Getting offered a job as emergency clinic PA...but am I ready?

So, I'm a relatively new grad (9 months), who has only worked a few months. I want to try to break into emergency medicine, and I am being offered a job in an urgent care/EM clinic in the city. It seems like a great job and all, but..

...I feel like I am just not ready, like I need more handholding. I am doing a trial shadowing...I go in with the doctor, and I find myself missing differential diagnoses, forgetting things, simple things. Feeling like I haven't even gone through PA school, despite the fact that I passed PANCE with flying colors and have many years of EMT experience under my belt. But the thought of being here overnight on my own and having to evaluate, diagnose and treat is utterly...scary. Perhaps I did not do enough independent work during my roations. Perhaps I am just really nervous and forgetful (I definitely am forgetful). But I don't know if I can handle it, and I don't know what I can do to prepare myself for the real deal, so to speak.

At my last job, I had a similar problem...I felt woefully unprepared to see four patients an hour in a discipline that I had to learn from scratch, and even after 3 months it was no easier...every day was frustrating, and I found myself constantly missing things, forgetting things...having a terribly tough time even remembering the basic treatment framework. And it went well noticed by my supervising doc.

Here, in my trial-ship at this new place, following the doctor, the most basic things escape me...like, what do I give for a cold? An antihistmaine? Which one? I just cant remember. I feel like I am missing the simplest mental flowcharts, the most basic "decision trees" in my mind for all the major diagnoses. On my couch, and around friends, I can talk advanced medicine and sound like the author of the Merck Manual. But I am finding that clinically, on the spot, I am panicking, forgetting the basics, staring down the patient while I try to remember what the heck he/she even just told me, and I really wonder if I have what it takes to be a clinician. I feel like the basics should just pop into my head...it shouldn't be this goddamn hard!! I shouldnt have to sweat and run for Currents and UpToDate just to treat the most basic ailments.

The same thing happened at my last job. I was eventually let go because, well, I just wasn't catching on fast enough to the art of it, and could not handle the patient load at the speed that I was processing information (and trying to recall the most basic treatment "decision trees"). I am scared, really scared; If I can't remember the most basic differentials and can't even remember what the patient said is bothering him (this has happened!!), I feel like maybe I'm just not cut out to be a clinician. And after decades of yearning to be a medical clinician, years of school, and thousands of dollars in tuition, I am panicking about what lies ahead.

Has anyone ever experienced this??

So, I'm a relatively new grad (9 months), who has only worked a few months. I want to try to break into emergency medicine, and I am being offered a job in an urgent care/EM clinic in the city. It seems like a great job and all, but..

 

...I feel like I am just not ready, like I need more handholding. I am doing a trial shadowing...I go in with the doctor, and I find myself missing differential diagnoses, forgetting things, simple things. Feeling like I haven't even gone through PA school, despite the fact that I passed PANCE with flying colors and have many years of EMT experience under my belt. But the thought of being here overnight on my own and having to evaluate, diagnose and treat is utterly...scary. Perhaps I did not do enough independent work during my roations. Perhaps I am just really nervous and forgetful (I definitely am forgetful). But I don't know if I can handle it, and I don't know what I can do to prepare myself for the real deal, so to speak.

 

At my last job, I had a similar problem...I felt woefully unprepared to see four patients an hour in a discipline that I had to learn from scratch, and even after 3 months it was no easier...every day was frustrating, and I found myself constantly missing things, forgetting things...having a terribly tough time even remembering the basic treatment framework. And it went well noticed by my supervising doc.

 

Here, in my trial-ship at this new place, following the doctor, the most basic things escape me...like, what do I give for a cold? An antihistmaine? Which one? I just cant remember. I feel like I am missing the simplest mental flowcharts, the most basic "decision trees" in my mind for all the major diagnoses. On my couch, and around friends, I can talk advanced medicine and sound like the author of the Merck Manual. But I am finding that clinically, on the spot, I am panicking, forgetting the basics, staring down the patient while I try to remember what the heck he/she even just told me, and I really wonder if I have what it takes to be a clinician. I feel like the basics should just pop into my head...it shouldn't be this goddamn hard!! I shouldnt have to sweat and run for Currents and UpToDate just to treat the most basic ailments.

 

The same thing happened at my last job. I was eventually let go because, well, I just wasn't catching on fast enough to the art of it, and could not handle the patient load at the speed that I was processing information (and trying to recall the most basic treatment "decision trees"). I am scared, really scared; If I can't remember the most basic differentials and can't even remember what the patient said is bothering him (this has happened!!), I feel like maybe I'm just not cut out to be a clinician. And after decades of yearning to be a medical clinician, years of school, and thousands of dollars in tuition, I am panicking about what lies ahead.

 

Has anyone ever experienced this??

Two things here:

1. you are the worst PA graduate in the world. . .so get out now and do something different (sorry to be blunt)

2. Way too much hyperbolic BS in this post. . .kind of like a Troll going overboard and not knowing when to stop ?

:heheh:

Which one is it?

I hope it's number two. If this is a real PA, I understand feeling like that (I'm only three months into my first year of PA school) but I would think that with time and practice you would slowly gain confidence etc. Maybe research is where you need to be? Or may some counseling to see why you are getting so worked up?

I won't be a PA for another month yet (yay!), so I won't pretend to know all the answers. But, have you considered doing a more team-based specialty (like Surgery)? The biggest thing I'm looking for in my first job is an environment where I can ask questions when I need to. If you are set on EM, have you looked into hospital-based jobs where you wouldn't be alone at night? I can understand where you're coming from - there are days that I'm just terrified from realizing that I'll soon be the one responsible for my patients and wondering whether I'll know the answers.

Two things here:

 

1. you are the worst PA graduate in the world. . .so get out now and do something different (sorry to be blunt)

2. Way too much hyperbolic BS in this post. . .kind of like a Troll going overboard and not knowing when to stop ?

:heheh:

Which one is it?

What an a***ole. And I'm sorrry to call a fellow PA that (if you are a PA, shame on you)...but you are an a***ole. Really hope you have no patient contact, What a jerk.

To the rest of the respondents, thanks for your input.

you'll be fine...it just takes time and experience

Relax. For some people they never experience just having so much crap in their head that nothing will come out when it needs to. Decline any job that you have to perform at any type of proficiency and instead get a very simple job with a great teacher. Give it time. Slowly build confidence.

 

A pneumonic I used and still use is MIT. For ddx. Medical infectious traumatic. Always develop a ddx list of attest five for EVERY patient. Get a little notebook and write down good points when u hear them. Takes notes when you talk to patients. Write stuff down when u have the thought

 

U have let ur head get ahead of u and lost ur confidence. Happens to the best of us and it just takes time to build a good foundation. At 8 years out I had a total jerk of an SP that started to really make me doubt myself, it all started because I would not cover a shift for another PA so they could attend a birthday party for a neighborhood kid. From there he constantly insulted and belittled me till I left. Let me tell you I will never let it happen again ( and I am a pretty confident person but he just into my head). You know what you need. Seek it out (slow pace with hand holding) and you will do just fine. Remember docs get at least three years of hanholding in residency then the first year out they still are really pretty timid, you are less then one year out. Relax enjoy learning about patients and the ds process. Ask questions AFTER you have thought the question through and have good idea at the answer. Communicate to ur doc your difficult and decline any job that has you there with out back up

Good advice. Writing things down, etc. Address the problem. Personally, I wouldn't go into EM until I felt I was ready, as there is a higher risk (in my opinion) of bad consequences if you don't do something correctly. I think someone mentioned surgery, which I think is a decent idea.

I recall from your earlier posts that you have been struggling to find work in NYC. From this post, I see you were let go from an earlier job, and from the info gathered from your earlier posts, it's easy to make the leap that you are feeling some tremendous pressure to make this current situation work, no matter what.

Ventana is right...you are playing some serious mind games with yourself. It may be time to think outside the box and seek some professional therapy to help unwind your right and left brain. Professional athletes do it, care providers do it, the average Joe does it. Find some sort of methodology that is a good fit for you that will help you slow down and take that literal/figurative deep breath. Yes, I have no doubt that you can try some self initiated meditation but a professional who can guide you down that path can drastically improve the efficacy.

If this is your only job prospect then it's even more important that you seek personal assistance to succeed in it.

Good luck

is the nastiness really necessary? not a great reply to someone reaching out for help when they are really struggling...

Two things here:

 

1. you are the worst PA graduate in the world. . .so get out now and do something different (sorry to be blunt)

2. Way too much hyperbolic BS in this post. . .kind of like a Troll going overboard and not knowing when to stop ?

:heheh:

 

Which one is it?

yeah -- you're a jerk. perhaps YOU'RE the troll. how crappy, to slam someone asking for help? maybe you came out of the box a perfect PA. but I don't think most of us found the early work days all that easy.

Don't listen to the negativity quietmedic. Its admirable that you are asking for help because you want to serve your patients better. I'm just a pre-pa, but like others said I think you're getting stuck in your head. Your nervousness is making you perform poorly so you lose confidence, which further hurts your performance, in a negative loop. You know the information like you said, but it sounds like you're freezing up. Maybe something as simple as Toastmaster classes can help boost your confidence, help you think on your feet, and put you more at ease. Whatever you do, I wish you the best of luck.

What an a***ole. And I'm sorrry to call a fellow PA that (if you are a PA, shame on you)...but you are an a***ole. Really hope you have no patient contact, What a jerk.

 

To the rest of the respondents, thanks for your input.

You're sorry to call me a PA after you admit to being fired from a job for incompetence, and about to be fired from another for incompetence?. . . see the trend? well, maybe not

As a poster above stated, go into research?. . .or, get with Ventana and practice what to give for a "cold"; or maybe teach u some listening skills so you "can't even remember what the patient said is bothering him". . .etc, etc?

This is not tiddly winks; u can kill somebody in the midst of feeling sorry for yourself

Totaly immature response and not at all reasonable if u don't have constructive thoughts don't insult others

Pls stop being jackleggish and sending me private messages.

yeah -- you're a jerk. perhaps YOU'RE the troll. how crappy, to slam someone asking for help? maybe you came out of the box a perfect PA. but I don't think most of us found the early work days all that easy.

No, not perfect. . .but i do know what to give for a "cold". . .did u have that issue as a new PA as well?

Is there anything more cowardly and pathetic than an internet bully? Clearly, he feels emboldened by his anonymity. Normal, well functioning adults do not speak to each other that way.

As for the OP, I hope you're able to see past that and know that there are plenty of people here who not only support you, but can relate to the feeling as well. I admire your candor.

Sounds like "test" anxiety except you have "patient anxiety". When I did my preceptorship I did under a mentor. It stressed me out and although I had done well in didatic and in all my rotations it was like all of a sudden I took a bunch of "dumb" pills. Can't really explain why except for stress or "performance anxiety". My preceptor was in a fast=track inner city ER setting. And for the life of me I had sometype of mental block when it came to asking a pt about their tenatus status. And everytime I would present a laceration/dog bite/wound I did not know last immunization. Did I know its importance...yes. Would I have gotten it right on any written test....yes Could I remember to ask the darn pt...no.

My advice is to do 3 things.

1. I think seeing a counselor would help.... you are fresh out of school and the weight of not only wanting to do well at a new job (this is a stress in any profession) but in our profession are actions/inactions can harm or kill someone and that factors in. I think you would benefit by talking with a netural person your thoughts and fears and how to get past "performance anxiety"

2. Just as a student....Read, Read, Read...get the most common things you are going to see in the urgent care setting down. URI/Bronchitis, STDs, sprains/strains/fx, Abd pain, back pain, eye= conjunctivitis/injury, bites, lacerations etc..... Make note cards if you have to.... But keep reinforcing what yo have already learned.

3. Anytime you start a new job it is difficult, you are meeting a ton of new people RN,EMT, RT, DR, etc....and in a hospital setting it is unlikely that you will be work with the same team everyday so it is hard to learn names because the players are always changing. You also are trying to remember the "system" they have and or EMR, Forms etc... I just started a new job and the first few admissions I did I was stressed and it was taking me 2x as long to do the admit. New EMR system but they are also still using forms for orders because I am not familar with the "form" I need to read every line (I am sure in another week I will be able to fill out the form blindfolded). But is also learning who does what, what are the procholols for the non=med stuff, I don't know any of the names for consults etc... basically you are inudated with allot of non-medicine stuff that is how the hospital/department runs. So go in early on your day off and shadow another PA and figure out the process flow and get that down. When i started my new job I insisted on being pair with another PA for the first week, not because I wasn't capable of seeing pt but I did not know the processes, work flow. So I was able to get my questions answered as we went along. They have a ton of forms Sometimes to admit a pt it is a 4 page order set form, and then depending on the Dx there can additional multi page forms to fill out. I know seems like alot but that is the SYSTEM,.

Good luck

Sounds like "test" anxiety except you have "patient anxiety". When I did my preceptorship I did under a mentor. It stressed me out and although I had done well in didatic and in all my rotations it was like all of a sudden I took a bunch of "dumb" pills. Can't really explain why except for stress or "performance anxiety". My preceptor was in a fast=track inner city ER setting. And for the life of me I had sometype of mental block when it came to asking a pt about their tenatus status. And everytime I would present a laceration/dog bite/wound I did not know last immunization. Did I know its importance...yes. Would I have gotten it right on any written test....yes Could I remember to ask the darn pt...no.

 

My advice is to do 3 things.

1. I think seeing a counselor would help.... you are fresh out of school and the weight of not only wanting to do well at a new job (this is a stress in any profession) but in our profession are actions/inactions can harm or kill someone and that factors in. I think you would benefit by talking with a netural person your thoughts and fears and how to get past "performance anxiety"

2. Just as a student....Read, Read, Read...get the most common things you are going to see in the urgent care setting down. URI/Bronchitis, STDs, sprains/strains/fx, Abd pain, back pain, eye= conjunctivitis/injury, bites, lacerations etc..... Make note cards if you have to.... But keep reinforcing what yo have already learned.

3. Anytime you start a new job it is difficult, you are meeting a ton of new people RN,EMT, RT, DR, etc....and in a hospital setting it is unlikely that you will be work with the same team everyday so it is hard to learn names because the players are always changing. You also are trying to remember the "system" they have and or EMR, Forms etc... I just started a new job and the first few admissions I did I was stressed and it was taking me 2x as long to do the admit. New EMR system but they are also still using forms for orders because I am not familar with the "form" I need to read every line (I am sure in another week I will be able to fill out the form blindfolded). But is also learning who does what, what are the procholols for the non=med stuff, I don't know any of the names for consults etc... basically you are inudated with allot of non-medicine stuff that is how the hospital/department runs. So go in early on your day off and shadow another PA and figure out the process flow and get that down. When i started my new job I insisted on being pair with another PA for the first week, not because I wasn't capable of seeing pt but I did not know the processes, work flow. So I was able to get my questions answered as we went along. They have a ton of forms Sometimes to admit a pt it is a 4 page order set form, and then depending on the Dx there can additional multi page forms to fill out. I know seems like alot but that is the SYSTEM,.

 

Good luck

I think this is great advice. It reminds me of how I felt getting ready for my first surgical shadowing experiences. I was/still am so tied up in worrying about how to scrub in properly, where to stand, how to move etc to maintain sterility and not get in the way, that I hardly have time to think about the medicine behind it all. Along with all the other recommendations of counseling etc, I think going in for a day (or a few days) to shadow a current PA there to see the system and meet a few people would not only get you familiar with the setting and system, but also show your new employer that you are eager to do things right and will hopefully put you more at ease when it comes time to actually dole out some diff dx and treatment.

Best of luck, I can't wait to be starting in the real world! Didactic year is soul-crushing at times.

Thank you all for your advice. I will probably seek some professional assistance to deal with the anxiety, I know this is not me and I know my stuff better than this. I appreciate it very much.

Haha and ai also has the tetanus problem when I was doing ER, major mental block.

Probably the best think would be a hospital job with supervision....the problem is, here in NYC, there are absolutely, positively no hospital jobs unless you "know somebody". I have applied to dozens of major area hospitals and have yet to get a single offer. Especially with current economics, even the biggest hospitals take months to get back to me and then more months to decide amongst the many applicants. I was not offered anything during clinicals and I really have no connections to anyone on the inside, so I don't think it will happen.

Is moving an option for you? There are so many great teaching hospitals in NC that LOVE PAs....just sayin :=D:

Honestly, if you graduated from a PA program and feel like that I wonder what the issue with the program is. I would have expected that this type of thing would have been tested multiple times throughout your clinical rotations, OSCE's, etc. Written assessments are not actually "doing it" and if you had no assessments involving actually "doing it", I'd put some onus on the program for graduating someone who obviously can't do it.

Pat