bmr Posted May 12, 2011 Share Posted May 12, 2011 Just wondering what other's experiences were their first year as a PA. I'm about 7 months into my first year in an IM practice and I still feel scared to death and anxious about every decision I make. Does it ever get less stressful? Link to comment Share on other sites More sharing options...
Avalon Posted May 12, 2011 Share Posted May 12, 2011 bmr, I totally feel your pain. I'm six months into my first year in family practice and get very little oversight at all from my SP. I'm anxious essentially all of the time and obsess daily about my treatment decisions. I imagine that the local pharmacists are tired of my stupid mistakes (oops, I forgot to order needles with that Lantus Solostar....) and the local radiologists are tired of my benign findings (yes, I really did palpate an enlarged thyroid lobe...). My stressful situation has, however, been very lucrative for my local wine merchant. I'm hoping we hear some encouraging words in response to your post. Link to comment Share on other sites More sharing options...
brigid2 Posted May 12, 2011 Share Posted May 12, 2011 Oh, Lord, right in there w/ you both. While it's not much comfort in the way of encouraging words, it is comfort to know I'm not alone 8 mos into a community health position in a 50% poverty rate rural area (w/ "exports" from the majory metropolitan area 4 hours away--relocation subsidized housing), few community resources, and not much oversight. I 'heart' my SP, truly, but there's really been so very little oversight or guidance, and I feel so "blind" no matter how much I read, and questioning my decisions. I totally feel the pain here, and I just don't know what 'normal' is in way of the learning curve here; it's very isolating, and hope to heavens I don't 'mismanage' someone. I know there will always be a "learning" curve, but when does the horrid anxiety go away??? Cheers for supporting local wine merchants...;)Good luck to us all! I know we'll be fine, right?? Link to comment Share on other sites More sharing options...
hrjames Posted May 13, 2011 Share Posted May 13, 2011 bmr, I totally feel your pain. I'm six months into my first year in family practice and get very little oversight at all from my SP. I'm anxious essentially all of the time and obsess daily about my treatment decisions. I imagine that the local pharmacists are tired of my stupid mistakes (oops, I forgot to order needles with that Lantus Solostar....) and the local radiologists are tired of my benign findings (yes, I really did palpate an enlarged thyroid lobe...). My stressful situation has, however, been very lucrative for my local wine merchant. I'm hoping we hear some encouraging words in response to your post. I'm 6+ years into my practice (urgent care + nursing home, weird I know) and while my job is different, the above really resonated with my feelings during my first year of practice. I felt weird picking up Sudafed at the random grocery store pharmacy because they would see my ID and say, "oh, so YOU'RE the new PA" and I just cringed about how they judged my practice having seen my prescribing habits. I can say that it slowly, slowly gets better. 3 years in I stopped worrying so much and now I am confident enough to go toe to toe with our practice docs or call a specialist to ask them why they ordered "x" if I can't figure it out. Certain docs run cases by me or have me take a look at something for them, maybe 1-2 times a month. It gets better. Really it does. Link to comment Share on other sites More sharing options...
sbellin Posted May 13, 2011 Share Posted May 13, 2011 About 14 years into it now and it seems to come second nature...but you can't ever let your guard down and become complacent because then something may bite you. Link to comment Share on other sites More sharing options...
Febrifuge Posted May 14, 2011 Share Posted May 14, 2011 Yeah, I'm there too. What's nice is that, since I'm in Urgent Care now as well, I've had to learn to let go a little. Yeah, I get copied on notes and results when people remember to do it, and more often than not I was right about something, or at least it's a good thing I did x, y, or z... but after a couple of months, I stopped calling the ER at the end of my shift to see about the patient I sent over (my favorite of those was "hmm, yeah, I don't know either. We admitted her overnight. You did the right thing in sending her, but it's weird and I have no clue what she has"). Most of my x-rays are ruling something out, so an unremarkable reading is a win. These days, it's more important to me to finish my notes and go home. I do my thing, I do my best, and Do No Harm. Honestly, that's all you can ever do anyway. Obsessing about what you might have done badly will make you prematurely old. Just think back on the day, and find ONE thing you can do better tomorrow. Just one; then follow through. And while you're at it, find one thing you did really well (often it'll be something that was once the thing you needed to be better at, on a different day). If you get to the point where you're not repeating mistakes, then you're improving. Link to comment Share on other sites More sharing options...
JustPassing Posted May 14, 2011 Share Posted May 14, 2011 I do my thing, I do my best, and Do No Harm. Honestly, that's all you can ever do anyway. Obsessing about what you might have done badly will make you prematurely old. Just think back on the day, and find ONE thing you can do better tomorrow. Just one; then follow through. And while you're at it, find one thing you did really well (often it'll be something that was once the thing you needed to be better at, on a different day). If you get to the point where you're not repeating mistakes, then you're improving. Soo much WIN in this paragraph. Thanks for taking the time to write this. Saved this in a folder of useful info I have, and will be sure to pass it along. Link to comment Share on other sites More sharing options...
Hemegroup Posted May 14, 2011 Share Posted May 14, 2011 Epocrates (both on my handheld and desktop) is a very good friend of mine ... ;) Link to comment Share on other sites More sharing options...
Contrarian Posted May 14, 2011 Share Posted May 14, 2011 I know there will always be a "learning" curve, but when does the horrid anxiety go away??? Good luck to us all! I know we'll be fine, right?? Yep... you all will be fine... and the anxiety NEVER goes away (or at least it shouldn't) but simply becomes miniscule... I can say that it slowly, slowly gets better. 3 years in I stopped worrying so much and now I am confident enough to go toe to toe with our practice docs or call a specialist to ask them why they ordered "x" if I can't figure it out... It gets better. Really it does. Yes it gets better... much better... especially when we realize everything the Physicians around us know... is in a book somewhere and all we need to do is find, read, and re-read those books and put what is in them into practice... About 14 years into it now and it seems to come second nature...but you can't ever let your guard down and become complacent because then something may bite you. Bears REPEATING: "you can't ever let your guard down and become complacent because then something may bite you." Epocrates (both on my handheld and desktop) is a very good friend of mine ... ;) Its funny you mention this because when I was in training... "smart phones" were new and PDAs were rarely seen. I had a PDA (Handspring Visor, Prism, and Pro) with medical programs (Epocrates, 5MCC, Harrison's) on it from day one of PA school. By the time I got to my Clinical Year... 3/4 of our class had PDAs. It was kinda funny because there were ~ 30 PDAs in our class all labeled with MY user-name... so that we could use the same programs. As a matter of fact, that yr was the start of the medical school REQUIRING all incoming student own a Laptop and started issuing them all PDAs. By clinical Yr... I got tired of looking like "BatMan" with a utility belt on so I ditched the pager and cell phone and bought a smart phone to integrate the functionality of all devices into one device. Yrs later... present date... I do not leave home without a fully charged Smart phone, and web connected Tablet PC. Both have Epocrates Pro, 5MCC 2011, and various other medical programs on them that I find myself using 2-5 times a day. This makes it very easy to answer pretty much any medical question that I encounter in daily practice, or take before and after pictures of wounds/healing... and actually show another provider/clinician a medical reference that I'm referring to during discussion about appropriate patient management. YES... Epocrates IS my friend YMMV Contrarian Link to comment Share on other sites More sharing options...
medic25 Posted May 15, 2011 Share Posted May 15, 2011 Its funny you mention this because when I was in training... "smart phones" were new and PDAs were rarely seen. I had a PDA (Handspring Visor, Prism, and Pro) with medical programs (Epocrates, 5MCC, Harrison's) on it from day one of PA school. By the time I got to my Clinical Year... 3/4 of our class had PDAs. It was kinda funny because there were ~ 30 PDAs in our class all labeled with MY user-name... so that we could use the same programs. We must have been training around the same time. We had a few of us in class with PDA's (I had my Palm IIIxe, the last one before color screens). By the end of clinical year almost everyone was using them, and we all had the same medical software downloaded from my roommates user-name! Link to comment Share on other sites More sharing options...
Hemegroup Posted May 15, 2011 Share Posted May 15, 2011 Oh man, yes, Epocrates Pro rules, I can whip out my phone and answer most any question about a condition in seconds (the patients actually seem to really appreciate it when I read out loud so that they can learn) and it helps immensely with choice/dosage/frequency/etc ... I'll have to look into those others you mentioned as well ... Link to comment Share on other sites More sharing options...
JFarnsworth Posted May 15, 2011 Share Posted May 15, 2011 To the OP: After a while, the panic goes away. The fear of not knowing enough doesn't seem to, at least in my case. Also, there are a lot of opinions on how to best treat a patient, but if you CYA you should be fine. In the same urgent care clinic I was chastised for giving antibiotic drops to one patient, and then chastised again for not giving them to another patient later. Same presentation, same diagnosis. Go figure. You just have to figure out what works best for you and CYA CYA CYA!!!! Link to comment Share on other sites More sharing options...
gracec210 Posted May 15, 2011 Share Posted May 15, 2011 What does "CYA" mean? Link to comment Share on other sites More sharing options...
Contrarian Posted May 15, 2011 Share Posted May 15, 2011 CYA= "Cover Your A$$" Which as a practicing PA-C requires you to be diligent and not become lackadaisical or cavalier when dealing with ANY patient. Know that their IS a double standard in the practice of medicine amongst providers. A simple "oversite" by a MD/DO is just that... a simple oversite. This exact same oversite committed by a PA/NP will often be characterized as: Major Mismanagement of a medical condition Practicing beyond the scope of training and knowledge Not knowing what you don't know. Dangerous provider... Needing to be strictly supervised So as practicing PAs... we have to be better and practice to a level beyond reproach... and back up all challenges to our medical decision making with concrete evidence based references. Which is why I go NO WHERE without a web connected Tablet (Xoom) and Cell phone with Medline, Emedicine, Harrison's, Epocrates, 5 Minute Clinical Consult links in the desktop links. I've found that being able to hand a physician a reference.... mere seconds after they question or challenge your medical decisions... usually curbs most nonsense. The ones that want to continue to challenge... are simply told to debate with the evidence (in their hand), dismissed, and walked away from... :wink: About three weeks ago... a "part-timer" physician who only works 2 days a week suggested in her charting that I ("The PA") inappropriatley prescribed a patient who is KNOWN to have substance abuse issues... vicodin. She then took it upon herself to d/c the vicodin and not prescribe the patient anything for her leg pain... then was silly enough to document all of this in her charting. What she didn't do was read my admission H&P, or the other Physician's encounter notes... because if she had read them... she would have noticed that the patient had a fresh 9x6cm 2nd degree burn to her left calf down into the Sub Q... that required extensive daily dressing changes. Sooo.... when I returned to work 2 days later... I restarted the Vicodin and then printed out current references on the ethical and proper use of pain meds in the substance abusing population then distributed them to the entire medical staff. Fortunately... by this time... the patient had already reported the facility to the State and Ombuds... As a "corrective action"... the medical director (smugly) asked me to give a "in-service" to the medical staff on the appropriate treatment of pain and the use of narcotic pain relievers in patients with substance abuse issue... she wanted me to do it because I also practice Addiction Medicine with 100 opiate addicts at my "other" job. Well... you guys/gals should have seen the look on the physician's face when the medical director told her what my experience was in addiction medicine and that she was REQUIRed to attend a in-service on the obligation to ethically treat pain and that the inservice was going to be led by ME...:heheh: YMMV Contrarian Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 15, 2011 Moderator Share Posted May 15, 2011 We must have been training around the same time. We had a few of us in class with PDA's (I had my Palm IIIxe, the last one before color screens). By the end of clinical year almost everyone was using them, and we all had the same medical software downloaded from my roommates user-name! there was 1 guy in my class of 80 who had a "laptop computer" and he was considered a techno geek. Link to comment Share on other sites More sharing options...
bradtPA Posted May 15, 2011 Share Posted May 15, 2011 Besides the Epocrates on the smartphone, The Hopkins guides for antibiotics, DM, etc are very good.http://www.hopkinsguides.com/hopkins/ub And when you are looking for a good reference, up to date is also very good to have access to http://www.uptodate.com Link to comment Share on other sites More sharing options...
akb7 Posted May 15, 2011 Share Posted May 15, 2011 bmr, like other's have said, it does get easier. I felt the same way when I was a new grad! I worked at an urgent care/occupational med clinic with little oversight. I felt anxious all the time. I would have loved to have a forum like this to connect with others having the same experience. While I work in a totally different field now, I feel much more relaxed. I am still "anal" about thing's and never hesitate to ask or run something by my SP. Like another mentioned I would be the one calling the ER and asking what happened to my patient. Still do! But hang in there, it will get easier. Link to comment Share on other sites More sharing options...
sbellin Posted May 16, 2011 Share Posted May 16, 2011 there was 1 guy in my class of 80 who had a "laptop computer" and he was considered a techno geek. Ya and tablets were paper then too Link to comment Share on other sites More sharing options...
medic25 Posted May 16, 2011 Share Posted May 16, 2011 there was 1 guy in my class of 80 who had a "laptop computer" and he was considered a techno geek. I still feel very old when I go in to lecture to PA students now and I'm faced with a wall of glowing Apple logos from the laptops on the desks; I don't know if they remember what a pen and paper are for :) Link to comment Share on other sites More sharing options...
njeanb Posted May 23, 2011 Share Posted May 23, 2011 Help please, How long does it take to find your first job, I am in nyc, I've been looking for my first pa job for about 2mths, no luck, went to a lot of interviews, had some offers but were either to 2 hrs away, no insurance, no benefits. I am so discourage, it feels like I 'm never going to find a job Link to comment Share on other sites More sharing options...
Just Steve Posted May 23, 2011 Share Posted May 23, 2011 Help please, How long does it take to find your first job, I am in nyc, I've been looking for my first pa job for about 2mths, no luck, went to a lot of interviews, had some offers but were either to 2 hrs away, no insurance, no benefits. I am so discourage, it feels like I 'm never going to find a job This is a bit of a drift from the original intent of the post. You may have better response if you post this under a fresh heading that you create. Your user name is listed as a "pre PA, which as I understand it, means you have not yet been accepted to PA school. It may seem a little "no big deal", but to my OCD brain, it also points to lack of attention to detail. If you are getting interviews, but no jobs, it sounds like the "catch" is in the interview. Perhaps you may be setting your standards too high? Perhaps you need to talk to a "career coach" to help you with your interview skills which covers everything from what to wear to what to say, body language...huge bulk of subject matter. NYC is well known for being a tough market to break into. Boss of mine used to say "you gotta eat a crap sandwich before you die. You can nibble around the edges, or you can take a big bite out of the middle..either way, you gotta eat it". It was his way of saying "pay your dues before you get to the promised land" Other words...you may need to dig in and take a job that is less than your ideal so that your resume gets some PA experience on it. You can do anything for a year or two. Sure, it's less than ideal, but I am betting being a PA student wasn't a walk in the park. At least working at a "less than perfect job" is still bringing in cash and putting food on the table. Good luck Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 24, 2011 Moderator Share Posted May 24, 2011 CYA= "Cover Your A$$" Which as a practicing PA-C requires you to be diligent and not become lackadaisical or cavalier when dealing with ANY patient. Know that their IS a double standard in the practice of medicine amongst providers. A simple "oversite" by a MD/DO is just that... a simple oversite. This exact same oversite committed by a PA/NP will often be characterized as: Major Mismanagement of a medical condition Practicing beyond the scope of training and knowledge Not knowing what you don't know. Dangerous provider... Needing to be strictly supervised So as practicing PAs... we have to be better and practice to a level beyond reproach... and back up all challenges to our medical decision making with concrete evidence based references. Which is why I go NO WHERE without a web connected Tablet (Xoom) and Cell phone with Medline, Emedicine, Harrison's, Epocrates, 5 Minute Clinical Consult links in the desktop links. I've found that being able to hand a physician a reference.... mere seconds after they question or challenge your medical decisions... usually curbs most nonsense. The ones that want to continue to challenge... are simply told to debate with the evidence (in their hand), dismissed, and walked away from... :wink: About three weeks ago... a "part-timer" physician who only works 2 days a week suggested in her charting that I ("The PA") inappropriatley prescribed a patient who is KNOWN to have substance abuse issues... vicodin. She then took it upon herself to d/c the vicodin and not prescribe the patient anything for her leg pain... then was silly enough to document all of this in her charting. What she didn't do was read my admission H&P, or the other Physician's encounter notes... because if she had read them... she would have noticed that the patient had a fresh 9x6cm 2nd degree burn to her left calf down into the Sub Q... that required extensive daily dressing changes. Sooo.... when I returned to work 2 days later... I restarted the Vicodin and then printed out current references on the ethical and proper use of pain meds in the substance abusing population then distributed them to the entire medical staff. Fortunately... by this time... the patient had already reported the facility to the State and Ombuds... As a "corrective action"... the medical director (smugly) asked me to give a "in-service" to the medical staff on the appropriate treatment of pain and the use of narcotic pain relievers in patients with substance abuse issue... she wanted me to do it because I also practice Addiction Medicine with 100 opiate addicts at my "other" job. Well... you guys/gals should have seen the look on the physician's face when the medical director told her what my experience was in addiction medicine and that she was REQUIRed to attend a in-service on the obligation to ethically treat pain and that the inservice was going to be led by ME...:heheh: YMMV Contrarian LOVE it - this is the type of education we need to push onto the doc's - we are just as likely to have an "interest area" where we possess more knowledge then our doc's but I have only meet a few doc's that are willing to admitt this and then defer decisions to the "expert" (the PA) thanks for sharing the story - made me smile this morning... , up to date is also very good to have access tohttp://www.uptodate.com I was liking using this and then looked at the price..... yikes! Guess I will not get it on my PDA but instead still use the hospital access Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.