Not enjoying medicine, wanting out

[GetMeOuttaThisMess]

I don't think this is fair to the OP.  I am doing my clinicals in a city where my patient population is nearing 90% Hispanic and a large portion of them do not speak English.  It gets tiring sometimes to have to go find a nurse, who is already busy doing their own thing, to translate.  Family members are sometimes there but don't always understand medical jargon enough to be helpful.  When someone translates for you, you aren't sure if what you are asking or if what the patient is saying is truly coming across the way you need it to in order to practice good medicine.  Hospitals offer translation services, but who has time to pass a phone back and forth with the patient?  Patients get upset when you tell them you don't speak Spanish and to hold on a moment until someone who does can see them.  Doing a thorough H&P requires a good command of the language.  All of this makes for a huge time sink and can leave you frustrated and unsure about your decision-making process.  It can be taxing when it's like this day in and day out.  

 

So, I doubt the OP has a dislike for the actual patients that don't speak English, but rather a dislike of the aggravation and hassle that often comes with it.  I can empathize. 

 

This issue was one of two primary reasons as to why I declined an ED position that was offered late this past week that would pay approximately $15K more than a position which I had already accepted.  The curse of taking a new ED position is having already worked in the arena beforehand and knowing what that bright light before you in the tunnel truly represents.  This position would have been in a similiar demographically served population.

[UGoLong]

I quibble with no one’s opinions or motives. We’ve all got them.

 

My point is that, if you find yourself deciding -- consciously or unconsciously -- that your patients aren’t worthy of your care because some of them really “know” English but want a translator anyway, and some of them are here illegally, and some of them are the cause of their problems, and some of them want cures to incurable conditions, then I just suggest that you might be in the wrong position, and maybe the wrong profession, for your temperament.

 

I don’t think that you are a evil person with bad motives; maybe you’re just burned out. It happens.

 

Just sayin’. 

[GetMeOuttaThisMess]

^^^ I think that there is a discernible difference between frustration with not being able to adequately communicate with clientele and your comment regarding their not being worthy of one's care.  I don't doubt at all that those who have been in the profession for decades may burn out (self included) but I don't agree that it necessarily has to impact our ability to provide appropriate care.  To the contrary, I think that one of the reasons that burn out may be experienced is the inability to obtain satisfactory compliance from the patient, or failure to obtain a successful resolution when both parties are trying to do their best to obtain the stated goal.  I don't see that the two necessarily have to go hand-in-hand, though certainly I don't begin to think that there isn't a higher likelihood of same in those who are.

[TWR]

I speak for no one but myself on the language issue but many non English speaking patients have been in this country for years and apparently have made no attempt to learn the language Recent immigrants I understand. I work in Houston and as know we have a large number of Spanish speaking patients. I have taken courses and make every attempt to communicate in there language. Don't they have some responsibility to learn English? How can you drive a car in this country and not speak or read English.

As an aside, I suspect this is one of the only country that you have to push "1" to continue in English. Afriend in the oil business was transferred to Germany and the office made no attemptto communicate in English. He learned German fast.

 

Sorry, got off of Bruce Banner's topic but addressed one of his issues.

[BruceBanner]

 

Honestly, non-English speakers are on your list?

 

 

Honestly, yes. YOU try dealing with 20 Spanish-speaking patients per day, every day, who have abysmal health literacy, and next to zero accountability for their own care. Do that for a couple years and tell us if you still love being a PA. 

 

 Doing a thorough H&P requires a good command of the language.  All of this makes for a huge time sink and can leave you frustrated and unsure about your decision-making process.  It can be taxing when it's like this day in and day out.  

 

So, I doubt the OP has a dislike for the actual patients that don't speak English, but rather a dislike of the aggravation and hassle that often comes with it.  I can empathize. 

 

 

^^^ I think that there is a discernible difference between frustration with not being able to adequately communicate with clientele and your comment regarding their not being worthy of one's care. 

 

Agreed, and the frustration does not come from having a Spanish speaking patient here and there. It comes from about 80% of my patient load making minimal effort to learn the language of the country in which they reside, having to track down ancillary staff who are busy with other tasks to interpret for me (families are unreliable for legal reasons), having a visit that is twice as long as it should be, and then seeing them the next week and finding out they didn't follow my instructions or even comprehend my sig for their medication. They don't have to learn English because they aren't forced to. We cater to them. Yeah, this is part of medicine, but when it happens day after day after day, it robs you of your joy. 

 

 

I've seen a few smug replies here and honestly I expected them. I think when you have a nice gig (or when you've never had a crap gig) it's easy to sit back in your lofty PA chair and pass pious judgment on other providers. Like I said, I got myself into this mess, and it's on me to deal with it. I'm not blaming my patients or my employer or anything else, just talking it out and trying to figure out where to go from here. I appreciate all the feedback.

[Joelseff]

Hang in there Bruce, I still think you can find a good spot to land. It's like Goldilocks and the 3 bears. And quite honestly I don't think there is such a thing as a perfect job (I know you know this too) but finding one that doesn't make you want to kill yourself should work out just fine lol. Wish you the best man!

 

[Guest Paula]

I had two patients today that reminded me of the discussion on this thread:

 

#1.  Female pt age 38 comes in asking for vicodin.  Her words: I want to restart my vicodin because I have a job interview today and when I start work I will be standing most of the day and I know I will get back pain.  My words: Do you have back pain now?  Her response: No, but I know I will as soon as I get a job.  My response: I will write you for prescription ibuprofen and then when you get back pain I will refer you to PT or chiropractor.  Her response: why does everyone else get vicodin from this clinic?...this was a waste of my time....  My unspoken response:  good, don't come back.

 

#2. Male pt age 50 comes in for follow-up for hand contusions following a drunken altercation:  His words: Hi, I feel great and didn't take any of the medications you gave me 2 weeks ago for my ear wax.  My hands are good and I got my stamina back and can still wash dishes. I'm still the town drunk but love reading Newsweek magazine and it makes me cry to read about the uniformed officers who got killed on 9/11. They are like you (I am not a uniformed PHS employee, however I will let him think so).  BTW: can you look in my ear it still feels like an ocean in there.  

 

My thoughts: well this is nice and I just should have brought in a couple of cups of coffee for a kaffe klatch as this is what it really is.  

[UGoLong]

Bruce, your gig doesn’t sound easy and I wouldn’t like it either.

 

We have a fair number of foreign-speaking patients (Columbus has the second largest Somali population in the US -- over 50,000 and counting) and many of them don’t speak English. We also have a fair number of Russian speakers and a few Spanish speakers. In our office, MAs call the university hospital and arrange for translators to accompany the patients -- otherwise we reschedule the visit. It doesn’t do them -- or us -- any good to try to communicate in pantomime at 110 baud.

 

Too bad your place won’t call in outside translators. They are paid for by law, as far as I know, since it is the patient’s right to have one. And family members don’t count.

 

As far as learning English goes, immigrants have generally followed a predictable path. The first generation learns a little, but mostly keeps to its own. The second generation generally can speak English like natives.

 

The first Somali woman I met was 25 years ago as an EMT. We men were not allowed to speak to her directly  -- we had to speak through her husband. In the ER, all of the men who could be replaced on her case by female caregivers were replaced. Her daughter -- or granddaughter -- probably wears a headscarf, jeans, and running shoes and speaks like she was born here, which she was. She could care less about the gender of her caregiver.

 

There are bad gigs and maybe you’ve got one. If so, leave before you start to doubt your interest in medicine.

[bmurphyl512]

Im sure you could find specialty in an area in which you don't have to deal with non english speakers, and uneducated people, but why bother?  You simply do not like being a PA.  I suggest finding a new career.  

[Iain1028]

"Insurance dictating my scope of care"

 

 

You ain't seen nothing yet…...

[Iain1028]

"I speak for no one but myself on the language issue but many non English speaking patients have been in this country for years and apparently have made no attempt to learn the language Recent immigrants I understand."

 

What't the incentive?  Everything is translated in hundreds of different languages, and you don't even have to show ID to vote anymore, not really….

[gbrothers98]

I have cared for children with congenital abnormalities and I have cared for the lady who faked a seizure multiple times per week after eating at a restaurant only to recover as we arrived in the ER and walk out of the ambulance.  I understand the spectrum.   Fair warning...I'm going to be hard on you but keep reading because I will back off at the end.

 

Life and people are messy.  Your "Don't Like" list is what life can be.  My interpretation is that you wish to care for people who have become sick or injured in a manner in which you approve.  I guarantee that this would be a bad opening for your essay if you were applying to get into PA school.  This business is not about us.  It is about people and all of their frailties.  We do silly, annoying, and stupid things.  Sometimes we complain of back or head pain when in reality we are so overwhelmed with our troubles that it is all we can think of saying.  However, sometimes we are complaining of back pain when it turns out we have metastatic prostate cancer that was undiagnosed. (An actual case that I have seen.)  Sometimes we complain of a sore throat when we actually have Ludwig's angina.  (Another case that I have seen.) 

 

However, I do applaud that you are expressing your messy and complicated feelings.  I am certain that you are not alone.  Our working life looks a lot like that of Physicians and they have an alarming rate of dissatisfaction, depression, and suicide.  Why should our ranks be different in that respect if everything else is starting to be more similar as time passes.  What do I know?  I don't work where you work nor do I live your life.  Maybe you are getting a steady diet of misery and I should be more sympathetic to your plight.  However, it is not your patients fault that you are currently in a job that is mismatched for your interests.  While you are figuring out what is right for you, try spending some time putting yourself in your patients' shoes.  If you label the back pain sufferer as a malingerer then you miss why they are coming to you to complain of the pain.  They may not be in pain, they may have a pain syndrome that science does't really understand yet, or they may have a big problem that has a common symptom.

 

All of that being said, if you are truly unhappy and a different perspective doesn't change your feelings then get out of this job quickly and find something you do love.  Forget about what it looks like on your CV.  Life is too short to be miserable every day.  You owe it to yourself and the people you love to work for peace of mind and to do great things.  Good luck and thank-you for sharing your story.    

This is great advice.

Several years ago I had an epiphany that I was miserable. Night shifts, difficult patients, SP who was an a$$h@le, lots of change.

I looked at my options. Young family, big mortgage. Not a lot of wiggle room considering the responsibilities I had taken on. Needed to make what I had better. Looked at the things that were making me miserable and realized most I did not have control over. 

So what could I do?

I focused on what I could do. I could strive to do an excellent job and be an example of what PAs can do in a immediately unsupervised setting. I wanted to provide for my family and my children. They did not care that I had to eat a sh&t sandwich on a regular basis, and since I wanted them happy and cared for, I stopped whining about the sh*t sandwich and after a bit, it really started to taste like PB&J. I got involved in projects and started exhibiting more leadership. The more I got involved, the better I felt. I also started to draw a hard line about work. No charting afterhours, no staying late. Get done and get out. Take every single day of vacation time I had coming to me, no more OT. 

I also realized that I had worked hard, very hard to get where I was. There was a gap of empathy when I encountered those who were not like me. But who was I to judge, I was there to help. So instead of getting mad at the patient with a mouth full of percocet tickets, I gathered up the balls to ask, what can I do to get you to a dentist? or I see we have seen you 6 times in 4 weeks for this problem, do you have a problem? are you a drug addict and need help? Some told me to F off, some said man my teeth really hurt and one said yeah I have a problem, a monkey on my back and I dont want it there. But I finally felt like I was doing what I was supposed to. I did this with all the patients I saw, I got more real and more honest. I was professional but I also drew a realistic line with everyone I encountered....this is what I can do for you. Smile, stand fast.

What I did in my mid 40s was that I finally grew the f%ck up and fully embraced the role I had been phoning in.

Introspection and insight are rarely suggested but it made me a better clinician and a better man. 

Try it.

G Brothers PA-C

[ventana]

This is great advice.

Several years ago I had an epiphany that I was miserable. Night shifts, difficult patients, SP who was an a$$h@le, lots of change.

I looked at my options. Young family, big mortgage. Not a lot of wiggle room considering the responsibilities I had taken on. Needed to make what I had better. Looked at the things that were making me miserable and realized most I did not have control over. 

So what could I do?

I focused on what I could do. I could strive to do an excellent job and be an example of what PAs can do in a immediately unsupervised setting. I wanted to provide for my family and my children. They did not care that I had to eat a sh&t sandwich on a regular basis, and since I wanted them happy and cared for, I stopped whining about the sh*t sandwich and after a bit, it really started to taste like PB&J. I got involved in projects and started exhibiting more leadership. The more I got involved, the better I felt. I also started to draw a hard line about work. No charting afterhours, no staying late. Get done and get out. Take every single day of vacation time I had coming to me, no more OT. 

I also realized that I had worked hard, very hard to get where I was. There was a gap of empathy when I encountered those who were not like me. But who was I to judge, I was there to help. So instead of getting mad at the patient with a mouth full of percocet tickets, I gathered up the balls to ask, what can I do to get you to a dentist? or I see we have seen you 6 times in 4 weeks for this problem, do you have a problem? are you a drug addict and need help? Some told me to F off, some said man my teeth really hurt and one said yeah I have a problem, a monkey on my back and I dont want it there. But I finally felt like I was doing what I was supposed to. I did this with all the patients I saw, I got more real and more honest. I was professional but I also drew a realistic line with everyone I encountered....this is what I can do for you. Smile, stand fast.

What I did in my mid 40s was that I finally grew the f%ck up and fully embraced the role I had been phoning in.

Introspection and insight are rarely suggested but it made me a better clinician and a better man. 

Try it.

G Brothers PA-C

well put!

 

we are all likely in medicine for the long haul...... and need to remember this

[GetMeOuttaThisMess]

Biggest mistake on my part has not been utilizing the paid leave I had accrued.  The only problem with that is that the last position made it seem like the world would come to an end if I wasn't available to perform the mandatory employment physicals for folks that the respective departments needed yesterday.  Some of us come to realize that what others see as a big problem isn't in reality.  The only problem is we aren't in a position to tell the dumbarses otherwise.  Thus, I got out.  Fortunate for me, a little over one presidential term left and I'm out, unless it is doing something that I want to do such as mission work, etc..  It is nice to be able to self assess and realize where changes can be made as noted above.  My makeup is not to make lemonade out of lemons.  In my case, I'm bullheaded enough to where if I can't change it to the way that it needs to be, IMO, then it's time to let it be someone else's problem, which is where my successor as I understand it is at today.

[TWR]

I agree about the paid leave. Do not lose. The practice will still thrive while you are unwinding doing what ever it is you like. I worked in ENT for 4.5 years in Houston and my sp made me feel like the practice would fold if I wasn't there. I left with 164 hours on the books but once notice was given, you could not get paid for one minute. Yes it was in the contract. I left a lot of money on the table. I did learn an expensive lesson. Still can't wrap my head around why, if I earned the time while employed, that I wasn't paid forit. Similar situation when I left NY in 2004 except I was paid for my unused pto and left with $10,000 in my pocket.

 

PS I also think NY was a better place to practice. Respect and all.

[GetMeOuttaThisMess]

I was fortunate enough to leave with my 240 hours of paid PTO.  I strongly believe that this "win one for the team" attitude (old school instilled by family from depression era) has led me to where I am today with my overall feelings about medical practice.

[Bohuntr]

I was like you for the first two years after graduation, I just wanted to forget I ever went to PA school and go back to my previous career.  All I could think of was how miserable I was with the never-ending flow of chronic complainers, non-compliant patients who continually make poor lifestyle choices, drug seekers and illegals.

 

Then I found my present job a few months ago.  I work at a family practice clinic right across from one of the largest Universities in the country.  I do primarily urgent care, but the Medical Director has a private practice that includes a lot of professors and their families so I occasionally get enough of her patients when she’s overbooked to ensure I don’t just see healthy college students.

 

My patients are typically 17-25, healthy, and come in with allergies, ear aches, STD’s, UTI’s, URI’s, fractures, minor suturing, depression, minor anxiety, etc… typically what you would expect from college age students.  I get to do a few ingrown toenails, cysts or lipoma removals to keep the basic procedural skills in tune, and can turn down anyone coming in seeking narcotics if I want to, though I have the option of prescribing if I believe it’s an honest need.  We are also associated with a hospital about a mile away, so I always have that option when patients need more care than I can give.

 

We have an OBGYN that comes in once a week I can refer to (as far as I’m concerned, that portion of the body is a playground, not an office space), and our Medical Director also does pelvic examinations during the week if it’s needed sooner.  The Medical Director is big into the Boston Heart protocol (it bills under preventative care) so she takes most patients with chronic conditions as part of her group; she tosses the pediatrics my way since that is one of my passions.

 

When our Medical Director is out I occasionally get a few of her patients, so I can keep up my knowledge and treatment of chronic conditions up to date, but don’t get pummeled with patients out test-driving their Obamacare after 30 years of poor lifestyle choices.  99% of my patients speak English, but as a campus I do get the occasional International Student who speaks Spanish, French, German, Russian, Arabic, etc… but their English is almost always enough to get them proper care; I have only had to send one patient to a hospital for an interpretive issue.  It’s not like the public hospital system where my Spanish-speaking patients with new onset knee pain were illegals who slipped on a mossy rock sneaking across the Rio Grande the night before. 

 

I know where you are coming from, but shop around.  You picked two fields, Ortho Spine and Occupational Medicine, that nobody should go into without several years in medicine.  Those patients are designed to turn people bitter.  I had 15+ years as a military medic before PA school and though ER would be the field for me, but I couldn’t have been more wrong.  I had the same bitter experience there that you feel right now, and it was all due to the chronic, bitter, ungrateful drug seekers and malingerers; everything that ends up in the fast-track side of the ER because nobody else wants to deal with them.

 

One thing I get in spades is where I'm at is GRATITUDE!, 99% of the people I see appreciate the care and time you spend with them.  Most of my patients are genuinely happy you spent the time to listen to them; they aren’t patients who have a government chip on their shoulder thinking they are getting the short end of the stick because they are on some low-income insurance program. 

 

Ever since I graduated PA school I have always asked the same two questions when the visit was over:

1. Do you understand our plan?  (I will give you a depo-medrol shot and Flonase, you will steam, take OTC Claritin and increase fluids.)
2. Do you have any questions you feel are unanswered?

In the walk-in urgent care clinics and ER's I worked many times I was told that they felt I was trying to get rid of them because they brought in a list of complaints and I would only address two.  Sorry, the words over the door say Emergency or Urgent, I'm not here to cure your 60+ years of poor lifestyle choices.

 

I shake hands with my patients at the end of the visit, give them a card and am building up a nice little group of repeats.

 

We have identical likes and dislikes for medical care, and I’m sure we aren’t in the minority.  Sadly, Obamacare is going to make medicine worse for the providers not better; the ungrateful chronic patients will eventually outnumber the grateful people who make responsible lifestyle choices. 

 

Sit down, find out where the patients you want to see are likely to go (maybe Dermatology, Plastic Surgery, a family practice clinic in a resort town, etc…. get creative, make your own niche if you can’t specifically find it) and start looking.

 

Best wishes to you,

 

John

[cc56]

To the OP I feel your frustration.  I am in my early 30's too and went into Ortho which led to ortho spine as a first job.  I actually worked for a company that got bought out and the new mega corporation made it horrible.  I had a lot of ER experience before PA school and went into ortho instead of trying ED.  I have been with the company(s) for approx 20 months.  I finally realized that I need to switch and have an urgent care and an ER interested in me.  I can not tell you the difference in my attitude/over all well being.  I would suggest before you throw in the towel try one more time in something that you might like.  

 

 Ortho spine has drained it out of me.  The hours I put in, the compensation, and the patients.  I would say that I like a lot of the patients and we can make them better.  I get enough narc seekers, car accident " I want my payday/ perm disability", and malingerers that it makes me not like it.  Right now it is the hours and lack of compensation that has really done me in.   It sucks when everyone tells you "spine is where the money is", and you make less than 50% the national average for "ortho".    Good luck, it feels good to hear others like me. I feel I have a bright future though now...

[GetMeOuttaThisMess]

I can tell you, money isn't the long-term answer either.

[BruceBanner]

I appreciate all the continued feedback. It's good to see a variety of opinions and that I'm not alone.

 

I think my opinion of medicine right now is discolored by my poor experiences and---barring some very unique non-clinical opportunity---it would be premature of me to jump ship on medicine entirely.

 

I know this isn't the right gig for me, and no amount of attitude adjusting is going to change that. Right now I'm just trying to be grateful that I am employed and to remember this wont last forever. I just need to wait on the right move and not jump out of the frying pan into another fire.

[GetMeOuttaThisMess]

For what it's worth, the fact that you can be successful at something that you don't particularly enjoy says something...

[PACProvider]

I am in the exact same spot. Two years out and exhauasted patients who don't want to get better. Have all the same complaints. I am still optimistic about the future. Reasons...

1. New grads get hired into many bad jobs that experienced PA would never take. Keep building experience and you will negotiate for the right job.

 

2. You took up medicine because of your commitment to help others. The annoying patients don't want your help. In time, you can learn to treat them with a smile while not engaging them with your heart.

 

3. Keep studying and keep seeking great practice opportunities. Forget about staying in a job that doesn't serve your needs. The reason docs explode in a rage when a PA resigns is that they know it is hard to find another person to do the job you are leaving

[delco714]

The possibilities and probabilities are all we have to work with in medicine, though. What we are drawn to in this imperfect science, what we in fact covet in our way, is the alterable moment-the fragile but crystalline opportunity for one's know-how, ability, or just gut instinct to change the course of another's life for the better.

 

- Atul Gawande

[Steel]

I came across this interesting forum while researching PA jobs.  I am researching PA jobs because I am considering re-entering the profession at some level.  I have taken quite a hiatus from it.  Over 31 years ago, I decided that being a PA maybe wasn’t what I wanted to do after all.  I had graduated from PA School (at a very young age) and passed the NCCPA certification exam (also at a very young age), but at that time I was unhappy with the job itself for some of the reasons the OP has stated, and there were other reasons as well.  An opportunity in an entirely different field unexpectedly presented itself, and I went for it.  That led to a 31-year career outside of medicine entirely.  I just recently retired from that career.

 

Now, in my later 50’s, I want to re-enter the medical field.  Maybe get re-certified as a PA again.  I know the recert process may be daunting, but I will see how it goes.  I am blessed in that I don’t have to do it; I would just like to do it.  Patient scenarios that were once frustrating to me now seem interesting to me in my later years.  I may be deluding myself, I don’t know.

 

I will share a few thoughts with the OP.  I understand your frustrations and situation.  Like others have suggested, perhaps remaining a PA and just changing your practice environment or specialty will do the trick for you.  I would also think that taking off 6 months to a year to try another profession would not place you in a position where you couldn’t return to the PA field.  I was fortunate in that my “new” post-PA career was enjoyable and challenging for about 28 years, but the last 3 years, not so much.   The lack of enjoyment was due to me becoming somewhat burned out and simply tired of doing what I had done for so long.  At that point, I was in too deep, and it was just a waiting game until retirement.  That is just the way it is sometimes.  I have no complaints.  I remain very grateful for my employment and to my employer.  My situation was probably no different than what many people experience.

 

But at your young age and stage, I would not continue doing something you hate.  That will end up hurting you and your performance may well decline.  I would suggest you find something else.  I know you said you feel you are “backed into a corner”, but you can sure look for something else while you are doing the job you are in now.  Sooner or later, something will become available.

 

I can leave you with this.  Life is full of surprises.  I never thought I would leave the PA profession and enter another one, much less stay in it for 31 years. 

 

 “…the best laid plans of mice and men”.

[EMEDPA]

I can tell you, money isn't the long-term answer either.

boy, is this true. I worked for many years at a job that treated PAs poorly, but paid a ridiculous salary with great benefits, sabbatical leave, 2 automatic raises/yr etc. After becoming a father and doing a bit of Introspection like George did above, I decided life was too short to work at a job I hated and was mistreated at, regardless of how well it paid, so I got out. I now make a bit less (at first it was a lot less) but I am a lot happier. bottom line: stop doing things that make you miserable. set priorities and play to your strengths. one of the things that I discovered about myself is that I don't want to be anyone's assistant and have folks(some less qualified than me) second guessing my calls. I'm fine with CONSTRUCTIVE criticism and seek it out, but was tired of "you are a pa, therefore you must not be as smart as every physician and nurse manager in this hospital".

Now I work solo at 2 of 3 jobs and alongside physicians who respect me and treat me as a colleague at the other.