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Stress, Satisfaction and Respect?


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I always wanted to go to PA school but due to misfortunes and finances I opted for respiratory therapy. I was an RRT for 12 years at a rural hospital and was miserable because I felt my work was in vain. I mostly took care of drug seekers and malingerers and felt like much of the procedures and tests that I did were in the interest for money and not in the interest of the patient. 

 

I decided to go for PA school to make a difference, I completed a bachelors degree in medical laboratory science. I work now for a university in a teaching position and the job itself is great and I enjoy it. This has made me second guess my first reason of going back to college which was PA school. I feel I may have been disillusioned by the abused system that I worked in (rural hospital). I have done shadowing in the ER and clinics, from what I saw I liked. I have some questions for some PAs out there that have been working for a few years now. 

1. What is your level of stress? 

2. How satisfied are you with being a PA?

3. How is the respect level from your coworkers and patients?

Thanks.

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1. depends how you define stress. I don't get flustered easily, but have a busy schedule (sometimes 240 hrs/month + school) and see sick pts. I work more than I want to and don't get enough sleep. exercise helps with the stress. so does spending time on medical missions outside the U.S.

2. better now after almost 20 years. I have had some rough stretches with some really bad jobs where I was treated like crap, but have finally settled into a few which treat me well and give me an appropriate scope of practice for my experience level.

3. pretty good now. patients were generally never a problem, it was docs who didn't want to work with pas or nurses trying power pays to get rid of pas and replace us with nps..

 

if I had to do it over I would go to medschool, but I am happy where I ended up, but it has been a long road to get there. I have to drive several hours outside major metro areas to get to quality jobs @ rural facilities, but the commute is worth it to finally be treated with respect.

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Your 3 questions cannot be answered with one answer fitting all.  In general, stress level will be based on the specialty and environment you work in. An inner city  ER can be a lot more stressful than a family practice in an suburban area.  Satisfaction is subjective.  You must love this profession and what you do to give you a level of satisfaction that you desire.  After all we are in the "business" of making people feel better.  Sometimes a "thank you" from a patient will light up the rest of the day.  Now respect is a whole different question with several factors including what state you practice.  Personally I found the respect I got in NY to be far superior to the respect in Houston, TX.  And always remember like they said in the old Smith Barney ad, "You must earn it".   Florence Nightingale and Mother Theresa have left us.  The "practice" of medicine and the "business" of medicine are here to stay.  Sadly the "business" often exceeds the "practice" of medicine.  All that said after 30 years most nights I go home quite satisfied  and glad to be a PA 

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1. I thrive on stress.  I work in a busy FP clinic.  I have my own patients.  I take care of diabetes, HTN, dyslipidemia, respiratory infections, and more.  Often, all in the same patient!  Seeing patients while taking nursing home calls, coordinating outpatient care, working with hospice, reviewing rads and labs and EKGs is all in a days work for those of us on the front lines.  But there are many jobs for PAs.  Many are more or less stressful.  Your situation will be different.

 

2.. I am very satisfied with being a PA, which is not to say that I wouldn't like to see change in our profession and health care in general.

 

3.  Respect is earned.  If you do a good job, you can be as respected as anyone else in health care.  

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Second many of EMEDPA's thoughts.  Having seen the many changes of the profession from when we posed no threat whatsoever to the physicians (unless they were forward thinkers) since we couldn't order anything without a phone authorization or physician signature, to where we are today seeing patients on our own, as with any profession as the job changes so do the challenges that you face.

 

1) non-existent in current setting with current practice parameters

2) Never was ever "satisfied" with the profession due to the "Smith-Barney" scenario, regardless of how well one may have presented themselves.  To expand further, as the profession was initially setup there was low/minimal risk of liability because the physician was always looking over your shoulder/authorizing things as noted (knowledge base exceeded clinical skills implementation availability).  As a result it paid well compared to other professions, you got to be involved with providing medical care, work decent hours in a lot of cases, and you didn't have to worry about things too much.  As the profession has developed, more clinical skill utilization carries the inherent risk of greater liability, which I don't think a lot of folks take into consideration until it happens to them.  Along with this comes the stress associated with greater responsibility.  Some folks from my generation for example may not be cut out for today's medicine (I think I've held up ok thus far).

3) It has varied over the years based on setting, physician exposures, and clientele (remains the same today for everyone).  More folks are aware of the profession and are more accepting of care provided solely by us (in some cases, such as my present situation, you don't have an option of seeing anyone other than a PA so if you don't like us, don't come to the clinic but go see your own PCP).  I had an IM physician decades ago who specifically told my specialty physicians that I was not to chart on HIS patient's charts since we were technically in-house consultants, though we may follow the patient ourselves in our own speciality clinic.  His frustration was based on the primary cause for most other providers not liking us....$$$ out of THEIR pockets.  Bottom line, I know what I'm comfortable with, and if I don't know it doesn't bother me to tell the patient, and I send them to someone who may have a better grasp.  Today, toward the end of my time, I enjoy the patient education (what sputum colors are concerning, why we don't necessarily care about strep pharyngitis any longer, what constitutes bacterial sinusitis and how it is very uncommon, etc.).

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1. I certainly feel "stress", but the stress for me comes in with trying to make sure that I'm balancing the number of patients I'm currently seeing with making sure patients don't wait too long to be seen.  I'm pretty comfortable with my practice style and my clinical suspicions are usually attuned well.

2. Again, another balance aspect- there are some aspects of being a PA at my current position that I do not like, but relatively speaking it's pretty great, and unlike at my old job my earning potential is sky-high.  The more I work, the more I earn, and the opportunity for locums work in the group is excellent

3. I'm still young in my PA career since I'm at the end of my initial certification cycle, but I've been thankful to enjoy great respect from nurses and ancillary staff and patients for the most part.  99.9% of the ER docs I've worked with have been pretty happy with me, but as others have noted it's the consultants that will pose problems.

 

Overall I'm still pretty happy as a PA

 

 and felt like much of the procedures I did were in the interest for money and not in the interest of the patient. 

 

This comment interests me, and I wanted to branch it out for discussion- we can make it a separate thread if need be.  This may purely be a result of the area I work in specialty-wise, but I find that the over-testing/over-procedure I see with providers is not due to an interest in earning more money, but due more to a provider's low tolerance for risk (you can read that as fear if you wish) and/or their inability to make clinical decisions based on history and physical.

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1) moderate to high. responsible for people that are sick and could die from that sickness if wrong decisions are made

2) satisfied 

3) varies ... medicine is customer service in many ways ... sometimes patients are not satisfied customers for varied reasons ... and they take it out on you the same way people take it out on the water or sales rep.  Some MDs will act as if they are better than you ... some of them actually will be. If you need to be number one and want to practice surgery being a PA might not be a good fit. If you want to be an internist or work out patient pulmonary you can have basically full autonomy. Although I have to caution you if you found RRT to be difficult PA is prob going to be worse in terms of dynamics w patient 

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This comment interests me, and I wanted to branch it out for discussion- we can make it a separate thread if need be.  This may purely be a result of the area I work in specialty-wise, but I find that the over-testing/over-procedure I see with providers is not due to an interest in earning more money, but due more to a provider's low tolerance for risk (you can read that as fear if you wish) and/or their inability to make clinical decisions based on history and physical.

 Has anyone ever been told that they needed to admit more patients, even though they don't need to be?

If I don't believe that I am truly helping someone get better and have to play this deep into the business side of healthcare, I don't think I will enjoy it. Are you dictated to how you practice medicine? 

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1) moderate to high. responsible for people that are sick and could die from that sickness if wrong decisions are made

2) satisfied 

3) varies ... medicine is customer service in many ways ... sometimes patients are not satisfied customers for varied reasons ... and they take it out on you the same way people take it out on the water or sales rep.  Some MDs will act as if they are better than you ... some of them actually will be. If you need to be number one and want to practice surgery being a PA might not be a good fit. If you want to be an internist or work out patient pulmonary you can have basically full autonomy. Although I have to caution you if you found RRT to be difficult PA is prob going to be worse in terms of dynamics w patient 

I did not find RRT to be difficult. Most of the ER night shift docs would page me to intubate the ICU patients if they were busy or RNs would specifically page me to get an opinion on vents or assessment, I was one of the hardest working/competent RRTs there.

 

 What I didn't like was doing daily ABGs on suboxone patients.

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1. stress is a fickle thing, and as E stated it depends on how you define it. As a new EMT I was stressed about driving an ambulance, taking a BP, holding c-spine, back boarding, pt care.... As a new medic I was stressed about managing a scene, multiple pt's, pharmacology, pt care.... As a new PA grad I was stressed about every pt and remember thinking how easy I had it as a paramedic. Personally, I work better in a less structured environment. Currently I work as the solo provider in 2 ED's  260+ hours/month. In one the doc is 30 minutes out, the other is by phone only. Personally I wouldn't have it any other way. I can't imagine working 9-5 five days a week.

2. I'm fairly satisfied as a PA.

3. Like others have said respect is earned. I've been fortunate in that I have had great docs that respect PA's in general and me personally (after I have proven my self). I have had the occasional specialist be less then nice.    

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1. I thrive on stress.  I work in a busy FP clinic.  I have my own patients.  I take care of diabetes, HTN, dyslipidemia, respiratory infections, and more.  Often, all in the same patient!  Seeing patients while taking nursing home calls, coordinating outpatient care, working with hospice, reviewing rads and labs and EKGs is all in a days work for those of us on the front lines.  But there are many jobs for PAs.  Many are more or less stressful.  Your situation will be different.

 

That is great, never a dull moment. Have you ever worked in specialty? If so how does it compare, more or less hectic?

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That very well may have been true, you may be able to elaborate more on this since you work in the ER. Is both the hospital and provider liable in a lawsuit if say the provider missed something?

I saw many physicians come and go, most of them would not go crazy while ordering in the ER, then a few months later as if a switch wereturned on, everything was ordered. Such as IVs for everyone, xrays turned into xrays and CT scans.... (corporate intervention?). The new physicians that got a contract soon followed the same "set of rules". The chief doc would order daily ABGs for everyone unless they were a kid, including cellulitis, drug rehab patients, UTIs, just to name a few. I got burned out very fast because this. Once Obama care kicked in, it got a little better. Was the hospital CEO telling the physicians to order all these tests/procedures for liability issues? I don't know maybe, or was this the business side? Has anyone ever been told that they needed to admit more patients, even though they don't need to be?

If I don't believe that I am truly helping someone get better and have to play this deep into the business side of healthcare, I don't think I will enjoy it. Are you dictated to how you practice medicine? 

 

I will say that in my time practicing, I have never had anyone tell me or any other physician or PA/NP to order more tests because it's better for the group's bottom line for reimbursement.

 

I've also never heard of a hospital CEO telling a physician to order more tests because of liability.  I have seen a physician order more tests because THEY could not handle the supposed fear of liability.

 

I can't speak to your exact situation of a chief doc ordering ABG's on everyone and why it occurred, but anecdotally when I've seen this it's because they are poor clinicians who can't discern when tests are actually appropriate (mind you this is a gross generalization).  

 

In regards to admissions, it's a slightly different story.  There is a set of criteria out there called InterQual that is used by CMS and many insurance companies and hospitals to determine if an admission will be reimbursed or not.  I want to emphasize that this does NOT influence whether a provider decides to keep a patient in the hospital- it simply means that if the provider determines that it's best for the patient that they stay in the hospital, THEN InterQual criteria is used afterward to determine if the admission is actually paid for, or if the patient would be in an observation-type setting which is not a full hospital admission.

 

For example, let's say you have a patient with multi-lobar pneumonia.  According to InterQual criteria, that alone will get a patient's hospital stay paid for, regardless of lab values, oxygen status or whether they are stable or unstable.  HOWEVER, the provider seeing them in the ER may decide to send that patient home because it's the best thing for that patient. They don't automatically get a bed in the hospital just because they have multi-lobar pneumonia- but if the provider feels medically they are better served by inpatient care THEN that visit will be reimbursed.  In the same token, a patient with community-acquired pneumonia in a single lobe but with every other parameter being normal would NOT get their inpatient stay reimbursed; however, if the provider seeing them in the ER was not comfortable with them going home, then the option would be placing them in an observation setting.  There is a fine distinction here, and I hope I made it a little bit clearer.

 

Also understand this has nothing to do with elective, outpatient procedures that some specialists surely do because they will be more likely to be reimbursed for them.

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I work in FP seeing my own patients, A-Z, but lots of acute and simple concerns.

 

 

1. Stress varies widely by patient load, patient complexity, and practice type. Most days in FP my stress level is low.

 

2. Presently I'm satisfied. I would like to see a few things change in the profession---like a title change and more standardized salaries, practice laws--- but overall this is what I signed up for. Wasn't always that way for me though. There are some terrible gigs out there.

 

3. Generally very good, but again this varies widely by practice setting and your level of experience. In surgery I got sh!t on. Rightly so, I didn't really know what I was doing, but it's still demoralizing. Most patients see you as synonymous with a doctor anyway, and the ones who do know about PAs seem to like us. A very small minority get perturbed they are seeing an "assistant".

 

 

I used to ask all these questions before I started PA school. They are valid. But in medicine---the PA side of things especially---the answer is almost always "it depends".

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i understood what you meant by frustrations w pt's while RRT and they only intensify as a PA/MD. people who have trouble seeing those issues froma different frame of mind have low work satisfaction in my opinion. might be specialty dependent as well

If I became a PA I would be satisfied if I could do what was best for the patient and not feel like I had to do whats best for someones pocketbook or be told that I wasn't admitting enough (yes one doc that left told me that an old CEO told him to increase his admit #s, he didn't, so he got no contract) From what I have read on here everyone is fairly satisfied and see a noble purpose in what they do, so that's good to know.

 

True Anomaly: Thanks for the insight. That gives me some hope that you have not heard any CEO tell providers to admit more patients or order more tests, I think I may have worked for a sketchy company.

 

db_pavnp: I think some of the RNs liked to chuckle when Mr. king needle junkie screamed over a blood gas but literally everyone that was not a kid got daily ABGs no matter the Dx.... new suboxone patients and needle junkies were icing on the cake and we had plenty of those(hep C has reached an epidemic here).

 

BruceBanner: Sounds great, Have you always worked in FP?

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