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About PASamsOTHERacct

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    Physician Assistant

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  1. 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.
  2. 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?
  3. 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....
  4. 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?
  5. 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?
  6. 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?
  7. 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?
  8. 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?
  9. 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!
  10. Sorry to bother y'all, not strictly a medical post. Just wanted to get thoughts/ideas, and vent. I have another account here, but wanted to stay anonymous-ish. I've been a PA less than 10 years, and I'm totally burned out. For the past bunch of years, I've been doing Urgent Care, and it's all I know how to do...but I think I'm done with it...and maybe done with PA, the way the industry looks. I've watched the urgent care patient meter creep from 2.5 patients per hour, to three, to four...and I can't do it anymore. I had energy ten years ago. But now...it's just cold, after cold. after cold. after cold. before dawn to long after dusk. 40 of them a shift. 12 hour shift after 12 hour shift. with full documentation. click. click. click. over and over. When I started in this field, the variety was interesting. And there was time to learn, ask, discover. But now it's a patient mill...everywhere. I come home from work exhausted, hungry, back aching, barely able to face another day of endless nonsense and endless charting that continues well into my home life. Click. Click. Click. Every ROS/PE the same enough to make me want to punch myself, but just different enough that I have to pay half-mindless attention which URI complaint i click on this time. Over and over. I've tried all the hacks for speed, all the macros available in the EHR, but there's just so much you can do to hack 40 charts a day. I'm bored, exhausted, wiped out, and have lost my passion...helping people, personally, without feeling like the clock was going to crush my soul, or if not the clock, the boss doc ready to fire me for slowness. It's not why I got into this profession. Everywhere I look in my region, it's the same...four patients an hour, five, maybe six. I'm sure half the high-energy folks here on PAForum can tear that to shreds that with no problem...blaze through twelve hours of four dozen colds and hundreds of pages, dictations and clicks of doc. I guess I'm the drained lunk. And high acuity is not my cup of tea...just don't have the brains for it, don't have the concentration, recall, and integrated, multi-directional multitasking thinking for it....and never did even in the ER. So fast track it is, and always has been, for me. And apparently, plenty of young, energetic PAs ready to blast through 150 patients a week as the hiring lines are out the door. But I am apparently not that person...the industry has hit the racetrack, but I only got older and more tired. And I'm only a quarter way though my career at best. I once thought I was in love with low acuity emergency medicine. But I am out of juice. And if that wasn't enough...due to life circumstances, i had to switch jobs a few times. My resume is filling up...six job switches in seven years, all for perfectly good reasons, (switched from a specialty to EM, then to UC, then one place downsized, then a locums job finished contract, moved across a state for another...a lot of happenstance mostly out of my control). But my resume is getting longer, and if I quit my current place before it totally kills me....i'll almost certainly be unhirable. Seven jobs in seven years..my PA resume will almost certainly be as good as trash. For good. Lost, don't know what to do next. Looking for some thoughts and experiences (and empathy, unless that's asking too much). P.S. With all due respect, please hold off on the "four an hour? I see six an hour ,seven days a week!" comments. I'm happy you have the passion and energy. I don't.
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