What really pisses me off when people are like. No child should be friends with an adult; it’s (insert word/phrase that has been misused so much it’s kinda ceased to have meaning to me anymore) is… My older friends? Even though I’m 28 and yknow. An Adult. Have literally saved my life. Like not only do they have more knowledge about how things work (like Medicaid and food stamps and student loans and resumes and and and all the other shit nobody bothers to teach you and can be hella confusing/nearly inaccessible unless you Know but is hella important/can really fuck up your life if you’re not careful) and like…more experience so when they tell you “it’s gonna be hard, but you can handle it” or “I know it looks scary, but it’s not that bad and I promise you’ll get through it” or “it doesn’t matter if don’t graduate college, look at me. I didn’t. I’ve got a stable, well paying job. It’s not impossible to be comfortable without a college degree. And look at (other friend who is sitting right next to them), they worked their ass off for a double degree and currently not using it! You’ll be okay, you’ll figure it out.” your brain can actually believe them cuz yknow. They’ve been where you are. They have that life experience. And they’re not gonna lie to you because they love you and respect you too much to do that.

Like I don’t want to make it sound like friendship is a commodity, but older friends and intergenerational friendships can be so extremely valuable, especially to vulnerable younger people in abusive households. And I don’t even mean like in that they can offer you a place to crash cuz not every friend is gonna be able to do that and that’s OKAY. But maybe they can still help you in other ways. Even if it’s “just” holding your hand and validating your fears while you cry your eyes out but reassuring you that they believe in your ability to work through it. They believe in *you*. (And yes, I REALLY appreciate the same sentiment from friends my age and it’s also extremely helpful and I love them so very much. But it just sorta hits in a different way coming from an older friend. Not in a way that’s better or worse. Just different.)

Also something something seeing that you have a future when you can’t see past the next year or six months is just. So fucking reassuring.

Also. Older friends are just plain fun. I love my older friends and my life would be so much poorer without them. So yknow. Fuck people that condemn intergenerational friendships.

Also also something something something ‘fuck you for making me feel terrible/paranoid about wanting to offer my own experience to those younger than me. To help them in any way I can. As another fantastic and dearly beloved friend says. “If you start sounding like my mental illness, YOU are the problem and maybe need to re-evaluate some things.”’

What it Takes to Be a Physician Assistant

Reflection

In the article, “7 Powerful Questions to Find Out What You Want to Do With Your Life,” I was made to think about the future I want by answering the seven questions presented to me. My goal is to be a mental health physician assistant, which will require a lot of hard work and sacrifice, but it will bring much happiness. I am extremely passionate about helping people, making them feel better, and changing their outlook on life. This job would allow me to help people every day, I would be able to make their mental state better, which would lead to a happier and better quality of life for my patients while helping me feel like I made a change in someone's life for the better. This job comes with so many more benefits from financial to mental health benefits from helping others.

This job would give me financial independence to succeed in my life goals and maintain the lifestyle I prefer to have. Physician assistants make a decent salary which would allow me to pay off my student loan debt in a timely manner and then continue on to build the life that I see for myself. The salary would allow me to have the future I see for myself that includes a small cottage and forested land, and I would also be able to maintain my slightly more high maintenance lifestyle. 

I would have the ability to travel somewhat with vacation time and the ability to move around with my job as long as I can get licensing in the states I choose to practice in. The ability to travel would allow me to fulfill my dreams of vacationing often in the Caribbean with my family and friends. Also, I could move around with my job which would be ideal as I would like to live in the pacific northwest as well as many other places around the United States, but this job also would require a lot of work input to get to the point where I have free time and financial independence.

Physician assistant jobs require quite a bit of schooling including undergraduate school followed by physician assistant school and then perhaps a residency if you are specializing, so it will require quite a bit of hard work and mental fervor. I am a very hard-working individual which I attribute to all the strong, hard-working, female figures in my life. Women like my mother, grandmother, and great-grandmother all showed me just how powerful women can be especially when it comes to working and supporting yourself and your family. Overall they taught me how to succeed and work hard for what I want in life. In order to find more information on this job, I consulted the Occupational Outlook Handbook.

Occupational Outlook Handbook

According to the “Physician Assistants,” article in the Occupational Outlook Handbook, the job outlook of physician assistants is very high as is the median pay and the education required is only a master's degree. This is a good field to get into as the pay and projected growth of the field is extremely high considering the rather short schooling time. 

Physician assistants have many duties that require practicing medicine with other healthcare professionals. They specifically examine, diagnose, treat, and educate patients as well as research treatments and assess patient progress. Since physician assistants work alongside other healthcare workers like surgeons and physicians, their duties differ state to state and institution to institution depending on what the supervising attendant physician allows them to do as well as the state. Physician assistants can work as primary care physicians especially in rural areas with a lack of physicians, or they can work in specialties like emergency medicine, surgery, and mental health. They also can work with different ages of patients.

The work schedule of physician assistants varies greatly, however, across all environments they are often on their feet and making rounds constantly. They also work 40 or more hours a week and they can work nights, weekends, holidays, or be on call.

In order to become a physician assistant, it requires between two and four years of undergraduate school and two years or more of physician assistant school. Also, students can advance by gaining more clinical knowledge in postgraduate programs for specialties. Many students work in related occupations while studying and they need to be licensed by passing the Physician Assistant National Certifying Examination. They take the recertification exam every 10 years as well. They must be proficient in communication, compassion, and problem-solving.

Physician assistants make $108,610 median pay with many earning more than that but none earning less than $69,000. The projected growth of the job outlook is 31% between 2018 and 2028. This is significantly higher than most other professions due to the fact that there is a high demand for healthcare providers for the aging population. Also, the pacific northwest and northeast have high employment rates for physician assistants due to the accumulation of grey state statuses.

 Although the statistics and data on projected job growth, salary, and other data are important, it is also important to understand what someone in the field actually experiences. In order to get more information about what the job actually entails I contacted Michele Dugan, a retired psychologist.

The Interview

Have you ever been gripped by the feeling that you could do more or that you could be more? This is a common feeling of many people who are in the field of helping others, much like Michele Dugan who saw all the good she did as a social worker and strived to do more by becoming a psychologist. Dugan was married and had children already when she decided to go back to school to study clinical counseling at Kutztown University in order to pursue her newfound higher purpose. Much like Dugan, I feel the call to help people on a more person-to-person, objective, and psychological basis. I always felt a pull towards the realm of medicine, however, I never really considered psychiatric medicine until I started working on an acute care behavioral health unit. Through working with my patients and coworkers I noticed that I truly enjoy the environment and in life, I want to pursue something that allows me to help those who are psychologically ill.

During our conversation, Dugan began by telling me about her life, the paths she took, and what led her to the very position she is in today as an accomplished, retired psychologist. Dugan moved to Kutztown in 1977 from New Jersey with her husband and children. At this point, Dugan already had secured a bachelors degree at Rowan University and had worked as a social worker. Once Dugan got her degree in counseling psychology she started to gather specialties, in fact, in 1995 she went to San Diego and got certified in clinical hypnosis. She said with much excitement, “Clinical Hypnosis sets me apart from other psychologists. That would be my biggest piece of advice to you. Find something you are passionate about and find ways to make your treatment different and special to broaden your specialty.”

In Dugan’s time as a social worker, she worked with many different types of people and she was able to explain to me what personality characteristics were most important as well as what she struggled with. Dugan recalled about being a social worker, “It is hard to know that you are sending home a parent who may abuse their child again or a child who may kill themselves. You have no control over what they do when they leave, and they are in severely bad situations.” She then went on to tell me that she turned to psychology for that very reason, she worked with more minor mental illness and relationship issues. Dugan explained to me that in order to be successful in this particular field it is beneficial to be understanding, compassionate and empathetic. She went onto describe that even with all of those traits there are a few cases that you know in your own heart that you could not handle whether the patient is a child molester, rapist, or anything that you do not feel you can handle. This is the point where I really started to connect with her story as I currently work on an adult behavioral health unit and nearly everyday I meet someone who has done acts that I cannot even begin to describe, but even so I hold enough understanding and empathy in my heart to give them proper treatment and respect. Although, hearing her own struggle with this particular issue allowed me to see that I am not alone in this feeling of could I really manage to set my own beliefs aside.

Dugan is now retired but she still holds onto the lessons she learned and manages to keep up with the issues of being a psychologist in the United States. One of the biggest issues she recognizes in the news is the lack of coverage for mental health by insurance policies. She explained to me that it is extremely difficult to turn down a patient just because they do not have the required insurance, which is why she went private practice so that patients could pay out of pocket if they had the means. I never really thought about the insurance side of seeking mental health treatment, which is why I appreciated the chance to talk to Dugan, a private practice psychologist.  She also recognized the lack of long term health care for psychiatric patients as well as the lack of mental health care in general especially in college towns like Kutztown. This led her to focus on patients that were not receiving proper mental health services at the university as well as providing outpatient services for patients who showed a desire to get better. I really enjoyed seeing this as she was drawing on her own strengths, I would also like to focus on patients who actually want to get better as it makes treatment easier. I also would like to work with patients long term to see how they improve and just be able to feel good about what I have done. 

Dugan has shown me what it truly means to work in the field of psychology. Even Though, we only met one day for roughly an hour she really opened my eyes to the difference between being a private practice psychologist and a mental health physician assistant. She encouraged me to really focus on developing my level of understanding and empathy as well as continue expanding my horizons by learning specialties like hypnosis that could be beneficial in the field and would set me apart from others. Hearing about how she acted based on emotion and her need to do more reminded me to never give up and to continue working towards what I feel I need to do for others and for myself. Even though the path of mental health is very difficult and many people do not understand your choice to get involved, I know that this is where my mind and heart are leading me. I have a strong desire to help people secure a better state of mental health and I know that this is the area of medicine that calls to me. I feel that everyone feels a pull to some sort of purpose or calling, all that you have to do is become in tune with your own desires, be brave enough to see your desires, and listen to your desires. 

Current Event

The Marshall Project, a nonpartisan news organization that specializes in news about the U.S. criminal justice system published an article written by Christie Thompson and Taylor Eldridge, “Treatment Denied: The Mental Health Crisis in Federal Prisons,” in 2018 regarding the lack of mental health programs in the United State and the effect it has had on the prison system and it’s intake of psychiatrically compromised inmates.

According to the article, the Federal Bureau of Prisons instituted a new policy that would get mentally ill inmates better psychiatric care while in prison. However, data directly from the prison garnered by a Freedom of Information Act request showed that the prisons were determining that mentally ill prisoners had no true psychiatric problems even with data showing that they have had psychiatric issues in the past. Essentially, this shows that they are decreasing their number of patients in prison that require psychiatric care and increasing care for very few prisoners rather than providing psychiatric care for the larger majority of prisoners that have had psychiatric problems in the past. 

The bureau is not only neglecting inmates who have severe mental illnesses by disregarding their existence, but they also are not providing the resources or incentives to employees to actually care for the mentally ill inmates. They increased the workload of many mental health employees in the prison system but they did not increase the number of employees which leads to overworked employees who feel they are undervalued. Prisoners are often neglected and left with not enough mental health care leading to prison violence and overall destruction of the prisoner's mental state. 

This article relates to my career path because these people in the prison system are mentally ill and are not receiving proper care, and the job I intend to have would have me working with these patients. Long term psychiatric care is something that is very lacking in the United States specifically because the funding has been cut to a lot of long term psychiatric hospitals because it is an easy way for the state prisons to save money. However, what they do not see is how much they actually are spending to make up for the lack of care. These people who belong in long term care end up causing public nuisances and then end up in either prison or acute rehabilitation and end up costing the same amount it would have cost them to be in a long term care unit, and they still do not have access to proper psychiatric care in the prison. The mentally ill in prison are often there for minor crimes like robbery or just being a public nuisance but instead of being released with a care plan they are often released with a few more doses of their antipsychotics and no plan. This directly relates to me because I will most definitely have to deal with these patients once I actually get into the field as they typically have nowhere to go. This can be worrisome as some of the mentally ill inmates are actually in prison for harsh offenses like murder and rape, and the likelihood of me having to deal with these patients is rather high as they are often given lenient sentences due to insanity. They then would eventually end up in my care. 

This article showed me that even though prisons are claiming that they are advancing the psychiatric care specialties, they are in fact doing so but then cutting care off of patients that need it because they do not have proper resources to staff this new demand. It can be hard to find the staff to work in a high-stress environment like a prison with psychiatric patients, but with enough education and proper training, I feel that it is a field that could really take off and provide a lot of job opportunities. Although the prisons are trying to advance themselves to better care for these patients they should not have to because there should be long term psychiatric care units outside of prison care for the inmates in there for petty crimes. I still want to learn what could be done to increase the amount of long term psychiatric care units or if they could find money in the federal or state budget to support more long term psychiatric units. Overall, I feel this article really connected to me because it showed me that I really will need to be the voice for my patients no matter who they are, and I will have to fight for them to have a proper care plan. After all that is what it means to be a health care worker, you work hard to care for your patient's success and you do not give up on them.