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Job burnout -- transition strategies?


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Hello fellow PA's!

 

I'm been working 4+ years in EM, and currently find myself in a job that I cannot stand any longer. First of all, I work in Camden, NJ which is a god-forsaken, urban wasteland.  The facility is a stand-alone ED, which basically serves as an all-in-one ER/family practice/STD clinic with no appointments and constant stream of patients. Patients either can't get in to see their PCP or simply do not want to wait, so they all funnel in here. Wait times in surrounding local ERs have steadily increased, so we are seeing more complex patients come in as people simply do not want to wait (knowing all-to-well that we will likely transfer them out). There is high autonomy which I am comfortable with.  I would say only 1 out of 10 patients I see truly merit a trip to the ER, and that's being generous.  There is constant eloping, AMAs, work-note seeking, walking out after preg test is negative, etc... The arrogance and rudeness of the average patient here is simply astounding. The drug seeking is actually not as bad as the suburban ER I worked at previously, presumably because street drugs are so easily to obtain. The volume is very high, as most patients are low acuity. And because of this, the entire staff is quite jaded and there is usually some push back on doing some testing unless it obviously needed. I've witnessed some pretty risky medical decisions being made in the spirit of "get 'em in, get 'em out". 

 

Now, I have to say I work with good people that seem miserable with work. Life circumstances have somehow trapped them into working here for years (debt, kids in school, inertia, etc...).  Speaking for myself, I think I've tolerated this job for just over a year only because the hours are better than most ERs and I've got this notion that I must pay off all my student debt before I move on (which would be about another 18 months out at my going rate). Well, I've decided I simply can't do that anymore. Its affecting my relationships and personal life. I'm fighting off low-grade depression, and constantly exercising just to stay sane.  I've lost a lot of enthusiasm for practicing medicine, although I still take pride in my work. I frequently feel like I'm wasting my time. I have other interests (much less lucrative) outside of the medical field. I not sure I can work emergency medicine anymore, but unsure what my next move is.

 

So, my loose plan is resign around next July, and take a couple months off to recharge and regroup, travel and explore options. I have a significant other but no kids, and we both want to get the heck out of the Philadelphia area. Colorado, CA, Oregon? Considering part-time work for a bit, maybe locum tenens? Non-clinical work? How problematic is it to apply for jobs out-of-state without an active state license? Anyone with part-time urgent care jobs that can chime in on their experience? I have to get out this situation before it sucks my soul away! Any advice or sympathy is appreciated! 

 

 

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You may want to look into another area of medicine.  I worked in the ER and UC briefly and I knew if I was there very long I would be completely burned out.  What about cardiology, pulmonology, or critical care positions?  I have also see a lot of ENT positions advertised looking for people with ER experience recently.  I am sure you will still have some of the aggravations we all have but working in a specialty has a different feel to it than in an UC or ER.  Sounds like your complaints with the ER are pretty run of the mill ER issues.  I do think some ERs are much better than others but even at the hospital I work at which is rural it has a tremendous amount of drug seeking and inappropriate visits and extremely long wait times which lends to stress for the provider and patients being ill by the time you see them.  For me my perfect fit is outpatient work in a specialty, I can understand how this is not the right fit for everyone but it may be a good change for you and you can always go back to working in the ER if you get bored.  I recently have had to set some limits on my schedule and generally be very vocal about how I want to practice, but since doing that I am overall enjoying my work days and I have been practicing for 13 years.  I can tell you that over time if you don't find a better fit you will burn out and it does take a toll on your mental and physical health.  Make a change now while you are still early in your career.

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Hello fellow PA's!

 

I'm been working 4+ years in EM, and currently find myself in a job that I cannot stand any longer. First of all, I work in Camden, NJ which is a god-forsaken, urban wasteland.  The facility is a stand-alone ED, which basically serves as an all-in-one ER/family practice/STD clinic with no appointments and constant stream of patients. Patients either can't get in to see their PCP or simply do not want to wait, so they all funnel in here. Wait times in surrounding local ERs have steadily increased, so we are seeing more complex patients come in as people simply do not want to wait (knowing all-to-well that we will likely transfer them out). There is high autonomy which I am comfortable with.  I would say only 1 out of 10 patients I see truly merit a trip to the ER, and that's being generous.  There is constant eloping, AMAs, work-note seeking, walking out after preg test is negative, etc... The arrogance and rudeness of the average patient here is simply astounding. The drug seeking is actually not as bad as the suburban ER I worked at previously, presumably because street drugs are so easily to obtain. The volume is very high, as most patients are low acuity. And because of this, the entire staff is quite jaded and there is usually some push back on doing some testing unless it obviously needed. I've witnessed some pretty risky medical decisions being made in the spirit of "get 'em in, get 'em out". 

 

Now, I have to say I work with good people that seem miserable with work. Life circumstances have somehow trapped them into working here for years (debt, kids in school, inertia, etc...).  Speaking for myself, I think I've tolerated this job for just over a year only because the hours are better than most ERs and I've got this notion that I must pay off all my student debt before I move on (which would be about another 18 months out at my going rate). Well, I've decided I simply can't do that anymore. Its affecting my relationships and personal life. I'm fighting off low-grade depression, and constantly exercising just to stay sane.  I've lost a lot of enthusiasm for practicing medicine, although I still take pride in my work. I frequently feel like I'm wasting my time. I have other interests (much less lucrative) outside of the medical field. I not sure I can work emergency medicine anymore, but unsure what my next move is.

 

So, my loose plan is resign around next July, and take a couple months off to recharge and regroup, travel and explore options. I have a significant other but no kids, and we both want to get the heck out of the Philadelphia area. Colorado, CA, Oregon? Considering part-time work for a bit, maybe locum tenens? Non-clinical work? How problematic is it to apply for jobs out-of-state without an active state license? Anyone with part-time urgent care jobs that can chime in on their experience? I have to get out this situation before it sucks my soul away! Any advice or sympathy is appreciated! 

I hate to hear a story like yours. The upside is you have options. Start doing research..lots. Explore every option you have and weigh the pluses and minuses and go. Having been in a similar situation recently I found immense relief just by having a plan. It is when you feel stuck things are at their worst. Locums is a good short term solution so you can get out of where you are, keep some income, and make a longer term plan. Call a couple of locums companies (or several) and see what is out there. You may be surprised. I wouldn't wait 6 more months to do something. You are in a high risk situation and you are burned out. It is a bad formula. 

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Agree with the above. Don't wait until next year. Start contacting locums' companies now. It can take months to get licensed and/or credentialed. I have heard good things about Comp Health and Staff point. Comp Health >>> staff Point. To your question about finding a job (in another state) w/o a state license, if you go through an agency (especially one that works nationally) they will help you with licensing, credentialing etc. Another benefit is the fact that you can work in several different geographical locations over a relatively short time then decide where you want to settle down/end up.

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Take a look into an up-and-coming area of healthcare. Governmental/large corporate employee clinic's. Hours are better, salaries are competitive, benefits are good, and it has been my experience that you don't have to put up with all the riffraff. I have made certain to choose positions in which I do not serve as the primary care provider, and only address the minor illnesses of the day. If they are not happy with the services offered, they can go pay their co-pay and see their PCP. While it may not be as challenging as emergency medicine/urgent care, it still allows you in some respects to use your clinical acumen to determine serious from nonserious.

 

 

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I feel your pain!  I did ER for 4+ years in a  similar setting before quitting .. I feel like i had my soul sucked out of me.. I wound up very jaded .  I now work in Urgent Care/Occupational Medicine - mostly b/c that was the only thing available at the time with decent hours and I am not much happier.  So my advise is to choose your next career wisely. Really make a list of what you think you can tolerate and what you absolutely cannot. I hope you find a satisfying job. Keep us posted! 

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