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Feeling uncomfortable with first job

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I recently started working at an internal medicine office about two months ago. The office is owned by one physician and has two separate locations which me and the other two PAs rotate between. This is my first job out of PA school and I have to say I have not felt all that comfortable with the guidance I am receiving from my supervising physician. There have been a couple of times where he was unavailable to consult with and other times where I have sensed some reluctance on his part to answer clinical questions. He often gives me the shortest answer possible when addressing my concerns. I feel at this point that I am putting myself at risk and not providing the best care for my patients. My question is, where do I go from here? I have been at this position for a very short period of time and I am definitely willing to find another job despite the fact that it would look terrible on my resume, but how do I ensure that I am not in this situation again? I am not in a position to do a residency. Would a hospital setting possibly be better as it is more team-oriented?

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settle in


he might jut be trying to get you to decide on your own (or he is just lazy, or something else)


this is a  VERY common feeling at first job in the first 6-12 months - you are being asked to apply your knowledge and that is hard


make sure you are making the best decision you can 


don't make any decisions that might injure a patient till you talk with him - but in PCP world you can hold all the ? till the end of the day or even a few days later and then sit with him for a 30 min "consult/training" on all patients. 




Might just ask  him to set this up for the first 6 months of employment just to give you some guidance....

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I guess I'll continue doing what I can on my own. I'm sure this feeling is common but I'm just not sure to what extent it's acceptable. I'm seeing about 18 patients a day so it is difficult to look things up in between patients but I do what I can. The SP regularly ignores my concerns. After two weeks he asked me if I felt comfortable working with just another PA in the office and I explicitly said I did not feel ready for that yet as the other PAs have a full schedule as well and are not usually available to ask questions. So three days later without any discussion....he puts me in the office by myself.

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The situation the OP notes is pretty common. Many of us didn't feel up to taking care of our first patients. And our SPs are usually busy people, which is why they hired us.


All of your school life, you were taught things in lecture. Now you are really in an apprentice situation. You are on your own, but you need resources to call on. Find a mentor. Talk to the other PAs!  Even though you are not in the same place as the other PAs (I gather), use them as a resource!  Experienced PAs expect it and it is really the only way for them to pay back the people who helped them in the beginning. 


When I started out, I was often alone caring for patients in a hospital. If I came across something I didn't feel comfortable with, I'd try my SP, but more often than not, I'd call the more senior PA in our practice. She was a great help. In the beginning I was on the phone a lot. After 8 years, maybe once a day. People call me and I think that helps both of us.


And be patient with yourself. Go slow with medication changes, etc until you feel comfortable. Eventually you will think "Oh, another one of these cases; I know what I'll do next."


Good luck!

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Guest Paula

You can always consult with specialists that your practice uses for referrals.  My collaborating physician usually says to me if I have a question:  Call the cardiologist, call the nephrologist, call the pediatrician, etc.  Although I am experienced 10 years now I still run a few patients by the doc and invariably he never answers my questions directly.....I have learned in many instances to by- pass him, but do document when I've called a specialist or consulted with my SP. 


I work in a state that requires no chart co-sig or prescription co-sig. 


Another tip would be to look at what your patient's conditions are that are in common, then go home and study.  I remember the first 2-3 years of practice in FP I spent time nightly reviewing conditions, treatments, medications, when to refer appropriately, etc.  It's tough but you can do it.  Get a working plan down of how you will treat a new-onset diabetic....what labs would you order if more are needed, what do you need to know before prescribing a medication, what follow-up do you want the pt. to have, what education do they need?, etc.


Think about your differentials too, especially with someone who comes in with complaints that need a good work-up.  Eventually you will learn when to order a lab, when not to, what to order, what to prescribe,etc.  Ask the other PAs too.  Find one who might be sympathetic to you as a new grad and be humble and gracious to them.  Hopefully there is a PA that will help you too. 


Pick one topic a night and review.  

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I feel your pain.

In retrospect, given one SP and several PAs and offices to staff, strikes me that you got involved in a situation where there is an unwritten expectation to be as self sufficient as possible.

In the long run, this will make you a stronger clinician. Unfortunately, it is a painful thing to go through. This can be a real eye opener for the new grad but it is the reality many face. There isnt going to be a disconnect between that salary you get and the expectations of performance.

I think you have been given great advice above concerning further study and seeking out mentors. Overall the bottom line is that you are being forced to take ownership. The sooner you drink that kool aid, your level of comfort will improve. 

The problem is if you cant get to that level. If so, then a more supervised environment such as a specialty or a position outside of clinical medicine may be for you.

Good luck.

George Brothers PA-C

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