Should I be offended?

[JMPAC]

I was speaking with one of the docs I work with and he made a comment that I didn't really like but am not sure if it's actually as offensive as I think. We were discussing the difference between how our PAs and NPs are utilized here vs another ER (I had been talking to a PA there). I feel like we're a bit more restricted in our ER and not utilized at the top of or license, not as many opportunities to get trained on different things (we don't do LPs, reduce fractures, put shoulders back in, paracentesis, run codes, etc) and we don't get paid for RVUs. I do feel like I've learned a lot and I work in the main ED so, I get a lot of great experience and I appreciate that, for sure . There have just been a few things that I've questioned lately. For instance, one of the docs I work with will check her numbers at the end of her shift and if she wants to increase them, she'll lean over and just decide to staff a few of my patients with me even though it's truly not necessary. Also, she leaves an hour and half early almost every shift to keep her numbers per hour higher. Her shift technically is supposed to end an hour later than mine but she'll ask me to pick up patients to pass off to the incoming doc so she can leave early (she'll sometimes ask this 3 hours before her shift is over) but then if I can see and dispo them in time, she wants to quick staff them with me to pad her numbers some more. It doesn't take any money away from me and it's not a problem unless I'm getting a whole bunch of level 4s and 5s in that I'm trying to take care of because there's no one else here at that time to see them, other than me, and then I end up staying here way late when she's left early.

Anyway, these are the kinds of things we were discussing and the doc I'm talking to tells me "to be honest, a lot of us docs see you guys as the work horse and a way to increase our numbers without having to do much more work." I told him that sounded like a bit of a disrespectful way to think of us and that we are here to work as a team and that we're licensed medical providers, too, etc. He also said that other docs have told him he's too nice because instead of just letting the PA know there's a lac in room whatever that they need to repair, he'll ask if the PA is busy and would they mind helping out with that. I said there's nothing wrong with being polite and none of us would ever say no to him, anyway. But, it makes me uncomfortable that the other docs think being polite and respectful to the PA is "too nice".

Sorry this turned into quite a rant, but I wanted to give some context. Am I just being naive? I feel like the docs should be respecting us as colleagues. I really don't staff patients with them unless I feel I need to (and I know my limits as a fairly newish PA) or there's some criteria that requires it. I am very independent and feel like I've really hit my stride as a clinician after 2 years. Also, a lot of the PAs and NPs I work with have a lot of experience and are excellent clinicians (most of them have more experience than this particular doc) and I don't appreciate them being referred to in this way. Am I being too sensitive? Is this just a hazard of the profession? The other ER I had been talking to a PA about sounded like the exact opposite of this (lots of independence, respect, they get made partner, etc etc). Maybe that's a rare situation?

I really appreciate the all of your perspectives on this message board because this is my first job and I don't have anything but clinical rotations to compare it to.

Thanks for listening! (Reading, I guess)

 

[LT_Oneal_PAC]

Sounds like he gave you a peek behind the curtain. I don't think HE was being offensive, I think he was showing you how deep that culture goes. Of course, I don't know how he said it, but it seems almost like he was doing you a favor, revealing that they don't respect you.

[quietmedic]

I don't know, ERs can be hit or miss.  I didn't have a great experience in ER, but I did learn a lot.  

My feeling is in Gerenal if you are learning, can tolerate the colleagues, aren't being outright abused, and are making good money...just take it for what it is.  ER Docs are a strange cast of characters, and if the worst they do is this sort of stuff, I'd just smile and brush it off. I stopped trying to figure them out ages ago, just too many DSM-V diagnoses to keep track of.  Use it for the pay and experience and move on when you are ready.  

[south]

I kinda have to respect Dr. NoFilter over there.  That's honesty.  And that in itself is a form of respect - he's giving the bad news to you straight.  A few things - 

• - I think you are asking yourself the right questions, should I take this one way or the other?
• the doc that likes to dump and run to pad her stats is a problem, especially if you are staying late, wow
• there are ways you can maybe deal with this, from the overt to not so much 
• stuff like that is how organizations become toxic over time
• good rant
• bullet points yay

[GetMeOuttaThisMess]

It has been this way since PAs first appeared in the ED (early 90's locally).


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[sk732]

There is an undercurrent of my partner and I doing a lot the heavy lifting when it comes to certain docs being on in the ER - they'll literally eat up their 8 hour shift doing the handover reassessments unless something with "Look Cool Factor" shows up, then they go into "Superior Doctor Mode".  In fact, if either of us are on days off in the rotation and the other one is away (there are only 2 of us), these ones are in fact incapable of running the ER on single coverage - they've gotten very (dare I say overly) used to us being there.  Of note, one of these is also a type that takes over an hour and a half in breaks in an 8 hour shift - I get 45 minutes for a 12. 

At least this doc was honest...I'd take it as a backhanded compliment, since they obviously appreciate you being there and the work you do, even though you're not getting to play at the top of your game.  

SK

[Guest ral]

Wouldn't bother me.

[EMEDPA]

might be time to move on to a place you are respected better. I have left several jobs like that over the years. max out the learning, then leave. I am at job # 8 now after 20 years and think I have finally found I place that is a good fit. the only reason to leave now for me would be if my ultimate favorite per diem job offered me full time hours. less likely now as they are moving to 100% IC providers...might still make it work....

[JMPAC]

might be time to move on to a place you are respected better. I have left several jobs like that over the years. max out the learning, then leave. I am at job # 8 now after 20 years and think I have finally found I place that is a good fit. the only reason to leave now for me would be if my ultimate favorite per diem job offered me full time hours. less likely now as they are moving to 100% IC providers...might still make it work....

I actually am in the process of relocating and have been interviewing for different jobs. This is what has me realizing these things - talking to PAs and docs at different ERs and urgent cares. I've found that some places are probably pretty similar to what I've got going right now, but there are others that appear to have a much better culture and much better relationship with the docs. I recall another ED that I was a student at and that PA was (from what I could tell) completely independent and just working along side the other docs and PAs. He didn't work in the trauma or more critical patient part of ER but he wasn't there to line anyone else's pockets. For the most part, I've really enjoyed working with the group I'm with and will be forever grateful for them taking on a new grad and giving me the opportunity to be in EM. Not all the docs I work with are disrespectful. There are a bunch that I think are just honestly helping me out when I need to staff a patient with them and a couple who are total machines and would never need help with "numbers" and whatnot.
And the doc who made the comment is very honest, maybe because he's under a year out of residency and working with PAs the way we do is newer to him. In the moment, I was taken aback (and I posted shortly after that moment during a lull in a night shift), but on reflection I do appreciate the honesty. I have certainly felt like that's how they saw us from time to time but he just confirmed it.
Again, I really appreciate everyone's perspectives here. I'll have to give an update when I get a new job and see how things really work somewhere else.

[Boatswain2PA]

Should you be offended?  No.

Should you take this new information into account when you make life decisions?  Yes.

[lightbearer06]

Find a small ED to work in. A wise person once told me "Better to be a big fish in a small pond than a small fish in a big pond."

When you work in a small ED, everyone knows you and can grow to respect your medical prowess if you are hardworking and a great provider. If you're in a large ED, you will have a hard time ever proving anything to anyone because there are just too many personalities to contend with, and you don't work with them enough to develop rapport.

[kargiver]

Medicine is a business.  In a big ER, the PAs (and NPs) are small cogs in the machine.  You got a glimpse of what is behind the curtain.  It's your choice to be offended or not - knowledge is power - but that is how the system works.

Much of what you aren't allowed to do is because you aren't paid on an RVU system.  Procedures are big RVU generators, resuscitations have critical care time, procedures, etc., so keep that in mind.  But this is one of the open secrets of EM - PAs and NPs are the motors that keep the fiscal machine running.  It WILL eventually bite the system in the ass.

My only issue is signing out to you for you then to sign out to another doc.  You are allowing yourself to be put in a potentially ugly legal position.  Sign-outs are always a point of concern, particularly in litigation, and a sign-out to a sign-out to a sign-out from Doc to PA to Doc has disaster written all over it.  Particularly if said doc is doing so to leave early.  They may view you as a workhorse, but liability wise you don't want to hold that bag.  I'd consider being cautious with those. 

Agree with the above - always better to be a big fish in a little pond...

G