1 year out,feeling very burned out, need perspective

[Dexter42]

I graduated a year ago and took a job in a surgical subspecialty, office based outpatient. Great manager, good pay, good incentive based on productivity.

 

Six months ago they demoted the manager and replaced him with a physician(who I've seen twice) and got rid of the productivity incentive. I got a 5k raise in base after a prolonged battle but lost up to 25k from the incentive for the coming year.

 

I'm currently seeing 20-23 patients a day five days a week. Because I have more openings than older providers, I sometimes see up to 8 emergency visits per day which is extremely taxing. I sent 3 people to be admitted last week they aren't all just simple acute visits. 

 

I was managing for awhile, but my ex-manager recently left the clinical practice and another PA has burned out and gone part time. I'm feeling completely at my limit at this point, and really hit a wall last week. I felt as though if I saw one more emergent I was going to break down in the office. Weekends aren't really recovering me for Monday like they used to. I've spoken up but I feel like I'm being gaslighted and I feel that they expect me to see even more patients in a day, some physicians see over 30 in a day. 

Is this just what it is to be a PA? Or are there better jobs out there? 

[UGoLong]

There are better jobs out there. Don't stay where you feel you are being taken advantage of, no matter what career you are in.

 

Be polite, but speak up for yourself. If that doesn't work, vote with your feet!

 

Good luck.

 

 

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[Maverick87]

Unfortunately, from what I've seen, most jobs are like this.

 

There are some that are not, but you may have to give up some pay.

 

I currently work in a specialty and make $90k. Somewhat low for a PA, but I'm not going to work with that sinking feeling in the pit of my stomach, I can actually sleep at night, I'm not stressed out at all really, and I'm able to have a life outside of work.

[EMEDPA]

with a year of experience you could easily find a better job in a variety of hospital based or outpatient practices that would offer you a better work/life balance. find an alternative, tell your current job your needs, and if they can't meet them take that alternative position. best of luck.

[ventana]

them boots are made for walking......

 

 

 

yup some employers just don't get it, and they never will

give it a good honest effort, leave as a professional

but LEAVE

[PRS-PA]

Agree with all above!

 

I would continue to go in, work hard, voice your concerns and both ask how they can be corrected and offer solutions.  Make it appear that you are willing to work through it.  

 

But each day I would be looking very hard at other positions that are coming available.  I would be looking to interview for said positions and ask potential new employers questions that reflect your current position ie patients seen in a day, productivity incentive, etc.  Once you think you found a position that would be worth taking, I would let your current place know your possible intentions, and see what their reaction is.  Unless everything changed and then some, I would be switching to that new position 

[UGoLong]

I wouldn't use a new job as a bargaining chip. You can only do it once and you are also marked as someone who won't stay in the long run.

 

Give them a chance now and then leave if the new job is better than the old.

[overthehorizen]

Everyone likes to talk about switching jobs as the primary source of negotiating power. Unfortunately, unlike most jobs in the private sector, there are many barriers to switching. The system is built to make it difficult to switch jobs and subsequently reduce your negotiating power. 

 

Examples of barriers include

1. State licensing board - leave a job in one state and you'll need to apply for a license in another. Time cost ranges from four weeks to three months.  Costs as high as $1000. PAs lose. Employers win.

 

2. Licensing required to apply for a job - this is a clever one cooked up by hospitals and practice administrators. It keeps your options limited to those within the state and thus effectively reduces your negotiating power. Sure, you are free to look outside the state. Now, the hospitals collectively meet at their national association convention and agree to make it a requirement to have a license before your are considered. So, want to look at jobs in fifty states. You have to apply for a license in fifty states. Cost to you is about $25,000 every two years to keep this negotiating power. So you retreat and apply for a license in one other state and apply in a limited constricted fashion. PAs lose. Employers win. 

 

3.Job transfer requires reference from the supervising physician - clever tactic to get you to reveal to your current employer that you are planning to leave. Cost : risk of lost job or cessation of promotions . PA loses. Employers win.

 

4. Job transfer requires reference from prior SP - again, you left your previous job for legitimate reasons. Pill mill with inappropriate prescribing, ethical problems by SP. There are many legit reasons for leaving. Prior SP knew you were a bargain and he was making bank on you. Prior SP slams his hand on the desk and yells at you for resigning when you leave and promises no reference out of spite (not for competency because he already said you were outstanding). Costs of transfer : High because prior SP will interfere will new opportunities. PAs lose. Employers win.

 

Folks, we can keep changing jobs and clawing our way for an ounce of respect and a few more dollars of salary and cme and vacation. Unless and until we win independent practice to separate ourselves from our Physician, we will never advance as a profession. Did you think the southern slave negotiated his way to freedom? Seriously. The plantation owners view of the slave and their economic relationship is no different than the Physician/PA economic relationship. 

 

In the tech sector, a company wants to staff up to build a new product. The get the word out they are hiring. Tech employers interview and a week later are in a new town , creating new stuff for a new organization. Doesn't matter if they were in the last job for one day, one week or one year. All that matters is demand, supply, value, skills, and a free market. Physicians do everything possible to limit supply, devalue the PA, prevent or underfund skill development  and thwart free markets with legislative protectionism. We must extricate ourselves from slavery. 

[PRS-PA]

I wouldn't use a new job as a bargaining chip. You can only do it once and you are also marked as someone who won't stay in the long run.

 

Give them a chance now and then leave if the new job is better than the old.

I disagree.  You need to make a evaluation if a new position is better then the current and what your worth really is.

 

If the OP is seeing 20-23 pts/day and is a competent provider, that should be worth more to the practice then letting them leave and replacing with a new unknown person.  Especially since they are seeing emergent patients and walk-ins versus simple, straight forward patients.  Who sees those patients when OP leaves?  Obviously, whoever those individuals are have a vested interest in the OP staying and may help make positive changes to allow the OP to stay!

 

Personally, if I was in that position, I would like to know what my worth is to the practice from their perspective.  If handle professionally, I believe that you can have an open conversation with the current practice about what the issues are, how they can be improved, and how compensation can be a part of the solution.  If you just leave, you miss the opportunity to know your true worth.

[UGoLong]

Trust me people; I used to be on the other side of the table. Once you come in to your boss and expect him or her to meet another offer, that is when you usually are marked as someone who will be leaving soon. If you are hard to replace, that's the day they start looking.

Better to make your needs and concerns known while you silently look around. When you find a better job (not just money, but one that better meets all your needs), I recommend that you take it.

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[south]

Not sure there is a question of what you should do, but what you're saying is that since you have arrived...

 

Compensation slashed ~25%

Turnover of all decent staff

Workload increased to breaking point (and getting worse)

Work-life balance and stress completely out of control (also getting worse)

You spoke up and were essentially ignored

 

Boogie shoes.

[Simplify]

Life is too short.  Find something else.

Plenty of jobs out there where work and life can meet in the middle.  

I work 12,  8 hour shifts per month in ED. 

Make just under 100k.  

Work is demanding but ~ 18 days off per month helps an awful lot. 

[moestown1016]

Sorry you're going through this. It has to be a tough position to be in. You shouldn't be feeling like this one year out. I think you probably know what you need to do. If you don't have a non compete clause maybe you can stay in same specialty?

 

 

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[electric130]

Great advice from everyone.  In a specialty where a provider is expected to be high volume and have availability that culture is difficult to change.  I have and am still somewhat in that same type of practice.  I have been able to set some limits though and have seen improvements.

I was exactly in your situation about a year ago. I did decide to look for other positions and was offered a position in my same specialty just a different group that I was prepared to take.  I negotiated a bump in salary, one less day of work and no weekends and decided to stay.  I honestly don't know how you would not be burned out working five days a week with acutely ill people seeing 20-25 patients a day, plus you are only one year out of school.  That would have stressed me beyond belief my first couple years working.   Currently working three 7 hour days and seeing typically 25 patients a day.  They are super busy, sometimes stressful days, but only working three days makes a world of difference.  I supplement my income by doing a non clinical job at home.  

Start looking...I hate to say this but from what I have seen if you have expressed your unhappiness then the only way this may change is if you have another position in place.  

[Dexter42]

Unfortunately, from what I've seen, most jobs are like this.

 

There are some that are not, but you may have to give up some pay.

 

I currently work in a specialty and make $90k. Somewhat low for a PA, but I'm not going to work with that sinking feeling in the pit of my stomach, I can actually sleep at night, I'm not stressed out at all really, and I'm able to have a life outside of work.

Here is the whole story. I started at 85k with up to 10k per quarter in productivity bonus after first year.

 

-Six months ago this was replaced with 95k base, 5k bonus. It would increase to 100k base the next year with 1-2 percent increases per year automatically. This was company wide for PAs. I was very happy.

 

-However, NPs were paid 5-10k less. Our roles are the same.This information and the entire pay scale based on experience was released company wide. With simple arithmetic you knew everyone's salary. The NPs understandably started a small revolution.

 

I had already signed the new offer and before the ink was dry they pulled it because of people's complaints. It was replaced three months later with 90k, bonus?, and no more increases automatically. That leads me to today where I'm scheduled up to 23 patients per day for 90k and a bonus for who knows what and no manager. 

 

After writing this down and reading your responses I think I'm just going to leave and not try to fix anything because it's way too broken at this point. I was mainly just scared of leaving and starting over again in a new specialty. Thank you for all your responses.

[EMEDPA]

Life is too short.  Find something else.

Plenty of jobs out there where work and life can meet in the middle.  

I work 12,  8 hour shifts per month in ED. 

Make just under 100k.  

Work is demanding but ~ 18 days off per month helps an awful lot. 

I also work 12 days/mo now( 10 12's and two 24s). agree that life is better with time off. I have a social life again.

[Guest ERCat]

I have noticed primary care tends to be like this. I am sorry you're having a hard time with your job.

 

I would wholeheartedly recommend emergency medicine. Working 16 days a month I make 153K a year base, plus about 20K bonuses. It is grueling but fun - never feels like a boring daily grind.

[BruceBanner]

them boots are made for walking......

 

 

 

yup some employers just don't get it, and they never will

give it a good honest effort, leave as a professional

but LEAVE

 

Agree with this 100%.

 

I've been there, most of us have had a job where we were abused or burned out. The employer will never get it, trust me, especially when physicians are seeing even more than you.

 

This is why it is always wise to have 3-6 months of income saved so you can walk out the door when you reach a breaking point like this. 

 

No worse feeling than feeling like you are at your wit's end but cant leave due to financial reasons.

[BruceBanner]

Trust me people; I used to be on the other side of the table. Once you come in to your boss and expect him or her to meet another offer, that is when you usually are marked as someone who will be leaving soon. If you are hard to replace, that's the day they start looking.

 

Better to make your needs and concerns known while you silently look around. When you find a better job (not just money, but one that better meets all your needs), I recommend that you take it.

 

Sent from my XT1254 using Tapatalk

 

Also +1 on this. I've had enough jobs both in and out of medicine to know. Bringing another offer up as a bargaining chip ONLY works if they cant afford to immediately lose you, and only once at that. You will be marked as a flight risk.

 

The vast majority of employers do not give a sh!!t about your job satisfaction, they only care about you showing up reliably and keeping the machine rolling, and not bringing everyone else down. And if you are really unsatisfied, eventually you will be marked as sour grapes and it's a matter of time before they find a reason to replace you. 

 

It's an unfortunate reality of modern healthcare. The practice needs come before provider tolerance and satisfaction, which ultimately doesn't benefit anybody. 1-2 x a year here the physicians have an in-service about "dealing with burnout". The solutions are always so trite and insulting, like "take up dancing", "exercise more", or "find joy in the simple things". Never anything sensible like, oh, you know, reduce patient load. It's because the bean counters and management are not the ones seeing patients. 

[Maverick87]

I have noticed primary care tends to be like this. I am sorry you're having a hard time with your job.

 

I would wholeheartedly recommend emergency medicine. Working 16 days a month I make 153K a year base, plus about 20K bonuses. It is grueling but fun - never feels like a boring daily grind.

 

Primary care is terrible. There's a reason why I'm being bombarded daily by recruiters for primary care, despite pulling my resume from job sites months ago.

 

Primary care and pain management. If I didn't know better, I'd think that PAs only worked in these fields.

[overthehorizen]

Marverick87 is right about Primary Care. IT is terrible. It could be amazing. The PA needs independent practice and he needs to be able to create his own practice to make Primary Care work for patients and the PA. It can be done. Regulatory restrictions, hospital ownership and Physician Ownership of plantation slaves make it terrible. When I get contacted about jobs in Primary Care now, I just send my "requirements" directly to the owner (no dealing with headhunters). They never reply because the system is built for hospitals and Physicians to win and PAs to lose. Maverick87 has a good point though. Don't waste time and money interviewing at Primary Care settings. Just spell out your requirements first. Then have them sign off on those requirements at the beginning of the interview. Use the requirements you specify as the basis for discussion in the interview. 

[GetMeOuttaThisMess]

Agree with this 100%.

 

I've been there, most of us have had a job where we were abused or burned out. The employer will never get it, trust me, especially when physicians are seeing even more than you.

 

This is why it is always wise to have 3-6 months of income saved so you can walk out the door when you reach a breaking point like this. 

 

No worse feeling than feeling like you are at your wit's end but cant leave due to financial reasons.

 

 

Remember that employers look at folks differently if they're already actively employed versus unemployed.  I know this from past experience and from our own recent position search where the administrator was constantly noting that applicants weren't employed and wondered why.