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Fighting burnout with time-off and building a physician assistant business.


In growing The PA Blueprint, one of our favorite aspects of this business journey is to connect, learn from, and follow other PA-preneurs.  We’ve learned a lot from this like-minded niche of a community and really have enjoyed our collaborations with these folks.  One of the most impressive PA-preneurs that we’ve been following is Karen Calcano, a Cardiothoracic PA-C, blogger, and business owner.  @KCalcano is one of the most authentic, candid, and honest people that we’ve been following. She is admired for her willingness to be vulnerable, speak up about her own challenges, and run counter to the “highlights-only-reel” that pervades social media.  This is why we reached out and invited her to do a guest post on our blog that we are calling “Real Talk w/ KCalcano.”  As expected, she delivered with her trademark candor and didn’t shy away in answering our tough questions.  Below is our interview with her, and we hope that you enjoy it as much as we did. We highly recommend checking out her website https://www.scalpelandheart.com. A big “Thank you” from The PA Blueprint to Karen, and stay tuned for future collaborations with her!

If you could go do it all over again, would you still choose to becaome a PA for your career?

I think I would. 

I believe this profession has allowed me to grow in ways that I only dreamed about. First, even with the added obstacles I had as an immigrant, as well as the lack of diversity & barriers to entry for people like me, I would choose PA again & again.

I met my husband in the OR working as a PA too, so there’s that! 🙂

It made sense to me when I chose it, & it makes sense to me now, even just fresh out of a bad bout of burnout. 

Originally I was on track to become a veterinarian, but right before applying I did the math and the cost of education did not outweigh my salary & my ability to pay off student loans.

 Working as a Veterinary nurse I had some veterinary friends who went to vet school & could not afford to pay off their loans. I took this to heart and decided that as much as I loved it, I simply could not afford to be on the hook for even more student loans than I already had from undergrad.  

Interestingly enough being a PA has made me able to financially help more animals than I probably would have had I gone that route. Animal causes are important to me & I feel as though that desire to help them is fulfilled by my own pets & in donating to worthy organizations that help them.

Overall the PA profession for me has been challenging & rewarding. It has tested my limits in every way imaginable & being a PA has also helped fund my life dreams like traveling & giving back.  It has provided me with many ways to make a positive impact on other humans & other beings which is very important to me.

What is one of the biggest career mistakes that you have made since becoming a PA?

God, lol I’ve made so many.

Let’s start with my massive student loan mistakes. If you want to know exactly what not to do definitely have a look at those blog posts.

Then there was the time that I was considering leaving my new grad job because I got another offer & I made the massive mistake of telling my attending.

In my naivete, I thought that as someone I considered to be a mentor,  he would provide me with guidance about making the right decision for me

Instead, he got angry with me, told everyone in the practice who then turned against me, then he even & legally threatened to make me pay back discretionary bonuses I had earned there!

 It made my last month there a living hell. Then to make matters worse, the other 2 PAs there took a 2-week vacation immediately & left me & to cover 7 surgeons & 8 hospitals as the only PA in a very busy cardiothoracic & vascular surgery practice. 

I learned 3 very important things from that:

  1. Just because you view someone as your mentor doesn’t mean they do.
  1. When given the opportunity, humans will tend to make decisions based on what is best for them, not for you, even if it’s the right thing to do.
  1. Never ever, tell people that you’re leaving until you are because they can really make it hell for you if they’re pissed you are leaving.

That was a memorable career mistake, to say the least. 

The next set of memorable career mistakes came as a PA practice owner.

 Eventually, when I got good enough in surgery, I left my hospital job & started a business as an independent contractor first assist.

 I went around town assisting across several surgical specialties & eventually it led me to make more than I could ever imagine making as a PA.

I had several hospital contracts in place as well as a good amount of surgeons that used me per-diem. I was busy & happy and I ran the back end of the business alone. 

Eventually, I got so busy that I hired people to help me with the back end as well as contractors to help me with the case overflow.

My first mistake was not scaling the business more intelligently by hiring the right people to help me grow this thing.  I’ve always been very entrepreneurial, with a really good instinct for good deals, pitching them, selling myself, and playing hardball in negotiations. 

So I was great at getting new business, but not so good at creating operating procedures to sustain the growth.

So what happened next is that eventually, I could not keep up with the demand for surgeries because I kept saying yes to all cases & running myself ragged.

Had I had the insight to focus on just the highest profitable cases & not just on increasing profit, any profit- I would have not gotten so burned out.

It was a very valuable lesson as a PA, as a business owner & as a person in general.

The lessons here are:

  1. When having to decide between your money or your time, pick your time. 
  1. To avoid burnout, charge more money for doing less so that your workload stays sustainable & you can also enjoy your life.

The money matters, but not as much as whether or not what you’re doing for the money is going to be sustainable for long-term growth.

Tell us about a time that you were burned out. What did you do to improve things?

Oh boy, this is a loaded question, because it’s complex in its answer, but I’m happy to talk about it because it’s important.

Burnout is a nebulous thing. 

It’s weird because nobody knows for sure if they have it or not if you have never experienced it.

For me, burnout has been formative, in terms of rewiring my relationship with work.

I mentioned in the last question that because my business was growing at a faster pace than I could manage, I was running around ragged, way past my ability to sustain it.

 Then came a sharp decline in reimbursement from insurance companies that I thought I could offset by doubling my caseload. I did that for a few years. 

In addition to that, I also decided to offset the loss of revenue to also go hard on my 2 side hustles: selling skincare with a multi-level marketing company & teaching yoga.

Telling this story now, I honestly don’t even know how I did it. I guess there is a season for everything & we live & we grow.

 I had also gotten engaged & was planning a wedding in another country in Nov 2019. 

By Jan 2020 I was already running on fumes, caffeine & prayer- then in March, the pandemic hit. Elective surgeries were canceled- these were the bulk of my surgical cases at the time.

So I went even harder, trying to make up for the loss in revenue.

Oh & I also forgot to mention my husband and I were trying to conceive since at the time I was 38 & the biological clock was something we had to contend with too.

Oh, what fun it is to be a woman in medicine sometimes, right? 

Believe it or not, I continued limping along like this at the same level of intensity & energy expenditure until July 2020.

Then it hit me like a Mack truck going 100. I crashed. 

The collapse wasn’t just mental, it also manifested as physical illness like GI problems, bad headaches, anxiety attacks & the like.

So after a long deliberation, some kicking and screaming & the screaming of my heart to do things differently- I walked away from my baby, my business & stopped working to get myself healthy again.  

It took me a full 7 months of not working, all hands on deck with doctors, therapists, etc  & a single-pointed focus on my wellness.

Once better & with more clarity, I was forced to look at my workaholic tendencies & the patterns that got me there.

It also made me examine the broken system I work in, which rewards overwork & self-sacrifice from training. 

Eventually, I returned to work but I am still very much in the process of rewiring my relationship with work for happiness & longevity.

If you are interested in what that journey looks like for me you can follow + subscribe here.

What frustrates you most about working in medicine?

One of the major things that really grinds my gears, & I speak a lot about this on my blog & IG is the ridiculous barriers to entry that are in place to enter medical professions, especially the PA profession.

It’s ridiculous to me that in order to satisfy the calling to work in medicine & help people, we are forced to take on insurmountable debt. This in turn eliminates many minorities, like me, from entering healthcare at all. This then leads to lower quality of care for everyone- it’s been scientifically proven.

I lived it. My path to PA was almost unsurvivable. I went hungry at times, almost went homeless a few times among other stuff that no passionate & committed aspiring medical professional should ever have to endure.

So the process to get into PA school as it stands it’s like basically taking an already disadvantaged student with several socio-economic disadvantages, & asking them to join a race to PA school when their starting line is 10 levels behind of the average matriculant.

It’s no wonder that about 87% of matriculating PA students are caucasian. The standards are impossible to meet for people who can’t afford to stop working.

 It makes me so angry & sad. & this has been the driving force behind my work in pre-pa mentorship.  I’m still trying to figure out how to make that sustainable since there are so few of us that I can’t keep up with every request for help.

So  I focus more on where I think I can offer the most help and as a writer, it’s with the PA personal statement because it is the only part of the application that truly levels the playing field.

The second thing I find most frustrating is the way the healthcare system does not prioritize the wellness of healthcare professionals.

It’s a system that is set up to overuse, over-work & exploit the compassion of workers who came into medicine to help others by guilting them into sacrificing their mind, body & souls for a “noble” cause. It’s killing us quite literally.

There is a false narrative that is being perpetuated by health care administrators, & the lie is that there is a shortage of healthcare professionals.

IMO, The truth is that there is no shortage of nurses, doctors or PAs, or any other healthcare professional. This is a lie that big business needs to sell so we keep showing up to work with ever-increasing unsafe conditions.

What there actually is, is a shortage of employers who offer humane working contracts & adequate compensation & PAs & other HCW are no longer just taking any job. We’re becoming selective, & I love that for us.

Many of us in healthcare are over-working and under-living. It makes me really sad.

I’d like to see healthcare workers recognized appropriately with safe patient ratios, humane schedules & protection from abuse & toxicity in the workplace of all kinds.

The system will take a while to change so the only thing to do is to shift the burden of responsibility for our wellness back to ourselves where we can make change sooner, by becoming more discerning of the types of work culture & conditions we choose to be a part of.

What is one thing that you wish that PA programs would do a better job with?

Definitely having more diversity in their leadership. 

Removing barriers to entry into the profession makes it harder for students of every background to enter.

Not everyone can stop working to volunteer or shadow. In fact, anecdotally, I would say most. 

This is a great sacrifice mostly afforded by people that have family or a support system that can financially take care of them while they pursue their medical training.

Yes, student loans are seen as the normal solution to this problem, but they should not be.

The application fees are ridiculous. I would like to see them be subsidized for qualifying applicants.

The tuition fees are equally ridiculous. 

Let’s not even get into the cost of interviewing if you have to fly places. Now it’s better because of virtual interviews, but still.

I would also like to see more safe spaces for minorities inside of the PA profession- in school & beyond for people of diverse backgrounds because just because a PA program makes a legally mandated arbitrary statement on how they are committed to diversity & equality doesn’t mean that is what is going on inside the program.

During the BLM movement, many programs made a similar statement, only to backslide after the heat was off them.

This is where diverse leadership matters a lot. Having more diverse leadership means there will be stakeholders & decision-makers who are sensitive to these issues & will work to address them more passionately & more effectively because they have first-hand insight into the problems that these students face.

What is one of the most candid pieces of advice that you would give a PA school applicant?

Supersede the minimum requirements & set yourself apart with a killer personal statement. 

I don’t think people realize just how important the personal statement is, because like I said the prerequisites & how well people do with these often depend on their privilege in terms of socio-economic support.

Transcripts & test stats do not translate as far as the unique disadvantages, obstacles & setbacks that a student overcame to get there.

What’s more, typically those who have been through more to make it happen are arguably better candidates because they’re more resourceful!

So the personal statement is one of the only even playing fields to really be strategic in setting yourself apart. 

You don’t even have to be a good writer to show with words how your life struggle on the path to PA directly translates to advantageous skills that will serve you as a PA.

This is why I dedicate the grand majority of my work with pre-pa students to this area. 

For more PA personal statement tips check out my blog & my PA personal statement course.

What was your most rewarding day at work, or a positive experience you keep in your mind?

These days, my most rewarding day at work is doing 20% work for 80% impact. You might also know this as the 80/20 rule.

I know it sounds vague but hear me out.

I’ve spent some time deciphering what the activities that bring me the most joy at work are, & I just make a point of doing that stuff as much as I can control.

It doesn’t always happen as in medicine can be unpredictable, but I do what I can to approximate doing more of the things I love to do at work & less of the things I don’t.

For instance, I really love Aortic valve surgery & seeing critical patients in the cardiovascular intensive care unit.

So my perfect day would start with seeing my CVUCU patients, then going to the OR & first assisting in an Aortic surgery.

Typically with this, I’d be done by noon- 2 pm which gives me enough time to myself after to do what I want, whether it be yoga, the pursuit of creative endeavors, or whatever else I feel like doing & enough time to dedicate to my family & loved ones too.

That’s the perfect balance for me & what a really rewarding day looks like for me these days.

It’s like doing less, but with a lot more impact.  That’s what I’m going for these days. 

Knowing what you know now, where do you see yourself in 5 years career-wise?

This is a great question lol! 

I see myself starting other businesses, outside of the traditional PA role that you’re used to seeing. I have a couple of ideas & things in the wings that I will reveal to my followers in due time!

For now, I’m focused on hacking my PA career to become completely financially independent so that I have the freedom to get to my bucket list sooner rather than later.

I hope to someday be able to do more to compensate for the lack of diversity in the PA profession. It may look like being able to offer my PA personal statement course for free & maybe start a foundation or scholarship for minority Pre-PA students as well.

I have also become passionate about helping the healers take better care of themselves. We could all use better tools to help us do that, & because of my experience recovering from burnout a few times have some insight as to what actually works.

& let me tell you, it’s not a pizza party!

I’m really into personal finance & the FIRE movement right now as well. I see this as a way to love everything about my PA career again, for the same reasons I started it in the first place, but without all the other BS that we have to deal with that takes away from that. 

That’s my true north. I’m a PA because I feel helping others is my raison d’etre.

Losing sight of that is so easy nowadays within the current healthcare climate, I think.

Long term, I think for me practicing medicine as a PA, at least in the traditional sense, will become more and more something I do for fun, rather than something I have to do for financial survival.

To connect with me you can find me:

@ kcalcano on IG



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