Mrs. PAC Posted August 28, 2013 Share Posted August 28, 2013 I have been working as a Family Medicine PA for 5 years and am completely burned out. Does anyone else feel the Same and what do you do about it? From all the chronic pains to patients who have become so attached to me and just want me to be their counselor. They don't want to be referred since ins most likely won't cover it. There are those that are there for simple follow up so they end up chatting a few min and then at the end of visit when I need to be starting my next patient they have more questions or often times a serious complaint like chest pain. How do you get patients to stop talking about everything else but what they came in for? They all want to know how my life is or how my recent trips were since I wasn't in office last few visits. Then next come the drug reps, I can't stand when they ask sooo many questions about if and how and when we use there drug, if not they want to know why..then they too ask questions about me and how I'm doing or if I have anything planned for weekend of any vacations. I could go on and on but would like some opinions especially from those who work in FM. Link to comment Share on other sites More sharing options...
gleannfia Posted August 28, 2013 Share Posted August 28, 2013 Yep. 26 year veteran here. FP is by far the area in which one is most likely to suffer job fatigue, especially if you are a woman. People will in general open up more and "dump" if you are female. Why do you think docs are not going into PC anymore? (among other reasons). It is also a symptom of our society, where everyone is maxed out on tech and experience little human connection. I felt more like a shrink when I was doing FP. Hear you on the drug reps, too. I have had to get downright rude with some of them. They can be incredibly pushy. And so many of them have "me-too" drugs, you don't want to waste your time. I have told at least one that my patients are my priority, not them. As to what to do? It depends upon your personal situation. If you are able to work part-time, that would help. I realize that most people cannot do this. You may want to consider training in a specialty. Many hospitals/clinics will train you in oncology, nephrology, etc. I went to oncology after getting burned out in PC. Now, I am doing locum tenens, where I have control over how much and when I work. That has helped me tremendously. However, I am single with no dependents, and I realize most people are not in the same situation as me. I wish I had a great answer for you. Just know that you are not alone, many of us feel/have felt the same. Primary care is tough. Much tougher even than oncology, in my experience. Link to comment Share on other sites More sharing options...
Jengirl81 Posted August 28, 2013 Share Posted August 28, 2013 Mrs. PAC- I could have written your post. I was also in FP for 5 years. Everything that you said would happen to me also. I wouldn't have changed it because I did get my school loans paid for through the NHSC, I learned a lot, and I did enjoy some of the patients. What did I do to get out of it? I got pregnant, took maternity leave (unpaid), and didn't come back! I did have intentions of returning part-time, but in the end, wasn't worth it. My stress level has gone down tremendously, along with a happier husband bc I'm not complaining about work every day. I was paid a base of 80,000 pluses around 5,000 in bonuses by the time I left. Lower than what I should have been getting with the amount of patients, and seniority I had. The PA who took over for me only lasted 6 months. What now? I'm looking for my part-time dream job- either Derm or urgent care. Good luck! Hope you find something that makes you happy. Link to comment Share on other sites More sharing options...
bobuddy Posted August 28, 2013 Share Posted August 28, 2013 12 years in FP. What helped me the most was to go from working 5 days a week down to 4. It made a huge difference in my attitude. I completely understand where you are coming from. Changing from FP to something like Urgent care might help. For those patients that want to say "oh by the way" - you can refer them back to their primary care provider and send them on their way. Link to comment Share on other sites More sharing options...
Jengirl81 Posted August 28, 2013 Share Posted August 28, 2013 You got it, bobuddy! Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 28, 2013 Moderator Share Posted August 28, 2013 yup 4 or 3 day work week is essential cutting people off and finishing the visit on time is essential - they can come back to chat later Realize you are just their PCP, not any more..... learn from the Docs and move m out...... Link to comment Share on other sites More sharing options...
bobuddy Posted August 28, 2013 Share Posted August 28, 2013 Mrs. PAC and everyone else- you will be able to relate to this: My last patient used the lovely new/improved technology of her smart phone to provide me a voice recording of her symptoms. She thought she was being high tech. She laid her phone down on the table next to me so I could hear her voice every complaint she ever had. I looked at the time length of this voice recording. 17 minutes and 24 seconds of her symptoms. I immediately picked up the phone, turned it off and handed it back to her. "Now, what brings you in today? " I said with a smile...... Ugh.... Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 28, 2013 Moderator Share Posted August 28, 2013 Mrs. PAC and everyone else- you will be able to relate to this: My last patient used the lovely new/improved technology of her smart phone to provide me a voice recording of her symptoms. She thought she was being high tech. She laid her phone down on the table next to me so I could hear her voice every complaint she ever had. I looked at the time length of this voice recording. 17 minutes and 24 seconds of her symptoms. I immediately picked up the phone, turned it off and handed it back to her. "Now, what brings you in today? " I said with a smile...... Ugh.... thats a good one!! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 28, 2013 Moderator Share Posted August 28, 2013 I found after 26 years the best way to avoid burnout was to stop doing things that make me miserable. one of my jobs has a particular site that is completely disorganized and the pa ALWAYS gets dumped on. I told them not to schedule me there any more. if they do I will likely start job hunting. fortunately, I have options, I realize many folks don't. Link to comment Share on other sites More sharing options...
FSUnoles Posted August 28, 2013 Share Posted August 28, 2013 they tell us out of school to go right into primary care. I get it but at the same time i didnt particularly enjoy the patient population when i did those rotations. I found life was much better in a specialty being able to focus on a specific set of issues and referring everything else out. It doesnt help the pay associated with primary care doesnt lure me with the loan amount i have to pay back Link to comment Share on other sites More sharing options...
cbrsmurf Posted August 28, 2013 Share Posted August 28, 2013 I actually like working in FP. I'll go show myself out now. Link to comment Share on other sites More sharing options...
bradtPA Posted August 28, 2013 Share Posted August 28, 2013 I actually like working in FP. I'll go show myself out now. I like it too. I just have to accept there are parts of it that are frustrating to get to the more enjoyable parts. Such as the new patient today demanding I write his 90 sixty mg MS ER tabs and 240 Percocet 5/325 mg tabs for breakthrough. Refused to go to pain management for help as well. He left when it was explained we did not do high dose narcotic therapy in family medicine and I doubt he will be back. That's the bad. The good, though is when you can get a sleep study on a horribly depressed fatigued patient, get them on CPAP, and have them come back stating its "life changing". Makes it worth it every time. Link to comment Share on other sites More sharing options...
gleannfia Posted August 28, 2013 Share Posted August 28, 2013 I actually like working in FP. I'll go show myself out now. Good. You are needed. Link to comment Share on other sites More sharing options...
KCMA79 Posted August 29, 2013 Share Posted August 29, 2013 I spent 18 yrs in PC before I burned out. Fortunately the agency I worked for allowed me to move into admin and then I carved out a niche in the medical aspects of disaster preparedness/WMD preparedness. Look for non traditional roles even if it means a loss of income, you will live longer. Link to comment Share on other sites More sharing options...
paleanne Posted August 29, 2013 Share Posted August 29, 2013 I've been in FP for 6 years and feel exactly the same way. I still love FP, but am overwhelmed with the expectation to see 25 or more patients a day, increasing paperwork, demanding patients, insurance companies, etc... In fact, I took a break from researching locum tenens jobs, to browse this forum. I'm beyond burnt out. I know this is not a good situation for me, my family or my patients. The physician I work for is near retirement age and I also suffer the guilt of abandoning him at the end of his career. My goal is to stick it out for one more year, due to some family issues and then go into locum tenens. I just hope I can make it for the rest of the year without having a break down.... Link to comment Share on other sites More sharing options...
Guest Paula Posted August 30, 2013 Share Posted August 30, 2013 I actually like working in FP. I'll go show myself out now. I like FP too. Go work on a reservation in the boonies. You will have the best time ever. You will get paid for 12 psychiatric days (Fed. Holidays), will be allowed to leave early, will get surprise days off because someone died and the ceremonies will be attended by the whole tribe, or it's nice out and the last day of summer is here and you know how LOOONNNGGG the winters are in the UP, with our 200-300 inches of snow. Plus the humor from the people will keep you laughing all day long. When someone comes in and says they now have square farts and wonder what is wrong with them....well,how can you not laugh! Plus you will get the patients who come up to you and hug you and say in front of everyone, including the doc and NP, that "thanks to this lady, she knew what she was doing and sent me to pulmonology," and lung cancer was found. (That's not the good part...). Plus the little kids....what potential! Helping Mom and Dad learn to parent is a challenge, but one that we must rise up to. I could go on and on. Helping a new onset diabetic and showing them how to use their insulin pen. Gosh, I almost want to get off the computer and go back to work right now! I LOVE MY JOB!. P.S. I am not on production, I can spend 15, 30 minutes or more if needed. I am not under pressure to see 25 pts. a day. I truly practice medicine and think I have it better than anyone. A glass of wine now and then after work helps, too! Off my soliloquy. Link to comment Share on other sites More sharing options...
Mrs. PAC Posted August 30, 2013 Author Share Posted August 30, 2013 I never thought FM would be this demanding and stressful but I love to treat my patients so much. The Doc hardly sees patients, I do all the work and he steps in room to say hello to patient. I interpret all labs and take all calls in office and am on call everyday. How do you go about such a change and explain to the doc that I'm going somewhere else? Where do you start and what is the most professional way to go about it. How much time do I need to give him? 4 wks? 3 months? He will make it very difficult for me to leave since I run his whole entire practice. I would love to do derm with focus on cosmetic injections. Ideally if I found a FM job that I was 100 % independent, and had to see 15-20 patients max. I see about 30 now and I have had it. I feel that he would ask me to train the next PA. Is that fair? Yep. 26 year veteran here. FP is by far the area in which one is most likely to suffer job fatigue, especially if you are a woman. People will in general open up more and "dump" if you are female. Why do you think docs are not going into PC anymore? (among other reasons). It is also a symptom of our society, where everyone is maxed out on tech and experience little human connection. I felt more like a shrink when I was doing FP. Hear you on the drug reps, too. I have had to get downright rude with some of them. They can be incredibly pushy. And so many of them have "me-too" drugs, you don't want to waste your time. I have told at least one that my patients are my priority, not them. As to what to do? It depends upon your personal situation. If you are able to work part-time, that would help. I realize that most people cannot do this. You may want to consider training in a specialty. Many hospitals/clinics will train you in oncology, nephrology, etc. I went to oncology after getting burned out in PC. Now, I am doing locum tenens, where I have control over how much and when I work. That has helped me tremendously. However, I am single with no dependents, and I realize most people are not in the same situation as me. I wish I had a great answer for you. Just know that you are not alone, many of us feel/have felt the same. Primary care is tough. Much tougher even than oncology, in my experience. Link to comment Share on other sites More sharing options...
Mrs. PAC Posted August 30, 2013 Author Share Posted August 30, 2013 That sounds great but don't you get tired from all the depression and anxiety pts have? Or does the Psychiatrist do the counseling? I like FP too. Go work on a reservation in the boonies. You will have the best time ever. You will get paid for 12 psychiatric days (Fed. Holidays), will be allowed to leave early, will get surprise days off because someone died and the ceremonies will be attended by the whole tribe, or it's nice out and the last day of summer is here and you know how LOOONNNGGG the winters are in the UP, with our 200-300 inches of snow. Plus the humor from the people will keep you laughing all day long. When someone comes in and says they now have square farts and wonder what is wrong with them....well,how can you not laugh! Plus you will get the patients who come up to you and hug you and say in front of everyone, including the doc and NP, that "thanks to this lady, she knew what she was doing and sent me to pulmonology," and lung cancer was found. (That's not the good part...). Plus the little kids....what potential! Helping Mom and Dad learn to parent is a challenge, but one that we must rise up to. I could go on and on. Helping a new onset diabetic and showing them how to use their insulin pen. Gosh, I almost want to get off the computer and go back to work right now! I LOVE MY JOB!. P.S. I am not on production, I can spend 15, 30 minutes or more if needed. I am not under pressure to see 25 pts. a day. I truly practice medicine and think I have it better than anyone. A glass of wine now and then after work helps, too! Off my soliloquy. Link to comment Share on other sites More sharing options...
Mrs. PAC Posted August 30, 2013 Author Share Posted August 30, 2013 I do not have experience with suturing besides PA school. What are the hours typically? Link to comment Share on other sites More sharing options...
Guest Paula Posted August 30, 2013 Share Posted August 30, 2013 That sounds great but don't you get tired from all the depression and anxiety pts have? Or does the Psychiatrist do the counseling? We have a behavioral health department and that helps. But I enjoy those patients, too. I'm kinda weird that way. Does your Doc see every patient you see? It sounded like that is what you were saying when you said he steps in the room to say hello? IF that's the case, you are being taken advantage of. If he sees hardly any patients, then you need to go to him and demand that you get the salary of an MD...oh, let's say $200,000 or so and he needs to take the $80,000 salary. Ask him to switch positions with you! If you truly are looking for a new job, then get the job first and make sure it is secure before you give your two week notice. You are not obligated to train a new employee. The Dr. you work with sounds lazy. Link to comment Share on other sites More sharing options...
bobuddy Posted August 30, 2013 Share Posted August 30, 2013 We have a behavioral health department and that helps. But I enjoy those patients, too. I'm kinda weird that way. Does your Doc see every patient you see? It sounded like that is what you were saying when you said he steps in the room to say hello? IF that's the case, you are being taken advantage of. If he sees hardly any patients, then you need to go to him and demand that you get the salary of an MD...oh, let's say $200,000 or so and he needs to take the $80,000 salary. Ask him to switch positions with you! If you truly are looking for a new job, then get the job first and make sure it is secure before you give your two week notice. You are not obligated to train a new employee. The Dr. you work with sounds lazy. Agree with Paula. Mrs. PAC - you are being taken advantage of. Start looking for a different position asap and when you find one and have an offer in hand - IF and only IF you really want to stay where you are currently working - then go to the doc and present what salary and hours you think is fair. If you really do not want to stay - then give your 2 weeks or 4 weeks (max) and say thank you very much for the experience. No, you do not have to train the new employee - but if you do, I would sit this new person down and tell them the facts about the job and what they are getting into. FWIW - I have started a few bitter threads this week. But, all in all, I love my job and my patients. I am in small town KY and this is truly a family practice. In many cases, I see the husband/wife/children/grandparents/aunts/uncles/cousins - you name it. I know exactly what is going on in the family dynamics so when I have a patient coming in for depression symptoms, most likely I know the cause. I attend birthday parties, weddings, cookouts, and funerals. I cannot walk down the street without patients waving hello from their vehicles or as in the case yesterday when I went to the local courthouse - a patient opens her office window to yell hello from across the street. The people in this town are my extended family and I make sure they know it and I try to treat them as such. I am sure it would be different in a bigger city. Link to comment Share on other sites More sharing options...
Guest Paula Posted August 30, 2013 Share Posted August 30, 2013 Agree with Paula. Mrs. PAC - you are being taken advantage of. Start looking for a different position asap and when you find one and have an offer in hand - IF and only IF you really want to stay where you are currently working - then go to the doc and present what salary and hours you think is fair. If you really do not want to stay - then give your 2 weeks or 4 weeks (max) and say thank you very much for the experience. No, you do not have to train the new employee - but if you do, I would sit this new person down and tell them the facts about the job and what they are getting into. FWIW - I have started a few bitter threads this week. But, all in all, I love my job and my patients. I am in small town KY and this is truly a family practice. In many cases, I see the husband/wife/children/grandparents/aunts/uncles/cousins - you name it. I know exactly what is going on in the family dynamics so when I have a patient coming in for depression symptoms, most likely I know the cause. I attend birthday parties, weddings, cookouts, and funerals. I cannot walk down the street without patients waving hello from their vehicles or as in the case yesterday when I went to the local courthouse - a patient opens her office window to yell hello from across the street. The people in this town are my extended family and I make sure they know it and I try to treat them as such. I am sure it would be different in a bigger city. We forgive you for the bitter threads. We all have them. I love small towns, nothing beats them. There is still a little bit of Americana in the US....you and I are part of it. Link to comment Share on other sites More sharing options...
gleannfia Posted August 30, 2013 Share Posted August 30, 2013 We have a behavioral health department and that helps. But I enjoy those patients, too. I'm kinda weird that way. Does your Doc see every patient you see? It sounded like that is what you were saying when you said he steps in the room to say hello? IF that's the case, you are being taken advantage of. If he sees hardly any patients, then you need to go to him and demand that you get the salary of an MD...oh, let's say $200,000 or so and he needs to take the $80,000 salary. Ask him to switch positions with you! If you truly are looking for a new job, then get the job first and make sure it is secure before you give your two week notice. You are not obligated to train a new employee. The Dr. you work with sounds lazy. It also sounds like Mrs PAC may be being used as a scribe. That is happening more and more as well. I had it in my last job, I will not put up with it. Link to comment Share on other sites More sharing options...
gleannfia Posted August 30, 2013 Share Posted August 30, 2013 We forgive you for the bitter threads. We all have them. I love small towns, nothing beats them. There is still a little bit of Americana in the US....you and I are part of it. Agree with you about the reservation. I have done IHS as a locus. Really challenging medicine, and rarely anyone looking over your shoulder. The VA is also good, sometimes depends upon the particular VA. Link to comment Share on other sites More sharing options...
SHU-CH Posted August 30, 2013 Share Posted August 30, 2013 If you feel like you are in a rut, consider becoming a preceptor for PA students. You might think it would add a lot of work to your day, but it is usually a very positive experience to have an eager, enthusiastic student on board. It will add a new vibe to your office. If you have a big patient load, have them see the patient four doors down the hall to start and then discuss the patient when you catch up to them. Most of your patients will be impressed to see you in your teaching role and you will be helping to ensure a healthy future for our profession. Just an idea... Link to comment Share on other sites More sharing options...
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