good first job vs a good job??

[HJK]

Current work in a VA hospital seeing the fast track patients and whoever non emergent patient passes through the triage. The place is ran by a major university with tons of residents Which means I am there to kindda expected to move the patients along, in and out.

 

The job is not challenging whether it is good or bad without peds or complicated women issues. I do enjoy full autonomy in terms of what I can do and order for most of the patients. I see about 2 to 2.5 patients an hour with usually one admission per shif. PAs get all the weekends and major holidays off. As I choose to be fee based I do not get benefits but better paid then upper 70s or lower 880s offered as a benefit eemployee. Have great groups of attendings who trust me with most of my decisions.

 

I have been looking for a part time position so that I can see peds and women but unsuccessful thus far mainly because I have only a year and a half under my belt and that I do not see variety of patient load at my current position being a PA at a VA hospital. Well now I have another interview set up for next week with an urgent care company with about six to seven branch offices in the state.

 

Hmmm..

 

I do enjoy taking care of veterans as I am one of them. However as for someone who tried to get into residency programs but couldn't, only seeing fast track patients without ever working in the main ED or taking care of high acuity patient does frustrate me more often then not.

 

Well.. I am mumbling and mumbling because I don't know what I want. This could have been a great job to move on as second or third job after a busy and challenging first job. Or am I unreasonable to think I can get a better job.

[EMEDPA]

FEW OPTIONS:

1.stay at the va

2.full time at the va, part time at the urgent care

3.full time at urgent care, part time at the va

4.apply to residency again.

 

if it was me I would do 4 with a backup plan of 2

[HJK]

I am considering the residency again. Previously applied to two and interviewed for both. I am guessing my chances have improved with a year and a half of experience added although don't know by how much.

 

Well, the life isn't that bad I must say. I HAVE A JOB!! haha.. thank you for reply!!!

[Guest Paula]

The good thing is that you are hungry to know more, do more and have the drive.   I agree with EMPA on how to handle your career.  Good luck.

[teapotter]

Chong - I looked for a post working at a VA ED, and found this thread.  Do you think your experience is typical for working at a VA? I.e. being in fast trak.  I am a new grad in the job market.  I aleady have a nice offer at an urgent care in a somewhat underserved area, and I have an interview at a bigger city VA in their ED (Portland, OR, which I believe is also run by OHSU).  I'm wondering if I would get to see more complex cases at the urgent care and would thus learn more and be more fulfilled...
 

[HJK]

Of course I can't say how things are at other VAs. For our department...

 

We have 10 beds for the fast track. There are about three residents in the fast track who need their experiences with complex cases one or two for each. There is always a patient or two who was not triaged correctly and ended up getting full work ups. That leaves 1or 2 beds. There is a full time nurse with part time tech covering the fast track. Hmm.. at peak hours there are usually 20 to 30 patients awaiting. I sure can take the next patient with this sudden headache developed a day ago and take that 1of 2 beds or the resident can take the next one so that I can take the second patient who just needs his medications, the third patient with his chronic knee And the next one who have this recurrent lower back pain.

 

As I said earlier, I do like taking care of fellow veterans but things are little different than what I imagine my ED career would turn out.

 

One thing that does scare me though... after a year and a half at the job, sometimes I do choose easier cases over a complex case because I can.. hmmm...

[skyblu]

Can you look for a hospital with no residency program in EM? The biggest reason I declined a position at what we call around here Man's Greatest Hospital (MGH, AKA Mass General Hospital, pretty much the mecca of medicine in the Northeast) is their residents do all the cool stuff, the PA's do all the grunty stuff.

 

So now I work at a much less fancy place, a community hospital in an urban setting, and I make 20% MORE money (those academic centers don't always pay too well), AND I see any and all types of patients. We have Fast Track shifts but just as many, if not more, Main ED shifts, and there is no limit to what kind of case I can see or run on my own. I typically don't present to an attending until I'm ready to dispo, or if I need help of course I call an attending. But on certain shifts, the only coverage we have is one doc and one PA for the entire ED, so on many occasions I am running a code or managing critical patients on my own while the doc has their own criticals.

 

So if you can find a job like that, even if just per diem, while you stay on at the VA which I'm imagining has awesome benefits, it might plump up your resume enough to open other doors.