Best First PA Job- Inpatient or Outpatient?

[begingri]

Hi everyone,

 

I am a PA student graduating in December. I am browsing different open positions in my area and am torn between applying for an inpatient or outpatient job. I want to work somewhere where I will have a good base of knowledge that can be applied to different jobs down the road in case I decide to change positions. For me, I am thinking along the lines of an inpatient internal medicine/hospitalist position vs. an ER/urgent care type job. I'm leaning more towards inpatient right now, but I'm afraid I may feel like I'll be stuck working inpatient and won't ever feel completely comfortable if I ever decide to work outpatient. 

 

How translatable are inpatient skills to outpatient positions? What are your thoughts on this? Thanks.

[Febrifuge]

Hospitalist is an extremely rough first job. IF you go that way, make sure to get in writing a specific plan for your new employers to get you up to speed on the details - try to shoot for something like what MD interns get, with protected time for reading, journal club, lectures, and other structured ways to get deep into the details of nephrology, cardiology, etc without having to just slap something together on the job.

 

Rounding on MICU patients you've never met because you've been out for a couple of days and then having to go admit an 85-year-old with a med list longer than the lyrics to *The Wreck of the Edmund Fitzgerald* and then having to decide if Mrs. Johanssen's K is where we want it yet even though the guy yesterday forgot to order it is not for the faint of heart.

[UGoLong]

My job is 50/50 office vs inpatient. I like the variety and feel that what you learn in one setting helps you with the other. In the beginning, I was on the phone a good bit of the day with my SP or a more senior PA, but now I am on my own most of the time (unless I need help).

 

As far as the transferability of inpatient vs outpatient skills, some skills are and some aren't. The hospital setting (I go to about 6 of them) is more system-intensive. There is the expected assessment and treatment, but much of the work involves data collection/analysis/feeding the system. I usually spend less time with the patient and more time with the hospital's various systems. You are also surrounded by very specialized people; it's what I imagine it would be like working on an aircraft carrier or a large factory.

 

In the office, I have about 15 minutes of face time and generally spend a good bit of that thinking about what to do next. In the hospital, usually you will get to see what happens overnight. In the office, you have to think longer term as you often won't see the patient for weeks or months.

 

If I was starting out and wanted to stay broad, I'd consider the ER route. You see a lot and there are people around to help bring you along. Also you could probably change out for a specialty or another setting fairly easily.

[rev ronin]

Apply for both.  Go for the place who will treat you like a peer, invest in you, and ask your own questions:

 

Q: Who had this position before?

A (good): We've been growing this practice and needed another PA to meet our goals, so this is a new position, but you can talk to the other PAs we have...

A (bad): I'm sorry, we can't discuss personnel matters.

A (bad): Well, there was Tim, but he left for the Himalayas, and Bob, but he took a job elsewhere, and then Fred, but we don't know what happened to him...

A (iffy): We've never had a PA before, but we hear they're good.  Our partners read an article about them once.

 

- or -

 

Q: Why did your last PA leave?

A (good): He didn't, we just decided to hire more

A (bad): He was a whiner, complained about the conditions and was really focused on what his contract said--not a team player at all.

A (iffy): He got a better job elsewhere, but we've looked at our compensation package and contract to make sure that won't be an issue.

[familygal]

Tough question!  I started out outpatient in a specialty practice but once I got credentialed in the hospitals within my first year, I started rounding on inpatients.  Both have their own learning curves and value.  Next I went to only inpatient in a different specialty, and now I'm in family practice, all outpatient.  From my experience, there hasn't been a whole lot of "skill sets" that translate between inpt and outpt.....some of the skills have just come with experience and time: knowing how to interview patients, identifying an emergency or really sick person, being comfortable doing procedures, and knowing what you DON'T know.  In my experience, I don't think there is ONE first job that will prepare you for everything down the road.  I would ask yourself where do you want to eventually be working? Do you want to stay in the hospital most of your career?  Then start out inpatient. And vice/versa.  ER, family practice is good.  You could always start out FP and after a few months start moonlighting in ER.  Or, you could pick a specialty group that will want you to cover outpatient clinic AND make rounds in the hospital...  One thing I can't recommend enough, however, is find a SP/group who will support you as a new grad, understand you are a new grad, and mentor you...

[familygal]

P.S.  One more reason why I love my career:  You can work inpatient (say for a hospitalist group or in an ICU), and those are a lot of times shift work, then moonlight in an urgent care.  I used to work three 14-hr days in the ICU during the week, then would do a 4 or 8 hour shift at a local underserved urgent care clinic.  But focus on getting that first job first!

[HLReed]

I was in the same position as you and my final decision came down to critical care vs emergency medicine (pretty different types of jobs). I ended up taking a job in a very large medical ICU. I have learned a ton of inpatient medicine and I think I will be equipped to handle most types of inpatient jobs if I choose to leave.

 

However, I do miss out on a lot of outpatient/urgent care/ ED skills and situations I enjoyed as a student. I don't get a lot of people coming right in off the street or get to be that first face they see during the course of their illness. I don't get to do a lot of those thorough, all-inclusive physical exams since most of my patients are too sick to move. Some days I would love to sit down and close a laceration or I&D an abscess (though the ICU is one of the few inpatient jobs where you can get a lot of procedures).

 

In short, I think I am very quickly learning inpatient medicine but would be pretty lost if someone came to me with many outpatient concerns.

 

I think the most important thing is to decide what direction you most likely want to pursue in your career. Which rotations you liked as a student, the type of atmosphere you like, etc. will help you choose. Then go for the job that teaches you the most and all those other little things that play into it.

[bosox2k1]

I graduated in May and during my rotations, I fell in love with my hospitalist rotation. Luckily, that hospital was hiring (Boston area hospital) for a new overnight position and I got the job. Now my role is covering the pager for the 'non house' patients and also admit 2-3 'non house' patients per night. Non house typically sees the less 'complicated' patients, but sometimes the house or teach staff is overbooked and we get some overflow.

 

Since it's my first job, the chief is very understanding of my capabilities and let it be known that I may have lots of questions for the overnight attending and that's to be expected--so I am lucky in that respect where I don't have to worry if I feel outside my scope.

 

Some classmates got hospitalist positions at other hospitals and they were thrown into the fire right away with little direction, etc. That would be a nightmare in my opinion. I love nights and I love the hospitalist position so far.

[begingri]

I graduated in May and during my rotations, I fell in love with my hospitalist rotation. Luckily, that hospital was hiring (Boston area hospital) for a new overnight position and I got the job. Now my role is covering the pager for the 'non house' patients and also admit 2-3 'non house' patients per night. Non house typically sees the less 'complicated' patients, but sometimes the house or teach staff is overbooked and we get some overflow.

 

Since it's my first job, the chief is very understanding of my capabilities and let it be known that I may have lots of questions for the overnight attending and that's to be expected--so I am lucky in that respect where I don't have to worry if I feel outside my scope.

 

Some classmates got hospitalist positions at other hospitals and they were thrown into the fire right away with little direction, etc. That would be a nightmare in my opinion. I love nights and I love the hospitalist position so far.

 

I have applied for and interviewed for almost this exact position, except it is in Michigan. It is a midnights position for the hospital admitting service. From my understanding, it's pretty much all admissions from 6 pm-6 am with no rounding. After 24 hours, the patient is on another service. There's also shifts for ICU admissions/rapid response team. They stated there is a 6 month training period with lots of education. I've decided I want to start in a hospital (hopefully this job, keeping my fingers crossed). I may try to find a part-time urgent care position to do a little outpatient work once I get comfortable and have a handle on my schedule.

[Just Steve]

Such a subjective question.  So many variables.  My first thought was "what's your background experience?"  I ask because if PA school is the first time you have had to apply critical thinking skills regarding patient care and you are depending on those 24-27 months of school to prep you for super sick patients or a LARGE daily case load or both, then inpatient may be a bit much to chomp off on your first bite.  Sure it's fun to be challenged and all that but if that institution is lacking in their training methodology you may get left in the breeze trying to train yourself at the expense of your personal life and sanity. 

 

However, if you have been around this medical thing for awhile and not riding your first rodeo, then cowboy up and dig in.  Hospitalists have a greater chance to do pretty cool procedures (chest tubes, intubations, central lines etc) than most PA jobs (even ER/Urgent Care). Plus you are gaining GOBS of patient management education with drips, complex med regiments, multi tasking...holy cow you can be up to your rafters in fun in no time.  

 

Just don't oversell yourself.  Jumping into a potentially very complex job as a new grad/employee is about 4.7 million light years different than the relative safety of being in student mode.  

 

Good luck