MTP Podcast Episode 1: LAUNCH
YAY! We are launching our first episode at the CAPA conference 2017. In this episode we, Rachael and Rebecca, describe our experiences as physician assistants in Ontario since its inception in 2010.
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MTP Podcast Episode 1: LAUNCH
Released: September 26, 2017
Length: 36 minutes
Legend: Rebecca Mueller (Becky)=B, Rachael Thompson=R
~MUSIC INTRO~
B: Welcome to Meet the PAs podcast. Here the experiences of seasoned PAs, up and coming development of policy from industry leaders, and the exploration of those new to the career. Interviews done with a Canadian twist and maple syrup
~MUSIC INTRO CONTINUES~
B: Welcome to Meet the PAs podcast. Here the experiences of seasoned PAs, up and coming development of policy from industry leaders, and the exploration of those new to the career. Interviews done with a Canadian twist and maple syrup
R: Welcome to the first Meet the PAs podcast!
B: Yay, we’re really excited to have you guys here and we’re so glad you’ve tuned in to listen to us. This first podcast is just going to be an introduction to who Rachael and I are, and our history as PAs and what brought us here today to the podcast so far, so that's how were going to run this one.
R: Yeah so, I’m Rachael, I’m a Canadian-trained PA, I was in the inaugural class of McMaster’s 2010 program, 2008 started, graduated in 2010 and I work in a semi rural small 10-bed hospital in MidWestern Ontario.
R: So how did I get to be a PA? Well I did my undergrad in science, and I knew I wanted to do something in healthcare and I knew about the PA program in the states and it sounded perfect, but, there wasn't really an option here for that. So after my undergrad, I actually took a year off and worked as a pastry chef. I took a year off and backpacked around Europe with my best friend and then I was a pastry chef for a year, and I was just trying to decide what I wanted to do.
B: So that is completely different, pastry chef to medicine!
R: I always knew I wanted to be in medicine but i loved to cook, and it was a place that I knew people and was friends with some of the people who worked there and it actually was an amazing experience and some of the people I worked with have turned into my best friends in the entire world.
R: I’m so glad I did it for two reasons: one because I made really good friends and learnt how to cook all fancy things and got to just really have fun for the year and the second reason being it was that year that the PA program came to Canada, so I was extraordinarily lucky.
R: One of my relatives works at one of the Universities in Ontario and said ‘Hey this PA program is opening up in Canada, you should apply’, and so I did and I was super nervous, because I knew they were only taking 20 some odd students, and I was taking an additional physiology course that summer just to make sure that I had the background in case I got in or if I was applying to med school or nursing school or whatever I was doing; I wanted an extra physiology course. I was working my butt off, taking this physiology course and applying to the program and interviewing for the program, and I was really lucky to be selected and enter the program at McMaster. That's sort of how I became a PA.
R: How did you become a PA Becky?
B: I’m from the States, so it's a completely different dynamic. I knew from a very young age that I wanted to work in medicine. So, I didn't know exactly if I wanted PA or Nurse Practitioner or Physician, what that might look like, but I knew I wanted to be in the medical field. When I was in High School, there was a program for students who were doing well in the school, that the State of Minnesota would pay for you to go to take college courses and they would also count at the same time for your high school classes so I actually went to college in High School and I got my 2-year nursing degree. So, I started working at a nursing home and subsequently at an internal medicine clinic at the age of 16.
B: So, I’ve been in medicine for a really long time and it was great because I had a way to pay, a little bit anyway, sort of helped me pay my way through University and PA school, as well. So, I then went to University already starting with a medical background and I started exploring my options and I knew pretty early on that I didn’t want the physician route; it seemed like constant work and you never had someone to go to if you didn't know something. I liked the idea of having somebody around when I didn't know the answer, it felt a little more secure for me, plus the job outlook for PAs, in the States anyway, was huge, and we're working on it here, it's improving.
B: I chose not to go the Nurse Practitioner route, and you might have thought I would because I started in the Nursing side, but I really liked the science background side of it, of the PA degree, so I wanted to go that route for that reason; just a little more in depth on the science side and also because I didn't have to dedicate to one speciality. Nurse Practitioners, from the little bit that I know anyways, they're definitely more solidified in the area that they studied in, but PAs can move around. So I liked the broad spectrum PAs can go at.
B: So, I got my University degree in biology and chemistry and I minored in medical ethics. It really saturated my medical background and then, I moved on to PA school in Chicago and completed my degree there. I moved to Canada for love, you’ll go anywhere for love, so that's what brought me here and I came to Canada in 2010 right after I got married.
B: I knew at the time that the program here was brand new, and the first graduates were in 2010. I had no clue about the differences between Canada and the US. I didn't know I was coming to Canada to be a trailblazer. I had no idea the animosity that happened between the nurses and PAs and the long road that would come ahead in terms of being allowed to practice and not working under your own license, and all those little details, I had no idea.
B: Currently though, I did come and I did get a job working in Oncology in Owen Sound. So, I did Oncology for 4 years, and then I moved to strictly palliative care. So, that's my long story background.
B: So Rach, tell us your experience, thus far, in Emergency Medicine. What do you like about it, what do you hope to see change in the future, all those kinds of things.
R: Well, rural Emergency Medicine is a little bit different than big city Emergency Medicine and that's part of the reason I love it. I actually fell in love with rural Emergency Medicine on my first clinical rotation. I was doing Family Medicine in MidWestern Ontario and the family docs did one or two days a week of call, so when I was doing family med rotation I got to see the rural emerg and I just thought it was sort of the perfect fit. Volumes are lower, the acuity is extremely varied; you do everything from coughs and colds, and stubbed toes, to major farm accidents, so the variety was there, which was something I liked and it sort of struck me as something I wanted to do.
R: When the job came up in rural emerg, I sort of jumped on it, and I have actually been there my entire career, going on 7 years now, being a practicing PA, which seems like a ridiculously long time.
Both: [LAUGHTER]
B: And you started there on the new grant program?
R: Yeah, initially the new grad funding had full funding for the first two years I was there, and then I had partial funding for another 2 years, and now, I have a rather unique funding model where my salary is paid by the doctors that I work with, and my benefits and what not are paid by the hospital, so we have a rather interesting funding mode going on.
B: You are technically a hospital employee?
R: Yes, I am still employed by the hospital, and so the physicians pay the hospital my salary
B: And then they subsequently give it to you?
R : Yeah
B: And how many physicians are splitting that salary?
R: 4, well 5 technically, I have 4 regular supervising physicians, and then I have one locum who comes on a regular basis, and then actually we have two locums that come on a semi regular basis, so i guess 6 total
B: So the locums actually contribute?
R: Yeah, so whoever I am working with on that day contributes whatever amount is due, which I actually don't even know what it is
B: Oh, so it's not like an even split, so they base it off who you're working with that day as who owes?
R: Yeah, so the docs that I work with more often, pay a little bit more, at least I think that's the way it works. I actually have no idea how it works in the background, but that was my understanding that if whoever i was working with that day, a certain percentage or certain dollar amount from that day went toward my salary
B: Does that create any kind of awkward dynamic on the day to day basis that you're working with them?
R: I don't think so, most of the docs are actually really happy that I’m there and some of them have actually asked me to work on my days off and that they would be willing to pay for me to come in. So I don't think that they mind doing it that way, it works for us, it's not ideal. I mean ideally, there would be funding models in place that were more systemic obviously, but it works for us
B: So, obviously you're well appreciated then since they’re asking you to come more often, and they're willing to pay you individually to do that. So obviously you've had really good results working there. How is it with your medical directives, and getting board approval, and that process? Is it fairly slow, do you have an easy time getting that through, or how does that go through?
R: Initially, it was a bit tricky. We took medical directives from somewhere else and modified them as we usually do, but my rural hospital is one in a group of 4 hospitals so the board for all 4 hospitals has to approve my medical directives, but i'm the only PA within the organization. So although the initial directives applied to all four sites, despite not having PAs, getting them approved by the board who didn't really understand PAs and why only the one site got a PA was a bit difficult.
R: Having my medical directives, I recently edited them and got them updated to reflect my skill level that I am now at, or at least somewhat reflect the skill level i am now at, was a lot easier, because I’ve talked to the board, I've been there a long time, my docs are really on board with giving me a little bit more autonomy and certain things that I had already been doing but now I don't have to get cosigned everytime i do them. And ordering more tests because they realized I am more than capable of recognizing when those tests are important, not important, relevant, not relevant, that kind of thing. It's still not ideal, I can't prescribe by myself, which is a bit of hinderance
B: So everything for prescription needs to be cosigned?
R: So I don't have to have meds I order within the ER cosigned; I don't order narcotics, and that's perfectly fine by me
B: Right, you don't really want that?
R: Yeah, I don't really want that, but if I need a narcotic acutely, the docs will give me an order for that very quickly, it's not been a major issue, but it would be nice to just write a prescription and not have to get it cosigned
B: For all the home meds?
R: For all the antibiotics, and rash creams, you know, silly minor things like that. But hopefully that will come along as the, particularly in Ontario, as the regulation and stuff gets more clarified, that’ll be a lot easier, I think.
B: Right, right
R: So yeah, I really do love my job, I mean everybody has good days and bad days, but I really enjoy my work, I think I'm really lucky
B: Do you see yourself staying at this place?
R: I hope so, I mean it's a bit of a commute for me, and I now have a young family, so it would be nice to be home a little bit earlier, I think. But, I really, really enjoy my work, so I'm not actively looking for anything else but any means. So, if something came up and I couldn't keep my job, obviously I would be looking or we get new doctors and dynamics can change and whatnot
B: And right now you're on a permanent full time status with the hospital anyway so there's no contracts that are ending...
R: Oh no, I'm on a contract, I’ve got a 3 year contract so [Laughs] i'm still on contract
Both: [LAUGHTER]
R: The frustrating aspect of keeping a job
Both: [LAUGHTER]
R: I mean it's a lot better now, it's a 3 year contract versus previously it was going every six months, which was super anxiety inducing, it makes you not...
B: You don't have any job security
R: You don't have any job security, so it makes you feel like you're unappreciated even if the people you're working with really do appreciate the work you do. And just not having job security makes you feel like you're not as valued as some of the other employees, which isn't really the case but that's sort of how I felt. But, a 3 year contract is sufficient for me to feel secure in my job
B: Right, and those 6 months contracts are happening in between when the initiative funding was ending and they didn't have a model to fund you?
R: Yeah and it was sort of ‘what would the hospital pay for, what would the government pay for, what would the docs pay for’, nobody really wanted to commit. So it's just the 6 month contracts at a time and every time it would expire, the government would extend it a little bit further, so the hospital and the docs are not obviously going to pay more if they weren't going to have to, obviously, that doesn't make any sense. So that was probably the most frustrating part of being a PA so far, is the insecurity around having a job
B: Right and obviously, you're not the only one to have that problem, that's what we're all here working towards, right? And CAPA is behind us, and hopefully we’re seeing some progress of that so hopefully, hopefully, that decreases the frequency that PAs are experiencing that in their jobs. And, so you mentioned that your scope of practice in the ER is actually pretty good aside from writing prescriptions on discharge. Does that include procedures, codes, like what kind of activity are you having within the ER itself?
R: Well, it varies obviously, depending on what comes in, but I usually see pretty much every patient that comes through the door, regardless of status, unless it's super busy, then sometimes the doctor and I will tag team and get people through the door as fast as we can. We are a very small hospital so if it's a code, everybody is there, the docs there, I'm there, all the nurses in the building, which is usually only 2. If it's during the day, we have an RPN, as well as the 2 nurses that are in the building, and if we’re really lucky then we have a nursing supervisor in the building, so if you happen to come in and your coding and it's 2 pm on a tuesday, there might be a total of 6 people in the room
B: I mean you are a primary example of how PAs can be used appropriately to increase access to care. I mean obviously you're in a small area and it is an area of high need, and with only an average two nurses in the building, and not just in the ER, but in the hospital, two nurses and one doc, you are there providing a significant change in the access to the number of patients that can be seen and moved through that ER
R: Yeah absolutely, and the community has realized that for sure and there was a lot, when I first started, there was a lot of hesitancy from the nurses around having a PA because they didn't, not so much that they were anti-PA, but they just didn't really understand the PA role. And so, you know, with the nurses union, whatnot, there was a lot of ‘oh they're going to take nursing jobs and if you have this you won't get more staff for nursing’ but the roles between an RN and PA are completely different, and now the nurses that I work with are really appreciative of having a PA and they love, and I am good friends with them, so I assume they like me personally
Both: [LAUGHTER]
R: But, they really do like having a PA, it makes the nurses life and job easier
B: Excellent, excellent, well you're on the front lines working for us that's for sure
Both: [LAUGHTER]
R: So, that's a lot about me and my, sort of, perspective on things, what about you, Becky, tell us about your time in oncology
B: I really love oncology, I love the science behind oncology, and the intricacies that develop in the interaction between chemotherapy and the different target therapies available, and we are attacking cancer cells. I really enjoy that, I also really enjoy the aspect of working with cancer patients, I feel very appreciated by them and their families and I feel like I'm actually doing something of value so I really enjoy it.
B: I happened upon oncology just by chance, like it wasn't something that I set out for. But, when I moved to Canada, I suddenly realized I didn't have a lot of job options in 2010. In fact, I didn't have the option of the new grad funding because that only applied to people who were new graduates in Ontario, so I couldn't utilize that. In fact, I don't remember at the time any job postings for people who were not new grads, and I wasn't part of the initiative of bringing the career to Ontario either; I didn't even know how to become a part of that.
B: So I just started putting out my application by hand, just cold calling, and I ended up getting the job in Owen Sound. It was originally posted for a nurse practitioner, but I got kinda lucky because the oncologists who were there all did their fellowships in the States, so they knew exactly what a PA was, and how to use them, and it went quite well.
B: So, I was the first PA in Owen Sound, and there's always like the new, rusty pieces of starting a new job and being the first of a career in amongst people who, that the oncologist might know who I am, but the administration at the hospital or the nursing staff and other doctors at the hospital didn't know what a PA was and who I was. So it took a little bit of time but once everyone got to know me, it worked very well.
B: I was quite happy with my scope of practice there; I was able to order all sorts of bloodwork, as well as imaging exams, including ultrasounds, CT, MRI, and I was, you know, I could talk to the pathologist and really understand what was happening, and really order any multitude of things. Even getting patients transferred to a more acute center, like Princess Margaret hospital, I had no issue talking to the oncologist there as well, it really went quite well.
B: I saw an average of about 10 patients a day, which in a family practice setting seems kind of low, but in an oncology setting, I think it's right on target. I don't think I could've seen more than 10 on a typical day. And, I also managed all of the inpatients, all of the admitting, and all of the discharging as well as seeing those 10 outpatient people in the clinic.
B: And that slowly evolved to, of course, doing some kind of palliative care, you can't do oncology without doing a bit of palliative care at the same time, it's just inevitable. I really also appreciated that aspect, I find it kind of a privilege to be a part of people's life during that period of their life.
B: So, that went really well for about 4 years, I really enjoyed it and then I started a family so that took me away from Owen Sound for a short period of time, and I moved to doing palliative care in the community in Brampton. It just worked a little bit better with my family, it's not quite as long of hours and it was only palliative care. Most of the patients were palliative due to an oncologic reason, but it was the only palliative care in the community which gave me a completely different perspective; not only a community versus hospital care, but also of the resources that are available in different clinics because they vary drastically and dramatically, which was something that I was not aware of until faced with that. But, I also very much enjoyed that.
B: I also kind of cover for some people in family practice settings, when somebodys on vacation etcetera. I do that because I like to help the people I know, it's not something I enjoy quite as much, family practice setting is not really my cup of tea. I like the acute severely ill patients for some reason,
Both: [LAUGHTER]
B: But, I admit it's a completely different dynamic that I really enjoy. So, right now I'm actually currently not employed. I’m spending time with my family, I’m enjoying putting out this new podcast, and I'm also enjoying spending time with you Rachael working on our PA Helpers thing too, which we'll talk about in a little bit, and so I’m doing that and enjoying that. And I am also dabbling in a bit of medical writing now as well so I guess I have my hands in a lot of buckets and that's okay for right now, that's just what works
R: Yup, and what is it about palliative care that you love so much?
B: I have no idea, it's just really awesome. It's kind of like this window into a world that everybody else ignores. It's part of life, everybody is born and everybody dies, and it's something that we need to put more focus on. If anybody deserves really good quality care at any point of their life, it is definitely at the end of life. And so many people are ignored when it happens or given not that ideal of care, I mean you shouldnt’ be dying in a hospital. Hospitals are busy, they’re loud, they’re for people who are sick and who are going to get better and leave. It's not for people who are at a time of life that we can't change the circumstance.
B: We can hopefully make it comfortable for them, but we can't change the circumstance and you ideally should be in a quiet, serene setting where there is room for your loved ones to be around you, and not full of these busy loud, beeping things coming over the speakers, and code red, and code blue, code all these things being yelled and nurses coming in and rushed and having to share rooms with maybe somebody else who is in a completely different setting of life.
B: That is not the way to go, nobody wants that. Ideally you should be calm, quiet, serene, and I hesitate to say this word, but even almost pleasant at times and if we can get our culture to kind of come to a different understanding of what it means to die, maybe we wouldn't have a fear of it and it could be something that, whether or not we want it to happen, we can be ready for it to happen. And deal with the grief, not only from the patient’s perspective, but also of the people they love at the time. Everybody goes through that grief and a good palliative care team should be able to handle the grief of the patient as well as the grief of the family members. It is so ideal for that to happen and I feel so blessed to have been allowed in the rooms with people who are in that situation.
R: And to offer them comfort…
B: And to offer them some comfort. People ask me all the time if it's really sad, and I don't find it very sad. The only times that I find it sad, disturbing and that I have had many tears over are the times where I can't get people comfortable. And that hasn't happened very often, I can count on one hand the number of times that has happened, but when it does happen, I really feel like I've failed and the whole team usually feels like we’ve failed.
B: It's definitely not a one person effort, it is a multidisciplinary effort, that when done successfully, is really a beautiful thing that you walk away feeling really good about and that you feel like the family and the patient probably feel good about too. I mean, it's sad still, like nobody wants to lose somebody they love, but when it goes well, it goes so well. And the times that it's sad, that I actually shed tears about and get angry over are when, for whatever reason, either medications don't work to control symptoms, or we run, which is the more common side is it's not medication, the more common side is that there are administrative issues that you run into that end up blocking your ability to successfully achieve a calm passing. And those make me angry to the point of tears.
R: Understandably, that's totally understandable.
R: So, Becky has a very unique perspective being trained in the US, so what are some of the big differences you see from Canada and the US as far as PAs at this point?
B: Well it's interesting. It was a huge shock factor moving here for me, because PAs have been established for 50 years in the US. I moved from a place where I was going to have no trouble finding a job, my pick of jobs, a really good salary, stability if i wanted it, and everybody pretty much understanding what a PA is, to a place where jobs seemed very scarce and nobody knew what a PA was, and the pay is substantially less. It was a bit of a shock.
B: Also, I was not prepared for the animosity that seemed to come along amongst other professions and we've mentioned in this podcast already particularly the nursing profession. Although, I want to be really careful to say it has not been individual nurses that I’ve come across, I’ve had VERY good experiences working with individual nursing staff, and become really good friends with them, that has never seemed to be the issue. The issue has really seemed to be on a more admin side, that unions and administrative groupings as a whole seem to be against the introduction of the PA profession.
B: I would say that in the US, there is a mild animosity, but it isn't anywhere on the same scale that it is here. Most of the time, I don't know if it's most of the time. Frequently, jobs in the US are posted for, it'll say looking for PA or NP in pediatrics or PA or NP in hematology/oncology, or whatever it is, they're often posted for both, because they’re both Master level degrees in the States, they both have the capacity to prescribe narcotics and on a similar level, like they prescribing authority is similar across the board. I mean there are certainly differences, but they are miniscule, if we’re quite honest, the differences tend to be more on the political side and you may have a reason to prefer one profession over the other. But, ultimately what it really comes down to is that most jobs, PAs and NPs are capable of doing, and that you want to find the right person for the job; the personality, the skill, the knowledge base for that job.
B: So, many jobs in the US are posted for either or. There are some that are still selected postings for NP or PA but those are becoming fewer as time goes on. And of course the scope of practice for PAs in the US is huge, HUGE, in comparison. I mean you would never, unless you're brand new to the practice, or a brand new grad, even just if you've been practicing for a while, you should start a new job not expecting a physician to follow you with every patient, and that just doesn't happen.
B: So here for many reasons, for billing reasons, for safety of practice reasons, for reasons that PAs haven't just been around a lot, and for the reason that we practice under the license of a physician here, a lot of physicians follow up after every patient. At the very least, a lot of physicians say ‘hey what did you do with this’, even if they didn't actually see that patient, but there’s a lot of repetitive work happening here, that doesn't need to be happening, that doesn't happen in the states. Certainly, if the PA comes across a patient they don't know what to do with, you go to the physician, of course you do, of course
R: Sort of the whole point
B: Yes, that's the whole point, but also part of the point is to see more people and reduce workload on individuals. So, a PA might see a patient every 15-20 minutes, but the doctor’s also seeing a patient every 10-15 minutes in the US, so you're seeing double the number of patients or more with each PA that you have on your load. They also do many procedures, they're doing joint injections, they can do the nerve blocks, and if you're in the OR, PAs do all the pre-op physicals, the post-op care, and they're closing all the patients in the OR.
B: So, that's a lot of work, which is not happening here. Most surgical PAs are not actually in the OR yet here, and they're not doing the pre-op physicals. They're still sending the pre-op physicals to the family physicians, which is another time-consuming effort because the patient on their own has to find the way to get in whereas if you've got a PA who can do the pre-op right there, it's time saving and cost saving on both sides. So, the scope of practice is almost incomparable. However, I will say that I see an improvement in the time, in the 7 years, that I’ve been here. I see an improvement in the scope of practice that most PAs seem to be having from when I started to now
R: Oh for sure, I’ve even noticed that, that's changed
B: Yeah, it actually seems pretty dramatic and I feel like the change that we’re seeing with the PA profession here is happening on a faster curve than it did in the States. In the States, when it started, was a huge struggle, year after year after year, not only to get the scope of practice and the independence, but to get the acceptance and approval to practice and get the numbers. And when you look at the numbers, starting in the US and starting in Canada, we’re having a faster increase of both the number of PAs practicing and the number of schools teaching PAs and the scope of practice changes. It's all happening on a faster curve than it started in the States
R: Well, that's exciting and good news
Both: [LAUGHTER]
B: Yes, exactly, and we have other counter ports that are also struggling but seeing improvements. We look at the UK and we’re in the UK and there's absolutely people who feel that the profession is slow to move but really when you look at it, the curve is happening quite quickly there. They have a greater number of PAs in the UK than we have here, but their scope of practice is comparable and so they’re seeing some improvements on a similar scale as we are. Same in Australia, the Netherlands, and even in Germany. So, we are spreading and we are here to stay
R: Yayyy
Both: [LAUGHTER]
B: And, of course, you can talk about the difference in pay as well, but it's tough to compare when the States has such a different system of healthcare and we won't get into all that here, but we can…
R: We can make it a topic in another podcast
B: And truth be told, PAs in Canada make enough to live comfortably off of, and it may not be the 6 figure income that most PAs are making in the States, but we are making enough to be comfortable
R: Yeah and I mean by comparison the doctor in the same job in the States would make significantly more than a doc here. So... they also have a LOT more liability
B: True, so it's not an even comparison
Both: [LAUGHTER]
R: No
B: Okay well, I think, is there anything else you have to add, Rachael, about your experience or?
R: No, I'm sure we’ll do more of these podcasts, where it’s just you and I. We’ll probably end up taking listener questions and talking about things that are up in the news. If you guys have any questions for either one of us or just in general you can always email us at, you can just send us an email from our website which is mt...
B: mtppodcast.com
R: Thanks!
B: You can contact us on there. We also have facebook, you can contact us on all the social media places, also you can contact us on LinkedIn. My name is Rebecca Mueller and Rachael Thompson, we’re both on LinkedIn. You can feel free to contact us anyway. Also if you'd like us to interview you, I mean this is what this podcast is about, getting to know our comrades and fellow PAS across Canada, and building some community for ourselves. So, if you’d like us to interview you, and you want to showcase something on the podcast, please let us know!
R: Yeah, we would be happy to have you on!
B: So, thanks for joining us for our very first podcast and our launch and I hope that most of you have been able to make it out to the CAPA conference, which is starting tomorrow and if you're not here, hopefully you can join us next year at the conference in support of our really wonderful and growing profession
R: Oh so, if you're a student, check out our sponsor PAhelpers.ca we have all of your study guide needs there to help you pass the Canadian PA exam
B: The first and only study guide made for Canadian PAs
R: With Canadian units and Canadian gold standards
B: [LAUGHTER] They also happen to be the sponsor of this podcast. Alright, thanks and take care everybody
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R: Meet the PAs podcast is sponsored by PAhelpers.ca where you can find all your Canadian exam prep needs. If you enjoyed this podcast, please visit us at MTPpodcast.com. Please remember to rate, review, and subscribe and we would love your feedback.
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