March 30, 2026 • 25 mins
You can study medicine for years and still feel unprepared for the moment you deliver news that changes someone’s life, then immediately have to walk into the next room and do it all again. That emotional handoff is one of the most invisible skills in healthcare, and it’s exactly what we unpack with Michelle Nesky, The Posh PA, who has spent more than 20 years as a physician assistant in oncology.
We get practical about what oncology care really looks like: the difference between medical oncology, surgical oncology, and radiation oncology, and why treatment goals can range from cure to recurrence prevention to long-term control of metastatic disease. Michelle shares how she “resets” between patient encounters, why you have to process hard moments instead of stuffing them down, and how relationship-heavy cancer care changes the way you communicate. We also talk about the game-changing shift toward immunotherapy, biomarker testing, and personalized cancer treatment, plus a reality check on chemotherapy side effects and how far supportive care has come.
Then we pivot to the other side of her work: helping future PAs get accepted. Applying to PA school through CASPA can be uniquely stressful because prerequisites and requirements vary across programs, and a small mistake can cost you an interview. Michelle breaks down what strong applicants do differently with essays, strategy, and interview prep, including the kind of “emotional reset” question that separates good candidates from unforgettable ones.
If this helped you, subscribe, share it with a friend who needs it, and leave a review so more pre-PA students and healthcare learners can find Shadow Me Next.
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Ashley Love (00:00):
Take it from Michelle Nesky, the posh PA and
someone who has spent 20 yearsin oncology.
Getting into PA school is hard,even harder than getting into
medical school.
But there are some days wheregetting in is the easiest part
of becoming a great clinician.
Because one day you'll walk outof a room where your bad news
(00:21):
has changed everything for apatient and step right into the
next like nothing happened.
It's the same voice, the samepresence.
Today I'm talking to Michelle,and she sees this gap all the
time.
So, what are the students whoactually thrive in this
environment doing differently?
Welcome to Shadow Me Next, apodcast where I take you into
(00:43):
and behind the scenes of themedical world to provide you
with a deeper understanding ofthe human side of medicine.
I'm Ashley, a physicianassistant, medical editor,
clinical preceptor, and thecreator of Shadow Me Next.
I invite you to join me as wetake a conversational and
personal look into the lives andminds of leaders in medicine.
(01:03):
This is Shadow Me Next withMichelle Nesky, the Posh PA.
Michelle, thank you so much forjoining us today on Shadow Me
Next.
You have dedicated your life tobeing a PA and now to helping
multiple of the next generationsof PAs at this point.
Thank you for what you do andthank you for sharing it with us
today.
Thank you so much for invitingme.
I'm excited.
(01:23):
It will be so fun.
So you have um worked as a PAfor a few years now.
Can you tell us about how long?
Michele Neskey (01:31):
Yeah.
Um, this is my 21st year as aPA.
I graduated PA school in 2005.
So my God, I can't even believeI'm saying that.
It's so crazy.
Yeah.
Ashley Love (01:41):
Absolutely incredible.
And you really have, you reallyhave flexed all the muscles of
being a PA over those 21 years.
Describe a couple of thoseroles that I think, you know, as
pre-health students, we alwaystalk about we love the lateral
mobility.
We love the fact that we canparticipate in and politics and
policy formation, all of that.
Have you done all of thosethings?
Michele Neskey (01:59):
Yes, in some way or another.
Um, I think, you know, what'swhat I think is funny is we do
talk a lot about the versatilityand flexibility of moving
through specialties.
I personally have been in thesame specialty for 17 years, but
I did start off as ahospitalist medicine PA, which
was like an inpatient job rightout of college.
(02:20):
So um, and it was great becauseyou know what?
I didn't really know what Iwanted to do.
I wasn't, I had a lot offriends in PA school who were
like, I want to do this.
I I've had day one of PAschool, I'm gonna be an
orthopedic PA.
And I'm like, I have no idea,you know, like I have no idea
what I want to do.
And so it was a nice way tolearn from other PAs because it
(02:41):
was a very heavy PA run serviceand be able to kind of see some
of the other specialties andwhat I wanted to do.
So then when we I moved toMiami with my now husband's uh
residency for his residency,that's where I got my first
oncology job.
So I was in, you know, internalmedicine first.
Ashley Love (03:01):
So I think it's a really important thing to not
specialize initially.
And if it's not everybody'sstory, right?
But I I was in GYN, which isgenerally it's a pretty, a
pretty general specialty.
Um, and you just you're able tohone in a lot of those skills
that you learned in PA school.
Yes.
Um, and of course, oncology,really, you're you're dealing
with all body systems andoncology.
(03:21):
So you know, dermatology is alittle bit different.
Michele Neskey (03:23):
We're very, very internal medicine heavy, like
very internal medicine heavy.
Here's what I knew I didn'twant to do.
And so I like for me, I waslike, I am not for surgery.
Okay, it's not for me.
And I am not for unfortunatelylike OBGYN.
I passed out twice in the ORduring OBGYN.
(03:44):
I'm like, this is not for me.
So there were things like Iknew I didn't want to do.
And I think that that's alwaysgood too.
You don't really think aboutthat.
It's like, here's what I know Idon't want to do, and then you
know, kind of move on.
Ashley Love (03:57):
And you know, it's so funny you mentioned surgery
because you also mentioned yourhusband's residency in Miami.
Yes, he is a surgeon.
Correct.
Absolutely not, not for me atall.
Michele Neskey (04:06):
Yes, he is a head and neck cancer surgeon.
Um, long surgeries, verydetailed, you know, very he's
very tactile.
I have, you know, he alwayssays my I have floppy baby
hands, you know, we're verydifferent in that kind of way.
Um, but yes, it was a veryinteresting journey for us.
Um, I met him before I went toPA school and before he went to
(04:28):
med school.
And so he got into med schoolfirst.
Um, I got into PA school a yearlater um in different states.
So my gosh.
Yes.
So we did a long distancerelationship for four years,
essentially.
Like through PA school, throughmed school, and then got
married and moved to Miami for aresidency.
(04:50):
And we're both from theNortheast, you know.
So um, so it was definitely abig change and there's
definitely challenges in that.
But you know, I thinkultimately that's what makes us
like our marriage kind ofstronger today, because there
isn't anything either one of uswon't say to each other at this
point.
Um, very open communication,um, very honest, you know, about
(05:14):
where we were with things, andyou know, um, it's definitely an
evolution for sure, but it canbe done.
So absolutely.
Ashley Love (05:20):
So very similar.
I mean, similar.
I'm sure in in head and neckENT he gets a lot of cancers as
well.
And you you do a lot ofoncology.
Do you guys talk shop at homeor does work really does work
stay at work?
Um sometimes.
Michele Neskey (05:32):
Uh we've shared patients.
So we really, yeah.
So we used to work at so whenhe did his residency, we were
not at the same hospital.
But when he did his fellowship,and then when we moved to South
Carolina where we are, weworked in the same hospital and
he's basically surgical oncologyand I'm medical.
Right.
So we would share patients inthat way.
(05:55):
And so that was kind of fun.
We don't work directlytogether, right?
But like we're sharing, weshare that patient.
So I'm like, oh, you saw a day,you know.
So that's kind of a fun thing.
Um, we don't work at the samenow, but we still kind of share
some patients um ancillarily.
Uh, we don't talk a lot ofshock at home.
Um, especially he doesn't wantto, yeah, you know.
(06:17):
Um, however, when we have a badday or when we like there's
been a really hard patience orwhatever it is, it sort of is
like you don't have to talk tome today.
Like I get it.
You know what I mean?
So, like that's kind of a niceunderstanding that we can
support each other through that.
And sometimes that just lookslike, let's just talk about
(06:37):
anything else, you know.
So we don't talk a lot of shopat home, so which is good.
Ashley Love (06:42):
No, it does.
And you know, it's it's such aninteresting distinction because
as I tell people, you know, wepick, we pick being a PA for the
lifestyle.
And a part of the lifestyle iswho you're going to spend your
life with, right?
And my husband works infinance, and I come home and I
start talking to him about theholes that I have made in
people's faces, and he says,Ash, I love you.
(07:02):
I do not love the words thatare coming out of your mouth
right now.
Please be quiet, you know?
And I said, okay, like let'schange the subject, but just you
know, that's why I'm a littlesnippy, you know.
I had a I had a silver dollarsize hole in somebody's nose
today, and it just didn't looklike I wanted it to look at the
end, you know.
So um, so it's veryinteresting, you know, when when
looking at these careers, um,it's sometimes it's a group
(07:24):
decision and you know, sometimesit's it's focusing on what your
life is going to look like 10,15, 21 years from now.
You mentioned something that Iwant to touch on quickly, and
that is medical oncology andsurgical oncology.
Could you give us a littledefinition and maybe explain the
differences of those?
Michele Neskey (07:41):
Yeah, absolutely.
So medical oncology, so there'sthree branches of oncology:
medical oncology, radiationoncology, surgical oncology.
Medical oncology is we give allthe treatments that are IV,
oral, um, any type of infusionaltherapies.
So chemotherapy,immunotherapies, um, you see a
(08:03):
lot of them on TV, right?
Like a lot of the um things ontelevision that you see for any
type of cancer.
Um, we also do hematology.
So it really just depends onwhat practice you're in.
But medical oncology, you caneither be hematology oncology or
just med on.
So hematology oncology meansthat you do both benign blood
(08:26):
disorders and cancer.
Medical oncology means you'restraight up cancer, no
hematology problems or anythinglike that.
But really, we are the onesadministering um any kind of
medication, you know, to apatient for cancer.
Um, surgical oncology, clearly,they are the surgeons, so
(08:48):
they're doing the removal of anycancer either curatively or
just to take it out for painpurposes or whatever it might
be, more palliative.
Um, so they take care of thewhole surgical aspect and then
radiation oncology is obviouslygiving external beam radiation
or proton radiation therapy tospecific areas of cancer.
(09:10):
Um, so the biggest differencebetween medical oncology and
both surgical and radiationoncology, those types of therapy
are really for localizedcancers, right?
Like you have a spot here,let's radiate it.
You have a tumor here, let'stake it out.
Our treatments are systemic.
So they're going throughoutyour whole body.
(09:32):
So while we do give treatmentsto people who've had surgery to
prevent recurrence, we also givetreatments to patients who have
metastatic, somewhat incurabledisease.
Um, and so that's really whatthe differences are.
Ashley Love (09:45):
Incredible.
And then in medical oncology,which is where you practice the
end goals are a little bitdifferent for each patient.
Um, right.
So, so you know, we all like tothink if we have cancer,
specifically metastatic cancer,we're gonna go in, they're gonna
give me chemo, my hair's gonnafall out, I'm gonna feel like
crap, and then I'm gonna getbetter.
And we have seen recent studiesthat have come out that have
shown that yes, we are makingmajor advances in cancer
(10:08):
survival rates, but the endgoals for patients aren't always
um the same.
Can you tell us a little bitabout that?
A hundred percent.
Michele Neskey (10:15):
So, you know, sometimes we are treating
patients for cure.
We're giving them chemotherapyor immunotherapy to cure them,
you know.
So meaning after surgery, ormaybe they they have a type of
cancer that doesn't requiresurgery, like lymphoma, for
example, where you can cure withchemotherapy, right?
And biologic therapy.
(10:35):
Um, and so some patients, weare going for it, like we're
going for the cure, you know.
Um, other people have had theirtumors removed and we're giving
chemo as an insurance policy toprevent, help reduce the risk
of cancer recurring, right?
You we can't say that thistreatment will 100% do that, but
(10:58):
we have studies that say givingyou this treatment after your
surgery reduces your risk ofrecurrence by this much.
So most people will go aheadand do that, then they go off
treatment, and then they go onsurveillance.
And then we do have otherpeople who are being treated um
for, you know, metastaticcancers or incurable cancers,
(11:20):
technically.
Um, and sometimes their outcomeis to just improve their
quality of life, uh, quantity oftime here with their friends
and family, keep the cancerunder control and have them
living as normally as possiblefor as long as possible.
Um, whereas other times we canreally transition people with
metastatic disease into amaintenance mode depending on
(11:42):
what type of cancer they have.
And they may not need to be ontherapy their whole life, but
what we're seeing now with someof the immunotherapies is that
after two years, you know, ifyou've had a response, we can
stop, you know, and even talkingabout metastatic disease and
two years of no cancer is crazy.
Yeah.
Like I just think back to whenI started this and it was like
that was unheard of, likespecifically for lung cancer and
(12:05):
like things like that, right?
Melanoma, yes, yes, melanoma,like all these.
So we've come a very long way.
So it really depends on thepatient, the type of cancer, and
you know, what the goals ofcare are.
Ashley Love (12:18):
So and you know, we that was the science, and and
as TAs, we love the science, butof course, we love the humanity
and medicine too.
And I would imagine that theconversations that you're having
with all of those differenttypes of patients are very
different conversations.
How do you how do you navigatethat?
How do you wear one hat andthen take it off?
And then the next room you wearanother hat, and then you know
what does that look like?
Michele Neskey (12:38):
Um, you have to sort of treat every encounter as
its own, if that makes sense,right?
So you you can't bring what youjust said in another room into
the next patient's room.
And if you have to take asecond, you have to take a
second and it's fine.
And most people will understandthat, most patients will
understand that, you know.
(13:00):
Um, and so you just but youhave to also, it's okay to do
that when you're in the middleof a busy clinic and things like
that.
But at the end of the day, youdo have to process those things
because if you don't, you know,they do build up over time and
cause a lot of emotional stressand burnout.
So I think what's importantabout that is every patient is
(13:20):
its own encounter.
And I am there to help them getthrough whatever situation it
is.
It is not about me.
Like it is about them, right?
So if it was a hardconversation, it was triple as
hard for them to hear than forme to deliver.
And so I always remind myselfthat that was harder for them
(13:44):
than it was for me, even thoughit was hard for me.
And I have to go help the nextpatient and meet them where they
are.
And that's I think the mostimportant thing.
Ashley Love (13:55):
This is the perfect time to break for quality
questions.
This is a segment on the showwhere we talk about an interview
question you might hear on yourown pre-PA or pre-med
interview.
The quality question here isthis Tell me about a time you
had to reset emotionally in ahigh-stakes environment before
showing up for someone else.
(14:16):
What did that moment teach youabout how you handle pressure
and responsibility?
This is the kind of questionthat separates strong applicants
from unforgettable ones.
It's not what you know, it'show you respond under pressure
and how you regulate youremotions in those moments.
Because medicine is notpracticed in isolation, it is
(14:39):
practiced moment to moment,patient to patient.
So the question is, can youreset or do you carry it with
you?
And it doesn't just stop atquality questions.
There are more resources foryou as a pre-health student on
shadowmext.com to include ournewly released application
readiness course.
(15:00):
So head on over tocourses.shadowmext.com and check
it out.
Michele Neskey (15:04):
Also gauging the patients.
So, first of all, like yousaid, oncology is a very
relationship-heavy specialty,which is what I love about it.
We see patients every threeweeks, every two weeks, every
six weeks, every whatever.
And like you get to know them,you know, you get to know their
families, you get to know theirhistory.
Some people are superinteresting and you've connected
with them.
So if you have to deliversomething that's, you know, um
(15:26):
technically bad news orwhatever, it's a little easier
because you have thatrelationship and you can kind of
say, I really don't want todeliver this, but like here's
what we here's what we have totalk about.
Whereas if you're trying to doit with somebody brand new, it's
it's definitely a differentconversation.
And you just have to read theroom and you have to read your
patient and knowing theireducation level, number one,
(15:47):
number two, what whatinformation do they want to
know?
And how can you know you worktogether to make that process as
smooth as possible?
So yeah, yeah.
Ashley Love (15:59):
I mean, and you know, I uh we're we're on such a
sad topic right now, but yeah,it unfortunately that is this is
a case.
You know, people do get quoteunquote bad outcomes and you do
have bad news.
But like you mentioned, they'reI mean, in the last 20 years,
advances in cancer treatment arejust they're mind blowing.
Tell me about somethingrecently that is um you're just
(16:20):
so proud of in the cancercommunity that that we have and
that we have available, maybemaybe in an anecdote if you have
one.
Michele Neskey (16:27):
Yeah, so you know, I think some of the
biggest, the biggest shift incancer treatment came with the
advent of immunotherapy andbiologic therapy.
So just so you know,immunotherapy is either IV or
injectable at this point.
And what it does is not to gokind of too geek on this, but we
(16:48):
can basically it stimulatesyour immune system to fight the
cancer.
So these drugs, as opposed tochemotherapy, where we're just
literally killing DNA of cancercells in any way possible and
all your other DNA through.
So, you know, I mean, so that'swhy there's a sometimes a lot
of side effects from that.
Chemotherapy is still a verystrong backbone for a lot of our
(17:09):
treatments.
And just to sort of, you saidthis in the beginning, people
have a very negative outlook onchemotherapy.
We've come a long way withchemo, okay?
Because we've come a long waywith pre-medications.
So not everybody loses theirhair, not everybody throws up
all the time.
Actually, I rarely have apatient vomit.
(17:31):
It's amazing.
So think about back in the daywhen people were like, you're
gonna lose your hair, you'regonna be sick all the time,
you're gonna be all thin andskinny.
Like some people do have sideeffects like that, but I can
say, like with authority, thatvery, very few of our patients
vomit.
So, I mean, we could havenausea, but not a lot of
(17:52):
vomiting, you know, noteverybody's losing their hair.
Um, so I think that's animportant thing to know.
Every chemo regimen's a littledifferent.
Um, but immunotherapy reallykind of changed the game, and
it's approved for a lot ofdifferent treatments.
And I think to me, I I have asoft spot for lung cancer.
I did um, you know, I worked ina community oncology practice
(18:15):
first, which just means it was asmaller, like outpatient office
connected to a hospital thathad a few physicians and we did
heme and onk, and so we saw alldiagnoses and all of that.
And the physician that Iprimarily worked with had a
specialty in lung cancer.
So I kind of started learningabout it there.
But then when I shifted, whenDave went to fellowship at MD
(18:38):
Anderson, I worked at a very Iworked in lung only like lung
and head and neck medicaloncology only.
So talk about the differentlike things.
But I will say this uh we havetwo patients I could name off
the top of my head who hadmetastatic lung cancer, who got
immunotherapy for two years,have been off treatment for at
(19:00):
least two years, and our aredisease, no disease.
It's unreal.
None.
Like stage four lung cancer,like, and there's a lot of
nuances that goes into that.
Not every stage one cancer isthe same.
A lot of markers andpredictors, and that's also a
huge advancement, you know.
All these markers we can testfor now in tumors to see if this
(19:22):
medication will work for you,right?
So just such a shift of a moreit's much more of a personalized
regimen rather than beforewhere everyone just got this,
you know.
Now it's like this isn't gonnabe a good for you, you're gonna
get this.
So it's definitely more drivento the patient's, you know, um,
(19:44):
specific pathology, genetics,you know, all of that kind of
stuff, um, where we're reallytrying to make it more
personalized.
And I feel like it really hascome that way.
But those patients that I see,I'm always just like, wow, like
this is crazy, you know.
Ashley Love (20:02):
You know, once upon a time, we would have called it
a miracle, is what we wouldhave called that, right?
I have a similar melanomapatient who um had uh melanoma
of the skin, which metastasizedto melanoma all over, brain
mets, multiple.
And every time I get a notefrom his medical oncologist
about a clear scan, it just Ihave to smile first.
(20:24):
It really does make you smile.
And it just, it really, it justblows my mind.
Michelle, you are incredible.
The fact that you have workedin oncology for this many years
is just mind-boggling.
And I'm so grateful for yourservice there.
But that is only half of whatyou do.
I know, which is even crazier.
So if you are listening to thisand you're thinking, dang,
Michelle is so cool.
(20:45):
I want to be a PA.
Where do I start?
Well, we will tell you where tostart, and that is Michelle
Nesky.com,M-I-C-H-E-L-E-N-E-S-K-E-Y.com.
Michelle, tell us about some ofthe amazing resources that you
have on your website.
Michele Neskey (20:59):
So um, in you know, I had my daughter in 2014.
Um, I went back to work andreally enjoyed it.
But, you know, I have a surgeonhusband who's super busy, and
um, you know, we kind of feltlike I was like, you know, I'm
at the point in my career wheremaybe I can create some
flexibility from home.
What can I do?
(21:20):
And I it started as a blog.
Like it started as a blog, noteven to like help previews.
Remember blogs?
I do.
It feels like now, you know,everyone right now is posting
about 2016.
Yeah, I had a blog.
Okay.
And it wasn't even a blog aboutPA school.
It was like a blog about me andDave, like how hard it was to
be like married to a residentand like that kind of stuff.
(21:41):
And then it kind of I had somestudents come through and
clinical research coordinatorsthat I worked with who wanted to
go to PA school.
So I just started helping them,you know, I just started
helping them kind of navigatethrough it.
And I was like, you know, thisthis is really fun.
Like this there could besomething here, and just like
word of mouth and Boom, like2019.
(22:01):
I'm, you know, I I I'm now likea pre-PA admissions coach, and
um, I've been doing it since2019.
Um, so what I do and what myother PAs who are on my team do
is we really navigate theprocess of PA school
applications.
And it's very confusing andit's very challenging.
And every year it gets more andmore competitive, and there's
(22:24):
more and more components.
Um, and I think the biggestpeople ask me this a lot is it
harder to get into PA schoolthan it is to get into medical
school?
The answer to that is no.
It is harder to apply to PAschool because of the variable
prerequisites and requirementsfrom program to program.
And that's where we really helppeople navigate through that.
(22:46):
But then we also help them withtheir essays and how to shine
in their essays, making surethey're not making mistakes on
their application by reviewingthem.
We mock interview people justto prepare them, you know, if
they get the interview, like youhave a one in three chance of
getting in.
So let's let's nail it.
So we practice with them, youknow, as much as possible.
And it's been amazing.
(23:07):
It's been so rewarding.
Did I ever think I'd have, youknow, all these followers on
TikTok and Instagram?
And, you know, no.
And also, like I'm, you know, Iremember so vividly going
through this process by myselfwith no medical people in my
family at all.
And when I did it, oh my god,this is great.
(23:28):
It was like like the first yearof Caspa.
So there was like maybe like 30schools and the rest were
paper.
Stop it.
So I had like paper stacks andlike, and I was like, this is
bad now, but at least it's notpaper.
Like it was it was like, soI've had to I've learned so
much, you know, about theadmissions process over the
(23:48):
years and have friends andcolleagues who are former
program directors on my team andadmissions um directors on my
team that have like opened myeyes to some things too.
So it's been awesome.
So now I work uh clinically twodays a week and I do the posh
PA for the remainder of thetime, and it's fantastic.
Ashley Love (24:09):
Absolutely incredible.
Yes, and I you've amassed amassive following on TikTok and
Instagram and YouTube.
And it's because the content isstuff people want to hear and
need to know, right?
I mean, you've nailed both ofit and you do it in such a fun,
engaging, and exciting way.
And obviously, that all justcomes back to the fact that you
love being a PA.
I love it.
(24:29):
I love it.
It it is a it's the job.
I mean, it is just the job.
So if you guys who arelistening, it's gonna be
Michelle.theposhpa, m-c-h e l edot theposh pa.
That's on Instagram and TikTok.
You can find her on YouTube atthe posh P A.
And check her out on LinkedIntoo.
She's there at Michelle Next.
You are incredible.
Thank you so much for spendingtime with us.
(24:50):
Thank you for creating thisamazing resource.
It's been a blast.
Michele Neskey (24:55):
Thank you.
Ashley Love (24:56):
Thank you so very much for listening to this
episode of Shadow Me Next.
If you liked this episode or ifyou think it could be useful
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
Shadow Me Next.
Please keep in mind that thecontent of this podcast is
(25:20):
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,and do not necessarily reflect
the official policy or positionof any other agency,
organization, employer, orcompany.
Take it from Michelle Nesky, the posh PA and
someone who has spent 20 yearsin oncology.
Getting into PA school is hard,even harder than getting into
medical school.
But there are some days wheregetting in is the easiest part
of becoming a great clinician.
Because one day you'll walk outof a room where your bad news
(00:21):
has changed everything for apatient and step right into the
next like nothing happened.
It's the same voice, the samepresence.
Today I'm talking to Michelle,and she sees this gap all the
time.
So, what are the students whoactually thrive in this
environment doing differently?
Welcome to Shadow Me Next, apodcast where I take you into
(00:43):
and behind the scenes of themedical world to provide you
with a deeper understanding ofthe human side of medicine.
I'm Ashley, a physicianassistant, medical editor,
clinical preceptor, and thecreator of Shadow Me Next.
I invite you to join me as wetake a conversational and
personal look into the lives andminds of leaders in medicine.
(01:03):
This is Shadow Me Next withMichelle Nesky, the Posh PA.
Michelle, thank you so much forjoining us today on Shadow Me
Next.
You have dedicated your life tobeing a PA and now to helping
multiple of the next generationsof PAs at this point.
Thank you for what you do andthank you for sharing it with us
today.
Thank you so much for invitingme.
I'm excited.
(01:23):
It will be so fun.
So you have um worked as a PAfor a few years now.
Can you tell us about how long?
Michele Neskey (01:31):
Yeah.
Um, this is my 21st year as aPA.
I graduated PA school in 2005.
So my God, I can't even believeI'm saying that.
It's so crazy.
Yeah.
Ashley Love (01:41):
Absolutely incredible.
And you really have, you reallyhave flexed all the muscles of
being a PA over those 21 years.
Describe a couple of thoseroles that I think, you know, as
pre-health students, we alwaystalk about we love the lateral
mobility.
We love the fact that we canparticipate in and politics and
policy formation, all of that.
Have you done all of thosethings?
Michele Neskey (01:59):
Yes, in some way or another.
Um, I think, you know, what'swhat I think is funny is we do
talk a lot about the versatilityand flexibility of moving
through specialties.
I personally have been in thesame specialty for 17 years, but
I did start off as ahospitalist medicine PA, which
was like an inpatient job rightout of college.
(02:20):
So um, and it was great becauseyou know what?
I didn't really know what Iwanted to do.
I wasn't, I had a lot offriends in PA school who were
like, I want to do this.
I I've had day one of PAschool, I'm gonna be an
orthopedic PA.
And I'm like, I have no idea,you know, like I have no idea
what I want to do.
And so it was a nice way tolearn from other PAs because it
(02:41):
was a very heavy PA run serviceand be able to kind of see some
of the other specialties andwhat I wanted to do.
So then when we I moved toMiami with my now husband's uh
residency for his residency,that's where I got my first
oncology job.
So I was in, you know, internalmedicine first.
Ashley Love (03:01):
So I think it's a really important thing to not
specialize initially.
And if it's not everybody'sstory, right?
But I I was in GYN, which isgenerally it's a pretty, a
pretty general specialty.
Um, and you just you're able tohone in a lot of those skills
that you learned in PA school.
Yes.
Um, and of course, oncology,really, you're you're dealing
with all body systems andoncology.
(03:21):
So you know, dermatology is alittle bit different.
Michele Neskey (03:23):
We're very, very internal medicine heavy, like
very internal medicine heavy.
Here's what I knew I didn'twant to do.
And so I like for me, I waslike, I am not for surgery.
Okay, it's not for me.
And I am not for unfortunatelylike OBGYN.
I passed out twice in the ORduring OBGYN.
(03:44):
I'm like, this is not for me.
So there were things like Iknew I didn't want to do.
And I think that that's alwaysgood too.
You don't really think aboutthat.
It's like, here's what I know Idon't want to do, and then you
know, kind of move on.
Ashley Love (03:57):
And you know, it's so funny you mentioned surgery
because you also mentioned yourhusband's residency in Miami.
Yes, he is a surgeon.
Correct.
Absolutely not, not for me atall.
Michele Neskey (04:06):
Yes, he is a head and neck cancer surgeon.
Um, long surgeries, verydetailed, you know, very he's
very tactile.
I have, you know, he alwayssays my I have floppy baby
hands, you know, we're verydifferent in that kind of way.
Um, but yes, it was a veryinteresting journey for us.
Um, I met him before I went toPA school and before he went to
(04:28):
med school.
And so he got into med schoolfirst.
Um, I got into PA school a yearlater um in different states.
So my gosh.
Yes.
So we did a long distancerelationship for four years,
essentially.
Like through PA school, throughmed school, and then got
married and moved to Miami for aresidency.
(04:50):
And we're both from theNortheast, you know.
So um, so it was definitely abig change and there's
definitely challenges in that.
But you know, I thinkultimately that's what makes us
like our marriage kind ofstronger today, because there
isn't anything either one of uswon't say to each other at this
point.
Um, very open communication,um, very honest, you know, about
(05:14):
where we were with things, andyou know, um, it's definitely an
evolution for sure, but it canbe done.
So absolutely.
Ashley Love (05:20):
So very similar.
I mean, similar.
I'm sure in in head and neckENT he gets a lot of cancers as
well.
And you you do a lot ofoncology.
Do you guys talk shop at homeor does work really does work
stay at work?
Um sometimes.
Michele Neskey (05:32):
Uh we've shared patients.
So we really, yeah.
So we used to work at so whenhe did his residency, we were
not at the same hospital.
But when he did his fellowship,and then when we moved to South
Carolina where we are, weworked in the same hospital and
he's basically surgical oncologyand I'm medical.
Right.
So we would share patients inthat way.
(05:55):
And so that was kind of fun.
We don't work directlytogether, right?
But like we're sharing, weshare that patient.
So I'm like, oh, you saw a day,you know.
So that's kind of a fun thing.
Um, we don't work at the samenow, but we still kind of share
some patients um ancillarily.
Uh, we don't talk a lot ofshock at home.
Um, especially he doesn't wantto, yeah, you know.
(06:17):
Um, however, when we have a badday or when we like there's
been a really hard patience orwhatever it is, it sort of is
like you don't have to talk tome today.
Like I get it.
You know what I mean?
So, like that's kind of a niceunderstanding that we can
support each other through that.
And sometimes that just lookslike, let's just talk about
(06:37):
anything else, you know.
So we don't talk a lot of shopat home, so which is good.
Ashley Love (06:42):
No, it does.
And you know, it's it's such aninteresting distinction because
as I tell people, you know, wepick, we pick being a PA for the
lifestyle.
And a part of the lifestyle iswho you're going to spend your
life with, right?
And my husband works infinance, and I come home and I
start talking to him about theholes that I have made in
people's faces, and he says,Ash, I love you.
(07:02):
I do not love the words thatare coming out of your mouth
right now.
Please be quiet, you know?
And I said, okay, like let'schange the subject, but just you
know, that's why I'm a littlesnippy, you know.
I had a I had a silver dollarsize hole in somebody's nose
today, and it just didn't looklike I wanted it to look at the
end, you know.
So um, so it's veryinteresting, you know, when when
looking at these careers, um,it's sometimes it's a group
(07:24):
decision and you know, sometimesit's it's focusing on what your
life is going to look like 10,15, 21 years from now.
You mentioned something that Iwant to touch on quickly, and
that is medical oncology andsurgical oncology.
Could you give us a littledefinition and maybe explain the
differences of those?
Michele Neskey (07:41):
Yeah, absolutely.
So medical oncology, so there'sthree branches of oncology:
medical oncology, radiationoncology, surgical oncology.
Medical oncology is we give allthe treatments that are IV,
oral, um, any type of infusionaltherapies.
So chemotherapy,immunotherapies, um, you see a
(08:03):
lot of them on TV, right?
Like a lot of the um things ontelevision that you see for any
type of cancer.
Um, we also do hematology.
So it really just depends onwhat practice you're in.
But medical oncology, you caneither be hematology oncology or
just med on.
So hematology oncology meansthat you do both benign blood
(08:26):
disorders and cancer.
Medical oncology means you'restraight up cancer, no
hematology problems or anythinglike that.
But really, we are the onesadministering um any kind of
medication, you know, to apatient for cancer.
Um, surgical oncology, clearly,they are the surgeons, so
(08:48):
they're doing the removal of anycancer either curatively or
just to take it out for painpurposes or whatever it might
be, more palliative.
Um, so they take care of thewhole surgical aspect and then
radiation oncology is obviouslygiving external beam radiation
or proton radiation therapy tospecific areas of cancer.
(09:10):
Um, so the biggest differencebetween medical oncology and
both surgical and radiationoncology, those types of therapy
are really for localizedcancers, right?
Like you have a spot here,let's radiate it.
You have a tumor here, let'stake it out.
Our treatments are systemic.
So they're going throughoutyour whole body.
(09:32):
So while we do give treatmentsto people who've had surgery to
prevent recurrence, we also givetreatments to patients who have
metastatic, somewhat incurabledisease.
Um, and so that's really whatthe differences are.
Ashley Love (09:45):
Incredible.
And then in medical oncology,which is where you practice the
end goals are a little bitdifferent for each patient.
Um, right.
So, so you know, we all like tothink if we have cancer,
specifically metastatic cancer,we're gonna go in, they're gonna
give me chemo, my hair's gonnafall out, I'm gonna feel like
crap, and then I'm gonna getbetter.
And we have seen recent studiesthat have come out that have
shown that yes, we are makingmajor advances in cancer
(10:08):
survival rates, but the endgoals for patients aren't always
um the same.
Can you tell us a little bitabout that?
A hundred percent.
Michele Neskey (10:15):
So, you know, sometimes we are treating
patients for cure.
We're giving them chemotherapyor immunotherapy to cure them,
you know.
So meaning after surgery, ormaybe they they have a type of
cancer that doesn't requiresurgery, like lymphoma, for
example, where you can cure withchemotherapy, right?
And biologic therapy.
(10:35):
Um, and so some patients, weare going for it, like we're
going for the cure, you know.
Um, other people have had theirtumors removed and we're giving
chemo as an insurance policy toprevent, help reduce the risk
of cancer recurring, right?
You we can't say that thistreatment will 100% do that, but
(10:58):
we have studies that say givingyou this treatment after your
surgery reduces your risk ofrecurrence by this much.
So most people will go aheadand do that, then they go off
treatment, and then they go onsurveillance.
And then we do have otherpeople who are being treated um
for, you know, metastaticcancers or incurable cancers,
(11:20):
technically.
Um, and sometimes their outcomeis to just improve their
quality of life, uh, quantity oftime here with their friends
and family, keep the cancerunder control and have them
living as normally as possiblefor as long as possible.
Um, whereas other times we canreally transition people with
metastatic disease into amaintenance mode depending on
(11:42):
what type of cancer they have.
And they may not need to be ontherapy their whole life, but
what we're seeing now with someof the immunotherapies is that
after two years, you know, ifyou've had a response, we can
stop, you know, and even talkingabout metastatic disease and
two years of no cancer is crazy.
Yeah.
Like I just think back to whenI started this and it was like
that was unheard of, likespecifically for lung cancer and
(12:05):
like things like that, right?
Melanoma, yes, yes, melanoma,like all these.
So we've come a very long way.
So it really depends on thepatient, the type of cancer, and
you know, what the goals ofcare are.
Ashley Love (12:18):
So and you know, we that was the science, and and
as TAs, we love the science, butof course, we love the humanity
and medicine too.
And I would imagine that theconversations that you're having
with all of those differenttypes of patients are very
different conversations.
How do you how do you navigatethat?
How do you wear one hat andthen take it off?
And then the next room you wearanother hat, and then you know
what does that look like?
Michele Neskey (12:38):
Um, you have to sort of treat every encounter as
its own, if that makes sense,right?
So you you can't bring what youjust said in another room into
the next patient's room.
And if you have to take asecond, you have to take a
second and it's fine.
And most people will understandthat, most patients will
understand that, you know.
(13:00):
Um, and so you just but youhave to also, it's okay to do
that when you're in the middleof a busy clinic and things like
that.
But at the end of the day, youdo have to process those things
because if you don't, you know,they do build up over time and
cause a lot of emotional stressand burnout.
So I think what's importantabout that is every patient is
(13:20):
its own encounter.
And I am there to help them getthrough whatever situation it
is.
It is not about me.
Like it is about them, right?
So if it was a hardconversation, it was triple as
hard for them to hear than forme to deliver.
And so I always remind myselfthat that was harder for them
(13:44):
than it was for me, even thoughit was hard for me.
And I have to go help the nextpatient and meet them where they
are.
And that's I think the mostimportant thing.
Ashley Love (13:55):
This is the perfect time to break for quality
questions.
This is a segment on the showwhere we talk about an interview
question you might hear on yourown pre-PA or pre-med
interview.
The quality question here isthis Tell me about a time you
had to reset emotionally in ahigh-stakes environment before
showing up for someone else.
(14:16):
What did that moment teach youabout how you handle pressure
and responsibility?
This is the kind of questionthat separates strong applicants
from unforgettable ones.
It's not what you know, it'show you respond under pressure
and how you regulate youremotions in those moments.
Because medicine is notpracticed in isolation, it is
(14:39):
practiced moment to moment,patient to patient.
So the question is, can youreset or do you carry it with
you?
And it doesn't just stop atquality questions.
There are more resources foryou as a pre-health student on
shadowmext.com to include ournewly released application
readiness course.
(15:00):
So head on over tocourses.shadowmext.com and check
it out.
Michele Neskey (15:04):
Also gauging the patients.
So, first of all, like yousaid, oncology is a very
relationship-heavy specialty,which is what I love about it.
We see patients every threeweeks, every two weeks, every
six weeks, every whatever.
And like you get to know them,you know, you get to know their
families, you get to know theirhistory.
Some people are superinteresting and you've connected
with them.
So if you have to deliversomething that's, you know, um
(15:26):
technically bad news orwhatever, it's a little easier
because you have thatrelationship and you can kind of
say, I really don't want todeliver this, but like here's
what we here's what we have totalk about.
Whereas if you're trying to doit with somebody brand new, it's
it's definitely a differentconversation.
And you just have to read theroom and you have to read your
patient and knowing theireducation level, number one,
(15:47):
number two, what whatinformation do they want to
know?
And how can you know you worktogether to make that process as
smooth as possible?
So yeah, yeah.
Ashley Love (15:59):
I mean, and you know, I uh we're we're on such a
sad topic right now, but yeah,it unfortunately that is this is
a case.
You know, people do get quoteunquote bad outcomes and you do
have bad news.
But like you mentioned, they'reI mean, in the last 20 years,
advances in cancer treatment arejust they're mind blowing.
Tell me about somethingrecently that is um you're just
(16:20):
so proud of in the cancercommunity that that we have and
that we have available, maybemaybe in an anecdote if you have
one.
Michele Neskey (16:27):
Yeah, so you know, I think some of the
biggest, the biggest shift incancer treatment came with the
advent of immunotherapy andbiologic therapy.
So just so you know,immunotherapy is either IV or
injectable at this point.
And what it does is not to gokind of too geek on this, but we
(16:48):
can basically it stimulatesyour immune system to fight the
cancer.
So these drugs, as opposed tochemotherapy, where we're just
literally killing DNA of cancercells in any way possible and
all your other DNA through.
So, you know, I mean, so that'swhy there's a sometimes a lot
of side effects from that.
Chemotherapy is still a verystrong backbone for a lot of our
(17:09):
treatments.
And just to sort of, you saidthis in the beginning, people
have a very negative outlook onchemotherapy.
We've come a long way withchemo, okay?
Because we've come a long waywith pre-medications.
So not everybody loses theirhair, not everybody throws up
all the time.
Actually, I rarely have apatient vomit.
(17:31):
It's amazing.
So think about back in the daywhen people were like, you're
gonna lose your hair, you'regonna be sick all the time,
you're gonna be all thin andskinny.
Like some people do have sideeffects like that, but I can
say, like with authority, thatvery, very few of our patients
vomit.
So, I mean, we could havenausea, but not a lot of
(17:52):
vomiting, you know, noteverybody's losing their hair.
Um, so I think that's animportant thing to know.
Every chemo regimen's a littledifferent.
Um, but immunotherapy reallykind of changed the game, and
it's approved for a lot ofdifferent treatments.
And I think to me, I I have asoft spot for lung cancer.
I did um, you know, I worked ina community oncology practice
(18:15):
first, which just means it was asmaller, like outpatient office
connected to a hospital thathad a few physicians and we did
heme and onk, and so we saw alldiagnoses and all of that.
And the physician that Iprimarily worked with had a
specialty in lung cancer.
So I kind of started learningabout it there.
But then when I shifted, whenDave went to fellowship at MD
(18:38):
Anderson, I worked at a very Iworked in lung only like lung
and head and neck medicaloncology only.
So talk about the differentlike things.
But I will say this uh we havetwo patients I could name off
the top of my head who hadmetastatic lung cancer, who got
immunotherapy for two years,have been off treatment for at
(19:00):
least two years, and our aredisease, no disease.
It's unreal.
None.
Like stage four lung cancer,like, and there's a lot of
nuances that goes into that.
Not every stage one cancer isthe same.
A lot of markers andpredictors, and that's also a
huge advancement, you know.
All these markers we can testfor now in tumors to see if this
(19:22):
medication will work for you,right?
So just such a shift of a moreit's much more of a personalized
regimen rather than beforewhere everyone just got this,
you know.
Now it's like this isn't gonnabe a good for you, you're gonna
get this.
So it's definitely more drivento the patient's, you know, um,
(19:44):
specific pathology, genetics,you know, all of that kind of
stuff, um, where we're reallytrying to make it more
personalized.
And I feel like it really hascome that way.
But those patients that I see,I'm always just like, wow, like
this is crazy, you know.
Ashley Love (20:02):
You know, once upon a time, we would have called it
a miracle, is what we wouldhave called that, right?
I have a similar melanomapatient who um had uh melanoma
of the skin, which metastasizedto melanoma all over, brain
mets, multiple.
And every time I get a notefrom his medical oncologist
about a clear scan, it just Ihave to smile first.
(20:24):
It really does make you smile.
And it just, it really, it justblows my mind.
Michelle, you are incredible.
The fact that you have workedin oncology for this many years
is just mind-boggling.
And I'm so grateful for yourservice there.
But that is only half of whatyou do.
I know, which is even crazier.
So if you are listening to thisand you're thinking, dang,
Michelle is so cool.
(20:45):
I want to be a PA.
Where do I start?
Well, we will tell you where tostart, and that is Michelle
Nesky.com,M-I-C-H-E-L-E-N-E-S-K-E-Y.com.
Michelle, tell us about some ofthe amazing resources that you
have on your website.
Michele Neskey (20:59):
So um, in you know, I had my daughter in 2014.
Um, I went back to work andreally enjoyed it.
But, you know, I have a surgeonhusband who's super busy, and
um, you know, we kind of feltlike I was like, you know, I'm
at the point in my career wheremaybe I can create some
flexibility from home.
What can I do?
(21:20):
And I it started as a blog.
Like it started as a blog, noteven to like help previews.
Remember blogs?
I do.
It feels like now, you know,everyone right now is posting
about 2016.
Yeah, I had a blog.
Okay.
And it wasn't even a blog aboutPA school.
It was like a blog about me andDave, like how hard it was to
be like married to a residentand like that kind of stuff.
(21:41):
And then it kind of I had somestudents come through and
clinical research coordinatorsthat I worked with who wanted to
go to PA school.
So I just started helping them,you know, I just started
helping them kind of navigatethrough it.
And I was like, you know, thisthis is really fun.
Like this there could besomething here, and just like
word of mouth and Boom, like2019.
(22:01):
I'm, you know, I I I'm now likea pre-PA admissions coach, and
um, I've been doing it since2019.
Um, so what I do and what myother PAs who are on my team do
is we really navigate theprocess of PA school
applications.
And it's very confusing andit's very challenging.
And every year it gets more andmore competitive, and there's
(22:24):
more and more components.
Um, and I think the biggestpeople ask me this a lot is it
harder to get into PA schoolthan it is to get into medical
school?
The answer to that is no.
It is harder to apply to PAschool because of the variable
prerequisites and requirementsfrom program to program.
And that's where we really helppeople navigate through that.
(22:46):
But then we also help them withtheir essays and how to shine
in their essays, making surethey're not making mistakes on
their application by reviewingthem.
We mock interview people justto prepare them, you know, if
they get the interview, like youhave a one in three chance of
getting in.
So let's let's nail it.
So we practice with them, youknow, as much as possible.
And it's been amazing.
(23:07):
It's been so rewarding.
Did I ever think I'd have, youknow, all these followers on
TikTok and Instagram?
And, you know, no.
And also, like I'm, you know, Iremember so vividly going
through this process by myselfwith no medical people in my
family at all.
And when I did it, oh my god,this is great.
(23:28):
It was like like the first yearof Caspa.
So there was like maybe like 30schools and the rest were
paper.
Stop it.
So I had like paper stacks andlike, and I was like, this is
bad now, but at least it's notpaper.
Like it was it was like, soI've had to I've learned so
much, you know, about theadmissions process over the
(23:48):
years and have friends andcolleagues who are former
program directors on my team andadmissions um directors on my
team that have like opened myeyes to some things too.
So it's been awesome.
So now I work uh clinically twodays a week and I do the posh
PA for the remainder of thetime, and it's fantastic.
Ashley Love (24:09):
Absolutely incredible.
Yes, and I you've amassed amassive following on TikTok and
Instagram and YouTube.
And it's because the content isstuff people want to hear and
need to know, right?
I mean, you've nailed both ofit and you do it in such a fun,
engaging, and exciting way.
And obviously, that all justcomes back to the fact that you
love being a PA.
I love it.
(24:29):
I love it.
It it is a it's the job.
I mean, it is just the job.
So if you guys who arelistening, it's gonna be
Michelle.theposhpa, m-c-h e l edot theposh pa.
That's on Instagram and TikTok.
You can find her on YouTube atthe posh P A.
And check her out on LinkedIntoo.
She's there at Michelle Next.
You are incredible.
Thank you so much for spendingtime with us.
(24:50):
Thank you for creating thisamazing resource.
It's been a blast.
Michele Neskey (24:55):
Thank you.
Ashley Love (24:56):
Thank you so very much for listening to this
episode of Shadow Me Next.
If you liked this episode or ifyou think it could be useful
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
Shadow Me Next.
Please keep in mind that thecontent of this podcast is
(25:20):
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,and do not necessarily reflect
the official policy or positionof any other agency,
organization, employer, orcompany.
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