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  1. Posting this bit of a rant partially because it's a bit of a cautionary tale and partially because it's comical. I work for an ortho group that is owned by a large hospital. I did not sign a contract when I accepted the position; none of the PAs are on contract. We have a wide scope of practice here, complete autonomy in the lvl 1 trauma bay, and a good amount of OR time. This was an awesome job. Unfortunately, over the past two years, APP leadership at the hospital level reorganized. The admin NP (who btw I'm not sure has ever worked clinically) apparently thinks that all the APPs on every hospital service should be treated exactly the same with a blanket policy for everyone, and the hospital is in charge of hiring/firing APPs, not the ortho group. She says our service line isn't making the hospital enough money so they can't justify hiring us more help, even though we are a hugely busy ortho trauma service and we don't have a residency. Our docs "can't" operate without a FA so we scrub non reimbursable cases and it takes several of us rounding every day (which is labor that has to be done but not making the hospital money because all those patients are global). On top of this reorganization we've just had more and more dumped on our plate in terms of call coverage for a couple satellite hospitals we cover, added new ortho urgent care locations to cover, added more surgeons but no new PAs - and we're now being asked to work at least two, if not four weekend days a month on top of overtime during the week (and no extra weekdays off for being on for the weekend). It's simply not tenable and I along with two others put in our notice last month. So, the people who are left are kind of screwed in terms of coverage, but I'm hoping it's an impetus for change to make the hospital wake up and improve things for them. I got a gig at the ED group across town at the "fancy" hospital. The benefits are FAR better. The pay is not out of this world since I don't have a ton of EM experience but it's a little better than my ortho hourly (minus all the call pay I'm currently making for the ridiculous amount of call that I don't want to take). The docs seem great and really laid back and the PAs told me they really aren't super stressed. Most importantly, they're an independent democratic group and they work really hard to find PAs that want to stay for a long time. I'm really hoping I can just let go of some of the stress I've been carrying around. Academically, I'm quite passionate about ortho and my happy place is in the OR. There's a couple of surgeons I love working with so I offered to stay on per diem for OR help. Since they're going to be extremely short staffed, and I don't get any benefits anymore other than malpractice, one would think they might at least pay me more? I'm not even asking for $80/hr which is my current on call pay. Which is an amount less than they're paying all the OR and ED RN travelers. Nah, hospital HR says it's my normal hourly pay. Comical. I'm a very loyal conscientious person and felt really guilty at first about leaving...but with that, I think I may just talk to my friends at the ortho private practice in town and see if they need OR coverage when their PAs are out on vacation. I can about guarantee they'd pay me more. Moral of the story for me, anyhow: 1) I'm not sure I would take a job again that didn't offer me an employment contract to sign that delineated exactly what my conditions of employment and work responsibilities are. And if those changed, I would want to sign an updated contract. 2) I'm of two minds about working for a big hospital system like this again as a practice employee. I think I'd want to feel out carefully how the leadership is and how much autonomy the individual practice versus the hospital has before I accept a position again. These big hospitals don't seem to care how experienced or how valuable you are to the team.
  2. That's not true in ortho anyway. PAs are way more profitable/turning RVUs in clinic than in the OR, and not all cases reimburse for a FA (ie, simple knee scopes, carpal tunnels, trigger fingers). When I was in private practice, I'd do a split OR day twice a week - help with reimbursable cases in the morning, go to clinic in the afternoon while he stayed and scoped knees.
  3. I don't have the answer, but this really resonated with me and I'm going to ramble a minute. Also have changed jobs with about the same frequency and I don't feel like I'm quite ready to leave my current but I know I need to to protect my mental health and overall well being. Really trying to make it another 10-15 years before I retire from clinical medicine, anyway. Might move on to a second career at that point. Working at a large semi-academic level 1 trauma doing mostly orthopaedic trauma as a hospital employee currently. It was awesome when I started and I thought for sure I'd stay forever, but the hospital reorganized "APP" leadership and brought in consultants and it's like screaming into the void when I have legitimate staffing concerns for patient safety because there are so many levels of bureaucracy you have to fight through. Also, we are pulled in a million different directions and asked to do more short staffed than any of the other services. Whereas we were once just pretty much in the OR and on trauma call at the big house, we're now also picking up call for two more satellite hospitals and have to run three urgent cares but the hospital says it doesn't make financial sense to hire any more of us. Now we're working at least two to four weekend days a month with no additional off during the week. I'm really sad. These are the best, smartest colleagues and friends I've ever worked with and I'd miss them terribly, I love that no two days are the same, I really love being in the OR and doing the dance of anticipating your surgeon's next step. I love all the procedures we get to do, love being in the trauma bay, love feeling like I'm practicing at the top of my license. I know objectively I'm great at my job and I really love orthopaedics. But I can't even take care of myself doing this job sometimes, and as far as I know we only get one life to live. There was a solid period earlier this year where I didn't cook for myself for weeks, wasn't exercising, wasn't doing basic stuff to feel like I was a human being, was just shuffling through trying to get by. Had a relationship fall apart over it. I had nothing to give myself, let alone my partner. I'm really hoping the ED group I interviewed with gets back to me with a yes. I haven't worked ED in almost 10 years and I'm legitimately considering going back, amidst a pandemic. Because they're a small independent group and I was told during the interview process "I want to hire PAs that will stay for a long time". The PAs I talked to all felt supported and like they weren't being asked to work to the bone. And the fact that their benefits are the best I've seen in years of interviewing doesn't hurt. I do feel like I have some moral injury and have toyed with leaving clinical medicine before. I want to try to stay a little longer because I still can't picture what else I want to do. But I need to put on my own oxygen mask first.
  4. We had an OPA in my old group - he's probably in his mid to late 60s now and just surgical assists full time. He was in the Navy around Vietnam and got OPA training at that point. I have no clue if any insurance reimburses for his services, but he's the best first assist I've ever met, so I'm pretty sure the docs just ate the cost of his salary.
  5. I've gotten a tentative offer for a GS job that is somewhere in Europe. It sounds quite interesting - I'm basically *the* specialty PA for the installation and my supervising MDs are 8-9 hours away by ground. Lots of autonomy and I've enjoyed working with military populations in the past (although I've never been military myself). And likely no more than 12 patients a day, which sounds like a dream. Anyone ever worked a job like this and have insight as to whether pay is competitive in the end? I immediately laughed when I saw the pay attached to the tentative offer. I have 10 years of experience and they offered me HALF what I currently make. Less than what I made as a baby PA. I immediately asked formally in writing to negotiate the salary higher and haven't gotten any word on that or if there is a living quarters allowance available (the cost of living is approximately the same there as it is where I live in CONUS). I know civilian hiring works at a glacial speed, and I was told "oh, it'll at least be a month or two." I've been interested in working outside the US for a while, but man, it is difficult in my mind to justify being able to travel all Europe but not saving anything at all for retirement for a few years (not to mention what that might do for salary negotiations for any future jobs). On the other hand, I don't have kids, a spouse, and am not super tied down...
  6. Ortho here - I work for a big practice and scrub with all our sub specialists. I recommend leaded glasses, especially if your CME will pay for them and you're doing a lot of foot and ankle or trauma/fracture cases (they seem to use the most fluoro, IMO). I got some Costa Del Mar frames off Amazon and they're not too heavy with a glasses retainer. I think they're around $200-ish. Good shoes and compression socks - whatever works for you. I also have a pair of cheap rain boots that live in my locker for arthroscopy cases (I loathe the disposable booties). Lead is huge - my practice buys us all our own lead after we've been there a year. Properly fitting lead does a world of difference in terms of actually protecting you (improperly fitting lead does not protect breast tissue well for the women!) AND being comfortable to wear for long cases. It's expensive though - probably good that they're paying for it for you. I think it's a couple hundred bucks for a good apron (or more for a skirt/vest like I prefer). If you do hand or spine, loupes definitely made a BIG difference for me in terms of being able to actually see and participate more in the case. They're pricey though - mine were about $1500. I like my own cloth scrub caps too (if your hospital lets you), but I doubt they'll let you use CME funds to buy those
  7. Has anyone here done a stint with the Foreign Service? I'm quite interested, as I've been thinking for years how I might be able to immerse myself in a different culture abroad yet still make a living as a PA (as we all know, the international options for employment for PAs short of military are still limited). I've worked in EM in the past although it's been a couple years, and now do ortho trauma. I don't really have a ton of direct primary care experience, but I like to think I'm pretty calm, adaptable and the idea of austere medicine doesn't scare me. Any input? For what it's worth, I don't really have a family to move around with me - my partner is active duty, and he's totally supportive.
  8. ^ Devil's advocate: sometimes you can be constantly exposed to it with parents working in healthcare while you were growing up, work in healthcare for several years yourself before going to PA school, be quite sure that's what you want to do with your life, and then actually get into practice for a few years and realize the state of American healthcare with all the numerous ways it can inflict moral injury...maybe it's not worth it and start thinking about other ways that you might be able to make money and be happier. I'm smart, and not to toot my own horn, but I'm quite competent and good at what I do. I am a good PA. But feeling like I'm just a cog in a wheel, the push to see more and more patients for less money, having no meaningful outlet to speak up and change what bothers me with my practice because I work for a massive institution, and not being able to find another job in my metro area that might possibly meet what I'm looking for, among other things...that all burns me out, big time. And life is just too short and precious to be distressed doing something that I spend anywhere from 8-12+ of my waking hours doing. I think some of it may certainly be that I'm more self aware and I've changed as a human too where my life goals and priorities lie over the past 10 years, but it remains to be seen how much longer I'll stay clinical too, as I replied further up the thread. I'm so tired of this notion that "you're wrong and don't have the intestinal fortitude to practice for 30-40 years and you took up a spot for someone else."
  9. I agree with all this. I've been a PA for close to 8 years now. Some of it is my current clinical setting, I think (employed by the hospital). We're constantly short staffed and asked to do more and more with the same number of PAs. There has steadily been more and more call added since I started, and I feel like I've been sold a false bill of goods in a way about how much call was involved when I took this job (been here about two years). It's like screaming into the void when I talk to my PA supervisor. If he takes something to admin, nothing gets done about it, so there's no use in complaining. I've literally had a surgeon tell me "well none of you guys leave so it must not be that bad" even though we all complain, all the time. Guess what? There's literally no other ortho jobs in the metro area because the market is saturated. That's why nobody leaves. I had some different complaints when I was in private ortho practice at my prior job - it was definitely all about the money and I was miserable trying to see 32 patients in a full clinic day and never being able to chart on them all and spending hours of my personal time charting. Got paid better, though. I've battled with if I want to stay clinical or not. I don't see an easy path out to transitioning to something non-clinical yet (clinical informatics maybe? consulting?) and I think my best solution is to try to work for myself. I've taken steps toward my own surgical first assisting LLC. It's a lot to set up, but the idea of having some control over my schedule and my vacation time and no call (I just work or don't get paid) sounds so appealing.
  10. No idea what part of the state you're in, but I saw this listing on NCAPA to walk into a practice ownership: https://jobs.ncapa.org/job/medical-practice-for-sale/49479177/
  11. This is very much an idea in its infancy, but I thought I would reach out to see if anyone else has started their own LLC for surgical first assisting and been successful at it. I have about 7 years of ortho experience under my belt. I'm starting to feel quite a bit of burnout and am examining my options for what I might be able to do to still stay clinical. I know I'm good at what I do, so I don't want to walk away entirely from clinical medicine. Being in the OR is by far what I love most about my job, and the idea of something where I can make my own schedule and get some autonomy back about taking time off sounds incredibly appealing. Did you hire someone to help with insurance billing? How did you find a SP? (I'm pretty sure I could reach out to my last SP and he'd do it if I compensated him.) How did you market/find MDs to work with?
  12. I think there will be one at the Salisbury, NC VA affiliated with Wake Forest.
  13. Personally, I looked on ebay and put together a Welch Allyn kit for about $150-170 (got all the various pieces in separate auctions). It isn't a fancy panoptic, but it works fine. I know some people in my class are using the "no-name" cheaper sets and have gotten by just fine (a lot of practices have the wall mounted models now anyway, so you might not even need them for rotations).
  14. ^ Wish they would have made that clear on their web site. It was a waste of my money to even apply there, then...and a waste of their money and time to send me the rejection letter. Oh well! Wake's PANCE rate has been hanging out around the national average for the past couple of years...I think it was down a little bit last year. At the interview they explained that although there is a review course available before taking the test, the general focus of coursework throughout the program is not simply to "teach to the test". They try to teach students to think and learn in a more clinically based, active learning style rather than just passively learning from lecture. Regardless, they are trying to look at ways they can improve the first time pass rate, and virtually all who had to take it again passed on the second try. I also think Methodist has some good things going for it too. I was impressed at my interview with the way they portrayed the program and it seems well organized. Additionally, they are building a brand new facility for the cadaver lab and lecture hall that should be done by this fall. In the end I decided to attend Wake, mostly because of the price difference and also because I feel that it's a slightly better established program.
  15. I am a Wake grad as well and was also an HES major and very involved on campus...I applied this cycle to ECU, UF, and MUSC out of the schools on your list, with a 3.18 ugrad GPA, 3.0 science, and a year's paid work experience in addition to the volunteer work experience I had during school. I got a very quick rejection at ECU (I'm guessing they probably have a GPA minimum which I did not meet). I was also rejected at UF and MUSC, but was accepted at Methodist and Wake. Would you consider adding Wake's program to your list? I know the program is a little different (they use PBL instead of the traditional lecture style), but I think they are probably more understanding of WFU's grade deflation (we briefly talked about my GPA during my interview, but it was not a sticking point). Getting paid healthcare experience will help, but I also would consider taking some more science classes post-bac to boost your GPA. Good luck, and PM me if I can be of help to you!
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