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Are curious and creative? Are you happy as a PA?


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Forgive me for butting into the professional forum, but I would like to hear from some professional PAs.

 

I am pre-PA and am shadowing at a primary care office.  I asked the supervising physician what he is looking for in a PA to hire.  He said that he wanted them to be clones of himself. He wanted the PAs to speak to the patients in the same way about the same things and prescribe the same drugs as he does.  He doesn't want any independent thinkers.  I get it.  Continuity of care.

 

But I really can't be a clone or a cog.   I don't need to have the final say, but once I've earned it through education and experience, I want my voice to be taken seriously.  And I will always have thoughts of my own.  I am a capable researcher of Pubmed with a curious mind.

 

I am so in love with making people's bodies better so that they have more quantity and quality of life. My brain will always turn in the direction of "Could this care be better and how?"  I will always take an unsolved problem and search for answers.  I will always take the best researched and most comprehensive approach to caring for people. I want the best, fastest, results with the fewest side effects.  I will always feel compelled to come up with the best solution I can within the given constraints.  

 

I have been so thrilled with my exposures to hands on healthcare, like examining a baby or listening to a heart murmur. But since speaking to this doctor, I have doubted somewhat my place as a PA.  

 

I am 33 and I don't want to go to medical school.  I am female, want to have a family, and have a number of hobbies.

 

Do you have any thoughts?

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lots of similar posts here, do a search.

am I happy as a PA? yes, but it has taken years(>15) to reach this point. I have had several jobs at which I was miserable. at some point a few years ago I just decided to stop doing things that make me miserable and to find quality jobs. what that means is I drive 3 hrs to one job and 1.5 hrs to another. neither is even remotely close to a major metro area. PAs in cities do scut as there are plenty of docs. want a great job? go where you are valued because docs don't want to work there.

I work solo at 2 out of 3 jobs and with just one other doc at another. I now refuse to work anywhere that I am not treated as a colleague and respected.

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Is it generally agreed that there is only scut work in major cities? And I take scut work to mean uninteresting work with little respect.

 

Is it at all a regional thing? Is it a matter of specialty? Looking specifically at Pacific Northwest.  Will this change with ACA as ability to pay for healthcare rises and demand for PAs increases?

 

Is it any different for NPs?

 

Thnx

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really depends on the work you want to do. a surgical or FP job is likely the same anywhere. where location really comes into play is for ER/critical care type jobs. big cities mostly have fast track jobs and hospitalist jobs with the pa doing routine cases. go rural and the pa is doing everything.

NPs by virtue of their licensing(not their training...) can open their own clinic in many states without an association with a doc. PAs can open their own clinics as well but they need a doc on payroll for chart review as required by the state.

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I have had the same sort of experiences. I am creative and love healing but at this point I kind of hate being a PA at this point, but it's all I know in terms of earning a living.

 

I am a young mid-50s and figure I'll just find something I can stand (maybe even enjoy?) based on some of the comments here, and some ideas of my own, until I can retire. then I will write, which is what I wanted to do in my spare time as a PA.

 

I just didn't know the work would be so all-consuming, I would be so stressed out, and work in so many utterly punitive environments.

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I haven't been working long.  I am VERY happy as a family practice PA, EXCEPT the number of hours I have right now.  I'm joining a solo doctor in his practice, so it takes some time to build up the patient load to keep me there full time.  My husband recently lost his job, so this puts me in dire straights at times.  I'm looking for a 2nd part time job currently.

 

That being said, my doctor and I have a great relationship.  I feel like he trusts me.  He lets me make my own decisions, but if I ask him his opinion, he willingly gives it, then asks me my plan.  Then he usually says, "yeah, sounds good!".  Most of the time, he says it's a matter of provider preference if our initial thoughts were different.  He occasionally leaves me alone in the office (with his cell number handy of course), which feeds my confidence, too.  

 

I had previously worked for this doctor as a medical assistant before PA school, so I knew we would work well together.  It's all a matter of who you work for/with.

 

I'm a female, graduated PA school this year at age 39.

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I have had the same sort of experiences. I am creative and love healing but at this point I kind of hate being a PA at this point, but it's all I know in terms of earning a living.

 

I am a young mid-50s and figure I'll just find something I can stand (maybe even enjoy?) based on some of the comments here, and some ideas of my own, until I can retire. then I will write, which is what I wanted to do in my spare time as a PA.

 

I just didn't know the work would be so all-consuming, I would be so stressed out, and work in so many utterly punitive environments.

What area of the country do you work in?  I hear some places are worse for pa's than others.  I find many areas of medicine to be creative, or potentially satisfying, but I need to work somewhere where my thoughts matter.

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I haven't been working long.  I am VERY happy as a family practice PA, EXCEPT the number of hours I have right now.  I'm joining a solo doctor in his practice, so it takes some time to build up the patient load to keep me there full time.  My husband recently lost his job, so this puts me in dire straights at times.  I'm looking for a 2nd part time job currently.

 

That being said, my doctor and I have a great relationship.  I feel like he trusts me.  He lets me make my own decisions, but if I ask him his opinion, he willingly gives it, then asks me my plan.  Then he usually says, "yeah, sounds good!".  Most of the time, he says it's a matter of provider preference if our initial thoughts were different.  He occasionally leaves me alone in the office (with his cell number handy of course), which feeds my confidence, too.  

 

I had previously worked for this doctor as a medical assistant before PA school, so I knew we would work well together.  It's all a matter of who you work for/with.

 

I'm a female, graduated PA school this year at age 39.

Congratulation on graduation!  It's good to hear you like your work and your SP.  It sounds exactly how I would want to be treated.  Do you find that your fellow students have found jobs they like?

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Congratulation on graduation!  It's good to hear you like your work and your SP.  It sounds exactly how I would want to be treated.  Do you find that your fellow students have found jobs they like?

 

Honestly, for several of my classmates, it's a little early to decide if they like their current jobs, as they have only been there a couple of weeks or so.  I haven't heard from some of them.  And a few haven't taken jobs yet at all (vacationing after school was over, or delayed taking their PANCE exam right away).  

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I also have a very curious and creative mind and in the ER where I work we have easy access to UpToDate and I am constantly looking up diagnoses to see if I am optimally treating things or are there alternative approaches since not everything will necessarily work in all psycho-social-economic situations...  I find the older docs with lots of experience are more laid back in doing a treatment that differs from what they've always done (kind of hard to actually hurt people) versus some of the younger docs that are paranoid about me deviating from their routine.  

 

But you also need to understand something, we aren't really supposed to be creative.  We are supposed to be following a standard of care.  We're not researchers or investigators or experimenters.  We are supposed to be analytic, making logical decisions based on findings, and evidence based in our practice.  You can joke and be creative in your interactions with the patient, but you should be rigorous in your history and your routine should be rote (so you don't miss important details).

 

Echoing another comment, I was also surprised to find how all consuming being a PA ended up being.

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we should have the flexibility to use different treatments within the standard of care though.

if the doc likes zofran and I like reglan  I want to give reglan and not be micromanaged as they both work fine. it is not my job to be a clone of my sp but to develop a safe medical style which works well for my pts. sometimes this means I do exactly what my sp does(asa for chest pain) some times it allows me to express a preference in tx(reglan vs zofran for example).

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I guess I've experienced creativity in care the most in my style of patient interactions.  I've worked with a lot of diabetic people and other people who needed a lifestyle change if their health were to improve.  

 

I lpaint a picture for the patient of what the patient might feel or do or experience if he or she were healthy.  I believe that the better I am at this, the more likely it is that people will take the risk of making changes. Change is scary.  I get pretty good results! I want the freedom to be able to do this, rather than having to follow a script.

 

 I also consider the very process of imagining there might be better care and going to look for more evidence to be creative in nature.  I basically want to be using my brain to solve problems intelligently.  I want to be able to approach my SP with new evidence and have the possibility that it will incorporated into the practice.

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I have been in my job for just over 7 years and think that there are amble opportunities to be creative. While there are some areas that have clear guidelines, patients often do not fit the mold. My SP generally has me where he isn't, and I can call if I need advice. Most of the time though, I'm on my own and have to assess the patient and figure out what to do next.

 

I have held other creative jobs: engineer, computer system designer, self-employed management consultant. In these jobs -- as in being a PA -- you always work for somebody (even if it's just your customer) and still there are significant opportunities to be creative and a problem-solver. I doubt even with the emphasis on evidence-based medicine that we will be getting to cookbook solutions to all patient care issues anytime soon.

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I guess I've experienced creativity in care the most in my style of patient interactions.  I've worked with a lot of diabetic people and other people who needed a lifestyle change if their health were to improve.  

 

I lpaint a picture for the patient of what the patient might feel or do or experience if he or she were healthy.  I believe that the better I am at this, the more likely it is that people will take the risk of making changes. Change is scary.  I get pretty good results! I want the freedom to be able to do this, rather than having to follow a script.

 

 I also consider the very process of imagining there might be better care and going to look for more evidence to be creative in nature.  I basically want to be using my brain to solve problems intelligently.  I want to be able to approach my SP with new evidence and have the possibility that it will incorporated into the practice.

 

I am good at this too and find it really helps patients. a LOT. but it takes a little more time and I've been reprimanded for "taking too long" with pts. 

 

isn't pt education supposed to be one of the huge assets in having a PA on staff? doesn't seem it. they want us to keep the mill running!

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Well, PC, just remember when someone says your practice style isn't meshing well with the production goals and priorities of the practice, it doesn't mean any more or any less than that. You could be "too slow," and they don't actually place value in those things that take more time, or they could have unrealistic goals. They might be expecting you to produce and add revenue value like an MD, but pay you like a PA. Only way to know is to sit down and have a nice friendly talk about expectations and practice style.

 

If you believe this extra time is valuable and pays off later - and I agree, it likely does - you have to get them to understand that. If you've tried and they don't agree, then it's a bad fit. Change your style, or find a job where it is welcome and valued as it should be.

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I work in a family practice setting. My program actually places me at this site after my first quarter in school. So I have been seeing patients here for 2 years before being hired. Once hired I was given full autonomy to see whom I want, and treat how I want. I never have to ask or check in, but I can always ask for help if I need it. I couldn't have asked for a better primary care position, as this setting has really allowed me to grow as a clinician. I am definitely not part of the majority, but I can tell you I am happy with my decision to become a PA.

 

I still have thoughts about medical school, but to work primary care, it just isn't worth it. It would only be worth it if I were to specialize. But that is another discussion all together.

 

I would not worry about having to become someone's clone. If you put in the hours, study, and continue to grow, your experience and knowledge will show. Once you have proven proficient you will be allowed to do more. This idea of having to prove yourself is not limited to PAs. Physicians have to prove themselves worthy for a minimum of 7 years! I feel like I'm going off on a tangent lol.

 

Answer: as of now, I am happy.

 

 

Sent from my iPhone using Tapatalk

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I work in a "big city" Oakland California. I work in FP and HIV and do NOT do any more scut than the MD. I see 15 pts per day, and rarely consult my SP. I see him at lunch and in the am and we have a very good working relationship. He' also a friend and he considers me a colleague vs a subordinate. The scutwork we do are the charts which suck so much I want to throw my laptop at the wall sometimes. Other than that and my extremely congested commute home, its awesome. My commute is 1.5 hours woth traffic one way, without takes 15 minutes....yah...bay area traffic is the pits.

 

Sent from my Galaxy S4 Active.

 

 

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Shadow someone else. Preferably a PA.

I have NEVER in my 13 years of PA practice been expected to be my SP's "clone". I have worked with a great variety of talents and personalities and all have had different style. I take the best things from some and nothing from others. I can't possibly imagine being expected to be a "clone." Blech.

IME there is plenty of room for both creativity and critical thinking as a PA. I would worry about a PA who didn't desire just that. While clinical guidelines exist, patients are individuals and treatment plans must be tailored to their needs, resources and abilities.

Now, as for me, I'm an outlier as I'm finishing med school in 7 mos. I was often happy as a PA but never content. I wanted to know more and do more than I knew and could do as a PA so I went back to school, 11 years into my career. I was often frustrated with the glass ceiling that exists in clinical PA practice and I decided to break through it. That's my n=1. You must figure this out for yourself.

Good luck :)

 

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