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Should I stay or should I go?


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Hello Fellow PAs!

 

I need some advice...

 

How important is a somewhat structured training environment to you?  I am all for "trial by fire", but I am also a firm believer in the "see one, do one, teach one" method.  That's how I learn the best.  My SP is not so good at training a new PA.  I have been in Ortho Trauma since December (my first job) and I was hired to basically replace the Trauma Fellows he had in the past.  It was discussed, at length, before I accepted the job, that I would require a different level of training (a lower level, admittedly) than someone who had completed med school and an orthopedic residency already.  I was assured that that would not be an issue and he loved to teach.  He was the head of Orthopedics at several medical schools in the past.  However, it turns out the people he loved to teach are the ones who are already at an advanced level in their training.  As the head of the department, he didn't really deal with training the med students, interns, or lower level residents.  That was handled by the senior residents, apparently.  SO, it has been a REAL struggle to learn and perform at the level he is expecting.  I have no doubt that I will get there.  I just don't know that I want to stick around at a job where I'm basically teaching myself.  He doesn't show much interest in my development as a clinician.  Actually, he doesn't really see me as a clinician.  He sees me as his assistant.  Not that I have a huge problem with functioning in that role as I get started in my career.  My big problem is that he constantly tells me my job is to "make his life easier" and that I'm a PA, not an MD.  I'm not trying to be an MD!  I just want to function as a PA and not an overpaid medical assistant or as only a surgical assistant.  The previous statement that my job is to make his life easier really bothers me.  While it's true, to an extent, that seems to expose an underlying contempt for my profession.  It seems he doesn't see PAs as teammates but as truly assistants.  I try hard and I have, in my own opinion, come a long way since starting.  I still have a long way to go but I know my experience and knowledge has grown exponentially, even if it has been by my own studying or by other people besides my SP.  I just can't shake the feeling that I (or any PA, for that matter) will always be seen as an assistant and can only do the things he delegates.  I have tried to get him to let me see patients in clinic but all he wants me to do is go into the room before he does and remove sutures, etc.  Like I said, an overpaid MA.  I do get to see a few patients in clinic when they want to come in and he isn't available.  This amounts to about 4 patients a MONTH.  He says "my patients are here to see me, not my PA".  While that is true for many patients (after all, he IS the super specialized acetabular surgeon), many patients are perfectly fine with seeing "his PA" for follow-up visits or for other things the MD isn't necessary for.  He just doesn't want that. 

 

So, anyway, my main question is...should I stay and hope it gets better?  Or should I start exploring other options?  I honestly don't see his opinion about PAs changing and I'm just not sure I will adjust to the role he wants me to play.  IDK...maybe surgery isn't the place for me.  I love the OR, but if that's all I wanted to do I would have gone to Surgical Assistant school...not PA school.  I live in a large city and there are plenty of other PA jobs out there.  I know the grass isn't always greener on the other side and, usually, it's just as wilted.  I just don't want to continue on at a job where the SP doesn't really get what a PA can offer and seems to not really respect me as a clinician. 

 

I apologize for the long rant and I'm sure it seems like a huge gripe session.  I just wanted you guys to get a feel for my frustration.  Any advice or experience with something like this would be greatly appreciated!!

 

Thanks!!

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Not as a PA, but coming from other work experiences a toxic environment is a toxic environment.  The fact you had to come on an online forum to ask advice about whether you should stay or not is really your answer right there.  Not that I would want to just walk out, but I'd definitely start looking at different opportunities if I was being treated that way in a job besides McDonalds.

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Yeah, I basically had made up my mind to at least start looking for other opportunities the first time he told me I should have went to med school if I wanted to do more.  He solidified his position today by actually putting that in writing in my performance review.  I don't want to make any spur of the moment decisions and I wanted to get as much feedback (positive or negative) as I could before I made a final decision.  Thanks for your input!

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Right here with ya. I started in Ortho 6 months ago (new grad). My SP had 3 PA's in the last 3 years (found this out later). When I first started, the other PA was on her way out. She "trained" me, which I would consider more of her hating her job, pissed that she was there and passive aggressive with me. My first day on the job I had asked one of the RN's if I could just shadow her and the other staff for the day just to get a feel for the flow of the office and find out where most things are, or where I need to go to get answers... which I believe is a fair request. Her reply was, "No, Dr. X will need you for clinic". Okay, that's fine... then shi* hit the fan. I became a well paid scribe/MA that day. He didn't teach/train me a thing, as I was expected to know the EMR right from the start. 6 months later, I am doing the same thing. In fact my normal duties include: scribe, finish HIS charts by the end of the day, room the patient, clear off the exam table when he's done including throwing the trash away after a procedure, apply DME, casts. One day he saw paper pieces on the floor.. stopped the patient mid sentence and turned to me and asked me I would clean it up when we got done... that was a kick to the perineum for sure. I finally got to start doing injections about 2-3 months in. woopidy doo. It's actually quite funny. I feel like I am pretty damn good at injections (patients tolerate very well, never have issues). I injected all the time in my ortho rotation. Still, EVERY time he "lets" me do an injection he always tells the patient "my ASSISTANT is going to do the injection, he's getting better, I taught him everything I know" blah blah blah vomit. Thankfully I haven't snapped yet.

 

That's just clinic. I was basically thrown to the wolves doing inpatient orders for our OR cases. He never told me that was my duty, but I learned from the OR staff that he doesn't do the orders, I would get the call and have to place the orders (which is a beast on its own if you've never done them before)... I learned that part by mucking everything up a few times until I got it right. That's fine by me, but he is so used to everyone doing everything for him that I am guessing he just thinks it should be done. So I had to learn the hard way. Oh, the best part is that while I am writing the H&P, prepping the patient for the case, positioning etc for 5-6 hours straight (might I add no time between clinic and OR for a break) he is in the lounge eating. Ill go a full 9-10 hour day without food sometimes.

 

Long story short.. it took me 6 months to figure out that it's not going to get better. Even if it did, our "collaborative" relationship is broken and could likely never be fixed. I started looking, and in about 2-3 weeks I had 3 offers on the table, all three with a salary increase of 20-25K. I had a few meetings with him about my concerns and that I wanted my role to increase after I told him that I had offers. The short of it was that he would match the salary and let me see patients but he wanted to see them too (ie more hand holding) rendering my visit with the patient essentially useless. What's sad is that I would want to stay if he would open up more... he's a great person and a great surgeon, but the grip on his practice is too tight.

 

Point of all of that is that I know what your going through. It downright sucks.. bigtime. Keep your chin up. Browse the interwebs every day and something will come up. You have experience, as little as it may seem, but it is still experience. It sucks to have to resort to that, and I have lost a lot of sleep over all of this because I hate quitting. At the end of the day I need to be happy and once I realize that I did everything I could, worked hard, showed up and approached him about my concerns and still got nowhere then I will be able to move on... so will you.

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#orthoproblems .. I'm being crass, but I hear this all over with ortho PAs. Others of course will have similar issues. You need to move on. All of those in similar positions need to too. It's a disservice to our profession and until it gets reinforced that this is wrong, it'll continue.

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Thanks man! Good to know I'm not alone.  I feel you on the 9-10 hour days without a lunch.  I guess that comes with the territory but I know it sucks.  I have been at it for about 8 months and I've about had all I can take, so I'll be looking for another gig.  I do get to do injections (like you said "whoopty do!") but that's about the only "PA thing" I do during clinic.  He never discusses cases with me prior to surgery and I'm constantly having to say "I'm not sure what his plans are".  Even if I ask him, I don't get much of a response.  The pay is not good but the bonus structure is not bad...50% after I bring in what he pays me.  However, I am constantly "on call" because trauma doesn't follow a schedule.  No call pay.  All that would be fine if I felt like he appreciated what I bring to the table.  Anyway, thanks for the reply and hopefully you can move on to where you are happy!

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Walkoffshot, I feel ya man.  I basically function as an assistant to the medical assistant in clinic.  I follow him into the next room and get their job started so they can finish what they are doing.  Then I stand there and try to take notes on anything new I hear.  It's sad, really. 

 

Anybody have suggestions for the best area of medicine to look into?  Where are PAs being utilized like we should, in general?  I realize that each job is different and each SP is different.  Just looking for general suggestions.  I'm thinking maybe Family Medicine.

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If you like ortho, keep pursuing it. I know several of my clinical mentors that have great relationships with their SPs. My new gig that I will be starting soon has it set up just the way I want it (how one of my PA supervisors had their clinic set up when I rotated). He has a list of patients which he will add to it when I start and get comfortable. Then we just tag team it until the day is done. We both chart on our OWN patients and that's that. I bill for my services, he bills for his. He says I will see new patients, examine, order tests and tee them up for surgery if they need it. The way it should be IMHO. I don't care too much to have my own "panel" and frankly in a specialty I don't think it would work. Like you said before, they are his patients, my intention is not to have my own... I will just see which ever ones I am comfortable with, and he is comfortable with me seeing.  

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I do love ortho.  That new gig sounds like just what I want.  I don't want my own panel either.  I agree that I probably doesn't work well in a specialty practice.  Maybe, maybe, in a general ortho or sports medicine practice.  We are trauma, and particularly pelvis and acetabulum.  Most of them need surgery and get scheduled for it after the initial visit.  There has to be a better way to utilize a PA than what he has in mind, though. 

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Good surgeons have told me, "the best possible first-assist is someone who could run the surgery themselves." If this MD really wants "just an assistant" then he somehow failed to understand the point of training the residents and fellows over all those years. More likely, the reason why he's no longer helping to prepare the next generation of ortho surgeon MDs is because he ran out of valuable perspective or wisdom to impart.

 

The other thing good surgeons have told me is "PAs are great. Like residents, you put in the time to train them and get them performing at an excellent level. Unlike residents, they don't leave you behind, so you can keep reaping the benefits." This guy sounds like he just doesn't understand what PAs can do for him and his practice. Do it professionally and appropriately, but ditch this person ASAP.

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Is either of these jackwads named Alan? Pretty sure I worked for him years ago.

No PA is a scribe -- ever.

I worked with another very uptight ortho but I saw patients and made plans. He counted on me for a complete pre-op using my medicine skills to ensure the patient was safe and ready for surgery.

If patients wanted to be seen in a timely fashion - I was their ticket into the practice.

I see the patient - document the problem and basically schedule the surgery and he comes in at end of visit - shakes hands, tests the nonexistent rotator cuff and - voila - done.

If I worked your impingement for 3-4 months without return to baseline - same thing - check it and off to a scope for that patient.

I made good money but put up with his narrow narrow oh my gosh narrow scope of practice and felt my brain shrink.

I could recite surgery consents in my sleep and truly only wrote for four drugs ever.

Mine was better than your experiences but still not quite right.

So, your examples are EXACTLY what ortho PAs should NEVER be doing.

Run - find a respectful job and bloom!

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Good luck finding another gig buddy. This guy wasn't gonna get you far. What's going in Ortho though? All these horror stories seem to be ortho-related. Is an inflated ego part of the job description for ortho MD's? Sure seems that way.....

Remember to ask as many questions as possible for the potential new job my friend. PLEASE

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Sounds like you have an SP who has NO IDEA what a PA is or what we can do. They are still out there. Once in a while an SP will change their attitude but I haven't seen that very often. My theory about ortho surgeons is they get a lot of flak for being jocks who only know how to cut bones and don't know any medicine. Like the joke, what do you call a double blind study? 2 orthopods looking at an EKG. From what I've seen, it takes a long time for an orthopod to figure out what PAs can do. I know some who are very good at utilizing PAs, but they are few and far between. Take it with a grain of salt- I live in Northern California so my experience is limited. I think ER PAs have the most autonomy and are truly seen as team members and colleagues. EMEDPA might have more insight on this since he's been doing it for a while. 

My advice is to try to find another orthopod (if ortho is your passion) or go into another field where PAs get to do more: family practice, ER, urgent care, derm, cardiac surgery, occ med, just to name a few. Good luck and let us know what happens!

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Guest Paula

GO!  Do Not look back.  

 

The job of a PA is NOT to make the life of a physician better.  That is one of the worst urban legends I hear about PAs and I believe it was the mantra at one time....maybe in the 70s and 80s.  But good grief, the profession has grown up and matured. 

 

No scribing....ever.  It will ruin the profession when a PA accepts a scribe role.....Yuk.

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The sad thing about it, Paula, as it was in my case and I'm sure with the OP is that in my supervisory agreement with job description (separate of the boards agreement we sign) is that it says nothing about scribe work. My role was discussed prior to signing my contract and I can assure you it was manipulated to sound like what I was looking for. I can only imagine it was the same in the OPs case. Unfortunately, sometimes you have to find out the hard way. If I would have known that I would be stuck in my current situation, I would have never signed. Of course we can always ask questions to investigate, but I have found out that things aren't always as they seem. I politely told my SP that these types of duties aren't what we are educated for... we practice medicine (ie diagnose, treat etc). If he wasn't aware before, he should be aware now. Sadly, nothing will change with him and it will likely be a revolving door and the next PA will go through the same. I will be sure the next PA understands the role, that is if I ever speak to the poor soul.

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Flip the coin, what does an ortho surgeon do? he cuts. 99% of all patients sent to ortho are already diagnosed. the surgery physically and mentally/emotionally relies on him. the patient will base their decision to use him or go with a second opinion based on him, not his "supporting " staff. one should remember, patients are usually sent to surgeon "so n so" because he is excellent/ well known/ i would have him operate on me/ or simply related to the refering md. It is still a business of medicine. his chance of being sued rides on him. he utilizes PAs to move the "bacon". they use the PA profession to make themselves rich. the least you should settle for is top pay and respect. don't think that you will get to do any real medicine as an orthosurg PA. If your intellectual mind wishes to go further, i would do as others above suggested. enter a field where you are one of the big fish in the lake. where the orthosurgeon calls you up because you refered to him with diagnosis already in place

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GO! Do Not look back.

 

The job of a PA is NOT to make the life of a physician better. That is one of the worst urban legends I hear about PAs and I believe it was the mantra at one time....maybe in the 70s and 80s. But good grief, the profession has grown up and matured.

 

No scribing....ever. It will ruin the profession when a PA accepts a scribe role.....Yuk.

This IS how it was done in the early 80's. Room pt's., make sure radiology studies were on the office boards or were in the OR with pt., round but understand that ANY orders had to be authorized before implementing, return pt. calls and refill meds, clean rooms after pt. visits, call referral physician and get them on the phone, and go set up for afternoon ESI/facet injections with YOU controlling the C-arm. Don't fall asleep in the OR while holding the retractors, and maybe, if you were lucky, first assist on a lami/disc with the possibility of using the bovie. Don't forget to go in on Sunday afternoon and get the H&P's done for the Monday cases! If you are a good boy, we might even let you dictate on the hospital dictation system.

 

 

Sent from my iPad using Tapatalk

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JMPA, I get what your saying. I am assuming you are not an Ortho PA. Personally, I think the idea that we don't practice "real medicine" is getting old, and I am still a pretty fresh PA. To each their own. What I do know is that ortho is a specialty of "medicine", therefore we practice medicine, and just as everyone has mostly agreed on is that we shouldn't agree to sub-par practicing methods. I don't think you quite understand that not all ortho is referrals with diagnosis that is already made for us. We also have established patients.. in fact in one particular day we would see 30-35 patients in a 3.5 hour window and about 50% of those patients will be established with new complaints, not referred. Yes, it's not as comprehensive as say managing a patient with diabetes and htn, but it's still medicine. So tell me why I am not able to see that 75 year old patient with knee pain, take a history, interpret the xray, examine them, give them their dx of djd, start PT/NSAIDs and/or give them an injection. Have them follow up in 3 months... if it doesn't resolve and it affects ADLs have a discussion with them about knee replacement. Easy. Tee it up for the doc. If they want to talk to the doc, have at it. As you say, we don't practice "real medicine" so how hard can it be. Any given day we will be 1.5 hours behind... patients get upset and leave. Wasted time and money... meanwhile I am the hamster on the wheel following the doc around with a laptop typing... makes zero sense. Oh "our patient whose requesting there quarterly injection had to leave because they didn't want to wait".. don't know how many times i've heard that in my clinic. Not to mention any ortho practice I have shadowed or rotated with has a PA that sees patients, with little to no resistance from the patient because they "want to see the doc". If a patient needs to be seen for a second opinion, then absolutely that patient should be seen by the doc. I wont argue that.

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I agree with everyone that this is not how you should be learning or setting up your career.  I work with a long time PA in ortho and actually am a patient of his for some knee issues.  He has his own full schedule of patients, sees new patients on his own and does injections on his own.  He also works alongside his SP in the OR and does rounding on post op cases.  He is a phenomenal clinician and is fully utilized.  He is also paid at the top of the scale, but is extremely productive.  This is how a PA should practice in ortho once they are trained and up to speed. 

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 Any given day we will be 1.5 hours behind... patients get upset and leave. Wasted time and money... meanwhile I am the hamster on the wheel following the doc around with a laptop typing... makes zero sense. Oh "our patient whose requesting there quarterly injection had to leave because they didn't want to wait".. don't know how many times i've heard that in my clinic. 

wow.  I would leave, too.

 

Any practice that is constantly 1.5 hours behind schedule is either inefficient, scheduling improperly, or needs more providers. All of us get behind schedule sometimes, but consistency means that a practice does not respect the patient's time.  You may now attack me because I "don't understand."

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If you consistently have issues with patients being upset about waiting and leaving, then a possibility for making things better for yourself is to figure out how much money the clinic loses daily with patients walking out and present that to the doc and remind him your training is perfectly fine for seeing these patients. Often the only thing that these guys understand is money and anything that affects it. If he doesn't get it after that, move on

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