New PA Burnt Out After 6mos Needing Advice...

[GoodVibes1313]

Hello All.

I have been doing a lot of thinking about changing my job in PC and try a specialty. Maybe some of you can give me some advice. I recently started a job in PC working 40 hours a week (new PA fresh out of school). Pay is fair. Benefits are good. Possible loan repayment. However, I am 6 mos in and started feeling the anxiety and burnt out in the last 1.5 mos. It could possibly be that one of the PAs at clinic is out and I have to cover her patients as well as her inbox along with my own. Her pts are also a lot more complex. I average 18-20 pts in an 8-hour day. The other factors that are likely contributing to the anxiety/burnout are 1.) I feel like I don't know anything 2.) Dealing with entitled/demanding/rude pts 3.) Everyone wants disability (which really frustrates me) 4.) All the paperwork to fill out 5.) Staying 2 hrs over daily to finish charting and 6.) Feeling nervous to go out, afraid I would see one of those demanding pts (usually related to Norco or xanax) outside work and they would get physical. I would like to think that maybe things will get better with time and I am calling it quit too early. Most of my pts are great and some of the above only apply to a small percentage. With that said, I still have a hard time waking up and going to work. I am so unhappy. I have considered specializing even if it will pay less for a PA without experience. I guess my question is, does it get better? Should I wait it out? Maybe go part time? I'm not sure anymore. Any feedback will be appreciated. Thank you.

[EMEDPA]

Should get better when you partner ts back from leave. if it doesn't consider leaving.

[Maverick87]

Hello All.

I have been doing a lot of thinking about changing my job in PC and try a specialty. Maybe some of you can give me some advice. I recently started a job in PC working 40 hours a week (new PA fresh out of school). Pay is fair. Benefits are good. Possible loan repayment. However, I am 6 mos in and started feeling the anxiety and burnt out in the last 1.5 mos. It could possibly be that one of the PAs at clinic is out and I have to cover her patients as well as her inbox along with my own. Her pts are also a lot more complex. I average 18-20 pts in an 8-hour day. The other factors that are likely contributing to the anxiety/burnout are 1.) I feel like I don't know anything 2.) Dealing with entitled/demanding/rude pts 3.) Everyone wants disability (which really frustrates me) 4.) All the paperwork to fill out 5.) Staying 2 hrs over daily to finish charting and 6.) Feeling nervous to go out, afraid I would see one of those demanding pts (usually related to Norco or xanax) outside work and they would get physical. I would like to think that maybe things will get better with time and I am calling it quit too early. Most of my pts are great and some of the above only apply to a small percentage. With that said, I still have a hard time waking up and going to work. I am so unhappy. I have considered specializing even if it will pay less for a PA without experience. I guess my question is, does it get better? Should I wait it out? Maybe go part time? I'm not sure anymore. Any feedback will be appreciated. Thank you.

 

Damn, I work in PC right now and haven't experienced this in the civilian world. 18-20 patients per 8 hour day isn't bad (that's about 2.5 patients per hour, which is the maximum that's manageable, imo). But if you're doing this 5 days in a row (which it sounds like you are), then, yes, that's a recipe for burnout.

 

Based on my time in a PC clinic in the military (where I suffered SEVERE burnout), the 5 month mark is about the time when burnout rears its ugly head.

 

I'll address your points as you've listed them:

 

1) That's normal. I'm almost 4 years in and there are times when I feel like I know nothing. Do you have UpToDate? Great resource for primary care. Also, it's great if you have coworkers that you can bounce ideas off of.

 

2) That's part of the job, unfortunately. I try my best to "kill 'em with kindness". I find that the majority of patients are nice and understanding, but the few that aren't really stick out in your mind. If they're extremely rude, then hopefully the owner of your practice will back you up and dismiss them as patients. If they are unwilling to do that, it may not be a good place to work.

 

3) Interestingly, I haven't dealt with this at all. Do you work with mostly medicaid patients?

 

4) Yes. Way too much paperwork in PC. I agree with you there. Not much to do about that unfortunately.

 

5) Do they give you laptops? I leave after I'm done with my last patient and then get to whatever charting I have left at my convenience.

 

6) I think you are thinking about things like this due to your burnout. It's not rational thinking. No one is watching you and waiting for you outside of work. Don't worry though. This is the exact thing that I experienced when I was burnt out. Paranoia.

 

Don't wait it out. Go part-time if you can. Maybe look for work elsewhere. If you try to ride it out, it will only get worse.

 

Trust me. As I've said, I've been there.

[TWR]

I think things are coming at you in a big fast wave.  Reach out to your CP and to other clinicians for help.  It should get better when the other PA returns.  You are one person.  Do what you can but do not let yourself get overwhelmed.  Doing Family medicine for 31 years and still go to my resources or pocket MPR daily.  My main resource is AFP magazine.  Great resource and wonderful CME at no additional charge.

[SedRate]

Hello All.

I have been doing a lot of thinking about changing my job in PC and try a specialty. Maybe some of you can give me some advice. I recently started a job in PC working 40 hours a week (new PA fresh out of school). Pay is fair. Benefits are good. Possible loan repayment. However, I am 6 mos in and started feeling the anxiety and burnt out in the last 1.5 mos. It could possibly be that one of the PAs at clinic is out and I have to cover her patients as well as her inbox along with my own. Her pts are also a lot more complex. I average 18-20 pts in an 8-hour day. The other factors that are likely contributing to the anxiety/burnout are 1.) I feel like I don't know anything 2.) Dealing with entitled/demanding/rude pts 3.) Everyone wants disability (which really frustrates me) 4.) All the paperwork to fill out 5.) Staying 2 hrs over daily to finish charting and 6.) Feeling nervous to go out, afraid I would see one of those demanding pts (usually related to Norco or xanax) outside work and they would get physical. I would like to think that maybe things will get better with time and I am calling it quit too early. Most of my pts are great and some of the above only apply to a small percentage. With that said, I still have a hard time waking up and going to work. I am so unhappy. I have considered specializing even if it will pay less for a PA without experience. I guess my question is, does it get better? Should I wait it out? Maybe go part time? I'm not sure anymore. Any feedback will be appreciated. Thank you.

Yes, it gets better. Most of the PAs I talked to as a student said that as a new grad, they had something close to a mental breakdown where they felt like they knew nothing, were going to accidentally kill somebody, and/or were feeling overwhelmed. Most said it happened around the 6-month mark. All said it passes, and by 1-1.5 years out, they said they felt pretty comfortable and confident. Btw, all of these PAs were in the same job they worked right out of school. Reach out to your sponsoring physician or a mentor. Like EMEDPA suggested, your coworker being out and you having to pick up the slack probably has something to do with it. I would urge you to find a release outside of work to give yourself a break. Exercise is always a good one. Charting late will hopefully get better as you become more efficient and get a system down. The amount of paperwork won't likely decrease but you'll get faster at it; you'll see lots of paperwork in specialties too. Entitled/demanding/rude patients will be in every specialty. Learn to combat it graciously. Most patients just want to feel understood. Some are just jerks no matter what.

 

Now, if it's the field itself that's the problem, then the feelings may not get better. But you will likely be more efficient and can handle some of those problems better. You'll just have to do some thinking as to whether you want to make the switch.

[Reality Check 2]

I really advocate for a 4 day work week being considered full time. Five straight days at always more than 8 hrs a day leads to burnout really fast.

Not closing the doors and turning off the phones at lunch contributes.

No sense to scheduling and accepting all walk ins is burdensome as well.

 

We are a one doc, 2 PA clinic. If one of us is gone for the week, then the others have their schedule blocked out several spots to take care of overflow such as labs, phone calls and refills for the missing partner. Usually 2 spots in the morning and 2 spots in the afternoon are blocked for 10-20 min apiece. Scheduling is kept light - such as not overscheduling complete physicals and keeping spots open for the drama and "emergencies" that always happen when someone is out of the office.

 

ANY job where you have to consistently stay late to finish required things is not scheduled appropriately or the workflow is bad or there is a combination of time wasters.

 

Come up with positives to change your world and approach with that. Whining doesn't help even when justified. 

 

Collect some of your own data on your day and how it flows and see where changes can be made.

[BruceBanner]

I also believe a 5 day workweek is too much for medicine. It's too draining. 

 

You are finding out the not-so-rosy truth that medicine isnt all it's cracked up to be. It wouldnt be so bad if you only saw 10-12 a day, worked 4 days, and went home on time. The "volume" gets turned down on those difficult patients.

 

But when you just get steamrolled day-in, day-out, and then get a measly 2 days off to try and forget about it, you cant ever really get a break. You cant shut it out. 

 

I find my job satisfaction is inversely correlated with 1) my patient load, 2) the types of patients I am seeing (simple injuries/acute visits vs. complex, comorbid, drug-seekers), and 3) the amount of time I physically spend at work. 5 days is too much. Because it's never just 40 hours. You have no time to enjoy life. 

 

The AMA and others like to give "dealing with burnout" advice, which really amounts to suck it up, be positive, and 'think of the patient'. I guarantee you these people giving burnout advice arent seeing 20 ppd in primary care. 

 

 

I'd advise maybe waiting until your colleague gets back, and if things dont look up, then look for other work. PA satisfaction is almost 100% job/clinic-dependent.

[treejay]

I would be up front about your challenges with manager/administration.  Try and see if you are able to negotiate fewer patients in a day, given that you are a new grad.  Justify this by the need to look things up since you are new.  This was effective for me and I was able to go from the planned 22 ppd to 15 which was a world of difference.  Unfortunately, they've recently ramped it back up to 22 which I think is not enough time for the often complex IM patients I see.

[tunafish]

I would be up front about your challenges with manager/administration.  Try and see if you are able to negotiate fewer patients in a day, given that you are a new grad.  Justify this by the need to look things up since you are new.  This was effective for me and I was able to go from the planned 22 ppd to 15 which was a world of difference.  Unfortunately, they've recently ramped it back up to 22 which I think is not enough time for the often complex IM patients I see.

 

I think negotiation should take place based on time spent at work and not "new grad" thing.  It is unhealthy to work 10 hours and be paid for 8.

[treejay]

I think negotiation should take place based on time spent at work and not "new grad" thing.  It is unhealthy to work 10 hours and be paid for 8.

agreed.  new grads take longer and therefore should see fewer patients in a day.  plus, I don't think a salaried position are viewed as working an exact 8 hours a day.  most salaried positions, at least in healthcare, I have found people work more than 8 hours a day.

[tunafish]

agreed.  new grads take longer and therefore should see fewer patients in a day.  plus, I don't think a salaried position are viewed as working an exact 8 hours a day.  most salaried positions, at least in healthcare, I have found people work more than 8 hours a day.

 

Viewed by who? I bet lots of people would be happy if you stay at work..well, always.

[ventana]

 

1.) I feel like I don't know anything

 

It gets better, if you are jumping in with both feet (or getting thrown in) this is a normal feeling and a good one to protect you from doing something stupid

 

 

 

2.) Dealing with entitled/demanding/rude pts

Well that is likely two fold - one they are preying on the "new guy" and hitting you up for things they know that they should not get or 2 that you have not defined your role enough and laid down the law with them. This takes developing a comfort level with your actions and also takes time

 

 

 

3.) Everyone wants disability (which really frustrates me)

My favorite answer to this is "you don't want me to fill those papers out because I don't think you are disabled and my advice would be that gainful employment would help with you _________ (fill in the blank, i.e. Obesity, DM, OA, Pain.....)". Usually shuts them up really quickly. The nice thing with this is that the 1-2 REAL patients that need disability, it actually becomes a pleasure to help document their disability and fight for them - cause you know they deserve it....

 

 

 

4.) All the paperwork to fill out

Sometimes you just goats reflect on what really needs to be done, how much really needs to be charted, and what happens if you don't do it..... Sometimes you don't have to do it all....

 

 

 

5.) Staying 2 hrs over daily to finish charting

Ahhh. NOPE don't do it...... I have counseled new grads to never do this. You define the standard in the first few weeks and if work for free they will expect you to continue to work for free. Just stop working for free. This does take you really staying focused and on point during the day, no FB surfing or posting on this forum..... But then at the end of the day wrap up soon after your shift and leave. If you can not get it done, and they are not willing to pay you, then you let it build up to they notice and call you on it. Or ask for help on how to speed up to get it done (less passive agressive)

BUT stop working for fee...... PA / MEdicine / career is life long, define your role and stick to it....

 

 

 

 

and 6.) Feeling nervous to go out, afraid I would see one of those demanding pts (usually related to Norco or xanax) outside work and they would get physical.

You just have to not worry about it to a degree...... Yes I avoid the one market that many many of my patients go to, but if that is where I need to go I just go. Used to be I would get questions all the time, not so much any more - cause my body language says don't bother, and if someone approaches me I simply state that sounds like something I should see you in the office for, why don't you call tommorrow and make and appointment to see me in the office......

Say this quickly and early in the conversation, and the politely state it was nice to see them but you have to go...

 

 

 

 

I would like to think that maybe things will get better with time and I am calling it quit too early. Most of my pts are great and some of the above only apply to a small percentage. With that said, I still have a hard time waking up and going to work. I am so unhappy. I have considered specializing even if it will pay less for a PA without experience. I guess my question is, does it get better? Should I wait it out? Maybe go part time? I'm not sure anymore. Any feedback will be appreciated. Thank you.

 

 

Hang in there - this is all 100% normal for your first year or two out.... It gets better, mostly through self reflection and realizing you made it and you don't have to work yourself to death..... You can and should do a good honest day's work, but then go home and enjoy it.....

 

BTW - doc's and practice administrators are known to try to dump stuff on PA and NP (not doc's, not partners, "just and employee" type mentality...... But just decline.....)

[Guest Paula]

Hang in there - this is all 100% normal for your first year or two out.... It gets better, mostly through self reflection and realizing you made it and you don't have to work yourself to death..... You can and should do a good honest day's work, but then go home and enjoy it.....

 

BTW - doc's and practice administrators are known to try to dump stuff on PA and NP (not doc's, not partners, "just and employee" type mentality...... But just decline.....)

 

Ha HA.  I did that...declined to participate in a Saturday health fair and got strange looks like they thought I would jump at the chance  to volunteer my time to provide free marketing for them and the clinic.  Nope.  Then I declined to participate in the open house for showcasing the new remodel of the clinic.  They wanted me to come in on my day OFF and set up a booth so potential patients could meet me and hopefully come to our clinic for services.  They never bothered to ask me about the date and time of the open house.  I just got an email about it and that I would be there (along with a few other new clinicians).

 

I politely declined as it didn't work in my schedule.  I had an office administrator come to me and ask why I couldn't just switch my day off.  She got an earful.  I did not go.  

 

Also, got asked to go to the local large paper mill and present a health topic talk on diabetes and hypertension, during my day off.  Nope.  I responded that an RN would be a better selection as my job is to see patients and make them money. 

 

I wonder what my employee file looks like?  

[Cideous]

Don't live near where you work.  I use to, and it got really old really fast.  I use to have patients stop me all the time.  I got somewhat paranoid after a few years, and for good reason.  I've had patients come to my house........Because they found out I lived nearby.  Never again.  

[MT2PA]

I can't imagine specializing would alleviate ANY of your concerns save for maybe pts seeking disability.

 

If you feel like you don't know anything in PC, specializing won't help.  You will always have demanding patients.  There will always be charting and paperwork.  There's always a chance you'll run into patients.

 

I'm not saying you couldn't consider other opportunities, but realize that your complaints are sort of the nature of the beast of being a provider.

[Maverick87]

Ha HA.  I did that...declined to participate in a Saturday health fair and got strange looks like they thought I would jump at the chance  to volunteer my time to provide free marketing for them and the clinic.  Nope.  Then I declined to participate in the open house for showcasing the new remodel of the clinic.  They wanted me to come in on my day OFF and set up a booth so potential patients could meet me and hopefully come to our clinic for services.  They never bothered to ask me about the date and time of the open house.  I just got an email about it and that I would be there (along with a few other new clinicians).

 

I politely declined as it didn't work in my schedule.  I had an office administrator come to me and ask why I couldn't just switch my day off.  She got an earful.  I did not go.  

 

Also, got asked to go to the local large paper mill and present a health topic talk on diabetes and hypertension, during my day off.  Nope.  I responded that an RN would be a better selection as my job is to see patients and make them money. 

 

I wonder what my employee file looks like?  

 

To me, it's a little pathetic that practices that have been around for a while even need to advertise. It's even more pathetic that they want their providers to do this kind of nonsense for free.

 

My current practice is expanding simply by word-of-mouth. Literally no time or money dedicated to advertising.

 

Interestingly, this is the first time in my career that I actually go out of my way to do things for free for them. Why? Because they're awesome. Love the practice. Love the physician owners. Love most of the patients.

 

Another interesting factoid: my employer specifically does not hire NPs or nurses of any kind. They can't stand nurses. Go figure. :D

[GoodVibes1313]

I want to thank everyone for their feedback. I hate "complaining" to upper management, but I have actually talked with them and they said they'll make some changes. We will see about that. Regarding specializing, I figured it would be a little more focused than family practice and, therefore, maybe less stressful. Of course, that is only an assumption as this is my first job and I have no experience elsewhere. I am going to keep a positive attitude and give it some more time before I make my decision. Thanks again.

[Joelseff]

I have been in IM/PC most if my 5, going on 6 year career. I have had burnout perhaps once a year. I take a two week vacation and usually helps. Recently, I covered Occ health in our system and the med director suggested I work there... I'm thinking about it. Thing is IM really is my field. You are a new grad, I don't know how much exposure to the medical field you got before school but my years in IM pre-pa, prepped me pretty thoroughly on the challenges of IM/PC as far as dynamics, environment and what the work entails. Not the actual doctoring part[emoji4] . You might have to switch specialties or pick up shifts at other specialties and see where you fit. Also, you are very new right now and you may not feel as bad about PC in another 6 Mos so sticking it out may be the key. 2 hours after work to finish charting?... Only?!? Lol hang in there it does get better

 

Sent from my SAMSUNG-SM-G870A using Tapatalk

[treejay]

I have been in IM/PC most if my 5, going on 6 year career. I have had burnout perhaps once a year. I take a two week vacation and usually helps. Recently, I covered Occ health in our system and the med director suggested I work there... I'm thinking about it. Thing is IM really is my field. You are a new grad, I don't know how much exposure to the medical field you got before school but my years in IM pre-pa, prepped me pretty thoroughly on the challenges of IM/PC as far as dynamics, environment and what the work entails. Not the actual doctoring part[emoji4] . You might have to switch specialties or pick up shifts at other specialties and see where you fit. Also, you are very new right now and you may not feel as bad about PC in another 6 Mos so sticking it out may be the key. 2 hours after work to finish charting?... Only?!? Lol hang in there it does get better

 

Sent from my SAMSUNG-SM-G870A using Tapatalk

how many patients a day do you see in your IM clinic ?

Regarding burnout, I think we as providers are too quick to accept that this is a norm of the profession.  The Mayo Clinic study last year showed ~56% of PCPs are burnt out.  That's unacceptable and from my perspective, steps need to be taken to remediate this stat

[Joelseff]

how many patients a day do you see in your IM clinic ?

Regarding burnout, I think we as providers are too quick to accept that this is a norm of the profession. The Mayo Clinic study last year showed ~56% of PCPs are burnt out. That's unacceptable and from my perspective, steps need to be taken to remediate this stat

I see about 15-18 pts per day. I told mgmt any more and I'm out. I agree re: burnout. We prob need to define that better. I think of real burnout as development of apathy to pts coworkers etc. I have felt this before but left that practice and it was mostly due to a doctor who was a dictator... I think some ppl may throw the word "burnout" around but mean stress. When I used it in my previous post I meant stressed out.. Our work is by nature stressful and I accept that but when I approach real burnout, that's when I know I need a vacay.

 

Sent from my SAMSUNG-SM-G870A using Tapatalk

[Maverick87]

Patient load seems to vary widely at my practice. In the summer, it seems to be 10-15 on average.

 

In the winter, it's about 17-22.

 

But our providers only work 3-4 days per week and there's a hefty productivity bonus as well.

 

From what I've seen and heard, there's a very low burn out rate.

[ColoradoIMCardsPA]

I can't imagine specializing would alleviate ANY of your concerns save for maybe pts seeking disability.

 

If you feel like you don't know anything in PC, specializing won't help.  You will always have demanding patients.  There will always be charting and paperwork.  There's always a chance you'll run into patients.

 

I'm not saying you couldn't consider other opportunities, but realize that your complaints are sort of the nature of the beast of being a provider.

 

I disagree. Outpatient primary care = spending 90% of your time arguing about narcotics with patients on Percocet, Ambien, Klonopin, Restoril, and Xanax concurrently; arguing about disability forms; arguing about antibiotics for URIs; dealing with actively decompensating patients who know they should have gone to the ER but want you to direct admit them instead so they don't have to wait; moochers calling the clinic for you to prescribe them antibiotics without them even coming in; 20-somethings who have diagnosed themselves with ADHD on an internet quiz and want you to now start them on more controlled substances; responding to wacky patient phone calls. Specialty practice cuts out most of this stuff, especially the narcotics and benzo arguments. Some of OP's problems seem to relate to the specific practice he/she works at but OP it sounds like you should start some longer term strategizing for how to get out of outpatient primary care.

 

Uh, not to sound jaded about outpatient primary care or anything.

[kittryn]

I switched from 8 years' surgical specialties (inpatient mostly) and gave PC a whirl, thinking I would maybe have more control of my schedule (12-14 hrs/day in surgery). I ran screaming from PC after 7 mos, for all the same reasons the OP (and others) have listed. I'd never go back. 

 

medicine has become a pain in the ass now in general anyway, mostly bc the corporatization of medicine no longer allows us the time to know our patients or practice the "art" of medicine. it's just lucy and ethel on the candy conveyer belt now...

 

 

[GoodVibes1313]

Colorado - that was very accurate. I work at a community health clinic in a very underserved neighborhood, so all those that were mentioned by you are pretty on point. I am considering other options now that I realized upper management won't be doing much to help with minimizing patient load (25 patients on my schedule lately! My IM colleague had more!) I can do 25 acute care patients, but the patients seen here are usually very complex with multiple co-morbidities. It's all about the numbers for them. 

 

What is making me stall at actively moving forward with other job opportunities is that I received a $50k loan forgiveness from the govt with a commitment of 2 years. This will take out more than half of my loan. So I am burnt out and in debt; horrible combination. I'm not sure if it will get better in this type of environment. Maybe I will be more tolerant, know more with time, and thus, stress out less? Or maybe not. I'm not sure if I can do this another two years if I decide to keep the loan forgiveness contract. Lots of thinking to do in the next 1.5 weeks.

 

Thanks for letting me kinda vent and unload on this board. :) 

[TWR]

You have to make your own decision but weigh everything. You are new so, yes, overwhelming. But each day you learn a little more and the stress factor will go down. I have practiced 30 years in Family medicine and not a day goes by that I don't have to look something up. That's what makes it fun for me. Never get bored. Also, try not to work at your own pace. This is medicine and you are not Lucy or Ethel boxing chocolates. You practice medicine!!