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Failing as a PA, just got fired from my second job after failing at my first. Help me please!


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You really have some good insights and thoughts here.

 

You should really think about working at a large academic medical center. STAY away from small groups or private practices that are volume focused (for now at least)....

 

Look at Mayo, Cleveland Clinic, Baylor, Hopkins, etc. These places are used to students, residents, and new practitioners. There will will still be some lumps, but you will learn, and you will be given the chance to fall a few times....without losing your job.

 

Just my 0.02 cents.

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Do you mind PMing me what program you attended? I am concerned how you went through PA school and have never heard of a discharge summary...

 

Yes, billing and charting is pretty important...

Agree that DC summaries were done during clinicals at (I would hope) ALL programs...but in OP's defense, billing was not covered in PA school...at least not mine. However, I knew how to bill pretty much as a MA pre-pa and what I didnt know I figured out my first few months in practice. I am just now getting the knack of "Maximized Billing" to the highest degree of complexity and specificity, which increases your value as a PA to a practice.

 

To the OP, maybe stop going to specialty and go find a good IM/FP job where you can get the hang of usual codes, SOPs etc.

 

Sent from my Galaxy S4 Active using Tapatalk.

 

 

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You really have some good insights and thoughts here.

 

You should really think about working at a large academic medical center. STAY away from small groups or private practices that are volume focused (for now at least)....

 

Look at Mayo, Cleveland Clinic, Baylor, Hopkins, etc. These places are used to students, residents, and new practitioners. There will will still be some lumps, but you will learn, and you will be given the chance to fall a few times....without losing your job.

 

Just my 0.02 cents.

 

I'd echo this- it makes you more likely to deal purely with the practice of medicine rather than the large amount of administrative tasks that were apart of a small group simply because there weren't enough bodies to spread around the office tasks.  But, discharge summaries and rounding and proper charting are a part of medicine- there's no getting away from this.

 

For those of you recommending residency, let me offer a bit of devil's advocate: it's not a bad idea, but you have to figure out what specialty you're actually interested in and stick with it.  Residency is not for people who can't figure out what they want to do with their career.  It is long hours for much less pay than you'd receive as a regular staff PA, and there are unique paperwork requirements that come with being in a program, similar to when you are in PA school- patient logs, procedure logs, "call-back" logs, practice exams, required presentations, regular conferences, etc.  And not to further dim the light of residency, but I have to be honest...as someone who interviews potential residency candidates, if you sat down in front of me with your current employment history, you'd have to make a very strong argument to me during the interview why I'd pick you over other candidates who truly desired to go into that specialty.  Having said all that, I really don't want to discourage you from going for a residency if you truly desire to do one, but you have to be aware of what it actually requires.

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Although PA forum is relatively anonymous, I admire you for your posts accepting responsibility, at least in part, for your failures and, moreover, for not getting defensive at all the posts taking you out to the woodshed, deservedly perhaps, for your lax attitude, lack of initiative and general failure to fulfill your duties. But I'm not posting this to beat you up some more; I think you've gotten the point.

ED and surgery are fantastic jobs for PAs but probably not a great place to start if you had no prior training or experience. Several posts have suggested primary care settings where you would have less demanding duties and more colleagues who might be able to support you. Those were very good suggestions.

There are jobs where you can get away with a poor attitude and lack of initiative, but being a PA probably isn't one of them so, if you want to press on, you need to adopt the mindset that, in your next job, you will do whatever it takes, including spending as much time as necessary to learn and accomplish the job until you are up to speed. You need to recognize that whatever job you are given needs to get done and you need to figure out how to do it. A positive "can do" attitude is easily recognized...and so is the opposite.

One of the previous posts refers to PAs as problem solvers. If you can't problem solve the admin work, you may not be as good as you think at the medical part. Some people love dealing with unfamiliar and stressful situations. Others turn into shrinking violets. A lifetime ago, when I was in my doctoral program, someone told me that every problem contains its own solution. If that seems oxymoronic to you, then you haven't become a good problem solver. Case in point: 1. You couldn't figure out how to do discharge summaries. 2. These are routine documents prepared for every surgical patient and should be in their charts. 3. A previous post suggested you could have looked at other patient discharge summaries to use as templates. In short, the solution was contained in the problem. You just had to see it. You need to develop skills and a mindset to become a problem solver. It can take a few years so your next job should be one where you can develop these skills and have the support you need to get there.

Use your resources. It took you a while, apparently, to get the idea of finding a hospital colleague to give you some help. What about the PA on maternity leave? Did you think about asking her? One of the things that led to your downfall was that you were being compared to her, every day. According to one of your posts, she had it so well figured out that no one else knew how she did it. That made her a super star. Would I be correct in guessing she came back from maternity leave right after you were dismissed? Learning to use all your resources is important in any complex job, including, and especially, diagnosis and treatment. They were, in a sense expecting you to be her. So it was her help you needed most.

In short, your problems boil down to poor attitude, lack of resourcefulness and poor problem solving skills. You can, in time, resolve these issues if you have the determination to do so. You successfully got into PA school and became a PA-C. That makes you an above average person to start with. Then you managed to get hired for two very good jobs so you probably have the intellect and the personality, now work on the other things. Good luck to you.

P.S. a number of people have provided you with thoughtful advice. May we ask that you report back at a later date on what you do next, what you have changed and how you have succeeded?

 

Sent from my Kindle Fire HDX using Tapatalk 2

 

 

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zeusfaber-

 

I can totally relate my friend, my first job was a very similar scenario.

 

I worked for an ortho spine practice at a huge level 1 hospital. It was my first job, and like you I was in over my head. I knew what things WERE, like d/c summaries, round notes, post-op orders, etc; but I didnt know HOW to do them. Not everyone learns these things on rotations (usually because preceptors have no time to teach you and you dont have the clearance as a student).

 

Additionally, I had very minimal OR skills (I had a very lax gen surg rotation and my ortho rotation was mainly shadowing), so that became an issue when they expected me to prep most patients, rooms, table/position, etc. The nursing staff grew to hate me because I was incompetent, and the practice owner and his two partners were too busy to teach me these basic things. The other PA's were swamped themselves, so I was kind of on my own, and things just deteriorated. 

 

I take full responsibility for sucking---it wasn't their fault per se---but it also sucked that their expectations weren't disclosed upfront when they hired me. They had never worked with a new grad and just assumed I could hit the ground running. Long story short, I got canned ("asked" to resign), and I was pretty bummed. I felt like a huge failure----how could I have gotten INTO a top program, graduated, aced my boards.....and now I just got fired??? Big blow to the ego.

 

Turns out there is a big difference between school skills and actual practice skills. Many surgical practices use PAs like an MA/PA/Admin combo. Billing and coding and all the paperwork and dictating can be complicated, and you would never know unless you are taught.

 

 

So, my advice to you would be to get into a lower-responsibility practice. Think occ med, urgent care, maybe even a low-profile family practice. The big hurdle you have to overcome now is 2 short jobs that you were let go from. This will be tough, because employers will ask. I just told them the essential truth---that I was in over my head and there was a discrepancy in expectations between me and my former employer. They needed an experienced surgical PA, I needed a practice that understood I needed training. It worked out for me.

 

Stay out of surgery. I don't think it's a good fit for you unless you find a doc REALLY willing to work with you on all the nitty gritty details of practice management.

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^ Sad but true nature of medicine. Hard to find a mentor. Hard to find doc who's truly willing to teach. We (they) are all too busy to teach and quota to meet. Don't blame them. Blame the greedy system. Blame the higher up. We (they) enjoy finish product. Ready made. Someone who can hit the ground running. But then, would turn around and pay you chicken change. Immediately you walk through door, all they see is how much can you generate for the practice. Will echo that the OP stay away from surgery & EM.

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To answer some queries: 

Regarding the discharge summaries, I did what I thought was effective at the time - I asked my SP. We did not have discharge summaries in the office but I would have easily researched at the hospital if I knew my SP's advice was not enough for me to do it the way I needed to. It wasn't until I got complaints that I asked a colleague. 

 

The other PA - yes, I did call her off and on, but since she was on mat leave, I hesitated to call her and bug her for every little thing. Most of the time, I didn't know I was doing something incorrectly until it caused a problem. She definitely is a superstar, and I do think it was a little unfair that I was thrown into her job without being trained in the non-standard office procedures and expectations at this specialty practice. Like I said, my SP was a really good guy and wanted me to succeed, but also didn't know how the PA did her job so he couldn't completely walk me through lot of things, or maybe I was expected to be smarter/more resourceful and figure them out more effectively than I did.

 

Problem solving/initiative: Definitely need to work on this, as well as not let myself get frustrated and de-motivated so easily. Also need to find a way to organize my responsibilities and come up with methods for fulfilling them. Need to be more aggressive about asking for help when needed. Hopefully therapy will provide some guidance. I've had similar issues at other jobs prior to PA school so hopefully will find a way to address it soon. 

 

Future jobs: I'm definitely going to stay away from private practice. I need to be in a place with MAs, admin staff, and other PAs since I clearly cannot dive into admin duties without training and support. I'm thinking of more general practice (IM/FP/obgyn) at large academic centers (hard to get into in my area), as well as the VA and Correctional Medicine. Occ med like someone suggested or community clinics are also on my radar, which seem like they would have more basic medicine and less "other" duties and facets of the job.

 

Thank you everyone for your feedback. I really appreciate everyone's thoughts and words of advice. I'll be continuing to check in here and will respond to queries, and I think everyone has been super helpful, respectful, and encouraging even with the well-deserved tough love. I appreciate everyone reading my very long-winded and repetitive explanations, too. :)

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^ agreed. The OP can not rely on others for training. It's survival of the fittest!

 

I wouldn't completely stay away from private practice. You're missing the point. Rather, stay away from surgical related private practice.

 

You can survive in FM/IM type of private practice.

 

Surviving at a Larger academic Ctr? The answer is yes and no. I seriously think that you start from smaller clinic where you can get a one on one mentorship preferably underserve comm and then work your way up.

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Guest Paula

I've been reading all these posts and from my perspective of primary care in rural and under served areas I must tell you it is not a bed of roses either. I started out as the sole provider with little sp involvement so make sure you have someone who will mentor you.

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Zeus,

 

For future reference, when you're responsible for another human being's health, EVERYTHING is important. There is no such thing as "Medicine Light". You either know how to practice medicine, or you don't. You can't guarantee that a very sick patient won't cross your path in your occ med office. And for sure, correctional medicine is not an excuse to provide half-assed service. Don't even get me started with your implication that you can't cut it taking care of paying customers but you're good enough to care for the veterans who have served our country! That's just offensive.

 

You sound pretty blasé about your duties and that alarms me. It's also very concerning that your never even heard of a discharge summary until your second job out of PA school!

 

Sure, training on the job would be nice. But you have to be more motivated and take some initiative too!

 

To be completely honest, I don't think you're ready to be a PA. A residency at this point is an absolute must. I'm not sure how, but it sounds like you missed a pretty big chunk of education somewhere.

 

Sorry if this sounds harsh. I don't intend it to be. But I take healthcare extremely seriously and my responsibility and profession's reputation even more so. Please get some further training before somebody gets hurt.

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I’ve read this string with some interest. Reading between the lines (because there is only so much information here), my guess is that you did not get fired because you screwed up a discharge summary or two. The rest of the iceberg is under water.

 

Many of us (myself included) had never seen a discharge summary in PA school (saw plenty of H&Ps, but only some of the rest of the medical documentation constellation). We did get the little Maxwell booklet (ubiquitous in the pockets of PA and medical students everywhere) that gave me a clue when I got into practice. Between that, asking some questions, and finding samples, it was no big deal to adjust. And adjust we need to do, on a daily basis, and forever.

 

But you don't seem to adjust well. That leads me to why I think you are where you are. I am glad to hear that you are getting some counseling because my suspicion is that you are not a good self-starter. If only you had a “good” boss, a “superstar” fellow-PA at your elbow, “examples” in the office file: whatever. In any new job, you just have to find resource people, whether it’s your boss, a coworker, a helpful nurse somewhere, or just a Google query. Then, some day, it’s your turn to help someone else. Without the ability to look for and find resources, we are stuck with our own meager knowledge.

 

There have been many well-meaning suggestions here, like taking a residency, etc. And I see some of that in your musings about yet other practice settings. My guess is that not much of that would likely work for you as a cure-all. Like many people with a missing trait, you start to think that just by changing your environment, you will eventually find your niche. In the end, it might mean trying a new career. Maybe you will try some of these things, but -- while there are all different kinds of jobs and bosses -- you might very well end up realizing that you just have a developmental need. Best to deal with that and then see where you are.

 

Good luck.

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Don't feel bad.  Inpatient medicine is not for everyone.  I was not good at it, but have thrived in the outpatient setting.  Also, I have found some of the inpatient people to be cutthroat.  Please know that this, too, shall pass.  There are many people in need of health care in the world, and you will, like me, find the setting in which you flourish and are appreciated.  Hang in there!  Most of us have been through this crap.

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I don't think he meant to be dismissive of the seriousness of care of humans.  I understand what Zeus is saying.  Having worked with all patient populations, I can tell you that the attitude and expectations of the patients you are serving can have a huge effect on your confidence and the way you deliver care.  Having worked in the VA and the prison as well as Indian Health populations, I have found the patients to be very appreciative of care.  Some of the patients in private practice have watched all of the Pharma ads on tv and have unrealistic expectations of what can be provided.  This doesn't mean we don't work just as hard to take care of vets.  But there is definitely a difference in the environment. 

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Inpatient and outpatient medicine are very different. With inpatient work you need to be proactive and a self-starter; the work is there but it does require more initiative. Outpatient work is generally presented to you. A patient is scheduled or a walk-in shows up and you treat them. Then you have a list of things you need to do, like dictations, referrals, billing, etc. It's more "checklist" type work than proactive work. Neither is better than the other, it's just that inpatient work is not for everyone.

 

Some of these replies are a bit cold suggesting the OP isnt cut out to be a PA. It may be more fair to say he/she isn't meant to be an inpatient PA, or a surgical PA, but the former is an arrogant statement to make to someone who got into and through a PA program.

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Inpatient and outpatient medicine are very different. With inpatient work you need to be proactive and a self-starter; the work is there but it does require more initiative. Outpatient work is generally presented to you. A patient is scheduled or a walk-in shows up and you treat them. Then you have a list of things you need to do, like dictations, referrals, billing, etc. It's more "checklist" type work than proactive work. Neither is better than the other, it's just that inpatient work is not for everyone.

 

Some of these replies are a bit cold suggesting the OP isnt cut out to be a PA. It may be more fair to say he/she isn't meant to be an inpatient PA, or a surgical PA, but the former is an arrogiant statement to make to someone who got into and through a PA program.

I agree. There are some arrogant PAs. I am thankful I did not listen to the naysayers early in my career. I believe Zeus, like me, will land on his feet and will prevail. A lot of people who think they are all that are anything but.

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While I don't feel like one of the naysayers, and as someone who works on a daily basis in both inpatient and outpatient medicine, I certainly don't mean to discourage you from a career as a PA. As many readers of the Forum have done, I have lived vicariously through your being fired from two different jobs now, involving two different sets of people and conditions. I feel that there are lessons for you to learn from those experiences.

 

No matter what you do next, you will change conditions: you will be working with a third situation and a third set of people and conditions. I hope that it goes well, whatever job it turns out to be. Still, your approach to the past two situations can't be ruled out as contributing to the problems that you had. And you probably don't want to keep changing jobs forever in an endless search for one where there is no stress and where there will be people at your elbow to help you at every turn.

 

As I noted before, it does not sound like you were as much of a self-starter as you could have been, and that is an important trait in most jobs and most careers. 

 

You are not a failure as a PA. Just take some time to decide what you will do differently on your next job. And, no matter how diligent you are in selecting it, there will be some surprises and things you will have to be resourceful in learning anew.

 

The story of life is often one of midcourse corrections. The halftime peptalk accompanied by offensive and defensive adjustments. A company’s new product that initially fails and is redesigned to be a big success.

 

Success often means sticking to your goal, but with a willingness to accept that we are part of the problem, to look inward, and to change as needed.

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