Shadow Me Next!

From PA to Physician, all for the NICU | Dr. Joanne Amos, DO

• Ashley Love • Season 1 • Episode 44

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What drives someone to leave a successful career as a Physician Assistant and return to medical school? For Dr. Joanne Amos, it was discovering her true calling in one of medicine's most demanding specialties: the Neonatal Intensive Care Unit.

Dr. Amos takes us behind the scenes of her level three NICU, where she cares for babies as young as 22 weeks gestation. Her vivid descriptions bring to life both the technical challenges (placing catheters "the width of a spaghetti noodle" in babies who sometimes weigh less than a pound) and the profound emotional landscape of working with families experiencing their worst nightmares. The balance she strikes between adrenaline-fueled medicine and deep compassion offers a masterclass in what makes a truly exceptional physician.

Her unconventional path from PA school to medical school truly took off after she discovered her passion for neonatal intensive care. This journey gives Dr. Amos unique perspective on the differences between PA and physician education, addressing common misconceptions and offering invaluable guidance for students navigating their own healthcare career decisions.

Beyond clinical expertise, Dr. Amos discusses the realities of NICU schedules, the challenges facing PAs seeking leadership positions, and how her perspective as both a physician and parent influences her practice. Her story reminds us that finding your place in medicine sometimes means taking the road less traveled and that the courage to change course can lead to our most meaningful work.

Follow Dr. Amos on TikTok, Instagram, or YouTube to learn more about her journey and gain insights into the world of neonatal medicine. Her story will inspire anyone considering a career in healthcare to pursue the path that allows them to make their greatest contribution, regardless of conventional wisdom.

Instagram: @pa.c_to_doctor 

Virtual shadowing is an important tool to use when planning your medical career. At Shadow Me Next! we want to provide you with the resources you need to find your role in healthcare and secure your place in medicine.

Check out our pre-health resources. Great for pre-med, pre-PA, pre-nursing, pre-therapy students or anyone else with an upcoming interview!
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Ashley:

Today on Shadow Me Next, I am excited to introduce you to Dr. Joanne Amos, whose journey through medicine is as interesting as it is unique. She began her career as a PA, only to discover her true calling as a physician in the NICU, a world of both delicate precision and profound emotion. From managing life-saving procedures on babies no bigger than your hand, to walking alongside families on some of their hardest days, Dr. Amos has learned what it meant to balance adrenaline with deep compassion. Her story is also one of courage, leaving a thriving PA career to return to medical school, fueled by a love for her patients and a desire to stand fully in the work she knew she was meant to do. In this episode, we talk about the reality of NICU medicine, the differences in PA and physician training, and the trust that underlines every clinical encounter. So Dr. Amos and I did not get a chance to discuss a quality question, but something that she said reminded me of something that you might hear on your own interviews. How do you see the role of PAs or other APPs in leadership evolving in the next decade? And what would it take for PAs to fully step into those positions? Dr. Annis, thank you so much for joining us on Shadow Me Next. You are an expert in something that I can give my my one-sided opinion on things. And to have your voice as the other side of steps is going to be absolutely incredible. I'm excited to learn. And I know that this is going to be so great for so many people. So thank you so much for joining us. Thank you for having me. So, Dr. Amos, we're going to do things a little bit backwards today. I'd like to hear about what you're doing now. What does your medical practice, a day in your life right now, look like?

Dr.Amos:

Okay, so I am in a what's considered a level three NICU. So the highest security is level four, and level three is the next step down. Um so we just have fewer subspecialties for the baby. So if something complex comes in, we'll have to send them to the subspecialists. So my schedule looks like essentially one week on, one week off. And how that works is there's either an NP or PA that's in-house 24-7. And then I am also on 24-7 for that week. So I will, if it's a good day, I will go in for rounds around 8 30, work in the hospital, be there all day, and then leave in the evening, um, afternoon, evening, and then I'm on call overnight. So if I have something happens, they need me there, I will have to go back in. So there have been a few times where I'll get called in at like 2:45, get home at 6:45, get everyone off to school, then go back to the hospital at 8, and then keep going. So it can be pretty exhausting when you're on, um, or you can have a good week and you get to sleep in your own bed the whole week. So it really depends.

Ashley:

Amazing. And then when you're in the hospital, what does that look like? Is it, I mean, surely you round on patients, you you chat with your NPs and your PAs about management and care procedures, are there procedures as well? I would imagine so. Yep. So NICU is nice because it is procedure, I would say, heavy and it's more unpredictable. So if you're kind of an adrenaline person like the ER, uh NICU is similar, we'll go to any high-risk deliveries. So if there is a complication in labor, then you do a C-section, all that stuff will go. So you don't always know what's coming down the pipeline for you. And then procedure-wise, we do all of our own lines. So you do umbilical lines, intubations, LPs, um, pick lines, so art sticks, all sorts of procedures. Wow, that is that's incredible. And those procedures are all incredibly difficult and complicated on adults. I um I can't imagine. Everything's doing on it. Yeah, it's so small.

Dr.Amos:

It's too tiny. Yeah. So we have like the catheters we use for the belly button are probably about as wide as the spaghetti noodle on the tiniest of babies. So it takes a little, uh, you have to have some good vision.

Ashley:

I would imagine, yeah, really tiny microscopic vision and very steady hands. Yeah. Um, which is interesting considering the fact, like you mentioned, that it is very adrenaline heavy and um you're moving quickly, and yet you still have to really center yourself and find that calmness in the moment, just the briefest moment while you're placing these lines. I would imagine. Tell me about the age of your patients.

Dr.Amos:

So we have anywhere from 22 weeks all the way to full term. Um, NICU is predominantly like late preterm term babies that you know come to us. Most people don't realize that there's a lot of term babies that end up in the NICU. Um, but we do take care of babies as young as 22 weeks.

Ashley:

Wow, that um there's a lot of emotions there, of course. I mean, I think bringing a life into the world anyway carries its fair share of emotions. And then the absolute last thing a parent wants to hear is that their baby is having to go to the NICU. Is that something that you are directly involved with, managing the emotions of those patients? And what does that number one, as a as a as a physician, what does that look like? And then number two, you're a parent as well. You know, do those emotions kind of play into it too?

Dr.Amos:

Yeah, it's um definitely challenging at times. I think obviously for anyone, the hardest babies are those full-term babies that something goes awry with. Um, you know, pregnancy's been perfect, labor's been perfect, and then something happens just at the very end. Um and it's pretty devastating. And I think it's hard to, it can be hard to separate yourself, especially as a parent, from those emotions. Um, I would say being pregnant in the NICU is not for the faint of heart. You just you know too much and of all the things that can go wrong. Obviously, it's a small percentage of patients that end up with us, but it's hard not to let your head go there. Um, but yeah, so when we admit patients, you know, I'll be there with the team. And a lot of times the dads will have to come because the moms are still in the C-section or they have an epidural and can't walk yet. Um, so it's that, you know, going over and updating the mom. And I think trying to give parents the best hope that they have. So I think they're terrified a lot of the times if they see that the team is calm and this is more of a, you know, we're used to doing this thing, everything's gonna be okay. Um, it helps because they truly have, they're so out of their wheelhouse when they end up in the NICU, it's just not something most parents expect.

Ashley:

I I really love the way that you put that because this is, as we've talked about already, this is a lot of people's worst days. It's not something I would imagine in a perfect world, if you didn't have to do your job anymore, it would be a beautiful world, right? If you did not have to come in and do these things every single day. But yet, because you do, because you have, because you you have experience and you've seen these things, you can then offer that reassurance. Say, hey, you know, I've been here, I've seen this, I've done this, this is the right thing to do. I would imagine that that would be really, really comforting for your parents of your patients. Let's go back for a second. Um, there's a couple of things that I wanted to touch on. First, let's talk about the team. So you mentioned you come in with the team usually. What does the team involve? What does that look like?

Dr.Amos:

So I think depending on the delivery room, it can be overwhelming. So you have a nice quiet berth, and then all of a sudden this team shows up of people you have no idea. So typically NP or PA, myself, depending on the scenario. Um PAs and MPs have a lot of autonomy in the NICU. So if it's kind of a regular, we go to all C sections. So the MP or PA will go there. If there's something that goes wrong or they need me, they'll call me for that. Um, or if we have a complicated complicated patient, I'll just go with them. Um, so it's, you know, NPPA, myself, respiratory therapist, and then a nurse, a NICU nurse at the bedside at a minimum. Now, if things get complex, we have a very small baby, there's typically more people. Um, so the care really starts from the beginning. And it's hard. And I, you know, some scenarios, it's easier than others. If we know they're gonna go into labor early or the baby's gonna come to NICU, we can discuss with them beforehand. Otherwise, they're hitting the step button and we come running in, and it's really hard because the parents are just panicked. Um, for us to kind of introduce ourselves, we're just focused on the baby. Um, and then I think from there, we'll take the baby, always we want them, the parents to see the baby before we go to the NICU. And then you use that chance. I mean, there's so much going on to kind of just say everything is okay, the baby's doing as we expect. We're gonna take them to the NICU, dad can come, grandma can come, whoever. Um, and then we kind of just move to the NICU and then take care of everything that needs to be done as quickly as we can. So typically within an hour for a small baby, we want everything done. So the lines in, fluid hung, uh, sugar checks, all that. So the first hour is really just kind of like this high pressure, high intensity time, even though we're all calm because you need to be calm around the babies. Um, and then once the baby's settled, it's just typical like management. Um, so everything else, fluids, labs, all that jazz get done quickly. And then it's a lot of just trying to tuck the baby in because they're not supposed to be here. Um, so you want to leave them alone as much as you can.

Ashley:

Yeah, that's really, really interesting. And it's so funny you mentioned that. I've had a C-section and literally I don't think I knew who half the people in the room were. You know, I think it's just as a patient, at least speaking on the patient side of things, there really is so much trust that goes into these things. And there's this is a really hot topic, and I don't want to step too much into it right now. But mistrust in medicine, I think right now is is so prevalent. And when you're in a situation like this, speaking as a patient, and of course you see this as a clinician, really sometimes it it's just it's just trust. That's all there is, you know. And and I'm a clinician and I knew what was going on. And I still like I like I said, I didn't know who half the people were. If my baby was taken, I would just trust that they were taken care of. And I think the people that work in the NICU are some of the most compassionate, intelligent, um, success-oriented people in medicine, really. I mean, you guys, your end job is to make sure that these babies are okay. And um, yeah, I'm so grateful for you guys and what you do. Uh, let's go back a little bit. What are some of the things? I think knowledge is power, um, but I also think, like you said, being pregnant in the NICU, knowledge can also be very overwhelming. Okay, so for a second, let's just talk about some of the things that um that you might be called in for, some of the diagnoses that you might see. And if this is something that's going to stress you out, I would recommend fast-forwarding a couple of seconds until we get through this. But tell us about some of these diagnoses that you're making and managing.

Dr.Amos:

Yep. So any baby that's born before 28 weeks, we are called in um just because they are high risk for complications. So we have to put lines in them. They are usually intubated, et cetera. So they will always be there for those. Um, there are certain things like hydrops fatalis that we will be there for. If there's a cardiac, congenital cardiac abnormality or anything else, they'll call us in. Some of these diagnoses we don't always know about beforehand. Most people do get their anatomy scanned, but there are some things that you just are surprised. And unfortunately, more people are going away from modern medicine while they're pregnant. So there are a lot more surprises than there used to be. Um, so any congenital defects. So you can have anything from, you know, valve pushing through your belly button to not having an anus. So there's lots of surprisingly large number of things that can go wrong in pregnancy. And luckily they don't happen that often. But anytime there's anything like that, we're always involved.

Ashley:

The medicine is just mind-blowing. I mean, it really is mind blowing. And then you step over to the parent side of your life and you it's just terrifying. You know, it's just all the things that can go wrong. Yes, there's there's a lot of emotions there. Well, thank you so much for sharing your career with us and and what you do right now. Well, this is the most incredible thing to me. So you began as a PA. Actually, perhaps you began as something even before that. I would I would love to hear briefly walk us through how you first realized you wanted to be in medicine and then this incredible journey that you have taken to where you're at right now.

Dr.Amos:

So I, so my mom worked as a medical assistant in a doctor's office. Um, but I wasn't really that gung ho on medicine in the beginning. So in high school, I think I was trying to sort out what I wanted to do. And one of my neighbors was like, Oh, I'm an EMT at the firehouse. You can take free classes at the fire station. So I was like, all right, I'll do that. Um, so I did a couple of ride-alongs, hung out at the fire station. I was like, this is fun. Like I liked, you don't know what you're kind of walking into with when you're an EMT. Um, but I knew I liked medicine. I was good at biology in my science classes. So I was thinking medicine, some variety. At some point, I was like, maybe a biomedical engineer, but I definitely don't have the engineer brain. Um, so then when I was looking, I was going to do some sort of like science undergrad. Um, and my mom was like, oh, what about a PA? Which I didn't really know too much about, but they the office she worked at had just hired one. So I shadowed a bunch of PAs, shadowed some doctors in high school, and then decided on PA school. I was still torn between, and I think most students are, pre-med, uh med school or PA school. It's a hard decision to make at 18. And the program I applied to was actually a three plus two, so a five-year program. And my 18-year-old brain, I was like, this is great. I'll get my undergrad done in three years. And if I want to do med school, I can do that afterwards, or I can continue and stay into grad school. So I just went with that because I was like, this is seems like a pretty good, surefire way to have a job out off after college. And that was, I think, my major reassurance was either way I could go to med school or I could continue in the grad program. So finished my three years, was still kind of thinking medical school. But one thing that I found the most daunting was like, there's really nothing guaranteed in med school. Get in, pay all that money and loans, and not match. It's rare that that happens, but it can happen. You could fail your step one, you could fail your step two. So those are all, or you can match into something that you hate and you're for the rest of your life. So all of those to me were like a huge deterrent. I was like, um, I like PA because if I don't like the fields, I can just switch into something else. Um, so I think that was a huge driver for me to continue with PA school. And then as I was getting through PA school, I realized perhaps I don't like medicine at all. I remember being on my rotations, being like, I don't like this one, I don't like this one. And I think it was on like my eighth or ninth rotation. I was like, oh God, I what have I done? Yeah, like I didn't don't like any of this. And I happened to do the adult ICU. And I liked the medicine, I liked managing ventilators, I liked the procedures. So I was like, this is great, except I find it really depressing. It's a lot of people towards the end of their life or young people that something horrific happened. And I was like, this is not good for your mental health. So then I still was like, I don't know what I'm gonna do. And I happened to get an elective in the NICU, and that was when I realized, okay, same medicine, same concepts, but with a population that is completely different, pathophysiology-wise, and there's just a lot more hope in the NICU, I found. So then I realized I liked the NICU. So I was like, great. But of course, some of the caveat being there wasn't at the time, I think there was one or two uh NICU residencies. And I didn't find out that I liked the NICU till it was too late to apply anyway. So the place I did my elective in was like, we'll hire you and kind of train you for six months to get catch up to speed. So I did that and then realized, oh, gee, like I'm still in over my head in terms of knowledge base, just because it is a very specific field. And I think a lot of the time you can gain experience the longer you do something. So if I'm in it for 20 years, sure. But there was a level of, I'm not studying Krebs cycle and gluconeogenesis on my own, and I'm not studying embryology that we come from and mesoderm and ectoderm and endoderm. And so those are things like you can look at and you can read, but nothing sticks. So I felt that in order for myself to feel confident and comfortable and treat the patients how I wanted to, my my next best step was going back to med school.

Ashley:

What did that look like? I mean, did were you just did you ever stop and think, am I out of my mind?

Dr.Amos:

Yeah, I think most people, when I told them, they're like, you're nuts. Um I was like, Yes, I am. Because most doctors, if you talk to them even now, they'd be like, oh, I should have done PA school. Right. PAs and PAs are like, oh, I should have just gone to med school. Uh so it's a very everyone's like on the opposite page. But I finished PA school and I figured I kind of still had that in the back of my head and I knew I needed some prereqs. So I'm like, I'll start working, gonna take these prereqs, see how I feel after I start working. Took my prereqs and kind of just decided, look, I'm just gonna go for it. I'd rather regret not getting, like, I'd rather just try getting in and then not regretting for the rest of my life, not even trying. So I took the MCAT and then I applied the following. So I worked for a full year, applied that fall-ish, I guess, the timeline for med school. So worked for two years full time before I had gone back. So it kind of was like as I was finishing PA school, I was still kind of like this knowing what I wanted to do, I needed more education. Had I gone into something like primary care or something outpatient, would I have been as motivated to go back to medical school? Probably not. I think just because I was in such a specific field, and if I liked everything too, like if I loved ortho and I loved surgery and I loved internal medicine, I don't know if I would have gone back because I didn't want to pigeon, I wouldn't want to pigeonhole myself into like one field. But because NICU was what I saw myself doing for the rest of my life, I was like, I think I need to make this decision.

Ashley:

So I did. I think it's a really, really great example of how versatile medicine can be. Even when we think we are at the end of our career decision making, and we realize, but in essence, you fell in love with a specialty. You fell in love with medicine that is incredibly complicated. And because you loved it so much, you literally went back to school and did tell me, how many more additional years of schooling was it? A decade later. So that's how much you love this, but all of that knowledge, every time you walk into a room, the presence that you can give these patients and their parents, knowing that this is absolutely where you belong and what you love doing, and this is how hard you've worked to get to where you're at. I mean, it's just the confidence in that that you must feel and that they must feel is absolutely incredible. Okay, let's let's talk a little bit about PA school versus medical school very briefly. Yep. Because as we know, it was um just a little bit of time ago that you're doing these things. Generally speaking, both are extremely difficult. One is a little bit longer. Um, is there in your opinion, is there any like a major, major thing that you would like to tell a pre-health student perhaps that is trying to decide one or the other, really just based on the schooling alone?

Dr.Amos:

I would not go under the assumption that PA school is easier because it's shorter. So it was, I mean, the intensity of PA school was unreal. And I think I blacked out a lot of my uh my schooling at this point, um, just out of pure stress. But I really we would have tests three times a week in PA school. We were in class eight to five every day, like there was no stopping it. Um, and then med school was still a lot of information, but it was more spaced out. And I would really truly recall we'd have like didactics in the morning from like eight to one or eight to two with like a lunch break. And then some days we would have lab, but like to me, I didn't count lab, I guess, as education because everyone's like, we were in class every day in med school too. And I'm like, yeah, but like we would have physical diagnosis lab, but like I would have that in PA school, but that would be like after my five o'clock lectures. So I felt the intensity was a lot more in PA school. You're just trying to cover so much information in one year. Um, so it was very overwhelming. Medical school, I think I had more time to kind of digest things before or tested on it, or I could like really study, process it, and then kind of move on to the next day. PA school, there was none. Like you were just, it was going full speed for a whole year.

Ashley:

When you made the transition from PA to physician and now you've been working in it for a while, are there any gaps that you've seen that you didn't expect? So things like clinical knowledge, which we've talked about a little bit. You know, you just did NICU is a really special case too. There's so much that you have to know. So we we talked about that, but um, what about like maybe leadership opportunities or research opportunities or just the system and in general? You've seen things from both sides now and you've experienced things from both sides working as a P and as a physician. Um, anything glaring that you've noticed that you just think we should be aware of?

Dr.Amos:

I think which I find frustrating, especially in this current environment, um the for PAs, there's definitely kind of like a glass ceiling at some point, right? Clinically, you can do everything, you can take on patients, you can do some like low-level managerial work in the office or whatever. But like true leadership positions really, you don't see that many PAs in them. And I don't think that's for a lack of ability. I think it's just lack of understanding the role. There's more NPs getting into those positions just because they they have a great lobby that pushes for those types of things. Um, but there's certainly that kind of not that you want to sit in meetings all day, but like administratively, I think PAs are a huge value and they're just can be very underutilized in certain situations.

Ashley:

Yeah, I would agree with that. So on your social channels, you have a really incredible online presence, and I'll tag it in the in the show notes for sure. Um, but you get a lot of questions, and you are so kind and so amazing to answer these questions and really mentor some of these students. What are some of the most common questions or misunderstandings that maybe a pre-health student or even even current clinicians have about the PA to physician, switch, or transition?

Dr.Amos:

Uh most common question is definitely people that are torn between PA and MD. The highest misconception I see, and I think it gets like torn apart in comments, is just, and I think some of them are, you know, they could all just be trolls and bots, but people really not understanding the education of a PA. So in comparison, when you have the whole NPPA mid-level role or APP role, you get a lot of heat, no matter how you post it. PAs, I think, though training is not like medical school, I think you have the broadest training in comparison. So you're the closest that you can get to medical school without the biocellular, molecular basis of medicine. So we get a lot of comments like, oh, PAs are just like doctors, or PAs are they have no idea what they're doing. They're not like doctors at all. They shouldn't have, you know, independent practice. It goes like both ways. So, like, there's a middle ground, which I think we should all come to, but your training, you're getting education in all of those areas. So you're getting rotations, which I try and highlight. You're doing OBG way in. Yes, maybe it's a short rotation, but same with med school, it's a short rotation until you do residency. Um, so your rotations and your education mirror that of medical school without the nitty-gritty science to some degree. Um, but there is obviously nitty-gritty science in PA school, it's just not as intense. And compare that to NP school, which I think people have a hard time with. You pick a specialty as an NP. So you're you're not like if you are a pediatric NP, you can only prescribe medicine for P patients. As a PA, I can run the gamut. I can write meds for an 80-year-old, I can write meds for a six-month-old. Um, and you have training in all of that, though it's more brief. Whereas an MP are kind of the specialists in whatever field they so choose in that regard. So I think the confusion is the education. And in PAs to me, and MPs are not necessarily comparable in some regard. Sure, they have the same role, but the education is so different. Um, and I think that is where a lot of the questions, controversy, comments come from.

Ashley:

That is a really, really great example. And I'm so glad that you highlighted that. I think in practice, oftentimes they appear the same, but you're absolutely right. You have to look back and you have to see how we were trained. And um, and that's what students really need to investigate and see because of the the the training that you get and the specialties that you you can work in afterwards are very, very different. So I'm really glad you highlighted that. Dr. Amos, you are incredible. Um, tell us where we can find you so that we can, you mentioned uh independent practices PAs, and that is another big hot topic. So I would love for you to share where we can maybe learn a little bit more about some of these other topics that you are very well versed in.

Dr.Amos:

Well, I am I'm on TikTok and Instagram, and I have some of the same videos reuse on YouTube. So whatever not my YouTube is not anywhere near up to speed, but I do have some videos there. Um, I would say TikTok or Instagram is my spot.

Ashley:

Very good. Awesome. Dr. Amos, thank you so much for spending the time with us on Shadow Me Next. I really, really appreciate it. Thank you for having me.

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Ashley Love

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