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29. PA's in Pink: A career in breast health
138 Plays1 year ago
In this Episode I speak with Hayley Root, PA-C who works in the field of breast health and surgical oncology at the University of Washington Medical Center. We talk about what her job entails as well as her scope and starting salary.
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Transcript
Introduction and Host's Personal Anecdote
00:00:15
Speaker
Welcome to the PA Experience Podcast. I'm your host, Sebring Sands, and as a PA, I take you behind the scenes to see what it takes to become a PA in all steps of the journey.
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Guest Introduction: Haley, PA in Breast Health
00:02:38
Speaker
Welcome everyone to another episode of the podcast. I have a great guest with you today. This time it is of a practicing PA in a different field. I think this would be very beneficial to hear from her what this field is, what can you expect in this field, and just possibilities. I think the PA program is expanding in fields that we were able to practice in. So this should be really interesting. So Haley, can you introduce yourself?
00:03:07
Speaker
Of course, thank you for having me. My name is Haley and I am a practicing PA in Seattle, Washington. Awesome. So what do you do? What's your field?
00:03:20
Speaker
So I work in breast health. The job title that I applied for was breast health specialist. Specifically though, I work in an outpatient clinic of breast surgical oncology and breast surgery. So I am a PA that works alongside three breast surgeons and I don't partake in surgery though. So I strictly am outpatient.
00:03:46
Speaker
seeing patients with breast abnormalities or breast concerns, as well as preoperative and postoperative patients that the breast surgeons have been working with. Awesome. And how did you land this?
00:04:03
Speaker
especially in Washington's other side of the country. So I grew up in Connecticut, and I went to Sacred Heart University's PA program. And after I graduated, my fiance got a job in Seattle, so I knew I wanted to join him out there. And I applied for jobs online, actually. When I graduated PA school, I had a wide variety of interests.
00:04:32
Speaker
So I have actually applied to jobs in plastic surgery, dermatology, pediatrics, and this job in breast health and women's health, I should say. I applied to jobs in that field as well. So I found this job on the university. So I worked for the University of Washington and the Fred Hutchinson Cancer Center. So I found it through the Fred Hutchinson Cancer Center's website and I just applied online.
00:04:59
Speaker
Whoa, did you see any advertising where you wanted to work with that system and then you just found that? Yeah. I was interested in working in that system. I went on to the Fred Hutchinson Cancer Center's employment portal, basically, to see what type of PA jobs were out there. I applied to the ones that I was most interested in. Okay. That's really cool.
00:05:25
Speaker
You touched a little bit upon what you do. What do you usually do in a day?
A Day in the Life of a Breast Health PA
00:05:30
Speaker
How many patients do you see? Do you write a lot of notes? Is it stressful? Is it not stressful? Work-life balance, how does that look like? When I was up looking for a job, the work-life balance was at the top of my list. I really wanted to make sure I had a
00:05:48
Speaker
a job where I felt comfortable working every day, but also felt that I wasn't too stressed and I was able to step away from the job afterwards. So my day-to-day looks a little different every day, but I guess on average, I would say I see about 10 patients at the very average, and that's a combination of new patients, post-operative patients, and return patients.
00:06:16
Speaker
So a new patient visit would be an hour. And I see new patients in the sense of a breast abnormality. So if they have, for example, breast pain or a breast mass or any like nipple discharges and other goods, just any symptom you could think of that's related to the breast.
00:06:38
Speaker
I also see high risk patients. So women who have a family history of breast cancer and those patients definitely take up a full hour of time because there's a lot to talk about when it comes to calculating their risk for breast cancer, discussion about prevention and screening for breast cancer. Okay. Do you feel like it'd be nice to do the surgical part of it or you feel like it doesn't really affect what you do? Yeah.
00:07:06
Speaker
When I was onboarding this job, one of the reasons why I was really excited to take it is during the interview process, they explained there would be a long onboarding process that lasted about, I guess I would say two to three months. So that as a new graduate made me really excited because I knew that would give me plenty of time to dive in and fully understand what goes into treating this patient population.
00:07:32
Speaker
So as a part of my onboarding process, I did work in the operating room with the surgeons assisting and I saw patients alongside the surgeons as well as some of the PAs and nurse practitioners in the Fred Hutch. So
00:07:48
Speaker
I should mention as a side note, I work at the Northwest Hospital location, and there's also the main Fred Hutchinson Cancer Center, which is in the downtown area. So I'm about 15 minutes to 20 minutes north of downtown. So I am the only PA at this particular location with these three breast surgeons, but at the downtown location, they have a lot of different PAs and MPs and breast surgeons. So they're a larger group.
00:08:14
Speaker
and I'm more of a satellite location. So I was able to train with them at the downtown location. So I was able to work with some PAs and NPs and to the surgeons that work there. I also shadowed the medical oncologists, radiation oncologists, radiologists, so the doctors who are reading the mammograms and MRIs. And I also worked with the occupational therapists for patients post-operatively to see how we help our cancer patients with occupational therapy.
00:08:44
Speaker
I actually had a really great onboarding process where I met every single person that I could possibly be interacting with at this job. And that did include working in the operating room a little bit, but I knew going into job applications that I wasn't looking for a surgical position. So this piqued my interest because I could still work with surgical patients, but not in the operating room.
00:09:09
Speaker
Okay. That's a really interesting scene working with the whole workflow of where the patients end up and who they work with. That's really, really cool.
Teamwork in Breast Health and Patient Care
00:09:19
Speaker
Yeah. I would see a lot of breast cancer patients or patients who have a high suspicion of breast cancer or
00:09:25
Speaker
So we work as a really interdisciplinary team. We have weekly tumor board meetings where the breast surgeon and surgical oncology team, as well as radiation oncology, medical oncology, pathology, and radiology meet to discuss the new cancer diagnoses. So we talk about what our recommendations are for the treatment plan, and it allows all the different providers to bounce ideas off of each other.
00:09:54
Speaker
make sure that what we're offering this patient for their treatment plan is really agreed on by the whole group and makes the most sense. So it's really rewarding to sit in and be a part of those meetings because a lot of the times the patients are, I'm the first one who sees them because they had a breast mass. And so I ordered their diagnostic imaging and then they needed a biopsy. So I ordered the biopsy and then we found out that it's
00:10:20
Speaker
on the biopsy that this is a breast cancer. And so I sort of seamlessly transfer them from my care into the breast surgeon's care and get them set up.
00:10:30
Speaker
present to the interdisciplinary tumor board about the patient that I diagnosed, which is really cool. Okay. Okay. Good. That like really is a good transition over to your scope as a PA in this thing. Are you seeing your own patients? Are you treating your own patients? And only if they get to that cancer diagnosis, then you send them to the surgeons. Um, do you, are you always diagnosing or are you teeing up for the surgeons? So how does that work?
00:10:57
Speaker
I see the patients independently. If I notice something that's unusual and there's a surgeon in clinic, I might have them eyeball it for me. Typically, I'm seeing the patient on my own and then if they are in need of a surgery, then I help get them scheduled to have a separate appointment with a surgeon. I'm almost like the gatekeeper.
00:11:24
Speaker
Okay. That's really, actually really, really cool. How is the PA atmosphere or scope and everything in Washington? How's that working out in Washington? That's a good question. From my perspective, it seems that PAs are very well regarded. And at the Fred Hutch Cancer Center downtown, the PAs and nurse practitioners work together and are seen as equals.
00:11:53
Speaker
And I haven't experienced any bias, I should say, from my perspective, but I don't want to speak on behalf of the whole state. And you don't have any issues with billing or anything like that, like the patients have to see the physician first in order to get the major of the billing. And then how's that worked a little bit?
00:12:10
Speaker
I haven't experienced issues with billing. I have hit some roadblocks because we do have patients who travel from out of state. For example, Washington and specifically Seattle is sort of a hub for Alaska. We have a lot of patients who are from Alaska that are seeking care in Seattle.
00:12:28
Speaker
If you imagine you have something like breast cancer, you really want to make sure you're going to a top institution. And so we have quite a draw of patient population. So I have noticed that it can be difficult working with a patient out of state because I'm not licensed in Alaska, that can cause some roadblocks. So we try to keep the out of state patients specific to the surgeons and the MDs rather than for myself.
00:12:56
Speaker
Well, working in oncology and especially this very sensitive area, how does that affect your emotional and just everything?
Personal Motivation and Career Insights
00:13:08
Speaker
Because I'm assuming you're breaking news to patients and how does that work and how are you able to cope with that?
00:13:15
Speaker
Yeah, it's definitely a difficult field and it's a difficult position to be in. I haven't mentioned, but one of the reasons why I was specifically drawn to this position is that my mother was diagnosed with breast cancer when I was seven years old, so very young. She was pregnant at the time of diagnosis, which made treatment options very difficult, especially we're talking 20 years ago.
00:13:39
Speaker
And so she went through her breast cancer treatment and my baby brother was delivered healthy and she survived for an additional two years after that.
00:13:53
Speaker
She passed away when I was nine years old. So it was a difficult experience to go through so young, but it made me really interested in helping others, especially getting into the medical field. And so when I saw this job posting, it just was like a calling that I was just meant to do this. And it's difficult. I guess I would say that since I've been through some similar experiences that
00:14:23
Speaker
the patients are going through. I can empathize a little bit. And it's never going to be easy to talk to patients about breast cancer.
00:14:35
Speaker
or to tell them that they have breast cancer. But I do my best to be optimistic because we have so many great innovations in the field of breast oncology. You know, back in the day patients were just sent off to get a mastectomy and they just removed the whole breast. And nowadays there's a lot more options for patients as opposed, you know, for whether they'd like to have a lumpectomy or a mastectomy and, you know, empowering the patients to say that, you know, they can choose
00:15:04
Speaker
what works best for them. And my job is really just to be the support system. And I'm really the intermediary person until they get to their breast cancer team because we do have a nurse navigator who's fantastic. And so she tends to take over at that cancer diagnosis to help navigate the breast cancer treatment as a whole.
00:15:30
Speaker
But I do my best emotionally on my own side, I will say.
00:15:37
Speaker
Man, that's so crazy. I'm so sorry that happened to you and your mom and that makes you the perfect person for this job, I feel like. Yeah. Yeah. Do you feel like that's what, how do you let you land the job or was it something on your CV that really impressed them or you're just really good at interviewing? How did, how do you think that worked out? Yeah, I definitely, so I don't believe that that is necessarily what landed me the job because I did,
00:16:05
Speaker
you know, before I even disclosed that I got quite far along in the process. My CV was pretty, I guess, full of activities and honors and experiences that I've had. And so I feel that, you know, a lot of what I did during PA school probably did help get open the door for such a sought after position.
00:16:32
Speaker
And do you think that there is a lot of positions in this field or it's really just very nascent and like only at these really high end cancer institutions that you can find these jobs?
00:16:47
Speaker
I do think that this particular job is more niche and might be more difficult to find, but any place that has a breast surgeon is certainly worth reaching out to introduce yourself and say that you're interested in supporting them.
00:17:04
Speaker
in the outpatient setting because that's basically what I'm doing is I just work alongside a breast surgeon. So I suppose anywhere else in the country that has a breast surgeon that's open to expanding their practice could certainly be an opportunity. But I would say in the majority of the country, I think most patients with breast complaints will see an OB-GYN or they are breastfeeding a lactation consultant. But, you know,
00:17:32
Speaker
counseling patients on high risk breast cancer care is a little bit niche and important. So I think there's a lot of opportunity out there, but you're right that this particular job probably wouldn't have been posted anywhere in the country. It does make sense that it was posted at the Fred Hutchinson Cancer Center specifically.
00:17:57
Speaker
Yeah, that's, that's really cool. And it relates us to, as I work in ortho outpatient. And then I'm working in surgery as well as PA is really rule. The outpatient setting, like the residents, they're mostly in the hospital and they're, because they're seeing so many patients and so many complex patients, but as PAs, we really take charge of helping surgeons and other physicians. If they have a larger practice that needs PAs.
00:18:25
Speaker
to really help manage patients and things like that. So that would be interesting to look at the surgeons and if they have a large enough practice, if they are needing a PA. Absolutely.
Supporting Surgeons and Career Benefits
00:18:38
Speaker
Yeah, it really helps keep the surgeons in the operating room. If you've ever worked with a surgeon, you know that that's their favorite place to be.
00:18:47
Speaker
very enticing if someone knocks on your door and says, hey, you know, if you let me take on those return visits who maybe are a year out from surgery, you might not necessarily have a lot to be reviewing with them. You can spend some extra time in the operating room or if you have cases that might not necessarily be ready for surgery,
00:19:07
Speaker
But they're just getting referred to you. I can sort of see them first and make sure that they really are interested in surgery or if close observation is an option. There are certain breast conditions that you don't necessarily have to go straight into surgery. You can sort of monitor them. So that's also an opportunity. That's really cool.
00:19:30
Speaker
I know this is probably really niche and very, probably not very helpful to know like your starting salary, but do you know when an average, a good average starting salary for PA and outpatient stuff in Washington is?
00:19:45
Speaker
I don't know off the top of my head. I don't mind disclosing myself. Personally, my starting salary was 115 and I had a $5,000 moving bonus, which I thought was helpful because I was going to be moving across the country. That made me feel like, okay, that first year I'm more closer to 120.
00:20:11
Speaker
Okay. And are you contracted or at will? It's an annual contract. I work technically under the University of Washington, so I'm also considered to be a faculty member. So they review that annually as they do without any faculty position. Okay. What was I going to ask?
00:20:38
Speaker
Yeah, so is it hard? Was 115 you feel like fair for Seattle? Because are you pretty much in Seattle? Yes, I am in Seattle. I suppose I probably could have gotten higher if I really pushed them. But this was a job that I was so excited for that I, you know, for them to even offer a moving bonus, I just felt that that was a great opportunity that I couldn't say no to.
00:21:05
Speaker
We negotiated a little bit, but in the end I just sort of was so excited. I couldn't say no.
00:21:12
Speaker
That's really, that's really, really cool. My brother actually moved there by using different industry, but he really likes it. Seattle's very futuristic, he said, and very much his speed, but that's, that's really cool. I'm from Spokane, Washington. So it's a completely different world over there. But you're familiar with Washington. Yes. Yes. That's, that's really fun. Um, so why did you want to become PA? Well, probably your mom having to have this, you know, this cancer might have helped.
00:21:41
Speaker
Were you exposed to PAs during that time or was it after? My uncle exposed me. He was a PA. He did emergency medicine. When I was talking with my father, it's his twin brother, I told my dad that I really didn't want to go to medical school, but I wanted to do something in the medical profession.
00:22:02
Speaker
And my dad said, you know, I don't know, I understand you don't want to go to medical school, but maybe PA would be something you would be interested in. And after talking with him, I also shadowed a PA that worked in a pediatric emergency room. And I just tried to expose myself to as many people that worked as PAs. And that's what really made me excited.
00:22:25
Speaker
want to start applying. So I guess I would say I decided I wanted to go to PA school. My sophomore year of college, I would say that's, you know, summer of freshman year, I was that deciding period and then sophomore year, I really went for it. And before that, I just always knew I wanted to work in medicine in some way. Okay. Do you know specifically why you didn't want to go to medical school or just like,
00:22:54
Speaker
don't want to go through all that craziness. Yeah, so I, of course, was not really interested in how long medical school would be, four years plus a residency, possible fellowship. It just seemed like a bit too much, too soon, because even at that time, I just wasn't
00:23:16
Speaker
I felt that the friends that I knew who were going to medical school really wanted to go to medical school, and they wanted to be a doctor, and they knew that in their heart and were excited about it, and I just didn't feel the same way. And I wanted some more flexibility. I knew that it would be very difficult to pick a specialty. As I mentioned, I applied to multiple different specialties after graduating PA school, so that was something I was really intrigued by with PA school is the opportunity to work in more than one area.
00:23:44
Speaker
across your career and I really was interested in a more collaborative kind of job. I was worried that as you know an attending physician you're the number one dog so to say and you have to have all the answers and that was intimidating to me and I just really liked the idea of working among other people rather than in charge of other people to make it more of a collaborative team effort
00:24:10
Speaker
to come up with treatment plans and bounce ideas off of each other and it seemed that a PA was a better fit for me. Do you feel like now in practice you wish you would have pursued that more or are you really quite happy with your role in the healthcare? Yeah, I'm very happy with my role. I'm very happy that I decided to be a PA.
00:24:33
Speaker
I feel that the physicians and the nurse practitioners and the other PAs that I work with do really respect me and we work well together. I also work a little bit with some of the residents that are doing their residency with the breast surgeons. And sometimes I see them, I say, oh gosh, I'm so glad I'm not a resident. So that sort of, that helps too.
Work-Life Balance and Job Satisfaction
00:25:01
Speaker
But I really, I think being a PA is great.
00:25:04
Speaker
And how is your work life balance like? Do you work 40? Do you have any on call or any responsibilities? Good question. I do not have on call and I work four days a week for a 40, so 10, four hour shifts. I'm sorry, 10 hour shifts, four days a week.
00:25:22
Speaker
Do you get weekends, holidays? No weekends, but I do not have to work holidays. Since it's an outpatient clinic, the clinic will close for holidays, so any federal holiday.
00:25:38
Speaker
Yeah, that's, it's a pretty great, it's a pretty great gig. Well, yeah. Like working outpatient at first, I was only an inpatient ortho and I was like, this is my jam. We're just doing surgeries. This is fun. But then being in the outpatient, like having weekends and holidays, this is so worth it. And I have four tens too. And that's really nice. Having an extra day off is really nice. So yeah.
00:26:00
Speaker
definitely it's very underestimated. And having a career too, like I'm salary, so I don't have to worry about my hours as much. I can take time off and my PTO is amazing. So PA life is actually pretty good. It's great. It really is, you know, and your responsibility is to your patients and writing their notes and making sure you get your work done. Like you mentioned, you don't have to worry about
00:26:24
Speaker
hourly work. So if you're good at your job, sometimes you have a little extra time to spend that lunch or doing something else. And talking about like the attending aspect, like I see that just in an outpatient surgery, you probably won't get this as a hospitalist or a inpatient general surgeon or anything where you don't really have to worry about who your patients are, but they're so focused on running their own little business
00:26:53
Speaker
of establishing patients and making sure they come back and making sure they're happy. And also the surgeries themselves, it is stressful. And I am so glad that I'm able to work and be done with work when I'm done with work. I don't have to take home work with me. I don't have to constantly worry about patients, if they're post-op or whatever. So that is a very strong draw to being a PA for myself.
00:27:22
Speaker
Yes, the pay is probably a third, depending on the specialty, you know, a half to a third of a of a physician or attending. But really, I feel like for the time spent and the stress of the job, it's it's really worthwhile, in my opinion.
00:27:42
Speaker
I completely agree. Yeah. So if you're worried about the pay, it's actually better than you might think. I mean, I think some states, like I come from Utah, I moved from Utah to PA school and I had a buddy or the buddy that started at 85, I think, which is like pretty low. Yeah. But it's a little bit lower cost of living, but
00:28:04
Speaker
They're getting up to like six figures and especially on the east coast and stuff like that. High six, like high 100,000, like 180, 190, probably even 200 if you're really experienced. So there is quite a pay difference. So if people are worried about that with experience, you get better. Right. You do.
00:28:27
Speaker
So at your job, do you worry about notes at all?
Career Journey and Advice for Aspiring PAs
00:28:31
Speaker
I guess you see 10 patients, is that pretty doable or are you scrambling like an urgent care or emergency room at all? Yeah, definitely not scrambling. I feel that I'm able to prep pretty well. So I do chart prep before every day. If I have enough time, I'll chart prep for the week if I can.
00:28:54
Speaker
That gives me a lot of opportunity to spend even more time with the patients because they don't have to worry about spending extra time on my note because most of it is already prepared. But it's definitely doable. I don't feel like I'm scrambling. I feel that I'm able to put together a pretty good note with the information that the patient provided me and my own treatment plan. I think it's definitely doable. Awesome. That's really cool.
00:29:25
Speaker
Okay. Um, so how was after peace school? Did you move right away to Washington? I guess with your fiance or were you still in kinetic for a while? Did you take the pants here or did you move out of state to take the pants?
00:29:40
Speaker
So I stayed in Connecticut until I had taken the pants and passed and then I was ready to go. I moved to be with my fiance who was in Texas at that time. So we were together in Texas for about two to three months while I was applying for jobs in Seattle. We had planned our move for March. So I got actually, the job application process did take a couple of months. It wasn't, you know,
00:30:09
Speaker
I didn't apply until after I passed my pants. I just didn't feel quite ready to apply earlier and I knew I'd have some extra time between when I was in Connecticut and when I was in Seattle, so I figured
00:30:21
Speaker
I wanted to wait until I had passed, and that would make me a much more intriguing candidate, I suppose, to say that I passed my pants, I have my Washington license. I'm definitely gonna be there, especially when you're applying out of state. I guess that can help. I'm not 100%, but I thought it could help. So I did take a couple months off before I started my job. I moved to Seattle in March, and then I started my job the June 1st.
00:30:49
Speaker
So I definitely, I had basically six months from when I passed my pants to when I started my job, which was nice because I do think everyone deserves a break after BA school.
00:30:59
Speaker
Oh yeah. And I think I was talking to one of my fellow cohort, Stephanie, she said, yeah, I took a couple of weeks off and then I really wanted to work. And she got a job in like February after graduating December. But she was an outpatient. I applied before I passed the pants. And then I took the pants a little later, but I got a job accepted in like January.
00:31:21
Speaker
then start until May, like mid-May, but it was great. I had a baby as perfect amount of time and was able to relax finally after gay school and then starting working, which is, it's nice to finally get paid for doing stuff.
00:31:39
Speaker
Yeah, it is. I guess I would say it's important to know that some of the places that you apply to might have a long onboarding process. I accepted the job, I guess it was the first week in March basically, and I didn't start until the first week in June. That wasn't because I wanted to wait until June, it was really just for them to cross their T's and dot their I's and make sure everything is organized for you to start.
00:32:07
Speaker
Because it's an academic institution, I'm not sure. I think that has to do a little bit with it. This is big bureaucracy. It is. Awesome. Any last words of wisdom? Anything pre-PA's want you want pre-PA's to know or PA students or new grads?
00:32:28
Speaker
I guess I would say hang in there and don't give up. If you're a pre-PA, don't worry if you have to apply again to PA school. It's completely normal. I'm sure you know that we have students in our cohorts that have applied more than once and that's okay. And to PA students, stick it out. You got it. There's really hard moments, but once you make it, it just all feels so worth it.
00:32:56
Speaker
you know, apply to more than one job in different areas if you have different interests. I think that one of the things I really enjoyed was I did interview more than one specialty, more than one location, and that interview makes such a difference for you to understand what type of job you're getting into, what the onboarding process is like, whether you would really fit in there. Because as I said before, being a PA is about being a team player and having a great
00:33:24
Speaker
group of other practitioners with you. So you want to be a part of the best team that fits for you. So stick it out. It's not easy, but once you make it, it's incredible. And I feel so grateful to all the other professors and friends and family who supported me to get me to where I am today.
00:33:48
Speaker
Awesome. That is a great advice. Stick it out because it's worth it. It's one of the reasons why PA school is so nice. It's only at 27 months for most programs and then you're out and it's great. You know, life is actually pretty great where it's not this high stress, like have to pass these things, all these high stakes exams. So there is some great life ahead of you. You just have to get through the struggle. But I think the struggle really makes you appreciate
00:34:18
Speaker
life after and also helps you become the person you need to become to find the job you want and do well at that. And you do use the things that you learn in PA school. I know that sometimes you're looking at it and you're like, I'm never going to need to know this. It'll come up.
00:34:38
Speaker
that is very true like even if it's little things you do tend to like oh yeah I remember that in PA school or that or or at least on rotations at least yeah rotations help a lot with knowing things you've messed up on or forgotten and you were reminded of so well thanks so much for coming on Hailey I hope you have a great rest of the day and your career