pa246810 Posted July 11, 2015 Share Posted July 11, 2015 I'm a licensed new graduate currently applying to jobs. I've had one job offer so far, but turned it down due to a lackluster contract in an environment that I suspected I would get taken advantage of. My problem right now in my job search is that after going through school, I now no longer think I belong in medicine, at least as a provider. It's painful for me to admit that, but the evidence is hard to ignore. I love science and the continuous learning medicine affords, I enjoy patient interactions (within reason), and I had previous experience working in hospitals and clinics as a medical assistant. Going into PA school, I was extremely excited to finally work towards the career I'd hoped for...but then came the slow realization, especially during clinical year, that I seemed to always be missing the mark and not enjoying calling the shots. During school, I kept thinking, "well, maybe I'll like/be better at the next specialty/rotation." My clinical skills seemed to never improve, I made multiple egregious errors that I'm lucky were caught, I was terrible at thinking on my feet, and I was heavily criticized by preceptors for the work I did. The knowledge I had gained from my didactic year didn't seem to exist in my head once I was expected to use it. I noticed that I was extremely slow at making clinical decisions (it was obvious when comparing to other students on the same rotations), because I just don't seem to ever make the connections I am supposed to, even at the student level. In hindsight, I think my personality is more suited for research, in that I am severely mismatched in my ability to keep (or enjoy) the pace and pressure of working as a PA. Frankly, I think I'm a dangerous clinician and I'm amazed that I graduated and passed the PANCE...but I never would have been able to fully predict this without going through the process first. Anyway, the above has led me to question why I am even applying to PA jobs right now apart from the fact that I have insurmountable loan debt, which feels like indentured servitude to the profession. My experience has been so negative that it's hard for me to lie on PA interviews that I actually want the job. I don't have non-medical work experience. My resume is absolutely streamlined into the medical field. I read the recent post of a PA who has been in practice for 4 years and is still not happy, and I'm afraid that will be me. Does anyone have any advice for me? Do you think there is any possibility of finding work in research? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 11, 2015 Moderator Share Posted July 11, 2015 if you are sure the clinical world is not for you there are several options: clinical research more education in a basic science field leading to work in that direction drug/device rep EMR clinician resource (you work for epic, cerner, or T-system, etc showing clinicians how to use their product) forensics/pathology. work doing death evaluations, etc. Some large cities like NYC use PAs for this. work for the cdc, un, who, etc on development and prevention type stuff. this is all policy desk work kind of stuff. Link to comment Share on other sites More sharing options...
pa246810 Posted July 11, 2015 Author Share Posted July 11, 2015 if you are sure the clinical world is not for you there are several options: clinical research more education in a basic science field leading to work in that direction drug/device rep EMR clinician resource (you work for epic, cerner, or T-system, etc showing clinicians how to use their product) forensics/pathology. work doing death evaluations, etc. Some large cities like NYC use PAs for this. work for the cdc, un, who, etc on development and prevention type stuff. this is all policy desk work kind of stuff. Thanks for the suggestions. I definitely hadn't thought of working in government policy or forensics/pathology. I'll start looking into these ideas and see where it gets me. Link to comment Share on other sites More sharing options...
Planteater Posted July 11, 2015 Share Posted July 11, 2015 Did you enjoy any of your rotations? What electives rotations did you have? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 11, 2015 Moderator Share Posted July 11, 2015 Thanks for the suggestions. I definitely hadn't thought of working in government policy or forensics/pathology. I'll start looking into these ideas and see where it gets me. just posted 7/8: https://a127-jobs.nyc.gov/ type in "physician assistant" in the keyword area to get to the link for medicolegal investigator. Link to comment Share on other sites More sharing options...
SocialMedicine Posted July 12, 2015 Share Posted July 12, 2015 do a residency continue to have a formal education structure you gained admissions to PA school and passed medical boards after finishing PA school have confidence in past success try the clinical career not easy to decide in 7 years you should have been a PA you will have lost a lot of skills and never had a real clinical job given your graduate degree and knowledge of many things through experience in medicine make sure you accept a non clinical job reflective of that Link to comment Share on other sites More sharing options...
Maverick87 Posted July 12, 2015 Share Posted July 12, 2015 OP, I think you should try out clinical medicine and see if you like it. I had the same doubts as you coming out of school and had similar experiences in my rotations. Fast forward about 3 years and I like clinical medicine after doing it a lot. You may like it too. If nothing else, you'll pad the resume. If you don't like it after say 2-3 years, then consider the options that others have given you, but I don't think you should give it up just yet. Link to comment Share on other sites More sharing options...
Guest ERCat Posted July 12, 2015 Share Posted July 12, 2015 I agree with the above comment. Honestly, I'm almost a new grad a well and you sound a little bit like me. Granted, I have loved certain rotations (especially ER) but there were many times I hated it not because I actually hated it but because I felt like I sucked at it. Maybe your issue isn't that you don't like clinical medicine, but that you lack confidence. It's easy to run away from something if you feel like you're not good at it. You have to understand that a lot of us feel unprepared getting out of school. While there are a lot of days I feel like a rockstar, there are some days where I come home and think "God, I don't know anything." I have also had many experiences where I miss something important. In fact, I miss something every day. That's part of being a student. And it also is sadly the reality of being a new PA as well. We are expected to have good supervising physicians for a first job to help us through that hump. I think that's normal. We are PAs. We haven't had the years of schooling and residency that is involved in becoming a doctor. All we have is two years. Of course we are not all going to feel totally confident from the get-go. I agree with you… I feel like a total liability right now. But you know what? I'm trusting the process. And I think as a new PA, it is far far far better to be scared than it is to be overconfident think you know everything. We don't know squat. You put in all this hard work for a reason. So at least give yourself a chance. It's true that if you go into being a pathologist assistant or selling medical equipment you'll lose your clinical knowledge and put yourself in a box. Try out clinical medicine for a few years… After all of this work, you absolutely owe it to yourself to find out. Realize that as a new PA, you are still going to have to study and learn on a regular basis... As you do more of this, you will get better. Link to comment Share on other sites More sharing options...
pa246810 Posted July 13, 2015 Author Share Posted July 13, 2015 Did you enjoy any of your rotations? What electives rotations did you have? Most of my rotations were extremely busy and probably not the best places for me to learn (large hospitals with other PA/NP/med students, residents, etc.). My electives were in dermatology and orthopedics. Derm was at a chaotic practice in which I was not allowed to see patients at all. Ortho was just a nightmare since the surgeons couldn't put up with my slow rate of learning. I tolerated rotations and was always happy for them to end. I'd rather stay far away from procedures. This was all a big contrast to my preclinical year that I actually enjoyed (yes, I liked the long hours of studying. I know I'm definitely in the minority). I actually welcomed studying for the PANCE rather than being at clinicals. Hah! Link to comment Share on other sites More sharing options...
pa246810 Posted July 13, 2015 Author Share Posted July 13, 2015 I agree with the above comment. Honestly, I'm almost a new grad a well and you sound a little bit like me. Granted, I have loved certain rotations (especially ER) but there were many times I hated it not because I actually hated it but because I felt like I sucked at it. Maybe your issue isn't that you don't like clinical medicine, but that you lack confidence. It's easy to run away from something if you feel like you're not good at it. You have to understand that a lot of us feel unprepared getting out of school. While there are a lot of days I feel like a rockstar, there are some days where I come home and think "God, I don't know anything." I have also had many experiences where I miss something important. In fact, I miss something every day. That's part of being a student. And it also is sadly the reality of being a new PA as well. We are expected to have good supervising physicians for a first job to help us through that hump. I think that's normal. We are PAs. We haven't had the years of schooling and residency that is involved in becoming a doctor. All we have is two years. Of course we are not all going to feel totally confident from the get-go. I agree with you… I feel like a total liability right now. But you know what? I'm trusting the process. And I think as a new PA, it is far far far better to be scared than it is to be overconfident think you know everything. We don't know squat. You put in all this hard work for a reason. So at least give yourself a chance. It's true that if you go into being a pathologist assistant or selling medical equipment you'll lose your clinical knowledge and put yourself in a box. Try out clinical medicine for a few years… After all of this work, you absolutely owe it to yourself to find out. Realize that as a new PA, you are still going to have to study and learn on a regular basis... As you do more of this, you will get better. That's true about not being confident in what I do, and I'm definitely considering that I might enjoy things more once I get more experience. I'd like to at least try one clinical job before I move on. But it still worries me that classmates *loved* their rotations (or at least a few of them), and I couldn't really say the same about any of mine. Did anyone else just not enjoy their clinical year? The only person who I've talked to who shared similar sentiments is no longer a PA (works in IT). Link to comment Share on other sites More sharing options...
pa246810 Posted July 13, 2015 Author Share Posted July 13, 2015 just posted 7/8: https://a127-jobs.nyc.gov/ type in "physician assistant" in the keyword area to get to the link for medicolegal investigator. I looked this up earlier. Very cool opportunity! Though I would need a minimum of 2 years of PA experience (or 1.5 using 6 months of pre-PA experience). I'll be keeping it in mind. I'd love to hear from someone who actually works in this area. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted July 13, 2015 Share Posted July 13, 2015 This might be "interesting" but be careful about jumping into this line of work w/o prior exposure. There are many traumatic ways in which individuals die and mentally/emotionally it isn't everyone's cup of tea. I was on the pickup end many decades ago for a large N. Tx county and the hours can be long, weather difficult, and require holiday coverage. Most field agents were <50 y/o for a reason. Link to comment Share on other sites More sharing options...
PA Mann Posted July 13, 2015 Share Posted July 13, 2015 Sounds like you are really struggling. How disappointing it must be to have these feelings. Trust me! We have all had these feelings. Those school mates you are comparing yourself too, the ones that rocked their rotations... they are great at pretending. They made mistakes too... they may have hurt a patient or even killed a patient. They just hide it better than you. In fact, your willingness to look honestly at yourself and your work is very promising. Have you hurt a patient accidentally? I have. Have you missed a huge tumor on a CT report? I have, thank goodness my supervising physician caught it. On the other hand have you reduced a teenager's paraphimosis in a rural clinic? He could not afford to go to the ER so I called a local urologist and asked him what to do. The urologist talked to me like as was an incompetent two year old... but you know what, I did what he said and that young man is alive and well today with all parts working. Your willingness to reach out on this forum tells me you will do good things too. Oh... And have you met a first year medical resident? Four years of medical school and they have no idea what they are doing. Seriously, heaven help their patient’s. We laugh at their medical decisions behind their backs knowing that we were once like them... and still are in some ways. And you, a PA, only received two years of training. Our physician assistant programs teach us just enough to survive. If they taught us to be competent medical providers we would be in school forever. Medicine is learned by doing. I asked my supervising physician, "When will I feel confident putting in a central line?" He said do one hundred of them. He was not kidding. And now that I have done more than one hundred central lines I am confident... so confident that I don't beat myself up if I get stuck. I realize we all get stuck and we all ask for help. One thing that has surprised me most about the medical profession is the extent to which providers, even the most experienced providers, COLLABORATE. My supervising physicians ask their peers (and sometimes even the PA's and NP's) for help with cases all the time. I have always been a 'lone wolf' and had to adjust my medical practice to match the reality of medicine... no one makes medical decisions alone... we work together sharing knowledge and experience. And there is the key word... EXPERIENCE. I too have felt like leaving the profession at times. The worst was when I was comparing myself to my school mates that just seemed like naturals. Why didn't they make the stupid mistakes I made? I have since learned they are not naturals and they did make mistakes. Bless their hearts… they are just really good liars. Please don't give up because you think you suck at practicing medicine. Because you do suck at practicing medicine right now... but you will gain experience. This experience will be hard won... patient's might get hurt... and jerks like me might laugh at some of your medical decisions because they are so wrong they are comical. But, in a few years, I will be coming to you to ask your opinion about a case that has me stuck. And another thing… You passed the PANCE. This was no easy task. The knowledge is there. And if you have forgotten some things (or a lot of things) do what the rest of us do, ask someone or look it up on the Internet. So, find a supervising physician that you trust (hopefully one that will pay you) and get to work. Review every patient together. Ask questions. Talk to other PA's. Scan the internet. Heck, maybe even look at your school notes. Collaborate. Make mistakes. Go home and break something (small) against the wall because you are sick and tired of patient's asking for hydrocodone. Treat one hundred runny noses. Drain one hundred abscesses. There is no doubt that the confident medical practitioner you are going to become will enjoy being a physician assistant enough to make some money to pay off your loans. More importantly, as you gain confidence you will enjoy the job. Link to comment Share on other sites More sharing options...
Cup Posted July 13, 2015 Share Posted July 13, 2015 . Link to comment Share on other sites More sharing options...
JMann Posted July 14, 2015 Share Posted July 14, 2015 PA Mann- that is a great word. Awesome advice! Link to comment Share on other sites More sharing options...
Febrifuge Posted July 15, 2015 Share Posted July 15, 2015 I've been a PA for six years, and I needed to hear it. Well done. Link to comment Share on other sites More sharing options...
dmdpac Posted July 15, 2015 Share Posted July 15, 2015 PA Mann - I think that was the most positive, thought provoking and encouraging commentary I've ever read for someone trying to start out (and even for those who have been practicing for a while). Well done, indeed! Thank you for presenting it so well. Link to comment Share on other sites More sharing options...
pa246810 Posted July 15, 2015 Author Share Posted July 15, 2015 Thanks for your reply, PA Mann. That made me feel a whole lot better. Good to know not all of that confidence is real...even in the most experienced clinicians. I hope one day I can make things look easy! Link to comment Share on other sites More sharing options...
Guest JMPA Posted July 16, 2015 Share Posted July 16, 2015 confidence is earned through reading, reading, reading and some doing Link to comment Share on other sites More sharing options...
JFarnsworth Posted July 17, 2015 Share Posted July 17, 2015 I would have to say that rotations are NOTHING like the real world. I didn't get to do that much during my rotations, and it was frustrating-- I thought I was a total idiot because that's kind of how I was treated. Looking back, I see that this treatment was for the protection of patients as well as myself. Sometimes, you have to just get out there and try different things to know what you like and where your happiness is. Life is a journey! My advice is the same as PA Mann's- it sounds like you have not had a lot of positive experiences in your rotations- but that doesn't mean that your future job will be more of the same. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 17, 2015 Moderator Share Posted July 17, 2015 I would have to say that rotations are NOTHING like the real world. I didn't get to do that much during my rotations, and it was frustrating-- I thought I was a total idiot because that's kind of how I was treated. Looking back, I see that this treatment was for the protection of patients as well as myself. Sometimes, you have to just get out there and try different things to know what you like and where your happiness is. Life is a journey! My advice is the same as PA Mann's- it sounds like you have not had a lot of positive experiences in your rotations- but that doesn't mean that your future job will be more of the same. rotation quality varies. at good sites, especially towards the end of your clinical year, you should be doing quite a bit. I have my current student (on her last rotation) do the full H+P, present the case, I go say hi to the pt and check a few pertinent things, she does all procedures and writes all scripts. of course she was a medic for 15 years before pa school and is fairly bright, which makes it easy for me. Link to comment Share on other sites More sharing options...
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