When you’re finishing PA or NP school, the transition into practice can feel a little like stepping onto a treadmill that’s already moving at full speed.
There are boards to pass, jobs to apply for, contracts to review, and, oh yeah, those student loans looming in the background. It’s understandable that getting a job can start to feel like the goal. But looking back, I think one of the most important decisions we make early in our careers isn’t just where we work. It’s how we’re supported when we get there.
For me, that support came through a postgraduate pediatric fellowship. It gave me something I didn’t fully appreciate at the time: space to learn how to actually be a PA. Years later, after moving from fellowship to full-time general pediatrics, then to rural practice at an FQHC, and medical education, I’ve realized how much those early experiences shaped the clinician I am today.
So, for anyone finishing training, looking for that first job, or considering a switch into pediatrics, here are a few things I wish more of us talked about.
PAs and NPs play an important role in pediatric primary care, particularly as communities across the country continue to face healthcare workforce shortages.
And the work is wonderfully broad. One minute you’re talking about tummy time at a two-month well visit. The next you’re managing asthma, ADHD, constipation, developmental concerns, or a teenager with depression. You care for healthy kids, medically complex kids, nervous first-time parents, and seasoned parents who can spot an ear infection before you even pick up the otoscope. That variety is one of the things I love about pediatrics. It’s also what makes the learning curve so steep.
We’ve all heard it: Kids aren’t just little adults. Their physiology is different. Their medication dosing is different. Their vital signs change with age. Their presentations can be subtle. On top of all that, you’re learning development, behavior, preventive care, and how to communicate with both a child and the adult who brought them.
That’s a lot to ask of a new graduate on Day 1, which is why how we onboard new clinicians matters so much.
After PA school, I completed a 12-month fellowship in ambulatory pediatrics at Carolinas HealthCare System, now Atrium Health. It completely changed my clinical confidence.
I worked in a large pediatric clinic alongside a mentor pediatrician, but the key was that nobody expected me to walk in on my first day and function like someone who had been practicing pediatrics for 10 years. My schedule started light. That meant I had time to look things up. I could double-check a guideline. I could ask someone, “Hey, can you take a look at this rash?” without simultaneously watching three more charts pile up in my queue. And (this feels almost luxurious to say now) I could usually finish my notes during the workday. Over about six months, my patient volume gradually increased until I was carrying a full schedule. That ramp-up gave me room to become faster because I was becoming better, not because I was simply being forced to move faster.
One day each week was also dedicated to didactics alongside pediatric and family medicine fellows. We reviewed studies, worked through cases, ran simulations, and presented clinical cases. It reinforced something I still believe strongly: graduation is not the end of learning how to practice medicine. In many ways, it’s the beginning.
Each month, I rotated through pediatric subspecialties like gastroenterology, ENT, and allergy. Those rotations were game-changers. Of course, I learned specialty-specific medicine, but two of the most useful things I learned were much simpler:
When should I refer? And what can I reasonably do before I refer?
That knowledge became even more valuable years later when I moved to a rural area, where the nearest children’s hospital and many pediatric specialists can be more than an hour away. A referral isn’t always just a referral. For a family, it can mean taking a day off work, pulling another child out of school, arranging transportation, and spending hours in the car. Knowing which initial workup I can start locally — and which child truly needs specialty care — can make a meaningful difference. That fellowship training didn’t just make me more confident. It made me more useful to the families I serve.
After several years of practicing full-time in general pediatrics, my career shifted again. I transitioned to a part-time clinical role at a Federally Qualified Health Center while also joining the medical education team at Hippo Education.
I’ve learned that balance isn’t necessarily about working less. Sometimes it’s about finding the combination of work that keeps you curious, energized, and connected to why you went into medicine in the first place. For me, mixing clinical practice with medical education did exactly that. There’s no single formula for a sustainable career. But I do think it’s worth asking ourselves periodically: Is the way I’m practicing medicine still working for me?
The answer can change over time. That’s okay.
If you’re finishing PA or NP school, or thinking about moving into pediatrics, I know salary matters. Benefits matter. Location matters. Student loans definitely matter.
But please ask about the onboarding.
Ask what your first week looks like. Then your first month. Ask how quickly your patient load increases. Ask who you go to when you have a question. Ask whether you’ll have protected time to learn the EHR, review charts, and figure out how the practice actually works. A higher salary can be very appealing. But walking into a full patient load on day one with minimal orientation and no reliable support can get overwhelming quickly.
And look for someone willing to show you the ropes. Maybe that’s a formal fellowship. Maybe it’s a supervising or collaborating physician that loves to teach. Maybe it’s another experienced PA or NP who remembers what it felt like to be new. You need someone you can ask the questions that feel “silly.” Someone who will look at the weird rash. Someone who will review the plan you’re second-guessing. Someone who will debrief with you after the case that follows you home. That kind of mentorship is priceless.
This may be the biggest lesson of my career so far. Medicine is enormous. Guidelines change. Weird presentations happen. You can practice for years and still encounter something that makes you think, Huh. I have absolutely no idea what that is. That isn’t a failure. That’s medicine.
You’ll have hard days. You’ll make mistakes. You’ll look things up that you think you “should” already know. The goal isn’t to reach some magical point where you never need help again. The goal is to keep learning, know when to ask for help, and work in an environment where doing those things is considered a strength.
I’m incredibly grateful for the path my career has taken, from fellowship training to general pediatrics, rural care, and medical education. But if there’s one thing I hope new clinicians take away from my experience, it’s this: Your first job doesn’t just teach you medicine. It teaches you what practicing medicine feels like.
Choose an environment that gives you room to grow. Find mentors who want to see you succeed. Stay curious. Ask questions. And as your career evolves, give yourself permission to rethink what balance and fulfillment look like.
We spend so much of our time caring for other people. Building a career that lets you keep doing that work (and still have enough of yourself left at the end of the day) matters, too.