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About PASamsOTHERacct

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    Physician Assistant

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  1. Hey all. I'm professionally lost, and trying to find an experienced career counselor to help guide me towards something new in Medicine or a related field. I have tried two so far, one of whom could only offer a few vague ideas and some resume building (but no direction), and the other who wanted me to make lists of my fantasy jobs (but offer no direction). Trying to find someone competent who knows the medical field and knows PAs, and who can take a good inventory of skills and offer some unique direction. If anyone has experience with one, please let me know! Thanks
  2. My experience in an inner-city hospital was absolutely horrendous. Toxic people, toxic managers, toxic work environment. I believe that is the rule, not the exception, in NYC. If you mean a city owned hospital, in my experience, they are bastions of terrible providers and massive incompetence, and more toxicity.
  3. Again, Thanks all for the responses. Read all of them, I appreciate the encouragement and validation. Residency is pretty much out of the question... Too few and far between (I'm geographically fixed), and I've been rejected in the past for EM... They very admittedly wanted fresh meat, super young and bounding with energy, and right out of school..and I'm none of the above. In any case, not interested anymore in the residency specialties...EM, surgery, etc. It's nice to hear volume of these places are demanding are ridiculous... It's crazy because in the New York City area, 50-60 patients a 12-hour shift is becoming standard. Standard. Interventional sounds interesting but honestly I'm not so comfortable with all the radiation exposure. In the meantime trying to find something in a concierge primary care or perhaps something unusual, like working in a rehab facility or such... Honesty really lost and directionless, but looking. But certainly keep the comments coming, I am reading all of them even if I can't respond to each individually. Thank you all.
  4. Thanks all for the responses. Read all of them, I appreciate the encouragement and validation. Got to figure out what's next for me...
  5. Sorry all for what might be a rant. Just trying to figure out if my career in medicine is just a failed fantasy. Unfortunately, my school clinicals were pretty crappy and disorganized, from the top down, due to a combination of factors...didn't learn a whole lot about the business of medicine. After graduating and spending a long while in an inane diagnostics specialty (an MA could do my job), I made the jump to emergency medicine. Worked in a busy, transitioning inner-city ER, and It was a complete, utter shit-show. Horrible leadership, no mentoring, no help for the other PAs, overall toxic ER. After a while, I was asked to leave because I just wasn't "catching on"...like, yeah, of course I wasn't, as somehow 4 weeks during school wasn't enough to fully engrave the entirety of emergency care to into my brain. But I digress. But the abuse was...exceptional, and the trauma remains. I had a brief good run early in Urgent Care, with a very supportive doc, and a moderately paced practice that had, max, 3 patients per hour on a busy day...4 per hour only on an insane full-moon, exceptionally rare occasion. Unfortunately, the place downsized one location, and I was the last in, so first out. Since then, I have been struggling. The PTSD from my time in the ER has never faded, and has bled through into my work. My last job was a monster of a corporate behemoth, with about 30-40 demanding, wealthy, multiply-comorbid, talkative, "oh yeah I forgot to mention this chronic problem" patients per 12 hour shift, with a consistent 3-4 patient per hour load for those 12 hours, with back-to-back 12 hour breakless, lunch-less, bathroomless shifts....and a whole cast of backstabbing, lie-to-your-face, cold-hearted ER docs staffing the place. It did not go well, and I was unceremoniously thrown out the door after a few months for failure to adapt to the kiss-ass environment, while solving all of the patient's problems and managing all their comorbidities and referring them out to all our associated providers, every shift, all by myself, within a sufficient time...and failure to avoid asking the supervising docs an occasional question on a complex patient. They made clear I was there to sink or swim, not learn, and that I was excess weight they were glad to be rid of. Now...I feel like a failure. I failed to hack the ER. So many PAs can manage it seamlessly..yet I was an utter failure at emergency medicine. And Urgent care? my peers are like "sure, 6 patients an hour for 12 hours is a breeze, why can't you get your shit together and handle 4? As I've long passed my high-speed teens, and after the abuse in the ER, I've slowed. I want to help the patients, form a bond, address their needs, and not have to shove them out the door because they are slowing me down. I have decision anxiety, comorbidity anxiety, time anxiety...all borne of an unguided, mentorless career. I hate the rush of 10 minutes to see a patient, discuss their (usually) complex situation with my sup, make a plan, answer their myriad questions and "oh also"s, push them out the door, and fully document and lock that chart...and do so, hour after hour after hour. This is not why I got into medicine. Yet I am aware that ALL my peers in Urgent Care and the ER are seeing 4 patients per hour with ease, juggling 8 rooms or beds at a time, and have the equivalent of pure cocaine running though their veins and adderall coursing through their brain...perfect recall, no questions, all knowledge, pure confidence, and endless energy. I feel like an utter failure for feeling like, "heck, why can't I just see 2-3 patients per hour and actually practice humanistic medicine." I feel like a failure at Urgent Care, at Emergency medicine, and a failure as PA...as this is the business we are in, and I just can't hack it at the speeds necessary to stay hired. I'm not a dumb guy, and when I am given plenty of time, I am an excellent diagnostician and planner, technically adept, and am great with the patients on a personal level...but this is not medicine anymore. No one wants to hire someone to see patients at 2-3 an hour. I feel like....maybe it's time to apply to Home Depot, or get my CDL truck driving license...somewhere with few decisions, somewhere I can excel, and not have to live with the way medicine is today. Sorry for the rant. Thanks for listening.
  6. Personally, I like Uniform Advantage's "Butter Soft" Scrubs. Very comfortable, lots of pockets. I'm particularly picky with fabrics and fabric sensations, and I find these are very soft, comfortable, but don't feel thin as rags; lots of pockets.
  7. I'm curious...as my Hospitalist/Inpatient rotation was a total waste of time, what exactly...are the demands, the typicals, what exactly is the day like? As a UC PA, what would I have to do to transition well? Oh, and....generally speaking, are there non-12-hour hospitalist jobs out there?
  8. Only in my dreams would either of those happen...not sure whee you worked, but in the places I've been, saying something like that will most likely get you fired on the spot, and they know that there aren't a tons of jobs out there...and not just that, but you can't win. If I prescribe Keflex for a patient, based on attending A's advice, and the next day, do the same thing for another similar patient, Attending B says "hell, keflex is crap, that doesn't work, call the patient back, call the pharmacy, and represcribe them bactrim..." it's an unwinnable situation. As a PA, I am not ALLOWED to practice as I see fit. That's policy. The final arbiter are the docs, and if one day, the ER doc totally contradicts yesterday's doc, I have to change my treatment plan (as we all know, get 2 ER docs together and you will have two completely different plans of care). There's no winning that one with a "vigorous defense". If I say "It's worked in my experience, and this is my usual custom" guess what...you just made an enemy, and my boss will get a phone call that i'm not playing by the rules. And i'll STILL have to change the script. Just saying....
  9. I'm in Urgent Care, but my prior job, in the ER, was absolutell hell. It was a transitional time in the hospital, and what passed for "training" and "constructive advice" meant being chewed out daily by ER attendings and nitpicked on every single word I uttered and ever letter I typed in my chart, every single day, for months. Being reamed out in front of other staff, for not getting one "crucial" piece of information from the patient, was a weekly occurrence. Suffice it to say, they took a previously confident PA, tore my soul out, and made me sweat at the thought of talking to an ER attending or even a scribe. It was a toxic place for all involved, and hell for me. The biggest a-holes were the ones who survived there; not softer types like me. It's been several years since then, but I've never recovered. I currently work in Urgent Care with a lot of ER attendings who staff it as well. Now, I have a bit of social anxiety and decision anxiety to start with, and was never the most confident guy in the world. But that job beat me down so hard, that every time I need now to confer with my supervising docs here, I start to sweat, and often can't get my story straight, forget pertinent facts. I hesitate and hesitate, scared to walk over and open my mouth Even the realization, during patient interview, that I will have to ask a (probably dumb) question of my attending-type colleagues, makes me forget to ask the right things in the room, and then of course, I ask the dumb thing. And iffy cases? Decisions? I start to sweat profusely, feeling like, if I wasn't so dumb and meek, I'd have the confidence and knowledge recall to not have to ask the docs my dumb question. As a result, of course, I come off anxious and uncertain, and the cycle perpetuates as the ER doc colleagues tear me apart with their cold, unforgiving eyes (seems to be a common trait among those types). And it seems like I'm the only one asking the docs questions often...the other PAs seem to know the right thing to do. Every time. Every single time. No fear. No doubts. No recall lapses. No hesitation in their voice. Ever. Has anyone ever dealt with this sort of PTSD from working in a bad place? How did you beat it? And how did you get the confidence to make the right decisions autonomously, every time? How did you deal with terrible decision anxiety?
  10. I actually started in pain management / addiction medicine...wasn't a good fit, the job was mostly about loudly scolding and verbally threatening grown adults who were struggling with addiction...not my cup of tea... I was wondering though, how hard would it be to transition into family medicine? I have, at best, a rudimentary understanding of typical long-term medical problems that I am always telling my UC patient to "follow up with their PCP about"...and know absolutely nothing about HTN and DM management. My brain has been wired for urgent care for a long time, and my primary care rotations were lousy and long ago. Would it be a terribly uphill battle?
  11. I'm confused with the DOT thing. To even begin the application process, the FMCSA says "First complete the required training to begin the process. Please note that you MUST complete the required training prior to registering." But they do not elaborate on what this "required training" is or how to get it. I took a look at dotstudyguide.bandcamp.com, but that does not seem to offer any sort of certificate of completion nor accreditation. Am I missing something? How can I tell if a course is accredited and offers the right completion documentation?
  12. Thanks all for your responses. Sorry I cant address each response, but I am reading them all, it's nice to know I'm not alone with this. @Sas, thanks for the comments. Yeah, unfortunately the place is the way it is...torn between the two ends. Sitting outside in the sun today, absolutely dreading another 12 hour shift in the cubby, I feel like..I think I know which of the two i like better...I think i may have to choose non-isolation over good job (on paper)... @Han, well, never thought too much of the specialties...I worked in cardiac diagnostics briefly but it was busywork. Yes, of course, i'd have to find a place that would be willing to (re)train me and probably a pay cut, don't mind the pay cut as much as being a total novice, but I guess that would be the cost of a change...any specialties you or anyone reading might recommend? I'm wondering about family or primary, but from what I understand, those are 4+ patients-per-hour cattle mills now too... @revronin, nice new picture, and yeah....gosh, that video says it all. Unfortunately, ain't nothing going to change...this is, as we know, the new normal of medicine. My primary care just joined some membership-only medical franchise that charges a $2000 "buy in" for patients, but guarantees them time to sit and talk to the doctor, and not be rushed through like cattle. I'm intrigued by the idea, had never heard of it, and am curious if I MYSELF could find such a place to work! @BruceBanner no, I get you. Honestly...I don't care about the patients anymore either, not a darn. In fact, I absolutely HATE them for bothering me with their obviously viral URIs all day long. I see them, literally, as nothing more than annoyances that not only FORCE me to document, but KEEP me from documenting as well. Literally, in my head, with every patient, i'm thinking "shut the **** up, i don't care, just answer my yes/no questions, let me pretend to smile and care, give you my long-ago-memorized speech about sinus infections, then prescribe you ABX anyway because you will demand it, ok, now shut up and get out of my exam room and stop wasting my time and energy.... because you decided to pretend DayQuil doesn't exist, and come in with this B.S., I have to spend twice the time I am spending with you charting your nonsense." I guess I'g getting burned...I mean morally injured. Truly...it does feel like PTSD. Every time I see my work clothes, my ID, my work bag...I get queasy and tense. To all...what do you think might be a good fit for me, as a UC PA with some limited Cardiology (diagnostic) experience, where I can actually have a workload that is paced moderately enough, and interesting enough, so that i'll actually give a damn again?
  13. Some more thoughts after some more work... I think i finally realized what's missing, in large part. This place, which I am despising more and more daily, is really decent by most measures; good co-workers, good supervisors; honestly, really good supervisors. Good schedule. Pay is ok. Supportive staff. But, as the fast track person (it's structured so that the MDs here usually see the higher acuity Urgent Care), my job involves sitting in a little cubby hole, with no windows, not near other staff, all alone, seeing sinus infection after sinus infection after sinus infection after sinus infection, for 12 hours straight, sometimes with no more than ten minutes for lunch as there are too many callbacks and labs to review. The place varies over the course of a day from between three to four patients in an hour; not much by or Urgent Care standards, but it's just barely enough when the patients always have more questions and new complaints they didn't mention at triage, charting gets more and more demanding, and I often end up five or six charts behind, further eating into my lunch half-hour; it's so frustrating that buy hour number 8, I literally start spacing out in front of the patients and get the urge to punch the patient in the face and tell them to shut up, let me explain to them what a virus is, and get them the hell out before I fall even more behind. I've had crappy jobs in the past, but one thing kept me in them: coworkers. I say it again. Coworkers. I think that's what's missing. I've never been this isolated at a job, sitting with no one to talk to; even in the rare occasion when I work outside of the fast track section, the docs are too busy to have small talk. In previous jobs, we all sat together, providers and MAs and X-ray techs and whoever else, and an otherwise mundane day could be made much more bearable because of the relationships and chit chat. Furthermore, and I'm not sure if I realized how much of an effect this would have, it's really an odd thing to sit in a windowless room for 12 hours. Most of the previous jobs had some natural light and natural outside life and movement coming through windows or streaming in from the waiting room, but this is like working out of a closet. Even my SAD lamp is no help. I really feel guilty leaving a job that has the rare qualities of great supervisors, minimal middle management, and professional, kind coworkers, I certainly can't discount how vital that is...but at the same time, I can't even stomach the thought of spending my next shift in a dark cubbyhole, alone, for 12 hours, let alone the next week, month, or year. Honestly, the thought of going to work nauseates me every morning now. I really am terrified to even ask my current job about going part time, or just asking for advice... I'll be seen as a complainer and weak in an industry dominated by endless-energy, hardcore ER trained "being it on and throw me more patients" types, ungrateful, and perhaps told, "sorry, it's 40 hours a week here, or there's always McDonald's". And I don't want to appear unhumble and picky...And I feel like leaving an otherwise respectable job with good supervisors and decent pay because I prefer camaraderie and interaction at work, and having some connection to nature outside, is babyish and immature. But I feel like this the place is tearing my soul out, and is making me rethink if I even want to stay in medicine. If I have to document another sinus pressure chart, I think I'll cry... But I have to, all day. I don't even know if I want to do UC anymore, as pretty much all the jobs in my region have a minimum of 4 patients per hour, and it's all the same URI crap. maybe I could hack it part time, with more "decompression" days, but I think the odds of finding a good part time job, with good hourly pay, with a window, and some co-workers to talk to, and a decent boss, are exceedingly low. And unfortunately, no teaching jobs or no-admin-experience-needed admin jobs within 100 miles last time I checked. And I'm getting to old for the prospect of having to beg someone to retrain me and hold my hand in my primary or family med...not that the patient load would be any better there. Oh, and before anyone asks, why did I take this job? It was actually a little bait-and-switch... They showed me one of their other centers where all the providers sit together in a nice sunny area. Unintentional on their part, but makes all the difference to me. My job makes me want to vomit... But what if it's only downhill from here?
  14. I appreciate that, but no, I actually can't....tried doing main ER and simply could not keep up with the combination of multitasking and complex workups...could not keep my story straight and never, ever knew what to do next. I've accepted it's not something I simply cant cognitively integrate. Luckily I did fine in UC thank god...at least when it was reasonable volume. On the East Coast...but thanks!
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