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From CASPA to career, the PA journey is a stressful one. Every physician assistant/ physician associate (PA) has started with that first fateful step: hitting "submit" on their application. And then every one of us had to put our fears, goals, finances, and achievements in the hands of strangers to find out if we'll join the profession of our dreams.
Becoming a PA is a years-long process for almost every applicant and practicing PA. Earning hours of patient care experience, passing pre-requisite courses, finding mentors and references, accepting a program, passing dozens and dozens of exams (on paper and in-person!), applying to and choosing a first job, and settling in to a fulfilling career takes prolonged dedication and focused intention. And for every PA - yes, every PA - some part of this journey feels impossible, overly stressful, or like it will never, ever end.
The good news? We've all been there, and there is a lot of truth to the adage "trust the process." By far the majority of accepted applicants go on to graduate, certify nationally, and practice successfully. But let's not trivialize the scary parts. Here are the five moments that PAs say were the most nerve-wracking and some strategies to help you breathe through them.
1. The Waiting Game: Hoping for a PA School Interview
You hit "submit" on your CASPA application. You’ve triple-checked your experience hours, crafted your personal statement, and poured your story into every detail. Now all that’s left is... waiting for an interview.
The PA program interview invite stage can feel like the longest months (or years) of your life. You refresh your email constantly, repeatedly check spam folders, second-guess every decision you made in your application and word you wrote, and haunt pre-PA forums looking for signs of rejection or encouragement. Pre-PA anxiety is very, very real.
Why it’s stressful: You’ve done everything you can, but you have zero control now. And because many PA programs release interview invitations on rolling timelines, it’s hard not to panic when others start posting their good news. It's not uncommon at all to need to reapply after a cycle without any acceptances, and it can feel like your life is on pause until you're in.
What helps:
Focus on what’s still in your control: update your resume, gain more patient care experience or diversify your achievements, practice mock interviews, and network with PAs who've been there.
Limit time in applicant forums if they heighten anxiety. No one's experience is exactly like your own.
Remember: silence doesn’t mean rejection. No news truly is no news.
Our advice:
Don't repeatedly email admissions coordinators or administrators. Unless you have a genuine concern about something missing, or need to update your application, they don't have anything to offer until the program has made a decision.
Don't live your life by the timeline. Your life will happen over those months to years it takes to be accepted, and the anxiety you experience will do nothing to improve your chances or change the outcome. Try to live and seek the input of what a good life means to you. If anything, it'll improve your understanding of what it means to find "work-life balance," and maybe provide an answer for an interview question about your own interests and goals.
Know your "why." Once you're in the interview hotseat, the most common question is, "Why PA?" If you don't have a clear answer, seek it out ASAP. Want help identifying your path? We love to talk about it!
Trick or treat?
This one is a scary one for sure. Trust us - every PA has blocked this time of apprehensively opening their email completely out of their memory.
2. Holding Your Breath: Waiting on Your PA School Acceptance
You prepared, dressed the part, and crushed your PA school interview. You walked out feeling hopeful, but now comes another round of uncertainty.
This wait is brutal because it’s the culmination of months (sometimes years) of work. Every ding of your inbox sends a jolt through your chest. PA school admissions interviews are totally different at each program, and it's hard not knowing what a program is really looking for. When getting into PA school has been a dream for years, an acceptance can feel so far once it gets that close.
What makes it so nerve-wracking: You’ve invested everything you have - money, time, and emotion - into your application. Rejection feels personal and permanent, even though it's not.
What helps:
If you’re waitlisted, send a short, professional update letter. Express continued interest and highlight any new experience or certifications.
Normalize reapplication. Many strong PAs didn’t get in the first time.
Use the downtime to reconnect with hobbies or people who ground you. Your worth isn’t tied to one admissions decision.
Our advice:
Really research the programs you've applied to. It is not uncommon for an acceptance to require a response within a short period of time - sometimes less than 2 weeks - and it's worth knowing if this program is really the one for you. It may be a challenge financially to accept a spot at a school hoping to go elsewhere, so weigh your options carefully. Don't say no unless you're sure, and don't overthink saying yes while still keeping options open. This is your future.
Waitlists exist for a reason! Many students may pull their acceptance in favor of a school they were better suited for. It's not a "no" until the program has started and they send final decisions.
Trick or treat?
This isn't an easy time, but, fortunately, this phase of the application process tends to move along a little more quickly than CASPA review. But with an average overall acceptance rate of less than one in three, we know that most PAs are devastated with this experience at least once.
3. The First Real Test: Passing Your First Clinical or Patient Encounter
Once accepted into PA school, the joy of celebration can fade quickly as the exams start piling up and that "water hose" of information starts pouring! PAs are routinely assessed on their clinical knowledge and clinical skills throughout their program (sometimes with multiple exams per week!), and that first exam can be terrifying. It's especially common for PA students to fear their first graded patient encounter or first clinical rotation with a preceptor. There's just something about someone watching you.
That first patient encounter (OSCE, clinical skills checkoff, or simulation) is enough to send anyone’s nerves into overdrive. You’re applying everything you’ve learned, while being watched and graded, and it's easy to lose your train of thought or have your mind go completely blank.
Why it’s scary: For many, this is the first time you feel the full weight of clinical responsibility. Imposter syndrome is loud in this moment, and it's so hard not to watch your peers and marvel that maybe they have it all figured out (they don't!).
What helps:
Prepare with your peers as often as you can! Practice interviews and physical exams out loud, and take your practice seriously.
Afterward, debrief your encounters with instructors. Feedback is a great teacher.
Remember: mistakes are part of learning. Every PA you admire has had that shaky first encounter too.
Our advice:
Practice consistency. When you're being graded, you want to minimize all chances of totally blanking and wasting time. Have a routine flow for your history and physical exam that you can edit based on complaint.
Pause with intention. There are multiple "transition" moments in a patient encounter - washing your hands, sitting down, asking the patient to move to the exam table, etc. Use those moments to think, process, and determine your next step. After each transition, repeat the collected data back to the patient, not with a diagnosis, but with an intentional review of each elicited detail.
Absorb the feedback. It can be easy to perseverate on that first "you should have..." and lose yourself to the memory of the encounter. Stay present with your faculty and hear them out. If you can, write down or record what they have to say. And when you watch back your encounter, look for those moments that didn't go as planned.
Trick or treat?
Treat that seems like a trick. The truth is, these encounters only get easier, but you have to have that first one to get to the good parts. A good PA has robust useful experience, and every mistake proves you tried your best to learn and grow.
4. The Big One: Passing the PANCE
This is the gatekeeper moment. The Physician Assistant National Certifying Exam (PANCE) is your ticket to practice, and just the thought of it can tap into insecurity, uncertainty, and that feeling of being underprepared. The PANCE pass rate is high, but taking any 4+ hour exam is stressful. And after 2 straight years of exams, the PANCE can feel like an impossible culmination of everything you learned.
Is PANCiety a term yet?
Why it’s so stressful: You’re not just being tested on one unit or one rotation, you’re being tested on everything. Years of education, crammed into one high-stakes exam that determines your future.
What helps:
Make a study schedule early and stick to it. Blueprint (formerly Rosh Review), Smarty PANCE, Kaplan, and Hippo Education are all reliable prep tools for PA students taking the PANCE. We recommend finding an exam strategy by using our Hack the PANCE guide!
Simulate exam conditions with timed practice tests.
Protect your mental health (you just finished 2 years of schooling!). Exercise, hydrate, and take scheduled rest days.
And if you don’t pass on the first try, know this: you’re not alone, and your dream career isn’t over.
Our advice:
Don't wait to start studying until after finals. Preparing for graduating PA school is so similar to preparing for the PANCE exam. Double dip those study strategies! Make sure you're covering your program's topics and the PANCE content blueprint released by NCCPA.
Not everything is clinical medicine! The PANCE includes task categories like "Applying Basic Science Concepts" and "Health Maintenance, Patient Education, and Preventive Measures." Those soft skills have data behind them, so don't neglect to prepare for questions on how to interview a patient.
Take the PANCE early (if you've done well on your final exams). Don't belabor more studying after passing exams for 2 years straight and sitting through a week of finals. There's only so much anyone can cram into their brain at once! Prepare thoroughly, take the exam, and get to the good part (PA practice!) sooner!
Trick or treat?
Scariest trick in the (haunted) house! Is there any way to normalize an exam that gatekeeps your whole future? Since you can only try twice in one year, it feels like it counts, and yes, that's scary!
5. The Final Wait: Landing That First PA Job Offer
You’ve graduated, passed the PANCE, and are officially certified. But before you can exhale, here comes another fraught waiting period: getting your first job. The job search as a new grad PA, and waiting for your first job offer (or for the one that matters), can take months of searching and applying, which is... hauntingly reminiscent. After proving yourself competent, capable, kind, and patient-centered, you're back in a huge pool of peers waiting to be called into your career.
Your applications go out. Interviews trickle in. You second-guess your salary expectations and what really is "normal." And when you finally get an offer, it’s followed by the stress of contract negotiations and "what-ifs."
Why it’s stressful: The job market can feel unpredictable, and new grads often feel unsure of how to advocate for themselves. Imposter syndrome can rear its ugly head when finding your dream job suddenly feels like an actual dream.
What helps:
Network early and often. Reach out to preceptors, alumni, and mentors who work in spaces you are interested in, live in areas you're looking to live in, or work for healthcare organizations you admire. A good reference can be huge in getting the job you want, and many jobs may be posted long after colleagues are aware of the need.
Use reputable PA job boards and professional associations, such as the PA Jobs site! We have details regarding practice law, expected salary, and reputable organizations hiring PAs in every state.
Before signing, have a mentor or PA organization review your contract. Always consider negotiating; it's an expected part of creating a contract agreement.
Our advice:
Use your resources. It is impossible to know the unknown! Many PA programs don't spend much time reviewing the process to practice after graduation. Meet with a mentor, spend time creating a CV that represents you, and search for jobs efficiently.
Don't take the first job that's offered to you, but don't wait months for what you think is the "perfect" fit. So many jobs are different once you're working, and it's really not possible to know if a job is the right fit until you work there. That first offer might not be your forever job, but it will open the door to your career.
That said - don't accept a job with red flags, no matter what. Nothing is worth compromising your sanity, your self-respect, or your license. Had a bait and switch? Don't hesitate to move on.
Trick or treat?
This step in your PA journey is a scary one, but we think we're leaving the haunted house. Think of waiting for your first job as a PA as your interview process. These jobs need to fit to your standards just as much as you need to fit for your employer's. While the waiting game is a tough part of the PA journey, this wait is worth your while. Find the career that suits you, and it'll make all of the time worth it.
You’re not alone in the anxiety
The path to becoming a PA is full of hard work, self-doubt, and long nights of wondering, “Will I make it?” You will.
Every PA who came before you has paced the room, refreshed their email while holding their breath, vented to friends and family, feared the worst, sighed with relief, and, eventually, cautiously walked across the graduation stage. Find some encouragement in sharing this experience - it's only hard because it's worth it. And know that every nerve-wracking step brings you closer to doing what you love: caring for patients and making a difference.
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