TinaM

Job Stress or burnout?

22 posts in this topic

Hi!

 

I think this is my first time posting to this forum, but I wanted to get some advise regarding burnout/stress.

I graduated about 2 years ago and started at a family practice clinic. I didn't enjoy how myself or the patients were being treated so I left after 6-7 months and switched to another primary care clinic. The employers and coworkers at this new practice are great. They really focus on hiring the "right" personality and ensure everyone gets along. BUT.....

The thing is, any time I see over 14-16 + patients a day, I feel ridiculously stressed out. I get all the new patients. Some of them come in with 5+ complaints per visits. I get A LOT of drug seekers, and when I refuse to fill the Rx they request, they complain to the manager or write a nasty review about me online. When I first started, a lot of the physicians were very open to questions, etc. But now when I have a question, certain physicians will tell me to "put my big girl pants" on. I hate complaining, but for a primary care/family practice PA, I have had QUITE A FEW patients I have literally needed to send to the hospital for immediate attention in the ER or to actually be hospitalized. I feel like I have bad luck (or maybe good luck??) as the PA's and even the medical assistants (who have been there for years), say I have much more complicated patients and apparently I always have a "good find." I've probably had 2-3 people shake my hand for random and rare anatomic abnormalities I've "found" on exam and sent for imaging or the other PA' seem impressed when I discuss one of my patients with them.

I worked for about 6-8 months at this new practice and then I went into this slump when the daily patient load seemed to pick up significantly. I literally went home crying for 2 weeks  every day after work during November with the amount of stress I felt. I have a lot of patients tell me when they leave that my OV with them was one of the best they ever had with a provider..... but I'm just not happy. I really try hard to develop a relationship with my patients, get to know them, conversate...etc. I know I have a history of depression/anxiety. But it's just getting ridiculous  and has really worsened since I've starting working in this field. I know my boyfriend/ family is getting tired of it.

I'm at the point that I think medicine is just not for me...but then if I go a few days to a week without practicing and I feel regretful for even thinking about switching careers. Then I work for like 2 days and am like.... hell I hate this again. Is this really the right field for me? 

Is this common? Would switching specialties help (I've been told by like 2-3 people that this would make a difference)? Do I need to just suck it up and keep seeing patients and maybe this is an experience issue? I just don't know what to do. I feel like I spent so much time and money going into this career and now I'm wasting it all if I change careers. 

I appreciate any and all advise...  

0

Share this post


Link to post
Share on other sites

The initial timeline is very normal for a new grad. Most have that breaking point around 6 months where they feel like nothing is working or going right.

 

As far as job stress, you can expect that to hopefully improve as you become more experienced and efficient. But there will always be stresses in the workplace, especially in medicine.

 

It sounds like there are a few components involved: your previous depression/anxiety, thoroughness, and workplace. Perhaps becoming more efficient will improve some of the burden. Perhaps switching offices to one with more supportive colleagues. Perhaps having a protocol in place for difficult visits such as drug seekers, that way you're doing what's best for the patient and also saving face. Maybe a move to a different field is in order since this is PC job #2. Anything else interest you? What about internal med or a specialty where you can develop those patient relationships? I'd advise you to think hard about your next move since it'll be your third in two years.

 

What do you do for yourself? Exercise, hobbies? It sounds like you need to blow off some steam.

0

Share this post


Link to post
Share on other sites

I actually workout about 5-6 days per week doing strength and cardio training (this is the fittest I've ever been). Some days I just feel so exhausted from work that I don't have the energy to workout at all. But, I really have no say in my schedule whatsoever. I figured it would have improved after being there for a year, but I just feel like my anxiety is just getting worse with the job? We had a meeting a few weeks ago regarding what insurance will ding us for ( ex. Rx ABX for URI's or not getting chlamydia cultures for girls < 26yo on physicals). I'm not sure... maybe part of it feels like I'm just not even practicing medicine anymore. I feel like I worry about what insurance is going to pay or getting bad patient reviews. I don't want my name blasted everywhere just because I didn't want to prescribe someone Tussionex. I had issues last year regarding my schedule. The manager kept forgetting to even assign any MA's for me every time I worked at our other location... and even when we have a full workday, I only have one ( I feel so bad for her). I had to literally harass them for 2-3 months to get my vacation scheduled and then our on-call/Saturday schedule came out and I was scheduled the same week I'm supposed to be out on vacation. But again this is PC job #2. My first job WAS FAR WORSE than my current job. Is this common? This was supposed to be a more prestigious clinic in our area... but I just feel like I keep getting crap-luck with everything. 

0

Share this post


Link to post
Share on other sites

Get out of family medicine.

 

My situation was similar to yours. That feeling at the pit of your stomach before you go to work? Yes, I know that feeling....very well.

 

Now, I'm in a specialty where I'm happy and not even remotely stressed out.

0

Share this post


Link to post
Share on other sites

burnout does not exist, only abuse. these symptoms of "burnout" are really reactions to abuse whether it be by the patient, the administrators, or self inflicted. i do agree that it occurs to most PAs, MDs, and probably nps. Sabbatical? life coach? turning to ones faith? these are just some ways to obtain clarification

2

Share this post


Link to post
Share on other sites

I worked in two different primary care settings before switching to a specialty practice. My stress from managers and patients went to zero. I enjoy uninterrupted lunch everyday and always leave on time. unless and until PAs win independent practice, these abusive jobs in primary care will abound. If we had independent practice, you wouldn't take drug seekers, you would dismiss a patient who wrote an unfair review on social media, you would not cower to a clinic manager and your physician colleagues would show deference. The above posters are right. It is abuse but it is wide spread. Leave for better medicine. You will be shocked at how much better you can do. A minor point....is conversate really a word?

1

Share this post


Link to post
Share on other sites

You did not mention whether you are being treated for your depression/anxiety.  If not you need to"fix" that first maybe, just maybe things will begin to fall in to place.  16-18 patients per day ain't bad.  Many of us see 25+ per day.  You say it is a prestigious practice yet the patients that you describe, drug seekers, multiple comorbidities, doesn't sound very prestigious.  For the multiple CC's, I would address the 2-3 most life threatening and let them return for the rest.  Maybe catch them at f/u for the serious CC's.  Likely many or all will have resolved.

0

Share this post


Link to post
Share on other sites

But, I really have no say in my schedule whatsoever. I figured it would have improved after being there for a year.

 

We had a meeting a few weeks ago regarding what insurance will ding us for ( ex. Rx ABX for URI's or not getting chlamydia cultures for girls < 26yo on physicals). I'm not sure... maybe part of it feels like I'm just not even practicing medicine anymore. I feel like I worry about what insurance is going to pay or getting bad patient reviews. I don't want my name blasted everywhere just because I didn't want to prescribe someone Tussionex. I had issues last year regarding my schedule. The manager kept forgetting to even assign any MA's for me every time I worked at our other location... and even when we have a full workday, I only have one ( I feel so bad for her). I had to literally harass them for 2-3 months to get my vacation scheduled and then our on-call/Saturday schedule came out and I was scheduled the same week I'm supposed to be out on vacation. But again this is PC job #2. My first job WAS FAR WORSE than my current job. Is this common? This was supposed to be a more prestigious clinic in our area... but I just feel like I keep getting crap-luck with everything.

 

That doesn't sound like a great work environment. I don't work in PC so I can't give you much insight regarding the field, but it doesn't sound like you have the resources you need nor the professionalism. The manager "kept forgetting" to schedule an MA as in that happened multiple times? Have you voiced any these concerns to the powers be? If the job is worth the fight to you, set up a meeting to discuss them and figure out a resolution. Otherwise, start looking elsewhere. Specialty offices have similar issues so if it's the manager/schedule stuff that's bothering you the most, switching fields may not be your answer. You should consider looking for work at an office that allows you the collaboration you need and respects your professional needs. As an aside, also start working on your confidence with difficult patients and drug seekers. As the others started above, put your foot down and limit CC to 2-3. Regarding drug seekers, does your state have a prescription monitoring service? Have you quoted the surgeon general report about narcotic over-prescription? Use these tools to help patients understand the importance of safe medication prescribing.

1

Share this post


Link to post
Share on other sites

Also, is there a way for your office to respond to those social media complaints? Or perhaps collect and post positive reviews?

0

Share this post


Link to post
Share on other sites

I would suggest a change to a specialty outside of IM, FM, or ER. Derm and psychiatry are listed as two of the specialties with the lowest rates of burnout; potentially one of those interests you?

 

At the very least I would suggest a change of venue. "Put your big girl pants on"' is hardly a professional reaction to a legitimate issue.

1

Share this post


Link to post
Share on other sites

Tina I could have written most of those words myself. I'm also in FM/primary care.

 

Listen, it's not a "new grad thing", It's a primary care thing.

 

I've been a PA for 5 years, about half of that in primary care. At first I liked it---there is great variety, frequent procedures, good autonomy. But it has a way of sucking the joy out of you. The good just doesn't outweigh the bad.

 

A few points:

 

-Look for work outside of the IM/FM/EM spectrum.

-Avoid walk-in clinics and storefront medicine

-Avoid on-call, OR-based surgical specialties. Some love it but If you dont like stress this is a bad choice.

-Avoid the "pain" specialties---occ med, pain mgmt, physiatry, etc.

 

In the meantime:

 

-Pad your schedule with follow ups!! I'm serious. If you can conjure up even a halfway good reason for bringing someone back, do so. It will dilute the stress of your day.

-Only address the most serious 1-2 problems in a visit. Tell them you are most concerned about X problem and in the interest of time and good care have them schedule a f/u for their other issues. Chances are they wont.

-If you are allowed to book longer time slots for procedures, do so.

-Refer often.

-Develop personal "policies" like one narcotic refill before pain mgmt, anyone 15 mins late has to reschedule etc.

 

This stuff will help while you look for a way out.

6

Share this post


Link to post
Share on other sites

Tina

 

#1 -- YOU CARE - that matters more to me than anything.

 

You figured out in a short time what took me years to fully realize.

 

Family Practice is not recognized as the multifaceted specialty that it is.

 

We have to know something about everything. 

 

Due to reimbursement issues - FP has developed a perception of QUANTITY to make money. Quantity rarely ever equals quality.

 

Seeing fewer than 20 a day is awesome but I understand the stress level. Since you care - you deal with things and it can be overwhelming. The patient's stories become part of you and take up space and energy and you worry about their outcomes. It can eat at your core. 

 

Having a crappy manager (see my other threads) REALLY impacts your capacity. Having a mediocre MA makes it worse. 

 

I am in a not-so-awesome solo FP setting with a lot of issues that I am evaluating to see if I can "get beyond them" or if they are just too far beyond my high standards and actually pose a threat to my license, etc.

 

I never thought I would have to consider MY professional standards as something to consider altering. It is depressing and degrading. 

 

I am looking at Urgent Care to get away from being on call, endless follow up, a doc who overuses benzos, ambien, narcotics and stimulants etc etc etc.

 

After researching and reading and contemplating - I simply do not know what it will take to see Primary Care undergo a revolution of sorts to be a respected specialty that requires time and effort as well as reimbursement. Not likely in my lifetime.

 

Stick to your standards, believe in yourself and look around to see if anything else sparks an interest where you can make a living and not be overwhelmed 24/7. Medicine doesn't really come with no stress but there are ways to reduce it.

 

Keep us posted.

1

Share this post


Link to post
Share on other sites

14-16 new patients per day with multiple lots of complexity for a 2 yr PA = that is abuse

 

That is even tough for an established comfortable PA or doc

 

A new patient with many problems should take about an hour

 

A "simple" new patient about 30 min

 

You are not burned out - you are overworked

 

Your choice - work less ie stop looking, speed up, move the meat. OR demand a lower patient count per day

 

Your billings are likely far higher then you think (if you are billing correctly) and you can likely see 10-12 per day and if they are paying you honestly (and billing/collecting well) they will still make $$ on your employment

1

Share this post


Link to post
Share on other sites

You sound like an excellent clinician.  I would not rush to thinking you need a new career.  Becoming a PA is a huge investment, you sound like you are very good, you are just in a bad environment.  I think the combination of trying to manage too many complaints in each patient and not enough support is a problem.  Your volume seems reasonable, but not if each patient has 5 problems at each visit.  Believe me, I get it.  

Even with being in a specialty I have struggled with burn out.  We have a number of non compliant, difficult patients, some with chronic GI diseases, others with psychiatric issues that manifest in "stomach pain" with no organic origin.  Ah....fun.  I have also found that my happiness with practicing taps out at about 15 patients in a 6 hour clinic time period.  I work 7 hours, one hour for lunch.  Unfortunately 15 patients is very rare, I usually see around 25 in that time, so about 4 per hour for a full 6 hours which is just exhausting.  I am at the point that I am done trying to buck the system and am actually taking a non clinical position for now.  I have practiced 15 years and have the flexibility to do this.  At your point in the game I would just try to find a better fit for you, I do think you could find something that is not causing you to cry every night for 2 weeks straight, that is just not healthy.  I do not think you are the problem, it is your environment, you deserve better.

With a specialty you would   feel like you may be able to get more in depth, and you would be able to focus on one area of medicine.  You seem very detail oriented, which of course is awesome for primary care, but it sounds like you just feel very overwhelmed by the amount of care each patient requires.  I can completely understand that.  Primary care was never something I wanted to do, exactly for that reason.  There is a huge benefit in getting a couple years under your belt though.  I would look into derm, ENT, psych, something outpatient and concentrated. Or you could even just see if there is another better fit for FM, although truthfully you will probably be expected to see more patients at  another practice, not less.

Best of luck to you, if you continue to be unhappy I would start looking.  

0

Share this post


Link to post
Share on other sites

No disrespect intended, but to the OP- how old are you? And what did you do before you went to PA school?

 

Just wondering.

 

 

 

Life is short. Find happiness.

 

If that means selling trinkets on the beach in Mexico, so be it.

 

If it means denying meth-heads norco in the ER, ok.

(They say it IS the little things, after all)

 

Been a part of medicine in one shape or form for almost 20 years now. And my take is you find your own happiness in this business. Dont wait for it to come to you.

 

You buck up and make the call and dont look back. Find a shady spot and setup shop.

 

I wish you the best, and hope you find what you need.

3

Share this post


Link to post
Share on other sites

For the "five complaint" patients, I learned a great line on a family medicine rotation: "What is the most important thing I can help you with today?"

 

As noted above, schedule a follow up visit for problem numbers 2 through 5.

 

Burnout is largely self inflicted - we let it happen to ourselves. You can take control.

3

Share this post


Link to post
Share on other sites

^^^^ agree with addressing the most important complaint.  You have to be tough and if the patient says they want all addressed because they won't come back and pay another co-payment, blah, blah blah....just smile and say.....that's your choice.....what is the most important thing I can help with you today.

 

Plus, when I was new at my FP clinic 2 years ago I got patients like yours.  I was the only one available to see patients so I got every warm body that needed to be seen quickly.  I have slowly built my practice and now follow ups are in my schedule, I'm more in control, I really don't care about bad reviews or being in the bottom 10% of positive reviews (one bad review will put you from 90%ile to 10%ile).  I still get paid, and still make my bonuses, so who cares about positive reviews?

 

I'm a bit more seasoned than you being a PA for 13 years, but it still was stressful starting at a new clinic,  I get your pain.  

0

Share this post


Link to post
Share on other sites

Agreed with most of the poster here

 

Mixed things up: Walkin, minor office procedure (e.g skin tag removal).

 

Learn to do your own knee or shoulder injection for your chronic knee pain pt with radiographic evidence of OA. You get the idea?

 

Take charge of your schedule. Work smartly. Not hard. Good luck.

1

Share this post


Link to post
Share on other sites

 

 

Take charge of your schedule. Work smartly. Not hard. Good luck.

 

 

This is EXCEPTIONALLY hard but I think is the key to success.  You control you own schedule - maybe not daily, but the parameters of the daily bookings need to be done by you.  no one else

0

Share this post


Link to post
Share on other sites

Once you become seasoned PA. You'll be golden. Believe me. It will gets better.

 

Smile! Smile!! Smile!!! Learn the tricks of the trade. Learn the politic side of medicine.

 

Don't focus too much on patients review. Stand tall. Stay focus.

 

Get a printout of your schedule or go through your census days prior. Strategies your panel.

 

Say no to seeing 4 new patients back to back for instance. Demand they spread them out - e.g. 2 in the morning session and 2 afternoon/evening session.

 

Enough said. Good luck.

1

Share this post


Link to post
Share on other sites

TinaM - I've been a PA for 6 years, 4 years in Primary Care and 2 Years Urgent care. I've seen 20-25 patients a day 9-6 pm and 40-70 patients a day st Urgent Care 8-9 pm at a big US corporation working 3-5 days a week. Definitely been where you were with anxiety/stress. Made a lot of money (paid off house and student loan), but at the end of the day it's about your health/happiness. Need to move to a different speciality like what people here recommend. Your career is a marathon not a race, don't burn yourself out so early, plenty of jobs out there and you will always have job security .

0

Share this post


Link to post
Share on other sites

Completely understand you, OP. I remember posting on this forum 6 months into my first job as a new grad about the anxiety/stress/burnout I had. It has not gone away but has improved a lot since. My stress was a result of working in primary care in a community health center in a very underserved area w/ complex patients c/o multiple issues, where qty trumps quality and admin don't give a f***. Even though I feel slightly more confident, less stressed out and can get through my day w/o hyperventilating, I don't plan on staying in primary care for very long. It's too exhausting.

 

While in PA school, my supervising MD suggested that I split my time between two different jobs to avoid burnout, and that is my plan when I leave from here. I won't leave primary care completely because I still want to maintain my general medicine knowledge, but I don't think I can commit 100% of my time to it; again, too exhausting. My plan is to specialize and then work per diem in family practice....or maybe even do something part time that is completely different from medicine. (Sounds good in my head, but how it plays out may be completely different. haha) If we can make it through primary care, we can do any specialty! Best of luck, OP! 

0

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now