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FancyPAntsy

4 years in, still regretting becoming a PA

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Wondering if it gets better?

 

I'm starting to wonder if I will find job statisfaction as a PA. I've spent 2 years in primary care, and 2 years in emergency med. I'm wondering if I'm in the wrong specialty or if I should look into another profession. My biggest problems the abusive patients, dealing with aloof and condescending attendings and consultants, and frustration with the inacessability of healthcare for patients. Seems like half the time I can't help someone with the reason they came to see me, and then they are mad or I feel bad because of the bill I know they'll get. It seems like patients expect us to completely change their lives, but if you're in the ER for the 200th time for your abdominal pain, or because you want STD testing at 1am, or because you have had 10/10 ear pain for 2 hours, chances are I am not going to cure you no matter what I do. Now here's a $500-$5000 bill for the 30 minutes we spent together...

 

School didn't prepare me for the dark side of medicine. It's been painful in ways I did not expect. I did not realize going into medicine: the level of sexism I'd be the target of, the daily strain of patients being manipulative for narcotics, or that most of my coworkers would be burned out themselves. A lot of my frustration is that we all work our rear ends off daily and it feels as if there's no reward. In fact we keep getting pressured to increase production. In most fields, if you show up with a kickass ethic and a good attitude you get somewhere! American medicine is set up to gradually beat your spirit to death. I went into this thinking I'd make a positive difference in people's lives and they'd be happier for it which would give me job satisfaction, instead it seems I can either meet expectations or be a disappointment. (Ironically I have the top PG score at my ER right now).

 

As a student I loved general surgery but wasn't able to find a job in surgery. Now that I'm settling down and looking at starting a family in the next year I don't think surgery would be good for my family. I've considered dermatology because it includes procedures, regular hours, and possibly more satisfied patients. Outside of this, I've done well with investments and daydream about opening a business outside of medicine. I am starting to think my personality is not a fit for this profession and I'm really struggling to find a passion.

 

Holy cow this turned into a rant. I know we all feel this way at some point, it seems some deal better than others. Those who get a lot of satisfaction: what do you do? How do you get past the stress and burnout?

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In many ways the art of medical care is at its lowest point ever.  It can only get better.  How long it will take to get better is not clear.  In the old days, the actual practice of medicine was very rewarding, although we had to deal with a lot of PA-discrimination that doesn't exist as much today. But the things you mentioned about the practice of medicine has changed.  I read a report this morning that the suicide rate among physicians has doubled in the past 5 years, already being one of the highest professions for suicide.  It is the same things you mentione. Falling revenues, abusive patients and etc.  I will share a link here just so you are not alone.  Somehow we have to fix things.  I gave my congressman a earfull two weeks ago. He said there was nothing he could do. But Washington can fix a few of the things.

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I find variety helps. I have 3 jobs:

urban trauma ctr

rural community hospital double coverage with doc seeing everything

rural critical access hospital solo coverage.

I also do medical missions and disaster medicine,

switch things up a bit so you don't get into a rut.

I'm also completing an additional degree ( DHSc global health) to keep sharp and learn new things. soon will start doing some part time teaching at a local PA program when done.

go where you are appreciated and have a great scope of practice. don't worry about money, focus on autonomy and respect and the money will come. best of luck.

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I'm guessing you live/work in an urban area, right? 

 

Try moving to the country.  You will quickly find that people out here are much nicer, less demanding, respectful, and appreciative of your efforts AND you will likely make far more money than you are making now (money = time).

 

I would need to make $350-$400K a year to live in NYC.  Yuck!! 

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It is interesting how things have changed.  Patients were in the past much more appreciative but then again we also had a lot more time to spend with them and charged much less money.  I don't think the basic nature of people has changed but they do feel pretty exploited for their 7 minute $200 visits that are not covered because of large deductibles.  We have also created unreasonable expectations for what medicine can and cannot do; we get angry at people for coming in when they should not but have failed to educate them about appropriate utilization and they get lots of mixed messages.   The pendulum of pain management is a good example.  For a long time we thought that pain was undertreated and encouraged medication use.  Now, the pendulum has swung in the opposite direction.   Patients are confused and, being only human, continue to want to feel "better".

 

Even providers now, when they become patients, feel a bit ripped off......I can speak from multiple conversations with PAs and MDs who have entered the jaws of the medical complex with unsatisfactory encounters.  We used to have the "privilege" of professional courtesy but  that is also long gone.   Everything is equal:  we all have the same access to mediocre, expensive, inpersonal and brief care.   Pretty much like fast food:  available on every corner, it will keep you alive (or at least not kill you quickly), but you might be less than satisfied with the total experience.  In order to get personalized care, one has to be known to a provider on an on-going basis.  this can deal with many of the issues you mention including drug-seeking, inappropriate visits, etc. 

 

In terms of how PAs are treated as providers....much better income and autonomy and respect now as compared to 1970-1980; also much more responsibility for outcomes and much less time to do our jobs.  It used to be that a PA was scheduled with maybe 20-30 minute appointments vs the MD's 10-15 minutes, no longer.  So our jobs tend to be very equivalent but the level of money and respect is still less than physicians command, and so we continue to feel a bit ripped off although very "well-utilized".   This has happened to some extent to everyone who works in the health care system so we end up working in places with universal low morale, which doesn't help.   When morale is low, groups pick on each other instead of providing support, and that is what we are seeing with the uncivil attendings, admitting providers and specialists. 

 

I think when we get used to the ACA and make some other much needed improvements, things will again swing upwards, and PAs/NPs will end up being the major providers of primary care and also most urgent and emergency care.  The degree of utilization and respect we get, along with the pay, will even out in the long run and I see us as physician equivalents within 50 years.   Although that seems like forever, it has been 50 years since the profession started.  We've just started to try to make the health care system conform to what most people need, and to be inclusive of most everyone,  and it's been rough sailing to be sure.   But now our numbers are such that we are really essential to making things work.   So, if you are just starting out, you will be integral in this.  Don't give up yet. 

 

In terms of professional satisfaction, I have found  through the years that adding teaching, writing, administration, and even research to the mix of clinical care helps.  Changing and varying specialties helps, as does seeing how things are done in other places/states or countries.    I think the bottom line is that we are all stuck in this together, whether as patients, providers or both, and the best thing to do is try to be as kind and helpful to everyone we can regardless of circumstance or blame.  Keep your curiousity and humanity alive.   You really won't find a better profession for doing that. 

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It is interesting how things have changed.  Patients were in the past much more appreciative but then again we also had a lot more time to spend with them and charged much less money.  I don't think the basic nature of people has changed but they do feel pretty exploited for their 7 minute $200 visits that are not covered because of large deductibles.  We have also created unreasonable expectations for what medicine can and cannot do; we get angry at people for coming in when they should not but have failed to educate them about appropriate utilization and they get lots of mixed messages.   The pendulum of pain management is a good example.  For a long time we thought that pain was undertreated and encouraged medication use.  Now, the pendulum has swung in the opposite direction.   Patients are confused and, being only human, continue to want to feel "better".

I respectfully disagree with you here.

 

Patients are certainly part of the problem. They are extremely entitled, which is a problem in our society in all aspects. But, in my opinion, they are not the worst part of health care. (I find overly entitled patients to be amusing and harmless for the most part)

 

I work in a system where people get health care for free and it is no better.

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 they are not the worst part of health care. (I find overly entitled patients to be amusing and harmless for the most part)

 

The worst part of working in health care is insurance companies, work comp paperwork, and EMRs !

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The next worst part of medicine is the administration at high levels who have no medical background and crunch our numbers and calculate if we squeeze in one more patient per hour they will make their bonuses at the end of the year.  

 

 

I work in a smaller town, rural and the patients are still appreciative and I have lost the sense of helping the patient find the miracle cure for their virus.  I do not feel guilty for their bill either.  

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I work in a smaller town, rural and the patients are still appreciative and I have lost the sense of helping the patient find the miracle cure for their virus.  I do not feel guilty for their bill either.  

 

I don't work in a small town, but I echo this- although, I approach it with telling them about how I can actually make them feel better with their virus.  I can count on one hand the number of times as a PA that I've have a demanding parents and/or patient about antibiotics after I talk with them about how I'm going to treat their symptoms- it actually amazes me how under-utilized and mis-used a lot of supportive care meds are.

 

Oh, and I also feel absolutely no guilt about their bill at the end of the visit.  I didn't ask them to come see me.  If it were to be a huge issue, I do have the option to simply medically screen them and it actually would cost them zero dollars simply for me doing an MSE and thereby fulfilling the letter of the law in EMTALA.

 

In answer to the big questions the OP posed, I simply have come to terms with what I am able to do in my limited visit and what I'm not able to do.  And I discuss this very openly with patients.  Some are actually kind of surprised when I tell them I'm not able to do much for them, but they actually appreciate it- and they don't get mad about us "not doing anything" because there's nothing I actually can do for them and I will tell them this.  It's those patients who actually DO need you, and that you CAN do something about, that makes the job extremely worthwhile.  6 years in, I'm still very satisfied with my career.

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OP, I was in a very similar place as you are about 1 year ago. I even had a lengthy thread about it here (search "Not enjoying medicine, wanting out").

 

The thing about being a PA is there is HUGE variability in what your day-to-day and QOL looks like. I really do believe if you got in and made it all the way through licensing there is a niche for almost everyone.

 

I started out in Ortho Spine which was a terrible choice for me. I was under-qualified for the needs of the practice and became a black sheep pretty quickly. I was let go less than 6 months into my first job. Bad way to start out.

 

After that I did Occ Med and for a long while I frankly hated being a PA. And at the time I didn't fully realize it was mainly due to a sh!t working environment. I kept thinking maybe I just have a bad attitude and am not cut out for healthcare...but a bad gig can bring out the worst in people. Every single day I was dealing with some level of malingering, adversarial relationships with employers and employees, repetitive mindless work and poor pay to boot. At first I liked it because of the hours and independence, but we were essentially production monkeys. I understand a practice has a bottom line, but you start to feel undervalued when every month there is a spreadsheet comparing your monthly production left on your desk....and you're paid $72k a year. Beyond that, the place was poorly managed and unprofessionalism was a chronic problem.

 

Long story short I got out and worked per diem for about 5 months. I was immensely happier and actually enjoyed the days I worked. I eventually got my current gig in family practice and finally feel like I am good at what I do and have some pride in my profession. Not to say I enjoy every single encounter, but people here generally want to be helped, they have real (if only minor) problems, and we see all walks of life. There is a ton of clinical variety and you can make the job as boring or as interesting as you want. If you want it easy, just refer everyone. If you want to work, then you can figure out people's problems yourself. Beyond that, I have a great SP and am respected as an independent provider. Yes I have to produce but they aren't rubbing it in my face.

 

So don't lose heart, OP. I would give it another year or two before you throw in the towel. Hospital environments can be caustic and soul-killing. You seem like the kind of person who would do well in a mellow, local private practice where you can essentially be your own entity. They are out there, but it takes some luck to find one.

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^ same here.

 

Variety is the key.

 

Those rushing into specialty. No thank you. You're treated like an MA or more or less to clean up there mess.

 

Variety is the key = High job satisfaction. FM (30%), UC (50% doing lots of procedures), & ED ( 20%). More happier than ever. I have 1 FT & 2 PT jobs.

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Unfortunately what Fancy PAntsy says is true.  I have experienced almost of what she said.  When I started to practice in 1986, I was thrilled eith going to work everyday even the 1/2 day on Saturday.  It was a medically underserved area in Queens, NY.  I had tons of respect from the patients and SP and staff.  We worked as a family.  Sure being in the "hood" did have its moments but they were few and far between.  I eventually took over the practice and purchased the center and for 18 years was as happy as a clam (what ever that means!)  Then moved to Texas and immediately felt the negative vibes from the "Docs"  One practice was a snooty ENT and they were quite demanding and when you walked in the exam room looked at you like you had dog s**t on your shoe.  My most recent practice (2+ years) is very similar to my own practice in NY (medicaid and ACA BUT this time (28 years later) the patients are rude demanding and don't care who you are just give me what I want!  Disappointing to say the least.  There needs to be a lot of work to get the respect I had in the 80's and 90's.  Entitlement should be something you have earned not handed to and expect!  Yes I do have concerns about the private pays and the bills they get.  Sorry for the rant.

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I'm coming up on 5 years and I feel it some times but the past year or two I found 4 words that have given me comfort. "It's Just A Job."

 

Sent from my S5 Active...Like you care...

 

 

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The answer is simple. Gumball machines in the lobby and the patients pay an access fee to the lobby. Our roles are to only keep the gumball machines full since they are more informed than we are. They already know what they need and want.

 

OK, let me revise this so that it makes some sense.  The contents of the gum ball machine include your favorite flavor of antibiotic, anti-anxiety med, and of course, narcotic.  It has become quite frustrating when you not only tell the patient what they need to do but you try to take yourself out of the equation by telling them that the recommended course is based on specialty recommendations.  They still don't want to listen.  It's a shame that you can't help folks even when you really want to.  


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Don't regret becoming a PA. The MD don't have it that good either. Yes. Most of them does.

 

We all are getting pinched. This is not exclusively PA. MDs as well. Our employers. More work and volume with low returns. The constant cut in reimbursement. Insurance claims denied. Yes. Medicine sucks!

 

 

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There are some nice niches as a PA if you are in need of a sabbatical. I am currently on one myself working dive medicine in Hawaii. Alaska (ANTHC) is always looking for CHA trainers. CDC EIS program is currently taking applications for next years class. 

 

For some, full time clinical is a sure way to burn out no matter how much you love practicing.  

 

Good luck

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There are some nice niches as a PA if you are in need of a sabbatical. I am currently on one myself working dive medicine in Hawaii. Alaska (ANTHC) is always looking for CHA trainers. CDC EIS program is currently taking applications for next years class

 

For some, full time clinical is a sure way to burn out no matter how much you love practicing.  

 

Good luck

nice program, but ridiculously competitive. folks with md/phds in infectious dz and public health apply and don't get it. I would consider doing it myself.

http://www.cdc.gov/eis/application.html

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An old rule I learned a long time ago is not to stay in a job you don't like. As you might remember from clinicals, every PA has a different job. Maybe you are in the wrong profession, but look around first and try to find something better.

 

My job is a mix of hospital and clinic, generally on my own. I have enjoyed it, though even with patients that you like (and I like virtually all of ours), working in the clinic can wear you down at the end of a long day. Room 1 to room 2 to room 3.... while the list of waiting patients builds up. In my case, I try to do as much hospital rounding as I can because I like the pace better and the results are more immediate, I know lots of people who work at all of the hospitals I go to, and the work involves collecting data and then sitting in a quiet place (usually) where I can input my notes and orders. Then it's back into the car to drive somewhere else while listening to "Mike and Mike" or "The Herd" on sports radio.

 

After nine years of this, and approaching another birthday divisible by zero, I've decided to go part time, spend some time with the grandkids, and add a second day as a PA educator at a local university. I also guest lecture for two other programs.

 

I've had jobs I became dissatisfied with during my now nearly 50 year working career. Use that dissatisfaction to change your situation, remembering that (a) dissatisfaction can be a good thing if it moves you to take action, (b) no, not all jobs are the same, (c ) see if you can change your job before you consider changing your career, (d) don't let yourself get bitter and pessimistic, and finally (e) always remember that you are in charge of you.

 

Good luck!

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this post points out how much of what we do is highly dependent on who we work with and the environment / Patient population we deal with

 

I think if you can find a practice or area that meshes with you are a person your outlook will change greatly

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if you can manage medicine for another 2-3 years consider an executive healthcare MBA. maybe your hospital   or another hospital you could work at    will offer tuition dollars.  Then go into healthcare management. If that is not realistic maybe take a few courses in mgmt .... i know some of the big b-schools and hospital systems offer courses in the topic.   Or consider corporate America. Work in healthcare consulting. I had an MD friend who transitioned into this field at 100K starting... and she never practiced as an MD ... left after 1 year residency. 

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Another thing I've noticed is that my (and I suspect others') job happiness is inversely correlated with the volume of patients I see every day.

 

If it were up to me I'd see 10-12 a day. Spend some time with them, chart, sip a coffee. Once I get into the 20 ppd zone I get buried in charts, labs, and phone calls and the burnout countdown begins. I'm sure some would laugh at those numbers but that's my threshold.

 

My SP, who has been practicing for some 35 years, once said to me "you can work as many days as you want here until you realize it's just a job."  I'll never forget that.

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I agree with Bruce Banner.  12 a day is reasonable and beyond that is a recipe for burnout.  I've been at my job now for 4 months now and I've already been asked by management if I'm getting burned out.  I find 18 is too much, depending on complexity.

 

At least in this job I still have the authority to control my schedule a little with only allowing 30 or 60 minute appointment.  Not a 20/40/60 minute appt as I tried that and was amazed at how all of them were scheduled for 20 minutes no matter what walked thru the door.  I went  back to the 30/60 minutes and not burned out but was on the fast track to burn out.

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OP, I'm kind of afraid of going into this profession and regretting as well. Honestly, I don't have a some deep ingrained passion for medicine. I work at a hospital right now and I'm not like "YESSSS I LOVE HELPING PEOPLE" after every patient, I'm more neutral about about it if anything. I think the best way to describe my situation is if someone offers me an office/accounting/retail/marketing/research job right now that pays $150k a year for 40hr/week I'll take that in a heartbeat. I know alot of you guys will be like "well you should get out now cause you gonna hate your life etc etc" and I really cant. My resume, major, gpa, and extracurricular are so built for medicine that I don't want to waste it all along with the time it takes revamp myself and find my true calling or whatever. I like your SP's advice BruceBanner. I think i've already accepted this to be just a job at the end of the day just like I would accept any other career as just a job since I'm not crazy passionate about anything sadly...

 

I do have a question: Would it be wrong for me to pursue the PA profession for practicality instead of passion? Don't get me wrong, I do enjoy helping people, but just not enough to call it a passion I guess. I just want to be in a stable career that pays decent in my mid 20s. 

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^ recipe for quick burn out and being a poor provider. The passion is not just about medicine and care of people, but also learning medicine and its art, something inherently difficult that most couldn't handle. You need to be dedicated in the pursuit of ongoing knowledge advancement as well. These two factors are extremely important for one to be a safe, effective and caring provider that will set you up for a successful career. Look at us who talk about burnout. It's usually second to an abusive environment in which separated we would flourish and be happy again..

 

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