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  1. Hi everyone, I am looking for some help and advice. I will preface this with a short about me. I am a PA with 8 years of experience in mostly primary care. I currently live in Michigan. I have no history of any malpractice claims against me and all reviews about me online I can find are positive or 5 stars. I went to a private school and have about 25k in student loans of an original balance of 180k.I am married with 2 young children. Being a PA is a second career for me after burning out as a teacher in AZ. My current situation is this: My wife is a teacher who has had a hard time finding work In MI because of out of state certification finally found a job she liked but was far away from my job and caused a burdensome commute. We agreed to move in spring of 2020. Shortly after my contract would be over. My employer learned of this when discussing if I would renew contract and they found a replacement for me this ending my employment in violation of contract (I was supposed to be given 60 days) I chose not to fight it because I knew I would need them as a reference I the future. I scrambled to find something in the 3 weeks I was given and was hired at an urgent care with no benefits no retirement. It is a newer clinic not part of a chain and less than a year old and I see about 10 patients in a 13 hour shift on average. I have been there 3 months now. I have interviewed at a small nonprofit private school that is starting a PA program, am waiting to hear back and a different urgent care looking for people to start in 3 months that is part of a larger physician group. It offers benefits PTO and retirement. Have also applied to other family med practices or specialties etc with many sounding sketchy or too far away. The whole situation has left me burned out and depressed. I feel inadequate as a provider and just disenchanted with medicine. Before the job change I was frustrated but primarily with the insurance bureaucracy. I do not think the current office has long term sustainability and think I need to find something better. Teaching would be nice but I wonder if there are too many PA programs and if it is sustainable past 5 years. Also I wonder if I am feeling so burned out and frustrated should I be teaching other students. Another urgent care would at least have benefits but sometimes I even just feel sick of dealing with the patients and trying to keep them happy. I need to at least be a PA for a few years more to pay off student loans. I really don’t feel like specializing much because a l have known too many that seem to push procedures and don’t listen to patients and I don’t want to get into that world. Not interested in doing insurance reviews because insurances are a lot of the problem with healthcare especially for low income people. I am looking for any opinions or guidance on what I should do. Should I be teaching? Should I even be practicing medicine anymore? I have already gotten placed on Cymbalta. Waiting for it to kick in. I know now I should have just lied to my old employer and said I would be around forever and jump ship at my convenience. I can’t do anything about that. Need some opinions on what to do going forward. sorry for such a long post......thank you for any opinions
  2. I don't really comfortable speaking this frankly to my colleagues. None of my close friends or family are in the medical field so they don't truly understand. I am still a somewhat new PA and I am already considering a new career path. I went to PA school 2 years after graduating college, so I don't have any experience in any other fields besides healthcare. But I've been having serious thoughts about quitting my job and quitting the medical field altogether. A little background about me, I am in my late 20s and I have been a practicing PA for about 4 years. During this time I have been at the same practice, a specialty and internal medicine office. There are several physicians, but I am employed by one. I see patients in the clinic, in several acute care hospitals, and at nursing homes. Although I like the variety and the types of patients I see are very interesting to me, there are downsides to the job that just become more apparent every day. I work M-F 9-5 and 2 weekends per month. I have to take round at the hospitals and take calls on those 2 weekends, plus take calls 3 weekdays out of the week. I often work 3 weekends a month, and occasionally even 4 when my contract technically says 2. My supervising physician is retirement age and he refuses to retire and instead delegates more and more tasks to me. For example, sometimes if he is too tired / lazy he will tell the staff to just transfer patient appointments to my schedule. Patients are understandably upset when they made an appointment with the doctor they've known for years and get switched to the schedule of a PA they don't know. I feel like "as the PA", and an employee of the doctor, I pretty much get saddled with all the grunt work and undesirable tasks that he doesn't want to do. I know in other settings PAs are treated with a little more respect and not just given the busy work to do. There are some upsides, I do like my SP, we work well together, and I feel like I can honestly and freely discuss patients with him without judgment. I also know that he may retire in a few years so this job won't be permanent either. I don't know if getting a new job will help. I applied for two separate jobs that I did not get. One was a family practice M-F with no call/weekends and the other was an allergy practice M-F with no call/weekends. Getting rejected for both of those jobs really discouraged me and made me feel trapped at this job. It won't be easy to find a new position. I get frustrated with patients too. It just feels like there are so many patients who are med seeking. Some providers in my area were recently sentenced to prison time for overprescribing narcotics. They were reckless with their prescribing and I am quite careful, but the fact that jail time is in the realm of possibility for our profession constantly looms over my head. Patients also often want to be on disability when they clearly do not need to. There are so many patients wanting DMV disability placards and getting irate when I tell them they don't qualify. In addition, patients whose licenses get revoked want me to sign off on them being safe to drive when there was a clear reason the licenses were revoked. Again, I am on the receiving end of the brunt of their frustration and anger when I say they need a specialist clearance. There is just so much liability in our career field and so much stress involved. Liability is always there medically too. YOUR decision can affect whether a patient LIVES or DIES and it's so much stress that I have actually developed my own health issues secondary to the stress. I have had a patient stalk me and become obsessed with me. He wrote me unhinged letters and made many calls to the office describing my car, etc. We had to get the police involved and I considered filing a legal restraining order. I know this is possible in any profession, but it feels like healthcare can be personal and intimate and patients can get the wrong idea. I again contemplated quitting the profession at this time. I have looked into other careers such as being a pharmaceutical representative, working in research, being an accountant, ANYTHING other than this. I have contemplated quitting and just living off my savings until I figure it out. I have talked to some colleagues to an extent, many are much older and have been PAs longer than me. I sometimes question if I'm just being an entitled millennial who wants life-work balance early on in their career until I realize that it's not normal or common to work 24-25 days in a row. It's not normal to only get 4 days off a month (if that. Some days I would get 2 days off a month.) I actually finally told my SP I was considering leaving because I was too burnt out. He trivialized my concerns and said "Why are you burnt out? You're young. I have been doing this for 40 years." Which is true, but this wasn't the life I envisioned for myself. After talking, he did acknowledge my concerns, and he hired an NP who can help me with the workload and guaranteed that I will only have to work the 2 weekends a month as outlined in my contract and I did get a raise. (I still feel like I'm underpaid which is a whole separate story.) Sorry for the essay, I just really needed somewhere to air out my frustrations with other people in my career field. Thanks in advance for reading.
  3. Hello fellow PA's! I'm been working 4+ years in EM, and currently find myself in a job that I cannot stand any longer. First of all, I work in Camden, NJ which is a god-forsaken, urban wasteland. The facility is a stand-alone ED, which basically serves as an all-in-one ER/family practice/STD clinic with no appointments and constant stream of patients. Patients either can't get in to see their PCP or simply do not want to wait, so they all funnel in here. Wait times in surrounding local ERs have steadily increased, so we are seeing more complex patients come in as people simply do not want to wait (knowing all-to-well that we will likely transfer them out). There is high autonomy which I am comfortable with. I would say only 1 out of 10 patients I see truly merit a trip to the ER, and that's being generous. There is constant eloping, AMAs, work-note seeking, walking out after preg test is negative, etc... The arrogance and rudeness of the average patient here is simply astounding. The drug seeking is actually not as bad as the suburban ER I worked at previously, presumably because street drugs are so easily to obtain. The volume is very high, as most patients are low acuity. And because of this, the entire staff is quite jaded and there is usually some push back on doing some testing unless it obviously needed. I've witnessed some pretty risky medical decisions being made in the spirit of "get 'em in, get 'em out". Now, I have to say I work with good people that seem miserable with work. Life circumstances have somehow trapped them into working here for years (debt, kids in school, inertia, etc...). Speaking for myself, I think I've tolerated this job for just over a year only because the hours are better than most ERs and I've got this notion that I must pay off all my student debt before I move on (which would be about another 18 months out at my going rate). Well, I've decided I simply can't do that anymore. Its affecting my relationships and personal life. I'm fighting off low-grade depression, and constantly exercising just to stay sane. I've lost a lot of enthusiasm for practicing medicine, although I still take pride in my work. I frequently feel like I'm wasting my time. I have other interests (much less lucrative) outside of the medical field. I not sure I can work emergency medicine anymore, but unsure what my next move is. So, my loose plan is resign around next July, and take a couple months off to recharge and regroup, travel and explore options. I have a significant other but no kids, and we both want to get the heck out of the Philadelphia area. Colorado, CA, Oregon? Considering part-time work for a bit, maybe locum tenens? Non-clinical work? How problematic is it to apply for jobs out-of-state without an active state license? Anyone with part-time urgent care jobs that can chime in on their experience? I have to get out this situation before it sucks my soul away! Any advice or sympathy is appreciated!
  4. At 25 yrs in - is this really what has become of medicine and is there any hope it will get better? Medicine isn't fun anymore. I don't get that kick of satisfaction that I am actually helping anyone anymore. Mostly - I am STUCK, TRAPPED - I support my family and need to have an income equivalent to what I make now. What else is there? I have beat myself up about this for months now. I make more than most people in my community. I should be grateful. I should not complain…. We still have kids to go to college. I support my family. We aren't in major debt but we need what I make to stay in the general condition we are in. Moving isn't really an option with the kids in high school. And, is it any better anywhere else? I am doubting it. I can't talk to anyone where I work or live - the whole town is now owned by 3 major employers and they buy up whatever they don't already have their hands on. Limited employers = limited options. The doctor I am paired with now is much younger than me with little experience and no spine, no leadership qualities. I am carrying our program yet this doc is "in charge". We have more administrators than we do providers. How does that work? Teaching is a favorite of mine. The PA schools in my state are state universities. I can look up anyone's salary. It is pathetic. The PA/PhD who runs the program makes nearly $40K LESS than I do. How can educators be paid so little if they are responsible for the future of our profession? They require a Masters degree to be on full time staff at the PA programs. I don't have a Masters either. I was told 25 years ago that I wouldn't need one. The only thing that mattered was my NCCPA. It wasn't like our program wasn't Masters level work anyway, I just don't have the degree to go with it. I have 25 years of experience though - that counts for squat unless I have the little letters. Why would I spend my money to get a Masters to go teach in a program that pays me way less than a clinical job? I am really good at what I do. I generally like my patients. This used to be fun and rewarding. The daily grind of talking to high school graduates with a cook book who deny my requests along with an asinine EHR and admins counting RVUs till the cows come home combined with subpar staff - what happened to RNs and LPNs? - and then tack on Meaningful Use and the whole Medical Home BS and I am done - cooked, finished. I am seriously going to be held accountable for my patient who will not stop smoking or can't get their A1c below 8?… Am I expected to go home with them at night and monitor their behavior? I have my own kids to raise, thank you. ​Combine all this with a staggering event in my career - I was named in a lawsuit - THREE years ago - based on one day on call with a different doctor and peripheral interaction with a disgruntled patient. It is now FIVE years since the incident in question and absolutely nothing has transpired. I am mortified, disgusted and embarrassed. I tell no one about the suit. I have never been deposed by anyone - the plaintiff's attorney is a schmuck who keeps filing motions and has delayed all activities for THREE YEARS now. I have little recollection of the event to begin with. Now, I am held hostage by this and nothing is coming to closure. My entire career could be detrimentally affected by this and I have no power, no say and it can drag on forever it seems. How is that legal or ethical or allowed? Makes me want to flip burgers. We contemplated buying a coffee stand - I don't drink coffee. I considered opening a restaurant - no training or hx of food service. I even considered going to work with the medical examiner - dead folks don't complain too much. I am betting I am not alone but there is no one to talk to confidentially where I live. My family doesn't get this. I feel guilty and trapped and needing to support my family. Is this really as good as it gets?
  5. Why do PAs burnout? I realize WE all need to find ways to de-stress our lives. What tips have helped you when things seem to fall apart?
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