4 years in, still regretting becoming a PA

[eighthnote24]

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

 

Lol....have I considered quitting....only about 15 times a day... But with 2 mortgages and a ridiculous student loan payment...and moving is not an option right now....and I live in an area of few jobs....plus I really like the people I work with....they make it bearable. But it's coming. Oh, it's coming. Possibly sooner than later as we had an incident this weekend in which I uncovered a case of spousal (elder) neglect/abuse, and was called every name in the book by the abuser (husband of the patient). Then I had the audacity to tell the abusive piece of crap not to speak to me in that manner, and to stop calling my nurses incompetent.

 

Myself and all 3 of the nurses involved put our account of the events in the chart and emailed them to admin...because sadly, due to recent events I was more concerned about how admin was going to react and blame all of us for *gasp* doing our jobs, than I was about finishing that APS report. I promise, if they try to pull this "customer service" BS on me with this one....I'm done. The bill collectors will just have to suck it up until I can find another job.

[eighthnote24]

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.

Totally accurate...I have seen these same phrases flying around here....

[eighthnote24]

 

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

It stands for "do what the patient wants." :)

[TWR]

I have been following this topic from the inception along with "Is this as good as it gets" .  Which is a different way of saying what the last 77 people have said.  Both of these post really bother me.  I have practiced Family Medicine for 30 years now.  The first 18 in New York where I owned my own practice in the early 90's.  Those were the BEST years of my career.  MY OP was 15 miles a way and was basically in place to satisfy state requirements.  It was a medically under served practice in Far Rockaway Queens.  No "doc" wanted medicaid but I was fine with it.  The 2 hospitals nearby loved me.  I was treated as an equal by the physicians.  My patients loved me and my 4 person staff did too.  They were with me my entire 18 years in NY before I moved to Houston, TX  I made a lot of money but could have made a lot more if I had tweaked the system, by ordering unnecessary tests and labs all for the "Money"!!  I practiced evidence based medicine and NO ONE was breathing down my back.  I made ALL decisions and worked 5.5 days a week often seeing 40 patients daily M-F and 15-20 on Sat. mornings til noon.  What I have come to realize after reading these 2 topics is that I really was an "independent" provider in NY.  Little to know stress and I couldn't wait to go to work.  As dependent practitioners threads like this will become more common.  If we had the independence that the NPs have we would not have any of the complaints I see on these 2 topics.  INDEPENDENCE!!!!!!!!!!!!!!!!!

 

Everything I said about practice in NY************ None of that is true in TX.  Sorry for the rant.

[chatcat]

  As dependent practitioners threads like this will become more common.  If we had the independence that the NPs have we would not have any of the complaints I see on these 2 topics.  INDEPENDENCE!!!!!!!!!!!!!!!!!

 

 

 

Indeed!

My happiest days in medicine were working in a small, privately owned office  without the need for over involvement of administration. Sadly, independent providers have little advocacy in the chaos of todays' administration driven environment. We do have the resources to provide much needed expanded clinical services which are restricted by administrative requirements.

 

By far my biggest frustration in the current environment of 2015 is the imbalance that we have in the union of management and clinicians. Somewhere along the way the boundaries have become blurred in what is inappropriate involvement of  a largely nonclinical administration  placing undue demands and interference  on clinical staff. I resent having anyone without a medical license telling me how to practice medicine or suggesting that I compromise my clinical practices to suit a management/administrative agenda. Yet, it's become widely acceptable for administration to micromanage clinical medicine largely without the balance of clinical perspective.

Is it any wonder there is an unprecedented "burn out" rate in medicine which I attribute to this loss of professional boundaries?

 

It's become acceptable to create a very complex layer of administrative costs and input into the practice of medicine. Administration places endless influence on clinical medicine and yet there is absolutely no data that supports better outcome with increasing administrative influence.(or cost)

 

As clinicians we are accountable for our competency through life long learning and testing , adhering to both state and national standards of practice and ethics while being transparent and accountable to the population we serve. Anyone who goes into medicine as a profession assumes a huge degree of accountability which we accept with our role in medicine.

 

On the other hand, the administrative influence in health care has very little accountability beyond following the mandated guidelines for such things as HIPPA etc. We all have faced the long credentialing processes required when entering new employment and know how long insurance companies can take in approval of claims for our patient's care. Large institutions often breach professional boundaries with their adminstrative projects that place the  burden of their projects on already overburdened clinical staff. Where is the accountability for the administrative arm of medicine? 

[FancyPAntsy]

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. 

:D I'm going to start calling them McOxycodones... Nice lol.

[TWR]

The answer to most of the responses to this post can be summed up in one word!!!!!  INDEPENDENT!!!

[sk732]

I miss my independence...I worked alone out in the sticks for 3 years in family med, with some EM dabbling.  Prior to that, I was in the military and had been left to my own devices on many occasions.  I know what I know well, know what I don't know and know what I need to improve on.  Moving to full time EM in another facility with a lot less independence is a bit of a kick in the junk actually.  Despite liking the medicine I'm seeing here (I have a shyte/weird magnet on my forehead), a lot of things are pissing me off at the admin level of how things are run - they're very reactive and not so proactive.

 

I say what's on my mind - but with a solution to what I perceive the issue to be.  Being ex military, that's how I roll - my bosses would let me say my mind as long as I had a constructive way of fixing things and then they'd let me run with it...I did the same thing with my subordinates.  One of the old principles of leadership is "know your subordinates' strengths and weaknesses, exploit those strengths and improve their weaknesses".  Allowing people to be part of the solution helps them develop their own leadership abilities and makes them feel listened to and appreciated.  It also allows them to succeed or fail and learn to cope with those.  The first and foremost of the principles I find is going by the wayside though - ACHIEVE PROFESSIONAL COMPETENCE.  I kinda wonder about that - seems in medical admin circles, it's much like the civil service, in that you're promoted 3 levels higher than your highest level of incompetence.  That explains the mentally challenged policies we get dumped on us that even more hamstring us from doing our jobs...since a lot of the folks making the decisions haven't a schmick what us at the pointy end do or are doing.

 

SK

[TWR]

SK,  the first half of your second paragraph is right on the money.  It was how I ran my practice in NY for 18 years.  Make people feel good and reward them.  I had the same 4 ladies work with me for the entire 18 years!!  I treated them as equals and NEVER said so and so works for me but said they worked WITH me.  I knew my financial success was due to there hard work which made patients happy and we thrived very well and grew over my tenure in NY.

[sk732]

The only people I can say that truly worked for me were/are my military subordinates...working for me though also implies that don't/didn't work against me, like some folks will tend to if they don't respect you.  My receptionist at my last job was like me - an employee of the Regional Health Authority, so was therefore technically my coworker...and my gatekeeper...and my triage person...and my calmer downer...etc.  I gave her the arcs of fire about how I thought things should run, and off to the races she went.  Treat people like adults, they act like them :-).

 

SK

[eighthnote24]

Aaaaand I just was hit with the last straw. Found out today that the hospital is paying $150 an hour to "physician champions" of AIDET to follow providers around and critique them on their use of said scripted program.

 

So they're making over twice what I make an hour, to critique people on their BSing skills, while I'm over here, you know, saving lives and stamping out disease.

 

Time to air up the tires and leave this mess in the dust....

[PJ82]

The more I listen to all of this the more it makes me appreciate the military!  I am planning to retire and then attend PA school.  Anytime I go see med ops I either run into a NP, PA, or MD.  They all give the same care and are treated with the same respect.  If I could do it all over again I would have done my cool guy running and gunning days and applied to the IPAP program.  I have heard zero complaints from any PA serving in the military.  For those of you who are still young I would strongly suggest you look into serving in the military as a PA...no you aren't going to make a ton of money but you will be treated with respect and be part of the family.

[winterallsummer]

Too invested to change now? Wait until you're fifty and think that over. I have said this over and over. Do not become a PA for the money. You will regret it. If you don't enjoy health care this job is not for you plain and simple.

 

Not being rude. I love being a PA and don't regret it at all. Sometimes I think maybe I should've gone to Med school but I'm willing to bet if I did, I'd be thinking just as or more often I wish I had gone to PA school.

 

There are better paying jobs with easier training. I was a tech for years before I became a PA so knew what I was getting myself into. Please, if you are going to become a PA for the money, seriously rethink it.

[GetMeOuttaThisMess]

Too invested to change now? Wait until you're fifty and think that over. I have said this over and over. Do not become a PA for the money. You will regret it. If you don't enjoy health care this job is not for you plain and simple.

 

Not being rude. I love being a PA and don't regret it at all. Sometimes I think maybe I should've gone to Med school but I'm willing to bet if I did, I'd be thinking just as or more often I wish I had gone to PA school.

 

There are better paying jobs with easier training. I was a tech for years before I became a PA so knew what I was getting myself into. Please, if you are going to become a PA for the money, seriously rethink it.

I would take it a step further and say that if you don't like dealing with people at their worst (feeling bad, argumentative, short-tempered, demanding, i.e.-have the patience of Job) DON'T go into this field.  I'm finding that the older I get the less patience I have for folks in general and that getting out in the next 5-6 years will have been about right (38-40 years total).  The medicine/science part is fine, it's the human interaction under these circumstances I would argue that wears folks out.

[Guest Paula]

^^^^^  Corporate Medicine and Press Ganey are to be blamed for this and our employers and administrators believing that health care is like going shopping.   If our customers don't like us, they shop elsewhere.  Administrators then spend inordinate amount of money on training us to be salespeople and marketing professionals.  This is what burns me out,  Patient's now know the scoop and complain to the customer service desk on the way out.  Then they get refunds occasionally or a better product (like another choice of a provider).

 

We get the "talking to" by management.  I don't think complaints  even go through QI anymore.  Our satisfaction scores are posted publicly within the departments with red lines highlighting those of us below 25%ile satisfaction surveys.  (One person who answers "would probably recommend" puts the practitioner in the 25%ile almost automatically, instead of Would absolutely recommend)..  Guess where I am? 

 

Demanding perfection from us is unsustainable.

[GetMeOuttaThisMess]

Great line from one of my then young ED physicians back in the day, "Don't tell them what they don't have (their self dx.), just treat them for what they do have".  Thanks again, "Tricky Ricky".

[Boatswain2PA]

Move to rural America. My primary contract has me working two 72 hour shifts a month and grossing about $140K. The docs I work for love having me cover the ED, the people in rural America are much nicer, never got a press ganey anything.....

[eighthnote24]

Too invested to change now? Wait until you're fifty and think that over. I have said this over and over. Do not become a PA for the money. You will regret it. If you don't enjoy health care this job is not for you plain and simple.

 

Not being rude. I love being a PA and don't regret it at all. Sometimes I think maybe I should've gone to Med school but I'm willing to bet if I did, I'd be thinking just as or more often I wish I had gone to PA school.

 

There are better paying jobs with easier training. I was a tech for years before I became a PA so knew what I was getting myself into. Please, if you are going to become a PA for the money, seriously rethink it.

 

I was simply making the point that instead of spending money on things and/or staff that could actually improve patient care, the hospital chooses to spend a ridiculous amount of money for something that takes little to no effort and probably won't even put their precious survey scores where they want them anyway.

 

Not leaving the profession, just the job.

[EMEDPA]

Great line from one of my then young ED physicians back in the day, "Don't tell them what they don't have (their self dx.), just treat them for what they do have".  Thanks again, "Tricky Ricky".

or as stated by one of my early attendings, " the treatment is more important than the diagnosis".

[ventana]

Try correctional medicine

 

Try rural medicine

 

Try urgent care

 

Try occ health

 

Try radiology special procedures - seriously fun and high tech and a lot of the times the patients are sedated or covered up...

 

The point is if you have a -C after a PA you are responsible for finding your niche....

 

It is out there, you just have to find it....

[Maverick87]

Move to rural America. My primary contract has me working two 72 hour shifts a month and grossing about $140K. The docs I work for love having me cover the ED, the people in rural America are much nicer, never got a press ganey anything.....

 

Wouldn't a 72 hour shift open you up to massive liability? I'd imagine that you wouldn't be able to get much sleep.

[EMEDPA]

Wouldn't a 72 hour shift open you up to massive liability? I'd imagine that you wouldn't be able to get much sleep.

depends on volume. I do 24s and could imagine doing 3 in a row as I typically get 6-8 hrs/sleep per 24. not all at once of course...when I was a medic I did 72s with 2 busy shifts with a slow station(overtime) one in between. of course I was 23 at the time...

[Boatswain2PA]

Wouldn't a 72 hour shift open you up to massive liability? I'd imagine that you wouldn't be able to get much sleep.

Average of 8 patients per day.  Sometimes more, sometimes less.  I think I've seen as many as 18 in a day here, and I've had shifts where I've had an 80% admit or ship rate.  But I've also gone 33 hours without a patient.  

 

This facility is S  L  O  W   to move the meat, and much of your time is simply waiting for labs/rads results.

 

You certainly learn to manage your sleep/naps.  

 

I also do locums at other places with 12, 24, and 48 hour shifts.  Hardest place (sleep-wise) is a 6500+ annual visit ED.  Not really busy enough to be a 12 hour shift, but often too busy to be a 24 hour shift.  

 

I really love my job.  I also do part time at a level II ED/trauma center just to keep my skills up, but I work much harder there and I'm generally paid less.  The administrative/bureaucratical BS is larger (see recent post about required EMTALA training), I have to brief the EP for things I routinely handle on my own in other shops, and the patient population generally sucks much worse.

 

Rural medicine (and rural life) is where happiness is.  

[kargiver]

Its not the job... its the system and people you work with that make or break you.  I cannot say this enough.  If you aren't savvy enough to be political, and not aggressive enough to stand your ground, then people need to find work environments where they are coddled.

 

Medicine is a service industry.  No matter how you slice it, dice it, cut it upside down, etc, if you work anywhere where there are a plethora of consultants and your attending sees everything, you are and will be - ASSISTANT.  Unless you choose to be aggressive, or political.  Then you can play the game the way they do - and they will fear you.  And that is all they understand.

 

Trust me on this one. 

 

If you choose to go do what the mission of the profession was oh so many years ago, go serve in underserved areas, carry the torch and care for those who need it where those who got into medicine in the first place did so for the wrong reason(s), you'll find what you are looking for - if you want a service industry job that is.  Don't believe the hype of USNWR about how great it is - medical burnout is real and it is worse with PAs - we are expected to see more to make more for practices.  But whether as a frontline provider doing EM, sitting behind the consultant desk of neurosurgery (I gotta admit, most of the neurosurg PAs I know have the system down cold - bravo) or some other second tier (meaning behind the front line) service that is buffered from the front line, or doing international work, there is something for everyone in the field.  But one MUST always remember - its a service industry, others come before you, and it is in incredible flux right now. Our politicians have demanded that healthcare is a right - they just have no real way to pay for it, and the profession itself is finding itself in the midst of all this chaos, then you will feel the angst.  But if you do what you do for the reasons YOU want to do it, then none of it matters.  I am going to get up from this keyboard and see the 92 yo syncope who likely has a fractured hip, admit her, treat her pain, and get her ready for her hemi that will be done in 4-6 hours.  Unless she is having a STEMI, in which case the helo will be here in 17 minutes before so goes to the cath lab.  But I am in the middle of nowhere, doing what I love, because I knew what I was getting into long before I started to do it.  And I wouldn't change a thing.  This was the deal when I signed for those student loans... and its still the deal with loan repayment.  But Suzie Bitty in bed 4 is going to get the care she needs because I knew what I wanted before I started this journey.  Which brings me to my final point:

 

Nosce te ipsum.  Know thyself.  The rest will work itself out.

G

[winterallsummer]

Eight note - duly noted. Was directed at someone else earlier in thread.