I'm tanking

[problem child]

after a few years' really good start as a (middle-aged) PA out of a top-shelf PA program, I hit some bumps which were really out of my control, and I now have some dings on my resume. now I feel I have "a reputation" in the (very small) world of giant hospitals where I live. in a nutshell, I have been fired after shorter and shorter durations at my last 3 jobs. 

 

the first bump happened when the surgeon I worked for had a death of a child. he closed the practice and moved. I thought I was going to stay with him for life, but that's not how it turned out. I took a job with a private practice in the same specialty, and after one year was canned when the elder partner of the practice retired. the younger partner didn't like me bc I was a better clinician than he was (really), and I used to challenge him for trying to cheat me out of overtime. so he canned me.

 

then months later (applying for jobs, credentialing delays), I got a job at a very prestigious institute -- a newly created, part-time job, and it turned out the job could not fit into part-time hours. I was being paid for 4 hrs a day but I was there more like 7-8 hrs a day to make sure the patients were being cared for. I brought it up at the 30 day, 60 day, and 90 day reviews, that there needed to be more hours, and I then started making my day truly fit 4 hours (well, 4.5) and I started saying "no". so they deemed me a horrible failure, and canned me after 5 months.

 

more months go by, applications, studying for boards, finally a recruiter talked me into a CT surg job that I was NOT qualified for (I have ZERO CT experience and never wanted to work in it in the first place), but they said, "no problem, we'll train you!", and the money was good, so that doesn't hurt, but 2 WEEKS in they said I needed to be flying solo in 2 weeks. 6 weeks later, they canned me.

 

now I am just scraping the bottom of the barrel, barely getting callbacks. I am getting some interviews but so far no offers. I am pulling my hair out and freaking.

 

I had some advice today from a recruiter to build a really solid cover letter to showcase my strengths, explain the gaps, and bullet-point my areas of interest, which I did. and I am using that cover letter with every application as of today.

 

I do have an interview on wed for a 3 mo position in a town 1.5 hrs away, and it might be another impossible job I am not qualified for (cardiac cath lab anyone? how is it?) in which case I'll tank again...and have another ding on my resume. I DO NOT WANT THIS!!

 

I have been unhappy in the culture of surgery in general, but love the work and the patients...but I am now trying to find an outpatient surgical or procedural position (which I love), or something not in surgery (which all sound really boring and stressful. family practice? kids? women's health? yagh...!).

 

I'm beginning to think maybe I just do suck, and should just get out, but I can't. I am a single mom with a kid happy in a school system/community for 5 more years, and I'm paying a mortgage.

 

advice?

[Guest JMPA]

you need a vacation, i would take time to reflect exactley wha field interests you and "gear up" for it prior to entering. cardiac cath lab can be challenging. you will need a strong cardiac backround, be agile with your hands, and be able to work in a confined area. there is also a lot of radiation and radiologic anatomy to become familiar with. may i ask what your initial job experience was in?

[GetMeOuttaThisMess]

I'm not sure that a vacation is what is needed based on the employment gaps, and most likely the time away from the last position. If you're in a large enough area interventional radiology might be a position. You might also wish to check into urgent care positions. Try not to fault yourself for the shortcomings of others.

[problem child]

I thought IR was also very crazy and intense, like CT. no? I have been contacted by an IR service and they said (before thanksgiving) that they wanted me to come up and interview.

[GetMeOuttaThisMess]

Procedures intense, talk with pt. before/after procedure. Thought it might be of interest since you liked the surgery setting without the pompous attitudes. I almost interviewed for an IR position with a university group recently but had another option closer to home (that I passed on). I figure that what's the harm in talking with them. If it is with a system that you've already worked with then you can't be too blackballed (meant as a positive!).

[ventana]

Seriously why do you keep going to surgical fields.

 

Find a small doc in the box and tell them you need six months of trining and get out of the pressure cooker

 

 

Also rather you are or are not a better clinician it is plain stupid to continually challenge a partner. You might some reflection on where you fit. If you want to be the captain of the ship try primary care and get out of the OR where you will never be the captain. Only exception to this might be IR where you get to run the room. My experience in IR was great but 99% procedures and 1% dx thought (which i realized i really needto be happy). But if you like procedures (highly skilled) IR might be the trick for you

[KMD16]

I completely agreed with the above statement. Am not sure what to tell you my friend. You should consider primary care/UC.

[problem child]

I think I did write that I want out of the inpatient surgical thing. maybe not. but I do. and I want out too of even the pressure cookers of outpatient care in the big, prestigious hospitals here. it's all the same, inpatient or out (but inpatient worse).

 

and it's not so much as I want to be captain of the ship as that I am capable of captaining...and to be treated perpetually like an appliance just rubs me the wrong way. I am a 50-something woman and have been an (excecllent) parent, and accomplished and overcome many very difficult and challenging things in my life...and it is very difficult, if not impossible, to entirely put aside my own sense of agency when showing up for work. it's one of my biggest strengths! but not so in the places I have been offered work the past couple of years.

 

it's just me, but I see all people as equal and equally deserving of respect (unless they prove otherwise), so the quasi-military hierarchy in some services (esp inpatient) never cease to catch me off guard and leave me truly incredulous. I don't see anyone as above or below me, and I find it shocking when someone treats me that way. it's not that I defy authority out of hand -- I respect authority as a matter of course. but it's just the manner in which the authority is executed that can feel so stunningly inappropriate that I actually LOL and think, "they MUST be JOKING!!". sometimes I SAY, "you're joking, right?" just to check. that doesn't usually play too well either :)

 

see, the thing is, I live in a place where almost all the work (close by) is in the big, prestigious hospitals. and it sux (for me) to work there.

 

good news - I got called yesterday -- after posting this cry for help -- for an interview with the job I REALLY want -- it's in a private practice, out a bit in the 'burbs, in interventional pain management, which means targeted injections, fluoroscopically- or US-guided. It is exactly what I want, and am soooo happy they called. thanksgiving got in the way of some of my inquiries being handled in a more timely manner, and I was flipping out.

 

I so do appreciate all the replies of encouragement, thank you, peeps, colleagues, and litter-mates!

[problem child]

@ventana: what's a "doc in the box"?

 

oh -- and I only challenged him directly when he tried to cheat me out of my overtime every month.

 

being a better clinician was not something I rubbed in his face; I simply quietly took care of the patients on my schedule and found many of his had been screwed up by his clinical decisions.

 

his father (the elder partner) would routinely would take my part ifthere was a difference of opinion, say, on a rad read or a treatment plan or some such thing. and boy did THAT tick the dude off....I would always cringe, but there wasn't much I could do about that.

[ventana]

doc in a box is generally, a standalone private practice or urgent care/primary care

 

I to learned the hard way that the physician always has the last say, a very challenging spot to be in, and one that I will never put myself in again.

 

 

  seriously need to get out of surgery

[UGoLong]

Excuse me, but I must admit that a picture flashes in my mind when I read how you feel about the "quasi-military hierarchy" and our age. I'm older (and a veteran) and I have noticed some issues graduates may have accommodating to the PA/MD work environment. Reading your posts, I found myself wondering if you had expected your "props" because of your age/experience and instead were treated as a new graduate/better-be-a -quick study by SPs who, though they might have been weird in their own right, still fell into the plus-or-minus 3-sigma range into which non-psychopathic supervisors routinely fall.

 

I started practicing when I was 60 and people often assumed that I knew more than I did. I didn't make a big thing about that but realized that I was just an "old" new grad. I would have to go through most of the steps that I had gone through 35+ years earlier in another profession. I was not due any special deference, though I thought I got a lot of that, too. A neurosurgeon called me "sir" on my first day in the hospital and people still insist on calling me "doctor" when I just ask them to call me by my first name.  

 

Wherever you go next, I just ask that you see yourself as a relatively new graduate who is older and wiser in some ways, but not in others. There is no need to challenge anyone to see who is the best provider in the whole wide world. I would hope that you went to PA school later in life because you wanted to do something special, not just to strive to be the king of yet another new mountain.

 

Be humble, learn, apply, adapt, and overcome.

[problem child]

Excuse me, but I must admit that a picture flashes in my mind when I read how you feel about the "quasi-military hierarchy" and our age. I'm older (and a veteran) and I have noticed some issues graduates may have accommodating to the PA/MD work environment. Reading your posts, I found myself wondering if you had expected your "props" because of your age/experience and instead were treated as a new graduate/better-be-a -quick study by SPs who, though they might have been weird in their own right, still fell into the plus-or-minus 3-sigma range into which non-psychopathic supervisors routinely fall.

 

I started practicing when I was 60 and people often assumed that I knew more than I did. I didn't make a big thing about that but realized that I was just an "old" new grad. I would have to go through most of the steps that I had gone through 35+ years earlier in another profession. I was not due any special deference, though I thought I got a lot of that, too. A neurosurgeon called me "sir" on my first day in the hospital and people still insist on calling me "doctor" when I just ask them to call me by my first name.  

 

Wherever you go next, I just ask that you see yourself as a relatively new graduate who is older and wiser in some ways, but not in others. There is no need to challenge anyone to see who is the best provider in the whole wide world. I would hope that you went to PA school later in life because you wanted to do something special, not just to strive to be the king of yet another new mountain.

 

Be humble, learn, apply, adapt, and overcome.

 

you are misunderstanding, and making assumptions about me which are not true. I am not trying to be king (or queen in my case). I can't try to explain it all over again, but my dilemma is in my posts. this is not about ego or arrogance or expecting "props", it's about a culture that is not a good fit for me bc I don't like it, understand it, or value it.

 

since you were a veteran you may feel more comfortable in the quasi-military culture of hospital inpatient med/surg. I didn't even want to be a girl scout when I was a kid bc I didn't want to wear the same thing as everyone else - ever! that doesn't make me an inferior person, it just means I am a different sort of person from those who do feel pride in wearing a uniform.

 

I've been a PA-C for 7 years, going on 8, and I always expect to be learning. I am humble, I never assume I am in charge, and I feel that providing medical care to patients is a privilege. I am good at it. some doctors value the independence which is my natural state. I always expect to learn my specialty, and be taught. but I also bring to the table autonomy and creativity in my patient care - and that works beautifully in some practices and not in others.

 

I appreciate the support, and I think I have found my 'doc in a box'; a situation which really does suit me more - procedural outpatient, best of both worlds.

 

thanks again :)

[GetMeOuttaThisMess]

Best of luck to you!

[problem child]

Best of luck to you!

 

thanks, GetMeOuttaThisMess! what about you? I know you've been in the weeds...anything getting better?

[GetMeOuttaThisMess]

Looks like I'll be getting another offer, for more than I've made previously in my thirty or so years, but I just don't feel the drive (feels more like medical prostitution). It isn't their fault (employers), it's mine. What I think I'd really like to do in medicine doesn't appear to be a viable option at this point and my career expectancy is too short to where I'm already looking to see that light at the end of the tunnel so that I can chase the ultimate dream...driving the NAPA Auto Parts truck with the blue cap on top for local deliveries while listening to the radio. Amazon drone will probably put me out of business there ;-). Bottom line, I'll go where I'm led and do my best to serve. I had always hoped for Marcus Welby, M.D. and got stuck with Grey's Anatomy.

[Guest JMPA]

Looks like I'll be getting another offer, for more than I've made previously in my thirty or so years, but I just don't feel the drive (feels more like medical prostitution). It isn't their fault (employers), it's mine. What I think I'd really like to do in medicine doesn't appear to be a viable option at this point and my career expectancy is too short to where I'm already looking to see that light at the end of the tunnel so that I can chase the ultimate dream...driving the NAPA Auto Parts truck with the blue cap on top for local deliveries while listening to the radio. Amazon drone will probably put me out of business there ;-). Bottom line, I'll go where I'm led and do my best to serve. I had always hoped for Marcus Welby, M.D. and got stuck with Gray's Anatomy.

is the insurance high for NAPA auto? it does sound like a dream job

[GetMeOuttaThisMess]

Not with ACA! Well, if people could get through.

[problem child]

Looks like I'll be getting another offer, for more than I've made previously in my thirty or so years, but I just don't feel the drive (feels more like medical prostitution). It isn't their fault (employers), it's mine. What I think I'd really like to do in medicine doesn't appear to be a viable option at this point and my career expectancy is too short to where I'm already looking to see that light at the end of the tunnel so that I can chase the ultimate dream...driving the NAPA Auto Parts truck with the blue cap on top for local deliveries while listening to the radio. Amazon drone will probably put me out of business there ;-). Bottom line, I'll go where I'm led and do my best to serve. I had always hoped for Marcus Welby, M.D. and got stuck with Grey's Anatomy.

 

wow. too bad. what would you want to do in medicine if you could?

[Guest Paula]

Looks like I'll be getting another offer, for more than I've made previously in my thirty or so years, but I just don't feel the drive (feels more like medical prostitution). It isn't their fault (employers), it's mine. What I think I'd really like to do in medicine doesn't appear to be a viable option at this point and my career expectancy is too short to where I'm already looking to see that light at the end of the tunnel so that I can chase the ultimate dream...driving the NAPA Auto Parts truck with the blue cap on top for local deliveries while listening to the radio. Amazon drone will probably put me out of business there ;-). Bottom line, I'll go where I'm led and do my best to serve. I had always hoped for Marcus Welby, M.D. and got stuck with Grey's Anatomy.

LOL!  I think I will wash vegetables in the local supermarket and return to my dietitian and vegetarian days when I retire. 

[GetMeOuttaThisMess]

See paramedic thread with PA's hypothetically incorporating into systems. It's the only area I never grew tired of (can't say the same for the ED, at least in a large metropolitan area). Regardless of my feelings, it's worked out the way it was intended.

[JFarnsworth]

To the OP,

I skipped a lot of the replies but all I can say is, hang in there. Most of us have had our share of situations that were a bad fit. I know I have. Just keep looking for work, get hired, and learn as much as you can. You don't have to defend yourself to the right employer.