MikeyBoy Posted April 13, 2015 Share Posted April 13, 2015 Hey everyone; haven't posted in probably 2 years, but it's good to be back, and would like to get some unbiased advice if you all get a chance. I've been in kind of a rut at work lately, in terms of satisfaction. A little background; late 20s, single, 4 years out of school, 3 years of that in critical are in a 14 bed ICU, soley staffed by PAs with a daytime intensivist. I split the month into 2weeks days/night because I like both rounding and then the autonomy of night work. I like my coworkers, am respected by my attendings, and like to think I do pretty good work which I do mostly enjoy. Compensation is about average for my area, CME reimbursement has finally been bumped up this year. So, at this point, I'm thinking should I stay with this gig since it's comfortable or see what else is out there? Two world class hospitals are 30 minutes down the road (offering transplant, ECMO, etc. which my community hospital does not do), and now locum offers have been rolling in (since I unfortunately posted my interest in travel/locum opportunities) which could also offer a snapshot of working somewhere else, without totally abandoing my fulltime gig now. Not sure if this is the usual feeling of being 3-5 years out of school, but I figured I'd re-enter the forum with this topic.... Thanks! Link to comment Share on other sites More sharing options...
Joelseff Posted April 13, 2015 Share Posted April 13, 2015 I think it's normal to get a little burn out at this point. I'm about at the same point in my PA career as you but much older lol. I recently left my practice where I had a panel of my own pts doing FP and HIV. I loved my pts and my scope but the pay was dismal and hours were long and tedious. Also my 20 mile commute was an hour and 15 minutes each way with the wonderful traffic we have in the bay area. I put in my CV for some locum jobs for feelers, recommended by a buddy of mine, and I got/get a lot of calls. I also sent my CV to a recruiter who found an urgent care/family practice setup 20 miles north of me but with a reverse commute and very good compensation and bennies. It was exactly what I needed. My schedule is pretty good and I catch a 4 day off run every few weeks. I am actually enjoying the low acuity of cases that I see. This may get old in a few years? Months? Who knows but now I am loving it. My advice is try out some of those locum jobs or look around. Sometimes a change of scenery is all you need. Hang in there. ETA: Welcome back BTW! Sent from my S5 Active...Like you care... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 13, 2015 Moderator Share Posted April 13, 2015 moving to a major academic medical center would likely expose you to more technology, but significantly decrease your autonomy. you would likely be put on a team, which included docs on every shift who would armchair every decision you make and order you write. I agree with the above poster who recommended some side gigs. in your position I would not quit my day job unless you find another similar position with equivalent or better autonomy with a better schedule, pay, and benefits package. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted April 13, 2015 Share Posted April 13, 2015 It's nice to have options, isn't it. Take a moment to reflect upon how fortunate you (and all of us) are. Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 13, 2015 Moderator Share Posted April 13, 2015 pretty normal as you have learned the basics now it becomes a little bit boring (and dare I say like work) But - this is where yo can really begin to learn the finer points, go on zebra hunts, read on the weird, and challenge yourself in other ways beside inhaling knowledge. Also would not be bad to try so specialty or other medicine. i did 5 years at one job, then did 2 years in Radiology, one year in chronic pain, one year in ER, 2 years in office based PCP urgent care, then started my own practice.... every job gets boring, that is part of becoming proficient, but you are young in your career and maybe should look around! ER might be interesting to get a glimpse of as your critical care work would be highly valuable if you are working main side, but urgent care would be totally different. Link to comment Share on other sites More sharing options...
MikeyBoy Posted April 13, 2015 Author Share Posted April 13, 2015 Great points, thanks everyone for taking the time. I just got back from a long run and did some thinking and came up with some thoughts after reading Joel's and EMED's comments; and I think Ventana you said it wonderfully. That's pretty much how I'm feeling right now. Boatswain, glad you brought that up. Definitely is a blessing considering the world we live in (insert praying emoji here). Great point about ER and other specialties. I was offered a Pulm/Critical care inpatient consult gig last year; at the time (and still currently) I'm not ready to do the 9-5 sort of thing. I like to travel and my vacation flexibility would be cut. ER is an interesting option; but I've been somewhat intimidated to making the critical care--> ER jump, and I don't think I could leave CC completely since I really do enjoy it. Maybe a part time thing in the future? Who knows. So I think I'm going to test the waters and see whats out there. Going to return some locum calls, apply to the big boy academic hospitals' ICU posting, and just keep looking. EMED you brought up a good point about autonomy and the overall picture; I think I would do a share day and see how it looks before commiting to being the 5th practitioner in line for a procedure or new patient. :) Link to comment Share on other sites More sharing options...
gbrothers98 Posted April 14, 2015 Share Posted April 14, 2015 Hey everyone; haven't posted in probably 2 years, but it's good to be back, and would like to get some unbiased advice if you all get a chance. I've been in kind of a rut at work lately, in terms of satisfaction. A little background; late 20s, single, 4 years out of school, 3 years of that in critical are in a 14 bed ICU, soley staffed by PAs with a daytime intensivist. I split the month into 2weeks days/night because I like both rounding and then the autonomy of night work. I like my coworkers, am respected by my attendings, and like to think I do pretty good work which I do mostly enjoy. Compensation is about average for my area, CME reimbursement has finally been bumped up this year. So, at this point, I'm thinking should I stay with this gig since it's comfortable or see what else is out there? Two world class hospitals are 30 minutes down the road (offering transplant, ECMO, etc. which my community hospital does not do), and now locum offers have been rolling in (since I unfortunately posted my interest in travel/locum opportunities) which could also offer a snapshot of working somewhere else, without totally abandoing my fulltime gig now. Not sure if this is the usual feeling of being 3-5 years out of school, but I figured I'd re-enter the forum with this topic.... Thanks! Sure. You are getting comfortable in your skin and know you can handle other challenges. Worthwhile to investigate any and all opportunities that present themselves to you, you have proven you are capable and employers will seriously entertain you for many opportunities. Then up to you to decide where you want to be. You've been given great insight above and it sounds like you are planning on turning thoughts into actions. Really up to you to make the most of it. From my 17 year perspective, I can share with you the things I wished I had pursued. I wished I had worked a bit less on a regular basis. I wished I had saved a little bit more money. I wished I had traveled a little bit more and taken a weeks vacation every season and plenty of 3 day weekends in the summer. I wish that there were times I had reflected and determined if I was being as effective and efficient as I could or was I just spinning my wheels and not been able to do some things I would have rather done. But overall these are minimal regrets in the grand scheme. I would just remember that your career is also a means to an end. You just have to decide where the end is. Good luck. G Brothers PA-C Link to comment Share on other sites More sharing options...
Maverick87 Posted April 14, 2015 Share Posted April 14, 2015 Hey everyone; haven't posted in probably 2 years, but it's good to be back, and would like to get some unbiased advice if you all get a chance. I've been in kind of a rut at work lately, in terms of satisfaction. A little background; late 20s, single, 4 years out of school, 3 years of that in critical are in a 14 bed ICU, soley staffed by PAs with a daytime intensivist. I split the month into 2weeks days/night because I like both rounding and then the autonomy of night work. I like my coworkers, am respected by my attendings, and like to think I do pretty good work which I do mostly enjoy. Compensation is about average for my area, CME reimbursement has finally been bumped up this year. So, at this point, I'm thinking should I stay with this gig since it's comfortable or see what else is out there? Two world class hospitals are 30 minutes down the road (offering transplant, ECMO, etc. which my community hospital does not do), and now locum offers have been rolling in (since I unfortunately posted my interest in travel/locum opportunities) which could also offer a snapshot of working somewhere else, without totally abandoing my fulltime gig now. Not sure if this is the usual feeling of being 3-5 years out of school, but I figured I'd re-enter the forum with this topic.... Thanks! I hear ya man. I feel the same way and will be changing jobs for the first time in 3.5 years soon. It can be scary, but without veering out of one's comfort zone, there can be no growth. Link to comment Share on other sites More sharing options...
MikeyBoy Posted April 14, 2015 Author Share Posted April 14, 2015 Thanks gbrothers. Yeah I think there is that fear in me, that if I stay where I am for another 6 years, I'll never really grow into the clinician I could be. I would just be treading water where I currently am; comfortable, but still about the same clinician I am at 28. Thanks Maverick, good luck with your move! Link to comment Share on other sites More sharing options...
whoRyou Posted April 14, 2015 Share Posted April 14, 2015 Change is rejuvenating when it’s a change of scenery and unwinding loosens the creative critic’s grip allowing new ideas to flow. Link to comment Share on other sites More sharing options...
SHU-CH Posted April 15, 2015 Share Posted April 15, 2015 If you are in a rut, volunteer as a preceptor for PA students. It will make you view your workday in a whole new light. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 15, 2015 Moderator Share Posted April 15, 2015 If you are in a rut, volunteer as a preceptor for PA students. It will make you view your workday in a whole new light.agree. I've been precepting on/off for almost 20 years and almost constantly for the last 2 years. I think I learn from each student while hopefully teaching them some things of value as well. Link to comment Share on other sites More sharing options...
Maverick87 Posted April 15, 2015 Share Posted April 15, 2015 I'm actually setting this up now. I've tried before but it was either a bad time for me or students didn't want to jump through all of the hoops of getting onto a military institution. We'll see this year though. Link to comment Share on other sites More sharing options...
polarbebe Posted April 15, 2015 Share Posted April 15, 2015 In a similar position but looking to do the opposite of what you are thinking of doing. 3.5 yrs at a huge academic hospital with plenty of coverage with house staff and critical care fellows... Means very few opportunities for procedures, much less input into management decisions BUT balanced by great hours (no weekends or nights at all), usually time to read and learn something, critical care teaching most every day in the morning by the fellow/intensivist (occasionally by me), usually leave on time, supportive director trying to mentor and increase our autonomy. At this time, I am looking to get a part-time/per diem at a smaller non-teaching hospital to develop my autonomy in a critical care setting. Working nights or moving out of NYC are not options at this time due to family. I will second getting into EM (having worked in EM for 4 years and 2.5 of that in the main ED while also doing crit care), there is a lot of overlap; especially given your critical care experience you will get up to speed very quickly (main ED not fast track) and I feel that it will help you become a better provider by seeing patients as they present/looking at it from a different angle. I feel working in a huge academic hospital with so much teaching during rounds, I've learned a ton (more than working let's say medicine in NYC, where many PAs cover ALOC - alternate level of care are patients who have no inpatient needs but are inpatient for dispo/placement issues)... but unless that center give you significant autonomy (with you supervising the house staff) it could be a step back for you. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 15, 2015 Moderator Share Posted April 15, 2015 I feel working in a huge academic hospital with so much teaching during rounds, I've learned a ton (more than working let's say medicine in NYC, where many PAs cover ALOC - alternate level of care are patients who have no inpatient needs but are inpatient for dispo/placement issues)... but unless that center give you significant autonomy (with you supervising the house staff) it could be a step back for you. agree. it seems to me like going from solo coverage to an academic ctr gets you exposure to more technology and another group of patients, but at the expense of never having patients of your own. the gold standard for pa practice is solo coverage with high autonomy. anything else is a step in the wrong direction in my opinion. Link to comment Share on other sites More sharing options...
MikeyBoy Posted April 16, 2015 Author Share Posted April 16, 2015 If you are in a rut, volunteer as a preceptor for PA students. It will make you view your workday in a whole new light. Yeah I already do this, along with all the new internal medicine hires we take under our wing during hospital orientation. It is a breath of fresh air, especially with the motivated, smart PA students when they are first learning about critical care. In a similar position but looking to do the opposite of what you are thinking of doing. 3.5 yrs at a huge academic hospital with plenty of coverage with house staff and critical care fellows... Means very few opportunities for procedures, much less input into management decisions BUT balanced by great hours (no weekends or nights at all), usually time to read and learn something, critical care teaching most every day in the morning by the fellow/intensivist (occasionally by me), usually leave on time, supportive director trying to mentor and increase our autonomy. At this time, I am looking to get a part-time/per diem at a smaller non-teaching hospital to develop my autonomy in a critical care setting. Working nights or moving out of NYC are not options at this time due to family. I will second getting into EM (having worked in EM for 4 years and 2.5 of that in the main ED while also doing crit care), there is a lot of overlap; especially given your critical care experience you will get up to speed very quickly (main ED not fast track) and I feel that it will help you become a better provider by seeing patients as they present/looking at it from a different angle. I feel working in a huge academic hospital with so much teaching during rounds, I've learned a ton (more than working let's say medicine in NYC, where many PAs cover ALOC - alternate level of care are patients who have no inpatient needs but are inpatient for dispo/placement issues)... but unless that center give you significant autonomy (with you supervising the house staff) it could be a step back for you. Great points. With a few interviews coming up, autonomy within a resident team is definitely a concern of mine, and something I'll have to tactfully ask about. I think it's a balance. At my current hospital I have a mix of autonomy- sometimes on my own at night (intensivist avail by phone) vs scutting along during the daytime with very autonomous intensivist coverage. So I'll be curious how these academic hospital teams work..... EM is becoming more and more of a "Hey maybe I SHOULD try it out!" type of option.:) I would like to eventually do locums in more rural settings, and it looks like the experience of an ED would really help me grow into a better/well-rounded clinician. Definitely something I will consider, even if on a part time basis at first for now. Link to comment Share on other sites More sharing options...
MikeyBoy Posted June 1, 2015 Author Share Posted June 1, 2015 Quick update, So I ended up accepting a position at a large academic center. I'll have a good deal of autonomy, which was my main concern voiced at the interview, along with educating residents and rounding on their patients as well, and research opportunities. Hours, salary, all improved. I'll still be doing the same, if not more, of the current procedures I do now. Definitely still feels like a leap of faith, but, as my current boss put it, I'd be an idiot to turn it down at this point in my career. Thanks for all the kind words and encouragement, really excited. Link to comment Share on other sites More sharing options...
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