in your career will be replaced by new pressures as you continue to advance.

But knowing what to expect at each step along the way can allow you to go in with your eyes wide open and realize that there’s light at the end of the tunnel.