First job and disappointment

[ort890]

I have been at my first job out of school for just over seven months now working in ortho/sports med private practice. My sp is new to practice and the practice itself is fairly new. I started with my current SP about five months ago, was with another PA and doc for the first twoish months of starting just in clinic. My SP is a great guy, nice to me. Not the average surgeon. There are several problems I have been running into mainly the fact that the volume of the practice between three surgeons is very low. I don't have my own schedule to see patients because my SP wants to basically see everyone since he is so new. We are seeing around 7-15 patients each day! We are maybe doing 1-2 cases each week and I'm still not credentialed at one hospital to scrub. I feel so behind in the OR compared to where my classmates who went into ortho are at right now. I will occasionally see patients on my own, mainly pre/post ops some follow up and only new patients if my SP is out of town or has to leave for a few hours. We are in clinic together each day and we basically see patients together, rarely have been seeing any alone at all. We take very minimal call and my SP goes in for it. I've said call me because I want to learn. There has been a few times where there were opportunities to reduce fractures, etc and I asked to do them and my SP ended up just doing it. It happens a lot in the OR and because of that, again I feel so behind. I understand he is new and trying to grow his patient base at a new practice but I just feel as if its not a conducive place for a PA. The original PA was let go, another one, who is a new grad, was hired and he basically sits around all day not doing much. I feel like a lot of this comes down to the volume not being seen. Thoughts? Wait another five months to see if it picks up? Thanks 

[overthehorizen]

You have clearly articulated the problems here. Basically, you have two issues. They have nothing to do with you personally. The first problem is that you got teamed up with a newly minted physician. I worked with as many as ten different physicians every month. A few are fresh out of fellowship. Just like your physician, they don't want to provide training on new procedures and skills because they are still trying to get experience themselves and they fear trusting anyone else. My experience with older physicians is so much more rewarding. The older physicians tend to respond to my initiative and requests for new skills and procedures. They are more confident and able to lead a team of people in the clinic. The newly minted physician just doesn't have the experience and leadership skill to work well in a team. The other major issue is volume. Like baseball, you will become a better hitter if you have more time at bat. Our job is not to just make money, it is to practice medicine and make money. You have to do whatever is necessary to put yourself in a higher volume environment.

 

"To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all"  - Osler

[Guest ERCat]

That sounds frustrating for sure. What you're describing seems like you are doing more shadowing than anything.

 

Don't compare yourself to your classmates, especially when you are seven months out. Everyone gains experience in different ways. You are learning.

 

On the other hand, it sounds like you have a pretty chill schedule. I can't imagine how nice it would be to really focus on just 7-10 patients a day! I would actually feel like I have the time to sit down and connect with the patient. Also, it sounds like you're supervising doc is a very nice guy. From the perspective of someone who tries to keep their head above water in the emergency room every day, those two things - chill schedule and chill doc you feel comfortable around and doesn't suck the life out of you demanding more and more productivity - are very hard to find. And allow for a good quality of life.

 

Provided your pay and hours are also good, I don't think I would walk away from this job too soon. As a new doc's first PA you have an opportunity to have a long lasting professional relationship and grow with the practice. Maybe you are being too passive in your approach, simply going along with this whole shadowing thing? It seems like maybe YOU need to take the lead here and ask for what you want. And who could turn you down - you're asking to do more, see more, help more, learn more! I think you should have a one on one conversation with your doctor, maybe even outside the office over drinks if that's how your relationship is, and tell them that you want to stay there for the long term but you want X, Y and Z.

 

And I agree with the above post. I work with a lot of different doctors in the emergency room and my favorite ones to work with are the experience physicians. It seems like the new ones are either overly overbearing and "tell me what to do," or don't want anything to do with me at all.

[SedRate]

I had a similar experience when I first started. I made full use of that time. I drove in to cases on the weekends, I shadowed in clinic, I read, I studied, I did CME, I slept. And now we're very busy and I see an equal number of patients on my own. I made sure to keep the lines of communication open so that I knew what to expect and where things were going. I made sure to always be prepared.

 

Some things to consider:

1. What are your goals and his goals? Like ERCat suggested, have a one-on-one to figure it out.

2. Does he plan on increasing his workload any time soon?

3. Is he fellowship trained? If he's brand-spankin' new, he might be collecting cases for his board cert, which might be affecting his caseload.

4. 4-8 cases per month is a terribly low volume for a surgeon. Does he intend on being more of an office-based practice? See #1.

5. Protect yourself. If you think you're not getting the experience you need as a new grad, see #1. After all this is your career so make it what you want.

 

If he's great like you said and you want to stick around, make this downtime count: do some CME, read some books, drive in to the cases/consults, enjoy your time off, interview around, sleep. It sounds like a pretty sweet gig that hasn't quite picked up yet due to him being new. Don't forget that you guys will get repeat customers the further out you are for follow-ups, referrals and such. I'd ride it out but continue to keep my eyes open on what else is out there in the event they decide to let you go due to low volume. Why was the other PA let go?

[ort890]

Wow, thank you for the detailed responses thus far! @Sed, I have been making full use of the time for sure, I'm just not the type of person to enjoy sitting around when I know I could be doing what I really went to school for. I'm sure I'll be wishing I had the time back one day haha. My SP is fully committed and is really wanting the practice to pick up, he is the same way and does not want to sit around. We had one case this week and as you can imagine its frustrating for myself and him. The other new doc in the practice is feeling the same effects. Dont get me wrong, I have learned a ton since I have started and have picked up on things that even he said some residents never would have and thats all because he is a great teacher and mentor thus far. We are seeing a slight increase in volume with returns but again it comes down to him most of the time wanting to pee on every tree that comes along. 

 

@Ercat With regards to the pay and hours, overall the hours are not terrible. There are weeks where we both will have a day or day and a half off because of no cases. I rather not be off and in the OR learning etc but what can you do. The pay is not terrible but not great for my area, but with respects to my hours, patient load etc it actually is probably pretty decent but again rather have it busy. I have another five months on my contract so I'm going to give it till then and see what happens. My biggest fear is if I do leave and it never picked up, going to my next job and being behind and having to explain that to a new employer. 

[SedRate]

Have you guys tried reaching out to nearby primary care offices, community centers, or maybe even therapy offices?

 

"Peeing on the tree" thing is pretty common for surgeons, especially new ones. I'm sure it'll improve as he establishes his practice and gains confidence in you. And once you guys pick up speed, he'll start being too busy to monitor every little thing. Hopefully.

[myironlung]

my opinion is if you like it busy then leave. Give another PA a chance who wants a chill schedule and SP. There's plenty of PA's who would love your set up.

[mmiller3]

I say stick it out for 6 months. If business picks up and you become busy, then you got what you wanted. If business does not, or does but you are still left twiddling your thumbs, then you get out; you can always tell your next potential employer that business was too slow and you tried to stick it out. That might look better than jumping ship so suddenly.