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About GMM2019

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  1. It’s not a great look in any field, not just medicine, to accept a job then abandon it for another opportunity. They’ve already invested a lot of time and resources in trying to hire you. But true, sometimes it can’t be avoided and that’s just life. I have a lot of engineers in my family. When a new hire burns them like that, they will never hire them again in the future. And managers from different companies talk. In certain specialties, the community is very small and someone always knows someone. Even if you don’t list certain people as references, PAs and physicians are pretty well connected - easy for them to call up someone informally and ask if they should hire you. It won’t matter for crap jobs if they’re just looking for someone with a pulse. But good jobs will care. Good jobs want dependable people who keep their word. It’s not the end of the world... but I wouldn’t make a habit out of it. I think once is reasonable and human. Two or three times is a pattern. Any more than that, and I don’t think I’d want to hire that person if I were in a position to make those kinds of decisions.
  2. Happened to me. Feel ashamed. Was so desperate to get a job in a certain location near family that I said yes to something I didn’t really want, deep down. Was a messy situation, would not recommend.... But things worked out and I secured a better job, with a better schedule, with a promising future. Do what’s best for you.... but know that there could be consequences with the original ER/hospital system/HR team. Medicine is a small community... don’t burn too many bridges.
  3. What goes well with the coronavirus? Lyme disease (stolen joke - can't take credit!)
  4. I started a new job fairly recently... the training process has been going well. However, it seems like the plan for me includes a few clinic sessions dedicated to just virtual visits. Of course, no one mentioned this to me during the interview process. I'm kind of bummed out... I don't mind doing the occasional virtual visit, but I don't really want to do a series of these 15 minute visits in a row, one after the other. In a typical schedule for me, I'd cap out at 8 patients per session, but these virtual visits could bring me up to 16 per session. I'm told that these visits are mainly just for established patients with a prior normal exam, like migraine patients, and usually just include refills. Does anyone else do virtual visits, and what do you think about it? I'm being told by physicians that virtual visits can be done across state lines, but I don't know if that applies to me too. Does anyone know about this issue as it relates to PAs? Will I get into legal trouble if I see a patient via video chat who is in another state, without a license for that state? I'm not sure how to double check this and I don't want to risk my license. For those that do virtual visits, do you ever order labs or imaging after a consult with these patients? In my specialty, I don't really feel comfortable with getting any testing unless I've seen someone in person. Plus, if someone needs further testing, I feel like they SHOULD be seen in person first. Any advice on how to protect myself, legally, with these virtual visits? Like any words of wisdom for the documentation? I come from more of an emergency med background, so consultations with patients via video screen still seems crazy to me. This isn't really the way I wanted to practice, but I don't have much negotiating power currently.
  5. Could you find an environment where you have more admin time? I came from the trenches of urgent care and found a job that is like 60% clinical and 40% admin and/or research time. Coming from seeing like 30-40 patients per shift, the change of pace is glorious.
  6. Wow this is depressing lol. I’m only at 95,000 ish, but only out of school for 1-2 years and in a saturated area.
  7. But the ER has on site labs, advanced imaging (CT, ultrasound), radiologists, usually more senior people around if needed, and more support staff to do EKGs and some of the ortho stuff (i.e. crutch training/fitting, etc). We didn’t have any of that in the urgent care where I worked.
  8. As someone who worked in urgent care as a new grad for 15 months, all I can tell you is that a lot of urgent care is a hot mess. I can say from firsthand experience that Augmentin and doxycycline are given out like candy for sinus infections. If you asked most of the urgent care PA/NP providers I worked with if patients should be screened for kidney function before prescribing Augmentin, I honestly don't think most of them would know that or think to ask about that. Some of the main issues: Urgent care records don't necessarily link to other EMR systems, even if they belong to the same hospital system; even if we had access to labs, most of use wouldn't really know how to accurately interpret them because we rarely ever order bloodwork Inexperience - my UC job hired new grads by the bucketful every year, without really training them; they would then put new grads together at insanely busy sites, with really sick patient populations Poor review system, never really received any feedback in my first year in UC High patient volume Patient's expect "customer service" and will aggressively throw a fit over not getting antibiotics - this can happen 10-20x per shift in flu season; UC providers can either spend the 20-30 minutes trying the deescalate the situation and convince the patient to try more conservative therapies, or they write the script and are in and out of the room within 5 minutes No intake forms asking about medical problems Few support staff members - usually just a tech to take vitals and x-rays A lot of pressure to move FAST - dictated by management goals, maybe other provider you might be working with if alternating patients Young managers making poor scheduling decisions and favoring certain people, like putting their "friends" in more favorable locations, instead of spreading out the experience level; this is how new grads end up together alone Usually never see the outcome of the patient and have no idea what happened to them I agree that the PA should've been a little more careful, but I can see exactly how the systemic flaws of urgent care can contribute to poor patient outcomes. Like the holes in the cheese model used to show how mistakes get made in hospitals. I couldn't handle the stress of working in UC and left for a different specialty that has a very thorough training and on-boarding system. I like UC in theory... but hated the sweatshop nature of it.
  9. I know many PAs who made the transition and seem happy with it, from the ED to UC. Urgent care was not for me... but I might not be the emergency med type either. I struggled a lot with it as a newer grad, and didn't feel like there was much training or support. I'd be getting out late almost every night (30min to an hour after closing), and would go home with 1-2 hours of charts every shift, because it took me a while to adapt to the pace. Didn't get compensated extra for getting out late or finishing charts. No one really met with me about how I was doing, or checked in with me. I worked mostly with another new grad PA, which seems insane to me even now lol. I get a little nauseous thinking about what I might've missed due to inexperience.... I also prefer being detailed in my charts, but felt like I couldn't do this in the urgent care setting. UC felt like a sweatshop to me, truthfully.
  10. I'm about a year out of school. I'm not super happy about where I work currently, and I don't have any close friends or family here. In terms of "mental health", I'm probably at my lowest point. For the first time ever in my life, I've had to see a psychiatrist - things got that bad. I'm really, really lonely here and I'm getting so burnt out at work. I'd really like to move back to my home state, but I'm having a lot of trouble with the job search process. It's really difficult to schedule interviews in another state around my current work schedule, and prepare for the interviews, travel, dry clean suit, network, apply for more jobs, etc. Job searching has turned into another full time job on my free days. At work, I'm often doing 13-15 hour days (supposed to just be 12 hours), with barely any free time to check e-mail or return phone calls during week days. I'm doing the best I can to juggle everything, but I feel so trapped here. I've thought about just quitting my current job so I can focus all of my attention on job searching... but I'm too scared to actually pull the trigger. A lot of places in my home state keep telling me I'm still a "new grad" even with a year of experience, and won't consider me any further. Also, I'm scared about having long gaps in between jobs because it might make me less marketable or get me in trouble with credentialing. My home state is a difficult place to get a job since there are so many PAs and NPs there already... So, I'm not really sure what to do... stay here and continue to be miserable or take the risk and quit. I'm a little nervous I won't be able to get another job in my preferred state with just my one year of experience... At this point, I don't even care about the salary or specialty. Is it too risky to quit without another job lined up? Will not having a current job affect me when applying for jobs? Thanks for any life advice!
  11. It will make your life a lot easier going to a program in the same area where you want to work. I regret not doing this.
  12. I mean... based on my experience with applying to jobs, I kind of wish I were an NP. 1-2 of the major healthcare networks in my preferred area seem to only hire NPs. It would also be nice to have union protection, especially as medicine becomes more corporatized...
  13. I've been out of school for less than 2 years... so I'm hoping maybe I can still break into something else. Hopefully... Urgent care isn't terrible when it's done well, and there is obviously a need for that kind of service. But I think too many private investors and business people are taking advantage of the urgent care bubble and they are completely destroying it. These private urgent care chains with unethical standards come into the market and put competitive pressure on urgent care facilities that are trying to practice high quality, evidence based medicine. Either way, I just find the work very uninteresting and soul crushing. I don't think I could tolerate doing it for years. I'm just sad
  14. I also work in urgent care, and my employer has started cracking down on us about this too. It makes me feel like we are taking advantage of patients and feels deceptive, even if it's not technically "wrong". I really hate working in urgent care and I regret ever taking this job. I want to get out of urgent care so badly. I'm scared that the longer I work in urgent care, the less marketable I will be as a PA in other specialties. I just don't know how exactly to break out. I see more and more of these clinics opening every day, which makes me very nervous about the sustainability of my job. My employer treats its employees fairly well overall (for now) ... but I've heard horror stories about working for some of these newer, private urgent care chains. Initially I thought working in urgent care was a great way to keep up my general skills and see a lot, but I've quickly grown to hate it. I used to be so hopeful about my career prospects as a PA, but now it feels like I've fallen into a depression slump. I've even considered switching careers altogether. Urgent care just feels like a dead end pathway - it doesn't seem to prepare you for much.
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