HMtoPA

Just wanted to close the loop. Finally got a formal offer this morning, which I accepted. The delay I think had more to do with my availability to start (I'm still months away from military retirement) than anything else. The medical director told me I was a 9/10 candidate, the 1-point ding because I can't start right away! Thanks everyone for your input.

Someone may disagree with me, but I don't think there is any need to perpetually list this job on your CV. Is that a lie of omission? Perhaps, but I tend to view a CV as a personal marketing document (i.e., not a legal document) that highlights what you want to highlight about yourself, and when you've accumulated some more experience there is going to be no benefit to listing a position that you held for 6 weeks. You WILL have to list the position when asked to provide a credentialing history. I don't know the legal requirements, but from memory the onboarding documents are pretty clear about wanting to know everywhere that you've been credentialed, ever. I'm sorry that you were let go so soon. To me that demonstrates a failure of leadership more than anything else. If you have an employee that is missing the mark that early on, you should be providing mentorship and a path toward success. I understand the reality is that many places just want to get you up and running ASAP and don't have the resources to dedicate to systematic training - the reality is that most of us learned on the fly as we went along. But I still think no one should be getting let go this early on barring some sort of gross incompetence or egregious personality defect. I feel like I've seen a trend lately of new grads being let go, fired, or quitting within the first 6 months of their first job. It seems different than it was even a few years ago. When I graduated 10 years ago, people still talked about being nervous and having imposter syndrome, but this is different. I don't know if it's a generational thing, a decline in quality of education due to the rapid expansion of programs, if many of these places are hiring new PAs for the first time and the reality doesn't match their expectations, or something else entirely. Regardless, I think it's becoming a failure of our profession, especially because I think the younger generation of doctors is actually becoming more anti-PA then pro-PA. My unpopular opinion is that we should all be doing some sort of post-graduate training program. Even a default 6-12 month family medicine post-grad "externship" (or whatever you want to call it) would be huge in easing the transition for people first starting out and better ensuring competence to practice. And I also think that specialty residencies/fellowships should be mandatory (with grandfathering) for those entering specialties - flame suit on!

I'm confused. Are you people not talking call salaried or paid hourly? If the latter, I'm not sure how they can make you take uncompensated call? If the former I can see an employer trying to screw you, but I personally would leave a job over that as soon as practicable.

Thank you all for the advice. I wore a suit - I'm glad I brought one with me to my current location overseas. The interview seemed to go very well. I'm expecting an offer later this week, but it could fall through just based on the timing (I'm still transitioning from active duty and am not available to start immediately).

I'm an Emergency Medicine PA finishing up my 20th year in the Navy with retirement on the horizon. I put out some feelers with a recruiter when I saw a job opening in the area where I own a home and plan on moving back to. Things progressed very quickly over a day or two, with my CV bouncing around between a couple of recruiters, an HR person, and a medical director. I was asked if I could take a call with the medical director, despite the time difference (I'm overseas). I happily agreed to this, kind of thinking it would be a pretty informal affair. Now suddenly I have an invite for a "Zoom Video Interview" and I'm freaking out a little because suddenly it sounds much more serious. The interview itself doesn't worry me so much. I'm pretty comfortable talking about myself, my skills and experience, and I'm confident that I have a lot to bring to the table. I doubt money will come up this early, but I'm prepared to ask for the top of the advertised salary range. I think what worries me the most, as silly as it sounds, is what do I wear to this thing? What is the current etiquette for civilian job interviews in our field? And is it more relaxed on Zoom? I'm going to be getting up for an interview at 4:00 AM my time, and I'm going to feel kind of silly wearing a suit and tie (no pants, of course, lol) in my room in the middle of the night, especially if the guy on the other end is in scrubs. But obviously I don't want to look like a slob, either. I'm so used to being told what to wear for the last 20 years that now I don't know what to do, lol. Help!

With regard to independent practice in the federal government, I am in the Navy, and I know your interest is geared more towards the VA. However, I will say that as a generalist PA, I was given wide latitude when I worked in family medicine, seeing my own panel of patients with no cosignature of notes and no prescribing restrictions. I work in the emergency department now, and with fellowship training I have supplementary EM privileges, see my own patients, and sign my own notes. Non-EM-trained PAs that I work with must staff their patients and get their notes cosigned. At all times, essentially, I have had either a supervising or collaborating physician on paper. I say essentially, because sometimes the ball was dropped administratively. However, this so-called supervisory relationship has never been anything other than a piece of paper, even if an onerous one. The only other sort of limitation on my practice I can think of is that when I was in family medicine, I was subject to a higher percentage of charts reviewed each month, I think like 10% versus the physicians’ 5%. In my current position, however, there is parity. I have a Washington state license, and I do not think that there would be a difference if I had a Utah or ND license. I think the biggest issue facing the PA profession right now is the idea of independent practice, because it just creates more red tape, and an extra hurdle in the hiring process. Physicians don’t want to be on the hook for our decisions, nor should they be. This should be job number one for the AAPA, in my opinion, more than any title change or PR campaign.

That may be, but at least you put it on the coach to be the stickler. In my experience with several dozens of these exams per year (when I did family med) for kids participating in multiple sports at multiple schools, I never had a kid come back needing a reexam or heard back from them otherwise. Some may have sought care from someone else and I never knew, but others were regular patients that I definitely saw again. I don’t doubt that there are some coaches somewhere out there that might be sticklers about this, only that I haven’t encountered them. In any case, it’s not a hill I chose to die on - I felt that by being clear that I did NOT perform the exam, and that this was done at the patient’s request, then I could morally, legally, and ethically sign the form. In my reading, the form shown in this thread (which is more or less identical to what I’ve seen in other states) doesn’t explicitly state that a testicular exam is strictly required, or at least that it cannot be deferred by the patient.

I absolutely would never, ever, ever conduct any type of physical exam on an unwilling, competent patient - perhaps most especially a genital exam on a minor. The fact that anyone is suggesting you should have done so is lunacy. I also would not have just gun-decked the form and document a normal exam if none was conducted. I do think perhaps you may have been a bit too rigid in the interpretation of the form, and maybe there was a more diplomatic solution available. The easiest thing would have been to simply cross-out that portion of the exam and write "patient deferred" or something. When I worked in primary care and had a sports physical come through I regularly did this, and never had one come back rejected - it really is just a check in the box. From a medico-legal standpoint, I'm not sure that there is much risk to skipping a testicular exam on a high school sports physical. In any case, you certainly should not be facing any sort of disciplinary action for respecting the body autonomy of a competent patient. WTH.

I'm a PA in the Navy gearing up for likely retirement in about 18 months. I'm not terribly worried about my ability to find a job afterwards, but I do want to avoid noob mistakes as much as possible. Hoping I can get a few questions answered: (1) Is it worth including anything on my CV from before PA school? I was enlisted as a Hospital Corpsman for about 10 years, and have been a PA for another 10 - should I include anything about my enlisted career at all? Things like combat experience, (lapsed) EMT certification, etc. I mainly want to highlight that my experience in medicine (and especially emergency medicine) is not strictly limited to the past 10 years, and I'm worried about having a resume that's too thin for my age. To be clear, I'm really highlighting relevant info (PA school, EM Fellowship, CAQ, etc.) and the "filler" is buried further down. (2) How soon is too soon to start contacting folks? I obviously don't want to get an offer way before I'm able to accept, but I know that the interview and selection process can take a while, and especially onboarding/credentialing is sometimes slow. I was thinking of maybe starting 6 months prior to anticipated start date? I'm hoping to get to work as soon as possible after leaving the Navy. (3) I have actually worked a moonlighting gig before, with a group at a location that I would very much like to go back to. Unfortunately, the recruiter and the VP who hired me that time around are no longer with the company. I did leave on very good terms with an (unofficial) open-ended offer to come back anytime. I would like to start putting feelers out further in advance for this job, rather than just cross my fingers that they post an opening at just the right time. My plan is to reach out to the current recruiter with an introduction and a CV just to kind of plant the seed that I'm looking in case something comes up - but how early should I do this? (4) What about compensation? I don't even know what a fair hourly rate is, but I really don't want to get some standard new-grad offer. I know it's region and industry-specific, I'll be looking primarily in Western Washington (probably not Seattle, though) for an ED job (ideally not UC). Also, have wages gone up at all in the last couple of years with all of this inflation? Thanks in advance for any insight you can offer.

Thanks for the replies, everyone. I think I will focus on FCCS (on top of my regular fellowship didactics and clinical duties) next month and save the $1200 for now. I can always do the DAC later, and hopefully get it funded through an employer.

I may have an opportunity to attend the Difficult Airway Course next month. I'm pretty comfortable intubating with a GlideScope and an RT standing by, but am by no means an expert (I'm currently in an EM fellowship, and have probably done between 2 and 3 dozen intubations). Anyway, my question is for anyone who has done the above course - was it worth it? If it were funded, it would be a no brainer, as surely I'd glean a thing or two out of the 3 days - but it would be out-of-pocket, and it's quite expensive - $1200. Yikes. I hate to give up that kind of money (and a weekend!), and feel like it wasn't absolutely worth it. Thoughts? One other wrinkle is that I think the course has several hours of pre-work requirements that I will have to do around the same time as pre-work for an FCCS course I'm already enrolled for. While also rotating through an inner-city ED that month. Not sure if that will be too much, or if it will all dovetail together nicely.

I don't disagree. Man, the nurses would've lost it, though, lol.

It's just this kind of paternalism that requires a name change. Some of these people at ACEP, EMRA, AAEM, etc. apparently hold the genuine belief that they can dictate the trajectory of our profession. For once, I'm glad that administrators run hospitals, because it means we'll always have jobs, regardless of what these @$$holes think.

Unbelievable that anyone thinks that something like this is a big deal after the last 4 years with the current POTUS. So she said something vaguely nice about Castro. So what? Bet she doesn't have a crush on Putin. Bet she never grabbed anyone by the p***y.

My point isn't that PAs can't or aren't practicing at a high level. But I know EM docs and trauma surgeons with 30-40 years of practice under their belt with more humility than I saw displayed in that post. There's a reason it ended up as a screen grab on Reddit (clue: it sounded a bit ridiculous).