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About PAofPlenty

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    Physician Assistant
  1. For the record, I have never written anything in my notes that I did not understand. When I did not understand, I have always written "Per Dr. Anonymous, the following recommendation were made. Leave final psychiatric consults at the discretion of the primary medical team responsible for the patient's disposition and this provider's attending physician. Patient was staffed, discussed and had recommendations made with Dr. " The situation that irked me particularly raw arose last week. A social worker was telling my supervising doctor misleading information and the doctor believed her. That same doctor told me to include that into my note. I suspected the information was wrong, did not write it, and wrote in my note that "This provider is transferring the care of patient to Doctor on this date at this time." My doctor proceeded and later was told by another senior psychiatrist on staff that social worker information was completely wrong and needed to be revised. It felt wrong "abandoning ship" on my doctor but my gut screamed and I listened to it and it saved me. It was uncovered that the social worker was wrong but (thankfully) my note steered clear of the cluster fuck. It just made me wonder if one of my supervising doctors knew what he was doing. I work with 3 doctors who each are on-service for 1 week then rotate off. I was taken aback that this doctor would trust a social worker who was incorrect. The other 2 doctors steer clear of said social worker. As for rounding quickly and getting out ASAP, the whole psychiatric consult team rounds at noon to discuss all patients as a group. Most of the time I am done by 2:30 pm and there have been days were I see only 1or 2 follow-up patients. I know the pay is low, but I figured having inpatient psych experience on a resume would have helped across numerous services. I would like to thank everyone for their honest responses. I have always known never to place information into a chart that was not accurate nor words that were not understood by me. I will continue to apply for jobs, keep my head down, and defer to my provider in treatment plans that I don't understand/agree with.
  2. Hey Everyone! New graduate with 6 months experience in inpatient psychiatry. Hospital wanted a PA to "assist in overflow areas" child pysch, emergency medicine psych, consult and liaison psych, geri psych, etc. Agreed to the job because I was told "varied scope of practice" and "we are in the business of teaching and training people" (Fiancee is a resident at said program and I know that was a factor in my employment). Took the job and after a 2 week shadowing period was placed into the consult and liaison service (a toxic and moral injurious prone service that is notoriously detested and openly called "malignant") were I have been since then. Residents rotate in and out each month. Residents see new psychiatric consults and I take the (mostly) delirium follow ups and suicidal/homicidal (i.e. legal hold) patients. I asked my supervising physician 3 months ago about "varying my scope" of practice, but was told to stay put for the meanwhile. Salary $90,000 (M-F 8:30 - 5:00 pm with average of 6 patients/day. No weekend and no call). My problem is that my work environment is toxic (other hospital services do not respect us, psychiatric patients routinely neglected and not given the medical standard of care, morally injured supervising doctor), medical-legal dispositions are provided by not reliable social workers/risk management/case management, and I feel that I am not learning new information nor seeing different types of patients. I feel my medical knowledge is stagnating and that I am not advancing in my field. I began applying to other jobs and the VA offered me a surgical PA position. I am guessing it will finalize with a contract in approximately 3-4 months. My current contract requires me to give a 90 day notice. Should I try to stick this out until I get a solid contract offer from the VA? I am a former veteran and loved surgery (honored my rotation and enjoy the service). I know the VA is far from perfect, but I regularly come home wondering if my notes/discharge planing/social work is going to cost me my license due to medical-legal grey issues. I document to hell-and-back, but with psychiatric patients and legal status' involved, I feel overwhelmed and undertrained to navigate the some-times very complex patients and mental health laws. Perhaps I am being too dramatic, but a few days ago, I was told by my attending to downgrade a patient's legal status to allow for them to get a surgery (which would not have been possible with their current legal status). I protested and transferred care over to that attending (and documented). However, that situation left a foul taste in my mouth (they told me to write medical-legal words in my note that I did not know what they meant...and come to find out..they didn't quite know either as the social worker was ill-informed). It sounds childish, but I like the positives of this job. However, the negatives are becoming incredibly glaring and feel that it would be better to leave with 9 months at my first job than continue in this place and try to milk out a year. I have been applying to other jobs, but feel that my resume screams "fired after 6 months." I feel like I was given the "bait-and-switch" and only now am I finding my voice as a new graduate. Thoughts?
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