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From Exam Rooms To Academia: A PA’s Purpose-Driven Path | Dr. Kenneth Bothelo, DMSc, PA-C

• Ashley Love • Season 1 • Episode 55

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We start with a simple question: what is your why? 

Today we sit down with Dr. Ken Botelho, a seasoned primary care PA and the founding director behind a new Doctor of Medical Science program, to explore how purpose, presence, and mentorship shape better clinicians and healthier teams. From the first lab review of the morning to the final patient call, he shows how showing up as a human can stabilize more than symptoms.

We dig into the realities of primary care right now: musculoskeletal injuries at the front door, diabetes and cardiometabolic risk on the rise, and anxiety and depression woven through many visits. With psychiatric access limited, primary care becomes the first line, demanding both clinical confidence and emotional skill. Ken shares how small choices (language, pacing, asking one more question) unlock trust and lead to better decisions. He also spotlights the hidden engines of the clinic: front desk teams, medical assistants, and call center staff who set the tone and carry the follow-through that make or break outcomes.

Then we step into education and leadership. Ken explains how the DMSc can elevate a PA’s career by formalizing mentorship, recognizing transition-to-practice learning, and turning precepting into structured academic credit. Teaching is a performance enhancer; it forces clarity, protects professionalism, and reveals the nuance we usually process silently. You’ll hear practical examples, like when to drop the white coat to build rapport, how to read the room, and why knowing a patient’s story changes the plan before the chief complaint is finished.

We close with a Quality Question worth keeping in your pocket: what is your why? Use it to unfreeze an interview answer, reset a tough visit, or guide a leadership decision. If this conversation gave you something useful, follow Shadow Me Next, subscribe for new episodes, and share it with a pre-health friend. 

You can find out more about Dr. Botelho at his LinkedIn page

Or visit The College of St. Scholastica directly.

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 Love:

Hello and welcome to Shadow Me Next, a podcast where I take you into and behind the scenes of the medical world to provide you with a deeper understanding of the human side of medicine. I'm Ashley, a physician assistant, medical editor, clinical preceptor, and the creator of Shadow Me Next. It is my pleasure to introduce you to incredible members of the healthcare field and uncover their unique stories, the joys and challenges they face, and what drives them in their careers. It's access you want and stories you need. Whether you're a pre-health student or simply curious about the healthcare field, I invite you to join me as we take a conversational and personal look into the lives and minds of leaders in medicine. I don't want you to miss a single one of these conversations. So make sure that you subscribe to this podcast, which will automatically notify you when new episodes are dropped, and follow us on Instagram and Facebook at Shadow Me Next, where we will review highlights from this conversation, and where I'll give you sneak previews of our upcoming guests. Today we're talking with someone whose journey captures what medicine looks like when you lead with humanity, curiosity, and a grounded sense of purpose. Dr. Ken Botello is a primary care PA with years of experience caring for patients at some of their most pivotal moments of their lives. But he's also the founding director of the Doctor of Medical Science program at the College of St. Scholastica. His story moves between exam rooms and academic halls, between stabilizing patients in crisis, and mentoring the next generation of clinicians. He shares how he discovered his path into medicine, how primary care taught him the power of presence, the quiet strength of supporting staff who hold the healthcare system together, and why being human is one of the greatest superpowers we have in an increasingly technological world. And towards the end, he offers one of the most beautifully simple, deceptively deep quality questions we've ever had on this show. Please keep in mind that the content of this podcast is intended for informational and entertainment purposes only and should not be considered as professional medical advice. The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect the official policy or position of any other agency, organization, employer, or company. This is Shadow Me Next with Dr. Ken Patello. Dr. Botello, thank you so much for joining us on Shadow Me Next today. It is going to be a fabulous time talking about a variety of different topics with you.

Dr. Ken Botelho:

Great. Thank you so much for having me. I'm excited to be here and chat and explain my uh journey to your audience.

Ashley Love:

Yeah, absolutely. Thank you. And quite a journey it's been. Um, if you wouldn't mind, let's start at the very beginning. Did you always know you wanted to go into medicine?

Dr. Ken Botelho:

No, uh, not at first. I think I've always had some interest in the sciences in general and felt like I, I guess you can use the word excelled when you're in school. You kind of can get a sense as to what you're better at, what you enjoy. Um, as I continued to go through high school, I recognized human anatomy was something that I enjoyed, human physiology was something I enjoyed. Um, and I've always had an interest in caring for others or trying to help stabilize others or support others. And so that naturally led me to medicine as my high school career expanded.

Ashley Love:

I especially like the way that you said supporting and stabilizing others because I think so often we hear people say, Well, I want to care for others. And I believe what we do as PAs, and you've been in practice for a while, I've been in practice for 10 years. We do care for our patients. We also care about our patients, but you're absolutely right. We are supporting them. Is that what you're is that what you're seeing in practice?

Dr. Ken Botelho:

Absolutely. We all have folks that come in, or so kind of expanding and kind of taking together the thread of what you just asked with this thread. After high school, I went into college and realized I wanted to go into medicine more in depth. And I was trying to choose the field because there's multiple out there. And uh one of my my best friends uh father had been a PA. And so I learned about the profession through him. And then to expand a bit more on what you had said in regards to um having compassion and and stabilizing patients, that is a natural part of the day-to-day, I think, as a PA, or in in my case, in primary care. You become a person that is truly a stabilizer and a healer for a community. You know, the community doesn't necessarily have to be a large place, but it maybe the community is your patient panel, the panel that you're responsible for. So when they come in, and even if it's just a cold, you know these patients. So the cold becomes, well, yeah, we can make you feel better, but how are you doing elsewhere? Like, are you doing okay otherwise? Um, and so that's where I guess uh some of that discussion about stabilizing comes from because you get to know people and you get to expand your humanity through others and try to help them along the way of their journey. And so that's really where I think I feel like I have the most value to others in general. And I know we're talking specifically about patients when you ask that, but it goes as far to, you know, the front desk staff and those that room our patients and those that call our patients when we can't get on the phone. Um, all those people play a role in making people better. And so that's part of what I will, my own journey is to try to pass that along further.

Ashley Love:

I want to take that and just absolutely run with it because it's something we have never ever mentioned on the podcast and something that we see as clinicians every day. And that is how our non-clinician support staff impacts our patient experience, right? Um front desk, check-in, check out, whoever's calling with lab results or pathology, et cetera. Those people can make or break patient experience, you know, and I'm sure you have stories, I have stories. Um, but let's talk a little bit about that from the clinician's point of view. How do you how do you foster good relationships with those those members of the healthcare team?

Dr. Ken Botelho:

And it always comes back to, and this is something that I'll I'll touch on later in the conversation as well, but it always comes back to my the the clinician's why. Why are you doing what you're doing? And I know a lot of the day-to-day is minutia about we got to click a box, or um we got to check on a lab from earlier in the day, or what have you. But it really comes down to trying to be kind to everybody that you meet. And if you can truly do that, or at least step back and reflect and maybe judge how you're doing it, you get better every day, and then you help make others better too. So that I think is the best way to answer that question. Um, everybody's got bad days, and and myself included. I think it the most important thing is to try to recognize when you do have bad days, they're bad days, but they're not all the days.

Ashley Love:

It's a bad day, not a bad life, right? That's like one of my favorite phrases. I love that. Well, thank you for saying that. And you're right, our why matters. Our why is what propels us forward as clinicians, our why allows us to communicate positively with the members of our team as opposed to um, you know, being uh degrading or berating, because perhaps if our why was just to make a bunch of money and they're not doing their job, we're not making money. Well, that's not helpful. If our why is patient care, it totally changes the picture um entirely. Let's I would love to hear about a day in your life. Specifically, think about clinic. As a PA in um in primary care, Ken, I would love to hear about what that looks like.

Dr. Ken Botelho:

Sure. So I would typically wake up in the morning um somewhat ready to go. Of course, depending on the morning, if it's darker and you're in uh Duluth, Minnesota, it might be a little darker in the morning, so we're slower. But regardless, um you kind of go into work, look at labs that may have come in in the day before, look at images that may have come in the day before, make sure that you have somewhat of the um what I call fires, and I don't mean that in a negative connotation, just in a connotation that needs to be addressed, that's all. Uh and so those are things that I typically will prioritize for the day. And that's before seeing a patient. And then once you start your day, you've got a list of folks uh ready to go in clinic. If you've been practicing for a while, you may know almost everybody on that list. If you haven't been practicing for a while, it can be a little intimidating at first when you don't know anybody on the list, but that comes with time. Um, I always try to ground myself when I go into the clinic or when I go into a patient's room. And one of the things that I I do is I, and this might be subconscious at this point, but I try to make sure that I'm there for them, not there for me. And it's difficult sometimes when life comes, and maybe the night before you had a bad night, or the day before or the day of, you know, you get stuck in traffic. Um, they don't care about that. And I don't mean that in a bad way. I mean that in a way that you're there for them. They're not necessarily there for you in that circumstance. And so that kind of goes back to my own personal why. And then as the day progresses, there's there's some chaos that's typically involved between folks being sick or somebody maybe having to go to the hospital that's on your patient panel. Um, may have to make a few call phone calls that aren't ideal. But in the end, you actually help these people get through their day and stabilize, like we talked about earlier in the podcast. So um it's highly rewarding. It's difficult, but not difficult in the way that it's not valued or important. Um, and it makes sometimes the difficulty actually makes it feel more accomplished, I guess you could say. And then by the end of the day, I think we've all kind of had enough for for our cup, and I get to go home and see my family and my my wife and my kids and my dogs that greet me at the door, and uh we'll answer some emails and and go from there.

Ashley Love:

It's a really lovely way of describing the lasting relationships that you describe with your patients. When you say you look at your list and you immediately know them. I mean, it it's one of the it's one of the ways that I counsel our students when they're trying to determine where they want to belong in medicine. Do you want to look at your list and have complete anonymity, not know a single person? Does that make you feel better about your day? Or like you mentioned, it stresses me out a little bit when I look at my list and I don't know anybody on it, you know. Um developing those patient relationships is what makes a lot of clinicians tick. Um remaining largely unknown to their patients is what makes other clinicians tick. So I think that was a really great and a big picture example of how to find where you belong in medicine. Thank you for thank you for describing that. Ken, what are some of the conditions top, top conditions that you treat in primary care and maybe your favorite?

Dr. Ken Botelho:

We're definitely seeing more musculoskeletal things than before. And I don't mean that I think it's more because we're the first line, right? So if you bump something or scrape something or injure something, folks will either go to the ER if they really truly think that's a fracture, or they'll go to an urgent care or you uh their primary if maybe it's not as emergent. Um and that's that's appropriate. Um, other than that, though, diabetes is certainly on the rise. And so diabetes and um the accompanied nutritional issues that will come with that, whether it be hypertension or chronic kidney disease or what have you. I enjoy, but it does take a bit out of me treating anxiety and depression. Couple things about that. As a primary care provider in today's world, you need to be able to treat those things. You folks that are experiencing anxiety and depression can't necessarily just go to right from primary care to a psychiatrist or or what have you. It it's there's not uh enough available. And as we've gone through medicine in the last 15 years, we're moving more towards primary care, being that first line of defense for anxiety and depression. Right. And folks are more stressed nowadays, and so being empathetic and and having a strong knowledge base in that area is incredibly important. So I would say that that's both probably one of the biggest chief complaints, but it's also one of the bigger under-discussed things where folks come in for a cold, like I said, but maybe they're more anxious and depressed. And if you're a primary care provider and you're seeing that patient, you're gonna have that conversation. So while it can take a lot of time, you can also make a bigger difference.

Ashley Love:

It's an underscore for so many of the conditions that we're seeing across the board in medicine right now, right? A patient comes in, so I work in dermatology, a patient comes in with these bumps all over their skin, and somebody told them that they have, you know, syphilis or some type of skin cancer. And it turns out they just have undiagnosed, severe anxiety and they're picking their skin to death, right? And we call it parigonodularis. So you have to be comfortable, like you mentioned, having these conversations with anxiety and depression. Um, you have to invite that conversation, you know, it it can't, you can't just come out with it. It'd be like hitting somebody with a Mac truck, right? Hey, I think you are depressed. Hey, I think you have anxiety. No, it's it's it's a softer, gentler approach. Ken, thank you so much for describing that. You mentioned, you mentioned that you're part-time now in primary care. And part-time in something that I think is so cool. Tell us a little bit about your role.

Dr. Ken Botelho:

So, right now I'm I'm more or less full-time as the the founding director of the Doctor of Medical Science program at the College of Saints Scholastica. And so we're building that program and we're launching in January. Of course, it's November as we're talking. So we're getting close to our launch. But while I'm doing that, I'm also working part-time in primary care, which looks very different from when it did when I talked to you about what my day-to-day was in a full-time capacity. Um, now I'm well, I was in Rhode Island at the time of the full-time capacity, and now I'm in uh Duluth, Minnesota. So as you're as you're likely aware, um moving across the country, you're not gonna know those patients that are on that list, right?

Ashley Love:

Right.

Dr. Ken Botelho:

But I know I have a very good reservoir to pull from of challenges that I've experienced when being with patients that I'm very um comfortable with. So that translates, you know, you can if you've done it long enough and you feel um comfortable in stabilizing other patients, sometimes a calm demeanor just going in the rooms sets the tone right away for folks. Um and this is something I I think I I should say too. In the world that we're using AI and and um and having more metrics and computers, and being a being a human is a superpower. So so if we're able to approach everybody like a human, not like a diagnosis, feel that immediately. And so that's something I continue to try to bring, even in a part-time capacity, when you don't necessarily know everybody. And so um I find it a bit invigorating not to know everybody sometimes too. It's like the other side of the same coin. You know, sometimes knowing everybody um can be a bit of a burden. I don't mean that in a bad way. I just mean it in that you feel a level of um responsibility that's very heavy, and that's okay. I mean, there's nothing wrong with that. And then being in having the other full-time role, sometimes there's a blessing in disguise to that, I suppose, right? So um I get to I get to practice non-transactional medicine, but still get to um enjoy some of the fruits of like the academic labor that we're working on and and some of the things that we're looking to do in PA education.

Ashley Love:

Which I cannot wait to talk about. So, Dr. Patello, tell me what a Doctor of Medical Science program is. Who who enrolls? What is the goal? What are we looking at here?

Dr. Ken Botelho:

Yeah, great, great, great question. So let me, I always like to ground it in the why. So, first off, um, right now, uh entry-level PA program is a master's level program, which is great, find and appropriate. Um, what this is, is basically the doctorate version where if one wants to take their career and have some level of elevation to it, whether it be through um a clinical capacity, through an academic capacity, or somebody wants to be an educator, or through additional leadership opportunities, we've created a pathway that allows you to grow and develop directly in those areas. Now, let's let's talk about the why, because this is where my background and our college and our program are different. So the why. Let's go back to the 1960s when the PA profession was created. It was started as physician assistant, and typically in the graduate setting after PA school, one would go out and work directly with a physician in a mentored capacity, right? It would be like an apprenticeship. Um, I think most of us think of a PA going into a clinic owned by a physician, they end up kind of being their right hand, and um, they grow and develop through that relationship. Now let's fast forward. Um we don't have physician-owned practices like we used to. So now who is mentoring us? It really depends on where you work, what state you work in. And that variability can be sometimes empowering, but sometimes it can be debilitating to folks that are seeking direction. And so what we're doing is providing academic scaffolding or academic credit for a lot of what we do after graduation. So if one is seeking out mentorship and seeking out support after graduation in a in a setting where they're getting reimbursed or their their job, um, a fellowship, a transition to practice program, what we are providing in part of our program is academic credit where they can reflect on those opportunities and gain doctoral credit. And now I'm not saying they're gonna gain their doctorate from just that. I'm saying that that's something that they can utilize. um credit towards. And then beyond that, for folks that maybe have been practiced, like for instance, for me, when I went my and got my doctorate, I was um, I was about, I think it was eight to nine years into practice when I started. And so I was quite seasoned, um, had a full patient panel, um was ready to go, so to speak. But I was looking for an additional layer of professional advancement and uh development, educational development personally, so that I had the leadership skills and I had the wherewithal to feel empowered to do more. And so that was my my ticket and my key to doing that. And what our program is designed to do is not necessarily just provide a transactional degree, but also provide the mentorship to get to the point where you feel confident, comfortable enough to expand what you're doing and grow and develop professionally. So we also have um academic credit for those that uh folks that are precepting. So for instance, if you're precepting a student um we are taking what you're doing for precepting we're kind of vetting that through the program that you might be utilizing um taking some of that evaluation of students and utilizing that towards academic credit. Now for your audience I want you to I want to flip this a little bit so when we're teaching or mentoring I will tell you right now to anybody that's listening that that is as much of a teaching moment for me as it is for those that are being taught or being mentored. And there's a couple reasons for that. So one is it keeps you on your toes. Yeah yeah um you know I love I I enjoy being kind of nonchalant to some degree and um kind of being myself and not as formalized. But you have to make sure you're a professional in those settings even when you're looking to kind of tone it down and I don't mean that in a bad way either but sometimes when you're you've known a patient for eight plus years and they kind of become a friend and a family member to some degree and I, you know, I I like to to say that because you get to know these people real well. But um I think when you're we have a student and you're trying to make sure that you're maintaining some level of professional boundaries it's it's not a bad thing. And then the other thing is that it makes you better as as a mentor um it makes you reflect on what you're doing on a consistent basis and how it teaches the next generation. I really think it's a it's like a nice a knife sharpener in a lot of ways for your own um for your own self. And so that's one of the reasons why we're looking to do that in terms of providing academic credit for what preceptors are already doing. And so there's more nuance to that but that's the gener the the overall concept behind our Doctor Medical Science program is to provide some level of academic credit for experiences that we can grow into and that we're already doing what a fantastic idea.

Ashley Love:

Something that you said I'm sitting here nodding because when you mentioned the teacher becoming taught is is basically what what we're kind of getting at here I find that I am so much more aware to the nth degree I think as clinicians we're already we're always aware of what's going on. We're paying attention to the patient's body language um the feedback that sort of thing when I have a student in the room with me and tell me if you've experienced this too I am so much more aware of what's going on um the the tiniest nuances and I could tell you so many stories about how we'll be having a conversation the patient and I and then something comes up something tiny and I'm able to step back into the into our office and really explain what just happened to that student. Whereas otherwise you notice it I notice it it's kind of there and we process it quickly and then we use that as information to to make our plan. But when you actually have to sit and explain that to a student it really is it's incredible. When you think about it it's very very cool to realize the amount of of the processing speed as a clinician that we have with some of these nuanced things so I remember specifically when I was precepting um more actively we talked earlier about having a patient list of like what's coming folks are coming in.

Dr. Ken Botelho:

You get to know your patients well enough you can see what's on the list and then you can see what they're coming in for and be like come on Bob let's let's get it together Bob you know and that's not going to translate directly to uh you know your mentee or those that's shadowing you but then you go through it because you already have in your mind as a clinician Bob's been here there and everywhere and he's got X, Y, and Z going on. And it's just um an example of knowing people, knowing their history and then having a good sense as to how to go about it and then even how to have an interaction with him in these circumstances, right? So but teaching and walking a student through that can be highly beneficial. But it's a just a like you had said Ashley it's a clinic clinical instinct to just be like okay come on Bob get us get right right right I love it.

Ashley Love:

When I'm in clinic we see dermatology we see a bunch of older patients and we see a bunch of younger patients um without thinking now I take off my wear a white coat over my scrubs for most visits. When I see children or older patients with dementia I immediately take off my white coat. I think it makes this more approachable um I do that without thinking and whenever I do it the student looks like oh well I guess we're done for the day and then we walk into a room and they look very confused right so little things like that. And then we get to have an ex and we talk about perception and why patient perception matters right just by me taking off my coat. So um like those small nuances uh when you're precepting students it becomes even more evident why you're doing what you're doing when it's just become almost commonplace to you. Very cool Ken I love that thank you so much for diving into that that's fantastic. Absolutely so Ken thank you for describing that program as we wrap up there is a segment on the show called Quality Questions and you have mentored a million people and and spoken to a million students and so I am very excited to hear um what this question you have for us is but this is a this is a segment on the show where we help pre-health students develop their own cache of interview questions. Dr. Patello do you have a quality question for us? Keep in mind that there's more interview prep such as mock interviews and personal statement review over on shadowmext.com. There you'll find amazing resources to help you as you prepare to answer your own quality questions.

Dr. Ken Botelho:

And when I say that is uh and we'll we'll talk about it a little bit but basically it's a question that you come back to when you don't know the answer to the question you're asking or they're asking you. So if there's a you know kind of a minutiae question and you get a little bit frozen always come back to this and that is something that we've already touched on what is your why and if you know your why you can answer any question it takes a lot of reflection to get there but if you do reflect on truly why you're doing something in the end you can answer almost anything I love that because I think I'm thinking back on the number of interview questions that we've discussed on this show.

Ashley Love:

And what would be really cool is to ask those random questions and then instead of answering them directly asking ourselves what is what is my why first and then seeing how perhaps your answer would change or your answer would be strengthened. I think that it's a very mature person who can answer that why against any other question that they're asked as well.

Dr. Ken Botelho:

Honestly when you're younger it's sometimes it's a lot to ask but I think it's a really great exercise regardless of your age. And to be honest with you, the more you ask that why regardless of your age as you get older the better positioned you are to answer it. I think it's about growth and development and learning and growing and never stopping learning too and realizing that even the mentor should be mentored sometimes.

Ashley Love:

That is the perfect note to end on. Dr. Ken Vitello you are amazing. I will link everything in the show notes below how to get in contact with you, your program. It has been an absolute pleasure today. Thanks likewise I appreciate it yeah yeah absolutely thank you so very much for listening to this episode of Shadow Me Next. If you liked this episode or if you think it could be useful for a friend please subscribe and invite them to join us next Monday. As always if you have any questions let me know on Facebook or Instagram. Access you want, stories you need, you're always invited to Shadow Me Next

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