#when i lived in england and attended a base school for military brats you also got pulled out of class for the gifted program bc there

[myapathyhaspeaked]

hey if there’s any first graders on here and you’re thinking about being disabled i highly recommend looking into the mild speech impediment guild. you get to skip class one to two times a week, and your teacher has to mark whatever assignment you were doing as complete or else it ✨violates the ada or whatever is in charge of iep’s idrk✨. and then you spend like an hour or thirty minutes idk i was 6-11 i had and still have no sense of time playing board games with several of your classmates, all for the low low price only your family being able to understand you and having to be real careful about any sentence that uses r, w, and l in quick succession (the first phrase of ballad of jane doe is like a qte for my mouth) because if you fuck up you will sound like a toddler and the group will stop to laugh because you said tliwight.

[globalpa]

Being a PA Abroad: The Reality

Moving Back

My time in the UK is again coming to an end. This is the fourth time my wife and I are buying one way tickets to move from the UK to the US. I am happy for the change, as I get wanderlust -- the kind of guy that jiggles my legs in the theatre after half an hour, or catch a glimpse of greener grass over yonder.  All my life, even as a military brat travelling every year, I have been on the move. Will I be living my whole life this way?      

The constant traveler: It's definitely not a jet-set lifestyle and the work isn't always exactly what you want it to be. When I was younger it was easy to find a temping office job or barista gig upon moving to a new place. But when you're older, with family and career, a little more preparation and less spontaneity is needed to make it work. 

    Financially, moving to and working abroad is challenging. Sacrifices have to be made.  You either keep selling everything, or keep most things in storage. Renting is a sink-hole. Living in London in 2016-2017 has been the most expensive place to date in my life. I am moving back to the Florida temporarily in November, until I start my new position (A new job as a PA abroad! I will talk about that below). We need to save money, repay daunting debts and student loans, living on relatives couches and spare rooms. No eating out or Disney World visits for us. This is the glamour you don't often hear about with people who live on the road. But for me, I'll take the novel life experiences over the material possessions any day. Concerning being a PA in England

First off, let me reiterate that my opinion is my own, biased as it may be, based on my personal experiences here working as a PA in the UK. It is not the same for everyone. Many PAs are doing great things, have satisfying jobs, and have a supportive atmosphere. Even though the NHS is this humongous entity (the 5th most employees for an organisation the world, right after McDonald's -- https://en.wikipedia.org/wiki/List_of_largest_employers), every hospital and trust is different.      

I wanted to share my thoughts post-national PA conference (https://www.rcplondon.ac.uk/events/faculty-physician-associates-second-national-cpd-conference). I can't help but to feel overwhelming disappointment, for several reasons. Not just about course offerings, but it felt like it did last year, except last year's conference was the first one at the Royal College of Physicians, and seeing all of us UK PAs together felt so novel, and it felt like there was so much planned in the next year regarding growth of the profession. They did expand from 15 to 30 programmes in the UK, and from 200 to 600 PAs, with projected 3500 PAs in the work force by 2020.     However, it felt the same in that the Physician Associate profession is still not regulated by parliament, therefore we still cannot prescribe, order ionising radiation, and thus still held with some scepticism from work colleagues unfamiliar with the role, and the press. I keep finding negative articles like this one from the Daily Mail that paint us in a negative light (http://www.dailymail.co.uk/health/article-4896782/Britain-begging-qualified-doctors-staff.html). Any press is good press?     I was looking forward to hearing about what developments have been accomplished by the Faculty of Physician Associates regarding the regulation issue, which to me seems the number one priority for this profession to flourish here. Alas, the only update is that Brexit pushed our agenda further down the queue, and it is a 2 year process minimum from when this starts and when regulation happens. I fear a large bottleneck for PAs in the future. All these newly minted PAs with nowhere for them to go, no one convinced to hire them, and them not able to practise to their full scope of practise. I left with a sense of disappointment that even after my time here, so much is the same. But there are other strides made. I just hope that when I look to these shores in 5 years, things will be different. I hope to see more UK PAs in general practice rather than hospital based medicine, as is the trend currently now.      

My own personal experience working as a PA in England has also been lacklustre. Let's not mince words: I don't like my job. I didn't move here for a boost in salary or for the clinical work. But that's not to say I haven't learned loads from it. I realised that Family Medicine is the place for me, and that makes me happy. I did refresh so much about acute hospital medicine. I learned how the NHS works from the inside perspective. However, my insight is limited because I only worked at one trust of hundreds, and mine is not the best one, well at least according to this red-top paper (http://www.mirror.co.uk/news/uk-news/ae-crisis-exposed-only-three-9801509). In fact, the 8 US PAs based in London through the NPAEP are at the worst 2 hospitals in the UK (based on A&E wait times). Working at a bad place for a good purpose is my solace: expanding recognition for PAs, helping the local PA training programmes, attending conferences, writing papers and learning more about clinical leadership. It will always boggle my mind about the inefficiencies of the system, and shear stress and struggle young doctors go through, the turnover of the senior staff, and that there seems to be no long term plans here (in NW London trusts) for PAs as there is in other trusts like Leeds. Hospitals here are reacting to the present, putting out fires now rather than planning for the future. I feel like just another warm body to fill the rota, and further demeaning that I cannot sign my own prescriptions.      

In neuro-rehabilitation medicine, I have learned loads about Neurology, and from what therapists do (physiotherapy, occupational, speech and language, psychology, environmental control technology). But it is a far cry from what I originally wanted to accomplish here. I originally signed up for a position in General Practice, but due to issues with getting my work visa approved, I was instead sponsored by the Hillingdon Hospital, and assigned to the neuro-rehab ward. It's one of our strengths as PAs to be flexible with our clinical practice. but it sure made me realise where my heart truly lies. I am happy that I am continuing my career in Family Medicine in the future... 

My Next Adventures

Firstly, I am looking forward to escaping another bleak, bone-achingly cold English winter, and spending it with dearly missed family in sunny Florida. As I said, we are living on the cheap, saving money, living with family, getting back on our feet for a few months until my next position starts. I hope to work locum PA jobs in family practice, urgent care, or emergency medicine for a bit.      

In 2018, I am proud to say that I will be starting a job I have been dreaming about since I first read about it in PA school in 2009. I will be a Medical Practitioner with the Foreign Service of the US State Department. This will involve me travelling around the world to different embassies throughout my career, on short 2-3 year assignments, to countries with various degrees of resources. I am thrilled to be able to continue to work abroad, but via my own country's scope of PA practise. I am pleased to be back into primary care again, greasing the wheels of diplomacy by serving the embassy staff and their families. I will have a job that seems tailor made for my eagerness to travel to all sorts of locations, and to do so frequently. Also, my family are also able to join me as well!     

When the time comes in 2018 when I am ready to join, and they are ready to have me, we will move to Washington DC for a group orientation and for preparation for my move abroad. My intention is to continue blogging about experiences being a global PA in this capacity.      

I was talking to my son Caspian as we stood in the queue at the petrol station. A sign said the jackpot for the lottery was 9.8 million pounds. I asked him what he would buy, and he said 100 footballs, and 10 football goals! I thought about it too, as one does. I was so happy to realise that even if I won it all, I would still like take this position with the Foreign Service.      

I am so looking forward to the many great, and not so great, new adventures to come. Again, the traveling life is not easy, and not glamorous, but I find it fulfilling, and introducing my family to different cultures, experiences, and ways of life is a wonderful gift I can share with them. 

...Life is But a Dream.