4 years in, still regretting becoming a PA

[Soulfari]

This thread is making me feel torn between:

 

A. Practicing ~heroic medicine on the wards or in the ED, and facing potential "burn-out via toxicity" [ED/IM/Surg]

 

and

 

B. Utilizing my pre-PA School network and going straight into Derm private practice after graduation. 

[BruceBanner]

^ DERM. What a quality-of-life goldmine.

 

 

Totally agree about managers vs. leaders. This is a huge problem in organizational healthcare, and even larger private practices.

 

Anyone with some organizational skills can sit behind a desk and send out condescending passive/aggro emails, approve schedules, and hold meetings. It's all based on protocol.  

 

Leaders know their men, they know each man (or woman's) strengths and weaknesses, they don't ask the team to do anything they would do themselves, and they see the bigger picture. The way I differentiate leaders from managers is that leaders generally make you WANT to do a good job, and make you feel worthwhile. Management is just division of labor, passing down whatever sh!t upper management passed on to you, and of course, lots of subtly condescending and impersonal emails in lieu of actually talking to your employees and getting your own boots on the ground.

 

I have little respect for management. They rule by protocol and fear. And big HCO's are the worst.

[EMEDPA]

derm, what a boring descent into mediocrity....unless you truly do full scope with biopsies, procedures, manage skin cancers, etc...too many derm jobs out there now are "cosmetic derm"

[Sam I Am]

I just came from visiting a friend who I used to work with in the same environment with the same SP.  When she was working with me and this abusive doc, my friend was miserable and looked incompetent and her self esteem took a plunge.  When she was let go, she found a job through Locums working with the underserved in a far away place.  What a difference a switch made!  She is well respected in her clinic, looks absolutely large and in charge, and people stop and listen and pay attention.  She looks like a completely different person and I'm hopeful to see that.  Prior to that, she hated being a PA.  She's back in the game now and won't ever go back to a toxic environment with an abusive doc.  An example?  While this doc was explaining/teaching/saying something, my friend was being proactive and looked something up on her phone for more information on the subject matter.  The doc got so upset by this perceived slight that she grabbed the phone away and slammed it face down on the desk in order to make my friend scared into paying more attention while she was talking.  The entire time, she continued talking as if nothing happened.  What would you folks do in that instance?

[Cup]

I just came from visiting a friend who I used to work with in the same environment with the same SP.  When she was working with me and this abusive doc, my friend was miserable and looked incompetent and her self esteem took a plunge.  When she was let go, she found a job through Locums working with the underserved in a far away place.  What a difference a switch made!  She is well respected in her clinic, looks absolutely large and in charge, and people stop and listen and pay attention.  She looks like a completely different person and I'm hopeful to see that.  Prior to that, she hated being a PA.  She's back in the game now and won't ever go back to a toxic environment with an abusive doc.  An example?  While this doc was explaining/teaching/saying something, my friend was being proactive and looked something up on her phone for more information on the subject matter.  The doc got so upset by this perceived slight that she grabbed the phone away and slammed it face down on the desk in order to make my friend scared into paying more attention while she was talking.  The entire time, she continued talking as if nothing happened.  What would you folks do in that instance?

 

Oh my gosh. That's absolutely terrible. I'm just pre-PA, but I have previously worked as an MA in a private clinic where the doctor had a horrible superiority complex, putting all his employees down and even tried to turn people against each other with lies (but we all knew it was BS). When the clinic was slow, he would literally spend 30 min to an hour berating all of us as we stood around him. If you tried to say something back he would just talk over you. The turnover rate was ridiculous.  In my short time working there (6 mo.), At least seven people had come and gone. It was a very toxic environment and I was miserable.

 

Anyway, I tried to just laugh to myself at how crazy he was instead of taking everything personally. Easier said than done. This thread is a good reminder of how coworkers really do contribute to your job satisfaction level, and that you should never feel stuck in any one job. It's also good to know that I should prepare myself to meet future crazy doctors/supervisors in a career as a PA.

[Sam I Am]

It's also good to know that I should prepare myself to meet future crazy doctors/supervisors in a career as a PA.

 

Also be aware of your first PA job when you graduate.  Make sure to ask the right questions.  "What are the SP's plan for supervising PA?"  "Has the SP EVER supervised a PA before?"  And lastly, DON'T ever go into a work place without a contract.  Make sure you can find a job where the SP is willing and competent enough to supervise/train/mentor.  See if you can sit and observe the practice - how they treat those at the bottom is a sure sign of how you, as a PA, will be treated.  

[EMEDPA]

yup, don't try to fix jobs like this or wait for them to get better, just leave. I've left a few jobs like this and it really made me a happier person and a better human being because your whole world view changes when you enjoy your work and are respected.

[Guest Paula]

I work in emergency medicine.  My job was great until about 4 months ago when our chief left to take another position and was replaced by another of the group's physicians.

 

This physician - turned - administrator, with his newfound administrator attitude (and salary), sat me down and flat out told me, exact words, that quality of care no longer matters and that I need to sit down and "speak from the script", i.e., the lines of crap that the consultants are giving us to increase favorable survey responses.

 

My retort to this, once I got over the shock of hearing that, was that if they really wanted me to do that I would have to see less patients to accomplish that.  In our group there are only 3 PAs and about 30 physicians.  Out of all those I have the highest numbers of patients seen, month after month.

 

I was told that was fine.  But I bet as soon as I start cutting down, they'll be yelling about numbers dropping and times getting worse.

 

I'm already fighting an uphill battle just being a PA in this system.  Many of the consulting physicians at our hospital refuse to speak to me on the phone simply because I'm a PA.  The uneducated, simple-minded patients that outnumber any other kind of patient we have in this rural area are not used to having a female provider and automatically assume I'm a nurse.  Even after explaining what I actually am, they don't take me seriously and I frequently have to send one of my male supervising physicians in to say exactly the same thing I just said.  (In our group of 33 there are only 4 female providers.)  

 

Sigh.  I really like the people I work with.  And honestly, this is pretty much the easiest job I've had, despite its issues.  But that lack of respect....that lack of ability to do anything about the injustices that are done to us and our patients....is killing me slowly.

 

What is an example of "speaking from the script"? 

[EMEDPA]

What is an example of "speaking from the script"? 

"we know that pain control is important to you, that's why I've given you 240 percocet/month for 3 months for your ankle sprain. please give our practice a positive review on yelp, thanks"

[Maverick87]

"we know that pain control is important to you, that's why I've given you 240 percocet/month for 3 months for your ankle sprain. please give our practice a positive review on yelp, thanks"

 

No way. Do some places actually make their providers do this?

[eighthnote24]

What is an example of "speaking from the script"? 

 

Well, there's the phrases that make us sound like waitresses:  "Can I get you a drink?  I have the time."  "Would you like a remote for the TV?"  "Would you like a warm blanket?"

 

And the phrases that just sound awkward:  "Our goal is to provide you with very good care."  "In 7 to 10 days you will receive a survey."  "We know you have many choices and we're glad you chose ***** Hospital, which is a very good facility."  (Very Good is a big thing here.)

 

Then there's the outright lies we're supposed to tell:  "Hi, my name is **** and I'm glad you're here!"  

 

They're now making our nurses (in the emergency room!) ask "How do you learn best - by seeing, by reading, or by being told?"  I've yet to hear a patient that didn't go...."Huh???" to that question.  

[eighthnote24]

"we know that pain control is important to you, that's why I've given you 240 percocet/month for 3 months for your ankle sprain. please give our practice a positive review on yelp, thanks"

Sadly, not far off.

[Maverick87]

Well, there's the phrases that make us sound like waitresses:  "Can I get you a drink?  I have the time."  "Would you like a remote for the TV?"  "Would you like a warm blanket?"

 

And the phrases that just sound awkward:  "Our goal is to provide you with very good care."  "In 7 to 10 days you will receive a survey."  "We know you have many choices and we're glad you chose ***** Hospital, which is a very good facility."  (Very Good is a big thing here.)

 

Then there's the outright lies we're supposed to tell:  "Hi, my name is **** and I'm glad you're here!"  

 

They're now making our nurses (in the emergency room!) ask "How do you learn best - by seeing, by reading, or by being told?"  I've yet to hear a patient that didn't go...."Huh???" to that question.  

 

 

Sadly, not far off.

 

Have you considered quitting? No way I would put up with this nonsense.

[EMEDPA]

No way. Do some places actually make their providers do this?

close, they want us to say " I hope you received excellent and safe care today" and "let me take a minute and sanitize my hands for your safety".

total feel good BS. I don't do it.

[Guest Paula]

OK, I get it and am getting the same thing in FP.  I don't ask my patients to mark me as excellent like the admin asks us to do.  It is something I don't even think about.  I haven't been getting enough patient satisfaction surveys back and they ask me and the MA to make sure the pts. get a survey on the way out of the door.  THe MAs don't have time for this nonsense either.   

 

My surveys that are returned all say I'm excellent anyway.

 

Except for that one........who ripped me to shreds because I didn't want to order a cxray for her cold and cough, or give her a ZPak for her "sinus infection".  She said I was distant and uncaring because when I relented and said I would order the xray I told her to go home and I would call her with the results, since I was busy and wouldn't be able to see the xray until lunchtime.  (It was normal as I told her it would be).  She called  5 days later and had yellow snot.  She's not my patient and I told the nurse that she had a cold, I wasn't ordering her ZPak over the phone and she could call her PCP.  Then 5 days later I get the copy of the complaint since she "had" to go to the competing urgent care in town on the weekend and get her Z-Pak.

 

THe clinic manager wanted me to write a response to the complaint.  I copied off my note from the one visit and wrote on the top of it  "My note is self-explanatory" and handed it back to the clinic manager.  

 

Sad thing is....the patient works in my facility....so I suppose the news is out that I don't give ZPak out for a cold and none of her family or friends will probably come to see me.

 

Shrug. 

[EMEDPA]

 

 

 

Sad thing is....the patient works in my facility....so I suppose the news is out that I don't give ZPak out for a cold and none of her family or friends will probably come to see me.

 

 

win/win

[Soulfari]

derm, what a boring descent into mediocrity....unless you truly do full scope with biopsies, procedures, manage skin cancers, etc...too many derm jobs out there now are "cosmetic derm"

By "Derm" I am solely referring to skin cx/surgery/mohs/scar revision/etc.

 

I do not want to manage rashes and acne. 

[True Anomaly]

What is an example of "speaking from the script"? 

 

Look up "AIDET".  It is the buzzphrase for these consultant groups, and the center of their entire message

[Guest Paula]

Look up "AIDET".  It is the buzzphrase for these consultant groups, and the center of their entire message

 

i looked it up.   I do all of that naturally.  Except maybe say thank you.  Usually the patient says thank you and I respond with "You're Welcome".

 

I've never been good with memorizing acronyms and I already forgot what the D stands for.  Oh, well.  

[Maverick87]

close, they want us to say " I hope you received excellent and safe care today" and "let me take a minute and sanitize my hands for your safety".

total feel good BS. I don't do it.

 

That's crazy man. I would never put up with that crap. I would either quit or deliberately undermine the process. Just me though.

[EMEDPA]

That's crazy man. I would never put up with that crap. I would either quit or deliberately undermine the process. Just me though.

:)

[Joelseff]

Well, there's the phrases that make us sound like waitresses: "Can I get you a drink? I have the time." "Would you like a remote for the TV?" "Would you like a warm blanket?"

 

And the phrases that just sound awkward: "Our goal is to provide you with very good care." "In 7 to 10 days you will receive a survey." "We know you have many choices and we're glad you chose ***** Hospital, which is a very good facility." (Very Good is a big thing here.)

 

Then there's the outright lies we're supposed to tell: "Hi, my name is **** and I'm glad you're here!"

 

They're now making our nurses (in the emergency room!) ask "How do you learn best - by seeing, by reading, or by being told?" I've yet to hear a patient that didn't go...."Huh???" to that question.

Sounds like Stepford

 

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

 

 

[sk732]

The worst thing is that the organizations actually spend money on firms who tell you to do these things...funnily enough, when I was in FP, since I was the lone provider, my satisfaction survey was my appointment list.  I had a few people leave and not come back - some because they didn't like what I had to say (ie - you've been on Ativan for 7 years as a "sleeping pill" and I'm not refilling it beyond date X), they were complete asshats themselves and I didn't put up with it, or after an honest mistake, they were unforgiving and never came back.  Those folks were few and far between.  The fact that I had full days up until the day I left there speaks for  itself I think satisfaction wise...and the fact my name was bantered around at high levels in the Ministry of Health at how well things were working out there ( I was a pilot project).

 

The fact that the patient didn't get what they wanted but got what they needed is what the problem with these admin types is - most have never really or actually been clinicians and don't know medicine.  Suggest that they put out a golden arches with an x at the bottom if they think people should just be able to come in and place an order for their McOxycodones with penicillin sprinkles.  In fact, that's the line I use with people when they come in demanding something - I tell them that it's not McDonald's, the system is you tell me what is wrong and then I tell you what you likely need, if anything at all.  I also tell them I'm not allowed to self diagnose, so what makes them think they're allowed to...the scary thing is, being in Canada, they think because the care is paid for out of their over taxed salary, that they have a right to show up acting like that because I'm their "employee" as it were, so must be even worse in the US where they're treated like customers more than like patients.

 

Sort of on topic incidentally, I was looking after someone a few weeks ago and their neighbour in the bay was from he US - the dude gave me a complement about how I explained something to these folks and said I was a pretty cool doctor...I told him I was a PA, at which point he reiterated to these folks that they listen to me, since he'd known a lot of PA's in Kansas that were a lot better with people than a lot of the docs he'd ran into :-).

 

SK  

[BruceBanner]

I tell them that it's not McDonald's, the system is you tell me what is wrong and then I tell you what you likely need, if anything at all. 

 

F*ckin' Amen to that.

[delco714]

 

 

They're now making our nurses (in the emergency room!) ask "How do you learn best - by seeing, by reading, or by being told?" I've yet to hear a patient that didn't go...."Huh???" to that question.

Clearly NOT verbal learners