RealityCheck Posted July 12, 2015 Share Posted July 12, 2015 At 25 yrs in - is this really what has become of medicine and is there any hope it will get better? Medicine isn't fun anymore. I don't get that kick of satisfaction that I am actually helping anyone anymore. Mostly - I am STUCK, TRAPPED - I support my family and need to have an income equivalent to what I make now. What else is there? I have beat myself up about this for months now. I make more than most people in my community. I should be grateful. I should not complain…. We still have kids to go to college. I support my family. We aren't in major debt but we need what I make to stay in the general condition we are in. Moving isn't really an option with the kids in high school. And, is it any better anywhere else? I am doubting it. I can't talk to anyone where I work or live - the whole town is now owned by 3 major employers and they buy up whatever they don't already have their hands on. Limited employers = limited options. The doctor I am paired with now is much younger than me with little experience and no spine, no leadership qualities. I am carrying our program yet this doc is "in charge". We have more administrators than we do providers. How does that work? Teaching is a favorite of mine. The PA schools in my state are state universities. I can look up anyone's salary. It is pathetic. The PA/PhD who runs the program makes nearly $40K LESS than I do. How can educators be paid so little if they are responsible for the future of our profession? They require a Masters degree to be on full time staff at the PA programs. I don't have a Masters either. I was told 25 years ago that I wouldn't need one. The only thing that mattered was my NCCPA. It wasn't like our program wasn't Masters level work anyway, I just don't have the degree to go with it. I have 25 years of experience though - that counts for squat unless I have the little letters. Why would I spend my money to get a Masters to go teach in a program that pays me way less than a clinical job? I am really good at what I do. I generally like my patients. This used to be fun and rewarding. The daily grind of talking to high school graduates with a cook book who deny my requests along with an asinine EHR and admins counting RVUs till the cows come home combined with subpar staff - what happened to RNs and LPNs? - and then tack on Meaningful Use and the whole Medical Home BS and I am done - cooked, finished. I am seriously going to be held accountable for my patient who will not stop smoking or can't get their A1c below 8?… Am I expected to go home with them at night and monitor their behavior? I have my own kids to raise, thank you. Combine all this with a staggering event in my career - I was named in a lawsuit - THREE years ago - based on one day on call with a different doctor and peripheral interaction with a disgruntled patient. It is now FIVE years since the incident in question and absolutely nothing has transpired. I am mortified, disgusted and embarrassed. I tell no one about the suit. I have never been deposed by anyone - the plaintiff's attorney is a schmuck who keeps filing motions and has delayed all activities for THREE YEARS now. I have little recollection of the event to begin with. Now, I am held hostage by this and nothing is coming to closure. My entire career could be detrimentally affected by this and I have no power, no say and it can drag on forever it seems. How is that legal or ethical or allowed? Makes me want to flip burgers. We contemplated buying a coffee stand - I don't drink coffee. I considered opening a restaurant - no training or hx of food service. I even considered going to work with the medical examiner - dead folks don't complain too much. I am betting I am not alone but there is no one to talk to confidentially where I live. My family doesn't get this. I feel guilty and trapped and needing to support my family. Is this really as good as it gets? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 12, 2015 Moderator Share Posted July 12, 2015 urban medicine sucks. look at working in a rural area where you will be respected, paid well, and given a great scope of practice seeing 1/2 as many patients as you currently do. Link to comment Share on other sites More sharing options...
RealityCheck Posted July 12, 2015 Author Share Posted July 12, 2015 I DID rural medicine and got hosed by a psycho CEO with no qualifications, crap benefits, being alone, no support, no staff and more patients than I could even handle with years under my belt. Where I live, rural means tin-foil, conspiracy theory, govt hating, anti vaccine families with guns and 10+ kids and no money. Sorry, I am glad it works for you. Been there, done that, left a scar….. Link to comment Share on other sites More sharing options...
RealityCheck Posted July 12, 2015 Author Share Posted July 12, 2015 Bonus to the situation - the current govt structure does NOT reward PAs in rural medicine for Meaningful Use or Medical Home but does reward NPs…. Go figure. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 12, 2015 Moderator Share Posted July 12, 2015 I DID rural medicine and got hosed by a psycho CEO with no qualifications, crap benefits, being alone, no support, no staff and more patients than I could even handle with years under my belt. Where I live, rural means tin-foil, conspiracy theory, govt hating, anti vaccine families with guns and 10+ kids and no money. Sorry, I am glad it works for you. Been there, done that, left a scar….. thought about moving? Link to comment Share on other sites More sharing options...
RealityCheck Posted July 12, 2015 Author Share Posted July 12, 2015 not until all my kids are out of high school. Link to comment Share on other sites More sharing options...
sk732 Posted July 12, 2015 Share Posted July 12, 2015 Anything you can apply towards some sort of niche thing? Travel medicine, a doc in a box, that sort of thing? SK Link to comment Share on other sites More sharing options...
Guest Paula Posted July 12, 2015 Share Posted July 12, 2015 Do travel medicine. Maybe you can find a job in Alaska for 2 weeks a month and fly back and forth. It might save your sanity. Link to comment Share on other sites More sharing options...
Guest Paula Posted July 12, 2015 Share Posted July 12, 2015 www.wildernessmedicalstaffing.com Here's a link someone from the forum sent me..... Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 12, 2015 Moderator Share Posted July 12, 2015 Seriously look into one of these two things Open you own practice 1) either do nursing home coverage (most lucrative but still some red tape) just make sure you are with a great facility/doc - many are horrible 2) for ultimate freedom - start a house call practice - can be done for less then 10k, no need to meaningful use, no need for an office, might need a part time CN/PCA/nurse to help with phone calls - I have done this and last year grossed 140k, of which I got about 80k not including full health insurance for family and 10k to retirment Or even combine both the above. A few words of adivce Easiest if there are limited medicare advantage plans in your area - and therefore I do very few Prior Auths Assisted living facilities are the best to get into (no travel time) Essential to do a trip fee (waived for assisted living facilitys) Straight medicare is pretty easy (although slow) to get credentialed with.... Keep your service area small - I start with serving the whole county, but have it down to about 1/5 that now - can drive from one end to the other of my service area in about 25 min (initially it was 1.5 hours) - travel time stinks..... Getting a good doc is essential - someone that is a mentor, but not in your business, and one that doesn't want to "take over" Hire a biling company - that is NOT just for physicians, instead get one that understands PA and NPs My specific plan..... Verizon Hot spot for internet anywhere I go and Iphone for references Practice Fusion (free EMR and scheduling) Kareo billing program - which I don't do anything with but my billing company uses (5.5% of collections) Quickbooks online for all accounting and payroll (does everything for payroll, direct deposit, and accounting for not much $$) Norton Antivirus - watch for deals - can get cheap Asus ultrabook computer For well less then $10k you can do this...... Control your own fate, tell the establishment to bugger off....... Other thoughts What about correctional medicine? or depending on where your are PHS (applications are open right now)? or maybe changing speciality to something different? Ball is in your court Link to comment Share on other sites More sharing options...
electric130 Posted July 12, 2015 Share Posted July 12, 2015 To OP just saying I can relate. Not sure what the answer is. At one point I felt like I had the perfect career and position. I was able to work part time, enjoyed my patients, loved my co workers. Now, I feel like my schedule is almost always overbooked. Instead of letting the RNs work that are efficient and helpful, and have been with us for over a decade we have a MA float come in to save money. They are doing the best they can, but are so slow and add to my stress. This is not necessary and only to save a few bucks. I feel like my SP is always looking at my production numbers (even though I typically see at least 60 patients in a three seven hour days), I actually like our EHR in the office, but of course at the hospital it is completely different and aggravating. Yet, I am supposed to put in all orders because my SP hates it too and it is time consuming. I still enjoy learning and patient care, I just feel like after working three days I have been hit by a truck...literally I am so wiped out and mentally frustrated it is like I am a different person. My SP is also retiring soon so I find myself trying to decide what avenue to pursue, you would think with 13 years of experience I would have a lot of options, but I am finding outside of the specialty I have been in I am really not any more marketable than a new grad. Some of the above suggestions are great, not an option for me since I want to work part time and cannot travel (military husband and school age children). I also have the frustration of not having a Masters degree and would love to teach part time but again that is not an option, and I completely agree the return on investment for a masters degree is just not there. I have also looked into changing careers but there is not anything I am trained to do that would even come close to my current income, I am in my late 30's and just do not have the desire to go back to school especially when I will have college costs for kids around the horizon. I plan to work another 10 years and then hopefully be done at that point and just volunteer. I think mentally I just have to remind myself this is just a part of your life, do the best job you can, be kind to your patients and just look forward to retirement! Link to comment Share on other sites More sharing options...
taotaox1 Posted July 13, 2015 Share Posted July 13, 2015 meaningful use.... reward... lol...... Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted July 13, 2015 Share Posted July 13, 2015 Assuming the ME is an option, what's the concern there? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 13, 2015 Moderator Share Posted July 13, 2015 meaningful use.... reward... lol...... mine was 15 dollars! Link to comment Share on other sites More sharing options...
sk732 Posted July 13, 2015 Share Posted July 13, 2015 Something else I find really useful - violence therapy...buy a heavy bag, some bag mitts, hang it in the basement, any number of different workouts you can get online through youtube and such, imagine your "Face of the Day" on the bag and pound the living Bejeezis out of it. It's good cardio, vents off a lot of that adrenaline carried over from being angry, won't get you thrown in jail for laying the shoe leather to your employer, is extremely cathartic and helps you sleep at night. Win win :-D. I know this how? Got me through countless days of dealing with assenine bosses and bad patient days. MM Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted July 14, 2015 Share Posted July 14, 2015 Ventana, I had a colleague that wanted to do house calls but he ran into 2 problems: 1. Private insurance won't cover house calls. You have to bill the patient as out of network/cash pay and the patient has to file for reimbursement. 2. Medicare has strict criteria on who qualifies for a house call visit, and it takes a lot of effort/prior authorization before you can be sure that Medicare will pay you for a house visit. Have you run into those issues? Link to comment Share on other sites More sharing options...
RealityCheck Posted July 14, 2015 Author Share Posted July 14, 2015 I would love to work at the ME office but they don't have any jobs for PAs. A autopsy tecch makes minimum wage. I saw an epidemiology job with the CDC based in my town with some travel. Considering that. Not sure the govt pays any better or close to equal. Trying to keep my household running, worry about a husband with some health issues that will force early retirement, deal w college expenses for kids and actually enjoy what I do and come home remotely sane.... Juggling chainsaws sounds easier some days.... Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 14, 2015 Moderator Share Posted July 14, 2015 Ventana, I had a colleague that wanted to do house calls but he ran into 2 problems: 1. Private insurance won't cover house calls. You have to bill the patient as out of network/cash pay and the patient has to file for reimbursement. 2. Medicare has strict criteria on who qualifies for a house call visit, and it takes a lot of effort/prior authorization before you can be sure that Medicare will pay you for a house visit. Have you run into those issues? Nope No point in credentialing with private payers -everyone has medicare and in my area there is no advantage plans as for medicare criteria - I am the testing/qualifying person - I know what to look for and document and it is pretty easy - have never had a visit denied due to this Link to comment Share on other sites More sharing options...
dspence12 Posted July 14, 2015 Share Posted July 14, 2015 If you're looking for a change, consider Paula's advice. I'm first and foremost a PA but currently run the medical program for one of those 2 week on 2 week off Alaska companies Paula mentioned above. It is called FairweatherMedical . Maybe something that would interest you. We are looking for experienced PAs. Link to comment Share on other sites More sharing options...
harrymloves Posted July 15, 2015 Share Posted July 15, 2015 I understand somewhat. Why don’t you consider other options like home nursing or homecare? The pay is decent, and you’ll be getting much more freedom, and the work is immensely satisfying, and you won’t need a lot of fancy degrees. I don’t know many nursing firms in the US, but around here, I’ve heard of C-care offering good packages to their staff. They are a professional healthcare service agency based out of Port Coquitlam, here’s a link to their careers page- http://www.c-care.ca/careers Link to comment Share on other sites More sharing options...
kittryn Posted November 5, 2015 Share Posted November 5, 2015 I would love to work at the ME office but they don't have any jobs for PAs. A autopsy tecch makes minimum wage. I saw an epidemiology job with the CDC based in my town with some travel. Considering that. Not sure the govt pays any better or close to equal. Trying to keep my household running, worry about a husband with some health issues that will force early retirement, deal w college expenses for kids and actually enjoy what I do and come home remotely sane.... Juggling chainsaws sounds easier some days.... I did a clinical rotation at the ME's office in NYC (manhattan). all of their field workers were PAs. we (PAs & PA students) went to death scenes/crime scenes and made assessments of death, worked with cops on-site, etc. I will say it is interesting but also, in turn, revOLting and TERRifying!! I've never seen such horrors! extreme rot and gore. it was like being in a horror movie. as a student, I went to all the death scenes/crime scenes/suicides/accidents, and also assisted on autopsies. super creep factor! Link to comment Share on other sites More sharing options...
kittryn Posted November 5, 2015 Share Posted November 5, 2015 besides my reply above, I identify completely with OP. I have found providing medical care to be a fast track to complete burnout, between the # patients expected to be seen, billing/admin hassles, asshat docs, and EMR hassles. I have left many jobs and been "excused" from many jobs bc of my inability/refusal to provide medicine the way we are forced to at this time. I simply cannot provide quality care within the parameters that now exist. I need to spend time with patients and get to know them, or else I feel I am only treating symptoms, not a human being. my patients love me, the bean counters hate me. I am currently in the pipeline for a couple of very un-prestigious positions (horrible mental health inpatient unit & a methadone clinic) which will allow me with the former, to set my own hours, and with the latter, see patients at a more sane pace. it takes eating some humble pie - bc I went to one of the most prestigious PA schools in the country, and live in boston - where some of the most prestigious medical institutions in the world rumble and hum - but I can't work the way they need me to work without experiencing severe impacts to my mental & physical health. I am willing to take less money for a more sane work life. I hope it gets better for you, reality check, I am in your shoes. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted November 5, 2015 Share Posted November 5, 2015 Someone sent me a PM for this post. However, my original moniker of Reality Check was corrupted and I simply cannot recover a usable password. I used another valid email address and became Reality Check 2. If that person still wants to contact me - try Reality Check 2. Sorry for the inconvenience. Burnout is better now that I joined a non-corporate medicine family practice with a very supportive doc. I am still working through the trials and tribulations of ambien, benzo, narcotic hell but that is not new and a plague across our country. There are still days and, yes, I still buy lottery tickets. Not sure what the future holds for PA's as medicine becomes more complicated. Will hang on for the ride now and keep trying to make it better for us a group. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 5, 2015 Moderator Share Posted November 5, 2015 Kitty- seriously look into the rural thing. I now have 3 rural per diem jobs. at each I see 0.5-1.5 pt per hr for a lot more money than I get at my inner city meatgrinder trauma ctr job. Will likely transition to full time rural practice within the next year if things continue as they have been at the primary job. I've been there long enough to have set aside some nice retirement funds, etc. Time to get out of dodge. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted November 5, 2015 Share Posted November 5, 2015 Kittryn - I completely understand about the ideation that we, as PA's, are expected to function as drones and worker bees within a framework of administration that basically goes against all medical ethics and how we were trained and believe patients deserve to be treated. Medicine is not McDonald's and, no, you can't have fries with that. I am not sure what it will take - the word revolution comes to mind - but then my mind sees a bunch of gowned and gloved PAs racing through the streets threatening people with digital rectal exams................... PAs need a much stronger legislative unit and a comprehensive idea of what the majority of PAs want or different pathways we can take to independent practice. I still go back to our broken system though. As long as insurance company CEOs are making 7 figures and 7 figure bonuses - nothing will work. I try to still feel worthy and fulfilled when a patient says thank you and gets better. Best I got for now.................. My very old 2 cents....................... Link to comment Share on other sites More sharing options...
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