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

Episode Transcript
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Ashley Love (00:00):
Hello and welcome to Shadow Me Next, a podcast
where I take you into and behindthe scenes of the medical world
to provide you with a deeperunderstanding of the human side
of medicine.
I'm Ashley, a physicianassistant, medical editor,
clinical preceptor, and thecreator of Shadow Me Next.
It is my pleasure to introduceyou to incredible members of the

(00:22):
healthcare field and uncovertheir unique stories, the joys
and challenges they face, andwhat drives them in their
careers.
It's access you want andstories you need.
Whether you're a pre-healthstudent or simply curious about
the healthcare field, I inviteyou to join me as we take a
conversational and personal lookinto the lives and minds of

(00:43):
leaders in medicine.
I don't want you to miss asingle one of these
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So make sure that you subscribeto this podcast, which will
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follow us on Instagram andFacebook at Shadow Me Next,
where we will review highlightsfrom this conversation, and
where I'll give you sneakpreviews of our upcoming guests.

(01:03):
Today we're talking withsomeone whose journey captures
what medicine looks like whenyou lead with humanity,
curiosity, and a grounded senseof purpose.
Dr.
Ken Botello is a primary carePA with years of experience
caring for patients at some oftheir most pivotal moments of
their lives.
But he's also the foundingdirector of the Doctor of

(01:25):
Medical Science program at theCollege of St.
Scholastica.
His story moves between examrooms and academic halls,
between stabilizing patients incrisis, and mentoring the next
generation of clinicians.
He shares how he discovered hispath into medicine, how primary
care taught him the power ofpresence, the quiet strength of

(01:45):
supporting staff who hold thehealthcare system together, and
why being human is one of thegreatest superpowers we have in
an increasingly technologicalworld.
And towards the end, he offersone of the most beautifully
simple, deceptively deep qualityquestions we've ever had on
this show.
Please keep in mind that thecontent of this podcast is

(02:08):
intended for informational andentertainment purposes only and
should not be considered asprofessional medical advice.
The views and opinionsexpressed in this podcast are
those of the host and guests anddo not necessarily reflect the
official policy or position ofany other agency, organization,
employer, or company.
This is Shadow Me Next with Dr.

(02:29):
Ken Patello.
Dr.
Botello, thank you so much forjoining us on Shadow Me Next
today.
It is going to be a fabuloustime talking about a variety of
different topics with you.

Dr. Ken Botelho (02:42):
Great.
Thank you so much for havingme.
I'm excited to be here and chatand explain my uh journey to
your audience.

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

No, uh, not at first.
I think I've always had someinterest in the sciences in
general and felt like I, I guessyou can use the word excelled
when you're in school.
You kind of can get a sense asto what you're better at, what
you enjoy.
Um, as I continued to gothrough high school, I
recognized human anatomy wassomething that I enjoyed, human

(03:20):
physiology was something Ienjoyed.
Um, and I've always had aninterest in caring for others or
trying to help stabilize othersor support others.
And so that naturally led me tomedicine as my high school
career expanded.

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

(03:56):
Is that what you're is thatwhat you're seeing in practice?

Absolutely.
We all have folks that come in,or so kind of expanding and
kind of taking together thethread of what you just asked
with this thread.
After high school, I went intocollege and realized I wanted to
go into medicine more in depth.
And I was trying to choose thefield because there's multiple
out there.
And uh one of my my bestfriends uh father had been a PA.

(04:27):
And so I learned about theprofession through him.
And then to expand a bit moreon what you had said in regards
to um having compassion and andstabilizing 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 istruly a stabilizer and a healer

(04:51):
for a community.
You know, the community doesn'tnecessarily have to be a large
place, but it maybe thecommunity is your patient panel,
the panel that you'reresponsible for.
So when they come in, and evenif 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 doingelsewhere?
Like, are you doing okayotherwise?

(05:13):
Um, and so that's where I guessuh some of that discussion
about stabilizing comes frombecause you get to know people
and you get to expand yourhumanity through others and try
to help them along the way oftheir journey.
And so that's really where Ithink I feel like I have the

(05:35):
most value to others in general.
And I know we're talkingspecifically about patients when
you ask that, but it goes asfar to, you know, the front desk
staff and those that room ourpatients and those that call our
patients when we can't get onthe phone.
Um, all those people play arole in making people better.
And so that's part of what Iwill, my own journey is to try

(05:58):
to pass that along further.

I want to take that and just absolutely run with it
because it's something we havenever ever mentioned on the
podcast and something that wesee as clinicians every day.
And that is how ournon-clinician support staff
impacts our patient experience,right?
Um front desk, check-in, checkout, whoever's calling with lab

(06:22):
results or pathology, et cetera.
Those people can make or breakpatient experience, you know,
and I'm sure you have stories, Ihave stories.
Um, but let's talk a little bitabout that from the clinician's
point of view.
How do you how do you fostergood relationships with those
those members of the healthcareteam?

And it always comes back to, and this is
something that I'll I'll touchon later in the conversation as
well, but it always comes backto my the the clinician's why.
Why are you doing what you'redoing?
And I know a lot of theday-to-day is minutia about we
got to click a box, or um we gotto check on a lab from earlier

(07:08):
in the day, or what have you.
But it really comes down totrying 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 howyou're doing it, you get better
every day, and then you helpmake others better too.
So that I think is the best wayto answer that question.

(07:30):
Um, everybody's got bad days,and and myself included.
I think it the most importantthing is to try to recognize
when you do have bad days,they're bad days, but they're
not all the days.

It's a bad day, not a bad life, right?
That's like one of my favoritephrases.
I love that.
Well, thank you for sayingthat.
And you're right, our whymatters.
Our why is what propels usforward as clinicians, our why
allows us to communicatepositively with the members of
our team as opposed to um, youknow, being uh degrading or
berating, because perhaps if ourwhy was just to make a bunch of

(08:03):
money and they're not doingtheir job, we're not making
money.
Well, that's not helpful.
If our why is patient care, ittotally changes the picture um
entirely.
Let's I would love to hearabout a day in your life.
Specifically, think aboutclinic.
As a PA in um in primary care,Ken, I would love to hear about
what that looks like.

Sure.
So I would typically wake up inthe morning um somewhat ready
to go.
Of course, depending on themorning, 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 ofgo into work, look at labs that
may have come in in the daybefore, look at images that may

(08:44):
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 aconnotation that needs to be
addressed, that's all.
Uh and so those are things thatI typically will prioritize for
the day.
And that's before seeing apatient.
And then once you start yourday, you've got a list of folks

(09:06):
uh ready to go in clinic.
If you've been practicing for awhile, you may know almost
everybody on that list.
If you haven't been practicingfor a while, it can be a little
intimidating at first when youdon't know anybody on the list,
but that comes with time.
Um, I always try to groundmyself when I go into the clinic
or when I go into a patient'sroom.

(09:27):
And one of the things that I Ido is I, and this might be
subconscious at this point, butI try to make sure that I'm
there for them, not there forme.
And it's difficult sometimeswhen life comes, and maybe the
night before you had a badnight, or the day before or the
day of, you know, you get stuckin traffic.

(09:47):
Um, they don't care about that.
And I don't mean that in a badway.
I mean that in a way thatyou're there for them.
They're not necessarily therefor you in that circumstance.
And so that kind of goes backto my own personal why.
And then as the day progresses,there's there's some chaos
that's typically involvedbetween folks being sick or

(10:08):
somebody maybe having to go tothe hospital that's on your
patient panel.
Um, may have to make a few callphone calls that aren't ideal.
But in the end, you actuallyhelp these people get through
their day and stabilize, like wetalked about earlier in the
podcast.
So um it's highly rewarding.
It's difficult, but notdifficult in the way that it's

(10:30):
not valued or important.
Um, and it makes sometimes thedifficulty actually makes it
feel more accomplished, I guessyou could say.
And then by the end of the day,I think we've all kind of had
enough for for our cup, and Iget to go home and see my family
and my my wife and my kids andmy dogs that greet me at the

(10:51):
door, and uh we'll answer someemails and and go from there.

It's a really lovely way of describing the
lasting relationships that youdescribe with your patients.
When you say you look at yourlist and you immediately know
them.
I mean, it it's one of the it'sone of the ways that I counsel
our students when they're tryingto determine where they want to
belong in medicine.
Do you want to look at yourlist and have complete
anonymity, not know a singleperson?

(11:17):
Does that make you feel betterabout your day?
Or like you mentioned, itstresses me out a little bit
when I look at my list and Idon't know anybody on it, you
know.
Um developing those patientrelationships is what makes a
lot of clinicians tick.
Um remaining largely unknown totheir patients is what makes

(11:38):
other clinicians tick.
So I think that was a reallygreat and a big picture example
of how to find where you belongin medicine.
Thank you for thank you fordescribing that.
Ken, what are some of theconditions top, top conditions
that you treat in primary careand maybe your favorite?

We're definitely seeing more
musculoskeletal things thanbefore.
And I don't mean that I thinkit's more because we're the
first line, right?
So if you bump something orscrape something or injure
something, folks will either goto the ER if they really truly
think that's a fracture, orthey'll go to an urgent care or

(12:14):
you uh their primary if maybeit's not as emergent.
Um and that's that'sappropriate.
Um, other than that, though,diabetes is certainly on the
rise.
And so diabetes and um theaccompanied nutritional issues
that will come with that,whether it be hypertension or
chronic kidney disease or whathave you.

(12:36):
I enjoy, but it does take a bitout of me treating anxiety and
depression.
Couple things about that.
As a primary care provider intoday's world, you need to be
able to treat those things.
You folks that are experiencinganxiety and depression can't

(12:58):
necessarily just go to rightfrom primary care to a
psychiatrist or or what haveyou.
It it's there's not uh enoughavailable.
And as we've gone throughmedicine in the last 15 years,
we're moving more towardsprimary care, being that first
line of defense for anxiety anddepression.

(13:19):
Right.
And folks are more stressednowadays, and so being
empathetic and and having astrong knowledge base in that
area is incredibly important.
So I would say that that's bothprobably one of the biggest
chief complaints, but it's alsoone of the bigger
under-discussed things wherefolks come in for a cold, like I
said, but maybe they're moreanxious and depressed.

(13:42):
And if you're a primary careprovider and you're seeing that
patient, you're gonna have thatconversation.
So while it can take a lot oftime, you can also make a bigger
difference.

It's an underscore for so many of the conditions
that we're seeing across theboard in medicine right now,
right?
A patient comes in, so I workin dermatology, a patient comes
in with these bumps all overtheir skin, and somebody told
them that they have, you know,syphilis or some type of skin
cancer.
And it turns out they just haveundiagnosed, severe anxiety and
they're picking their skin todeath, right?

(14:14):
And we call it parigonodularis.
So you have to be comfortable,like you mentioned, having these
conversations with anxiety anddepression.
Um, you have to invite thatconversation, you know, it it
can't, you can't just come outwith it.
It'd be like hitting somebodywith 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.

(14:35):
Ken, thank you so much fordescribing that.
You mentioned, you mentionedthat you're part-time now in
primary care.
And part-time in something thatI think is so cool.
Tell us a little bit about yourrole.

So, right now I'm I'm more or less full-time
as the the founding director ofthe Doctor of Medical Science
program at the College of SaintsScholastica.
And so we're building thatprogram and we're launching in
January.
Of course, it's November aswe're talking.
So we're getting close to ourlaunch.
But while I'm doing that, I'malso working part-time in

(15:08):
primary care, which looks verydifferent from when it did when
I talked to you about what myday-to-day was in a full-time
capacity.
Um, now I'm well, I was inRhode Island at the time of the
full-time capacity, and now I'min uh Duluth, Minnesota.
So as you're as you're likelyaware, um moving across the
country, you're not gonna knowthose patients that are on that

(15:30):
list, right?

Right.

But I know I have a very good reservoir to
pull from of challenges thatI've experienced when being with
patients that I'm very umcomfortable with.
So that translates, you know,you can if you've done it long
enough and you feel umcomfortable in stabilizing other

(15:52):
patients, sometimes a calmdemeanor just going in the rooms
sets the tone right away forfolks.
Um and this is something I Ithink I I should say too.
In the world that we're usingAI and and um and having more
metrics and computers, and beinga being a human is a

(16:13):
superpower.
So so if we're able to approacheverybody like a human, not
like a diagnosis, feel thatimmediately.
And so that's something Icontinue to try to bring, even
in a part-time capacity, whenyou don't necessarily know
everybody.
And so um I find it a bitinvigorating not to know

(16:36):
everybody sometimes too.
It's like the other side of thesame coin.
You know, sometimes knowingeverybody um can be a bit of a
burden.
I don't mean that in a bad way.
I just mean it in that you feela level of um responsibility
that's very heavy, and that'sokay.
I mean, there's nothing wrongwith that.
And then being in having theother full-time role, sometimes

(16:57):
there's a blessing in disguiseto that, I suppose, right?
So um I get to I get topractice non-transactional
medicine, but still get to umenjoy some of the fruits of like
the academic labor that we'reworking on and and some of the
things that we're looking to doin PA education.

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

Yeah, great, great, great question.
So let me, I always like toground it in the why.
So, first off, um, right now,uh entry-level PA program is a
master's level program, which isgreat, find and appropriate.
Um, what this is, is basicallythe doctorate version where if
one wants to take their careerand have some level of elevation

(17:50):
to it, whether it be through uma clinical capacity, through an
academic capacity, or somebodywants to be an educator, or
through additional leadershipopportunities, we've created a
pathway that allows you to growand develop directly in those
areas.
Now, let's let's talk about thewhy, because this is where my

(18:13):
background and our college andour program are different.
So the why.
Let's go back to the 1960s whenthe PA profession was created.
It was started as physicianassistant, and typically in the
graduate setting after PAschool, one would go out and

(18:34):
work directly with a physicianin a mentored capacity, right?
It would be like anapprenticeship.
Um, I think most of us think ofa PA going into a clinic owned
by a physician, they end up kindof being their right hand, and
um, they grow and developthrough that relationship.
Now let's fast forward.
Um we don't havephysician-owned practices like

(18:58):
we used to.
So now who is mentoring us?
It really depends on where youwork, what state you work in.
And that variability can besometimes empowering, but
sometimes it can be debilitatingto folks that are seeking
direction.
And so what we're doing isproviding academic scaffolding

(19:24):
or academic credit for a lot ofwhat we do after graduation.
So if one is seeking outmentorship and seeking out
support after graduation in a ina setting where they're getting
reimbursed or their their job,um, a fellowship, a transition
to practice program, what we areproviding in part of our

(19:46):
program is academic credit wherethey can reflect on those
opportunities and gain doctoralcredit.
And now I'm not saying they'regonna gain their doctorate from
just that.
I'm saying that that'ssomething that they can utilize.
um credit towards.
And then beyond that, for folksthat maybe have been practiced,
like for instance, for me, whenI went my and got my doctorate,

(20:08):
I was um, I was about, I thinkit 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 anadditional layer of professional
advancement and uh development,educational development
personally, so that I had theleadership skills and I had the

(20:32):
wherewithal to feel empowered todo more.
And so that was my my ticketand my key to doing that.
And what our program isdesigned to do is not
necessarily just provide atransactional degree, but also
provide the mentorship to get tothe point where you feel
confident, comfortable enough toexpand what you're doing and

(20:55):
grow and develop professionally.
So we also have um academiccredit for those that uh folks
that are precepting.
So for instance, if you'reprecepting a student um we are
taking what you're doing forprecepting we're kind of vetting
that through the program thatyou might be utilizing um taking
some of that evaluation ofstudents and utilizing that

(21:18):
towards academic credit.
Now for your audience I wantyou to I want to flip this a
little bit so when we'reteaching or mentoring I will
tell you right now to anybodythat's listening that that is as
much of a teaching moment forme as it is for those that are

(21:40):
being taught or being mentored.
And there's a couple reasonsfor that.
So one is it keeps you on yourtoes.
Yeah yeah um you know I love II enjoy being kind of nonchalant
to some degree and um kind ofbeing myself and not as
formalized.
But you have to make sureyou're a professional in those
settings even when you'relooking to kind of tone it down

(22:04):
and I don't mean that in a badway either but sometimes when
you're you've known a patientfor eight plus years and they
kind of become a friend and afamily member to some degree and
I, you know, I I like to to saythat because you get to know
these people real well.
But um I think when you're wehave a student and you're trying
to make sure that you'remaintaining some level of
professional boundaries it'sit's not a bad thing.

(22:25):
And then the other thing isthat it makes you better as as a
mentor um it makes you reflecton what you're doing on a
consistent basis and how itteaches the next generation.
I really think it's a it's likea nice a knife sharpener in a
lot of ways for your own um foryour own self.

(22:46):
And so that's one of thereasons why we're looking to do
that in terms of providingacademic credit for what
preceptors are already doing.
And so there's more nuance tothat but that's the gener the
the overall concept behind ourDoctor Medical Science program
is to provide some level ofacademic credit for experiences
that we can grow into and thatwe're already doing what a

(23:10):
fantastic idea.

Something that you said I'm sitting here nodding
because when you mentioned theteacher becoming taught is is
basically what what we're kindof getting at here I find that I
am so much more aware to thenth degree I think as clinicians
we're already we're alwaysaware of what's going on.
We're paying attention to thepatient's body language um the
feedback that sort of thing whenI have a student in the room

(23:32):
with me and tell me if you'veexperienced this too I am so
much more aware of what's goingon um the the tiniest nuances
and I could tell you so manystories about how we'll be
having a conversation thepatient and I and then something
comes up something tiny and I'mable to step back into the into
our office and really explainwhat just happened to that

(23:56):
student.
Whereas otherwise you notice itI notice it it's kind of there
and we process it quickly andthen we use that as information
to to make our plan.
But when you actually have tosit and explain that to a
student it really is it'sincredible.
When you think about it it'svery very cool to realize the
amount of of the processingspeed as a clinician that we

(24:18):
have with some of these nuancedthings so I remember
specifically when I wasprecepting um more actively we
talked earlier about having apatient list of like what's
coming folks are coming in.

You get to know your patients well enough you
can see what's on the list andthen you can see what they're
coming in for and be like comeon Bob let's let's get it
together Bob you know and that'snot going to translate directly
to uh you know your mentee orthose that's shadowing you but
then you go through it becauseyou already have in your mind as

(24:52):
a clinician Bob's been herethere and everywhere and he's
got X, Y, and Z going on.
And it's just um an example ofknowing people, knowing their
history and then having a goodsense as to how to go about it
and then even how to have aninteraction with him in these
circumstances, right?

(25:13):
So but teaching and walking astudent through that can be
highly beneficial.
But it's a just a like you hadsaid Ashley it's a clinic
clinical instinct to just belike okay come on Bob get us get
right right right I love it.

When I'm in clinic we see dermatology we see a
bunch of older patients and wesee a bunch of younger patients
um without thinking now I takeoff my wear a white coat over my
scrubs for most visits.
When I see children or olderpatients with dementia I
immediately take off my whitecoat.
I think it makes this moreapproachable um I do that
without thinking and whenever Ido it the student looks like oh

(25:48):
well I guess we're done for theday and then we walk into a room
and they look very confusedright so little things like
that.
And then we get to have an exand we talk about perception and
why patient perception mattersright just by me taking off my
coat.
So um like those small nuancesuh when you're precepting
students it becomes even moreevident why you're doing what

(26:10):
you're doing when it's justbecome almost commonplace to
you.
Very cool Ken I love that thankyou so much for diving into
that that's fantastic.
Absolutely so Ken thank you fordescribing that program as we
wrap up there is a segment onthe show called Quality
Questions and you have mentoreda million people and and spoken
to a million students and so Iam very excited to hear um what

(26:32):
this question you have for us isbut this is a this is a segment
on the show where we helppre-health students develop
their own cache of interviewquestions.
Dr.
Patello do you have a qualityquestion for us?
Keep in mind that there's moreinterview prep such as mock
interviews and personalstatement review over on
shadowmext.com.
There you'll find amazingresources to help you as you

(26:54):
prepare to answer your ownquality questions.

And when I say that is uh and we'll we'll talk
about it a little bit butbasically it's a question that
you come back to when you don'tknow the answer to the question
you're asking or they're askingyou.
So if there's a you know kindof a minutiae question and you
get a little bit frozen alwayscome back to this and that is

(27:21):
something that we've alreadytouched on what is your why and
if you know your why you cananswer any question it takes a
lot of reflection to get therebut if you do reflect on truly
why you're doing something inthe end you can answer almost

(27:42):
anything I love that because Ithink I'm thinking back on the
number of interview questionsthat we've discussed on this
show.

And what would be really cool is to ask those
random questions and theninstead of answering them
directly asking ourselves whatis what is my why first and then
seeing how perhaps your answerwould change or your answer
would be strengthened.
I think that it's a very matureperson who can answer that why

(28:11):
against any other question thatthey're asked as well.

Honestly when you're younger it's sometimes
it's a lot to ask but I thinkit's a really great exercise
regardless of your age.
And to be honest with you, themore you ask that why regardless
of your age as you get olderthe better positioned you are to
answer it.
I think it's about growth anddevelopment and learning and
growing and never stoppinglearning too and realizing that

(28:36):
even the mentor should bementored sometimes.

That is the perfect note to end on.
Dr.
Ken Vitello you are amazing.
I will link everything in theshow notes below how to get in
contact with you, your program.
It has been an absolutepleasure today.
Thanks likewise I appreciate ityeah yeah absolutely thank you
so very much for listening tothis episode of Shadow Me Next.
If you liked this episode or ifyou think it could be useful

(29:01):
for a friend please subscribeand invite them to join us next
Monday.
As always if you have anyquestions let me know on
Facebook or Instagram.
Access you want, stories youneed, you're always invited to
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From Exam Rooms To Academia: A PA’s Purpose-Driven Path | Dr. Kenneth Bothelo, DMSc, PA-C

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}From Exam Rooms To Academia: A PA’s Purpose-Driven Path | Dr. Kenneth Bothelo, DMSc, PA-C