first job-typical?

[David the Nome]

Looking for some advice/input....

 

I am a new PA, 3 months out of school-had one year experience as emt-b. I took an offer from an EM group who staffs both ED and urgent care centers. For the first two months, I was placed in the urgent care. I found it stressful, not necessarily due to the complexity of cases, but because of limited resources and the huge volume of patients. After the two month period in urgent care, I just started working in the main ED of a large, inner city EM department. My first shift was yesterday--and i was completely overwhelmed. It was myself and one doc-who was so busy/pre-occupied with managing his own patients that he had no time to help or answer any of my questions. I felt so incompetent and on an island all night long. AT different points, i wanted to cry, felt like i was going to puke, and wanted to quit. I know that I am going to dread going to work. I like EM, but feel totally overwhelmed and incompetent.

 

Of note-I was not given any type of training/orientation in either the urgent care, or ED. I was just put on the schedule and told to work. Basically expected to function as a physician, with only one year of school rotations and one year of emt experience. My question is, is this normal for a first job (particularly in EM)? Or is there typically some sort of training period involved. I ask because I feel it is unsafe for me to being seeing complicated patients like this with no real oversight or guidance. It seems like it is a disservice to myself, the patients, and the doc that I'm working with.

 

SO those who know better, is this typical, and should I stick it out? Or is this a bad situation from which I should jump ship and attempt to find a position with more teaching/oversight?

[Resptech99]

I am not an expert on first PA jobs. However, general life experience has taught me that the only thing worse than a job you hate, is a marriage you hate. Regardless of whether your experience is typical or not, the average person spends far too much time at work to be that unhappy. Find something else that is a better fit for you.

[EMEDPA]

that is a typical job for an experienced em pa, not a new grad. you may need to find somewhere a little more appropriate for a new grad who still needs to consult regularly. nothing wrong with that. I was very fortunate at my first job. there was a residency there and my SP was the residency director. day 1 he told me he would treat me as an intern and no question was too silly or inapropriate. his door was always open as were the doors of the chief residents who I consulted frequently as well. after my first yr there my SP asked me to run a rotation for the new interns to teach them em procedures. at the beginning of the third yr he basically treated me as a chief resident. it was a great job but after a bit more time I had maxed out my scope of practice there and moved on to where I could see sicker pts and learn more.

[HopefulPA]

Why does a busy, large volume inner city ED only staffed with ONE doctor and ONE PA-C????? Seems there are other problems than just the lack of availability of the Attending.

[David the Nome]

Good question. I work nights. during the day there are two docs and two PAs .

[EMEDPA]

Why does a busy, large volume inner city ED only staffed with ONE doctor and ONE PA-C????? Seems there are other problems than just the lack of availability of the Attending.

they probably have an in house trauma team, admitting residents, etc

when I work per diem at a local level 1 trauma ctr at night after 2 am it is just me and 1 doc although we have many other in house resources to call on.

[medic25]

Sounds like a poor set-up for a new graduate. When I first started at my hospital as a new grad (large teaching hospital, inner city Level 1 trauma), the new PA's got 1-2 orientation shifts before getting thrown to work; it was overwhelming for most, and contributed to some attrition problems. In the last couple of years we have greatly expanded the orientation. New PA's are partnered up with experienced PA's for at least a couple of months, working as an extra body while able to ask questions and not shoulder a full patient load. We also encourage everyone to attend morning report with the residents and weekly didactic sessions. New PA's are also not allowed near Urgent Care for several months, as they will be functioning independently here, rather than with an attending like in the main ED.

I would highly recommend looking for a position in a teaching hospital, preferably with an EM residency. The senior staff are used to doing some hand-holding with the new grad PA's/interns, and are generally very open to teaching.

[Contrarian]

Not saying this is the case here... but the only other few times I seen anything like what is described by the OP was when the new PA "over-sold" their abilities during the interviewing process.

[David the Nome]

Well, I definitely didn't oversell my abilities. In fact, the senior PA told me specifically that he was going to "take me under his wing". Problem is, haven't seen him since the interview.

[NoClinic4Me]

I've heard stuff like this before, we've even had some of our stellar new grads end up in places like that and left due to lack of help from the MD's. My group actually puts new PA's in the main ED because it is usually at least quadruple MD staffed and the opportunity for help is everywhere. They spend up to a year there first before being allowed to work in the fast track alone. Fast track is 100% alone and required lots of time management skill, confidence in your ability, and awareness of what will get you in trouble if you miss it (see sticky above on fast track disasters). A new PA cannot possibly be expected to pick up those "needle in a haystack" subtle about to be train wrecks on a remote fast track. For me, a new grad shouldn't be working single coverage for quite some time unless they've done an EM specific residency. Even then, quality is variable.

 

Pat