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I'm a relatively recent PA grad who is almost a year into my first position as a CC PA at a large tertiary care facility. In a perfect world, I would like to stay for at least two years to further refine my skills, expand my knowledge base, and show some maturity/stability to future employers. In my current position, I make more than the national average for new grads, have full benefits including 401k with match, malpractice with tail, ample CME/licensing, and find that my SPs are fantastic people and educators - this is what sold me on the position and makes it so attractive. Since being here, I have worked hard to build strong relationships with my core team, including the notoriously surly surgical team, and have rather rapidly ascinded to the ranks of "one of the reliable ones" in the group.

Despite these positives, I am starting to feel like this position is non-sustainable for the below reasons:

  1. Census: I currently have 10-14 beds to cover per shift, provided the units are not over capacity or we turn over beds. Some days I am seeing upwards of 20 critically ill patients on my own. There is no plan to add additional providers, despite numerous complaints from APPs and physicians.
  2. Quaity of care: Blows. See above.
  3. Administration: Is becoming progressively shadier by the day.
    1. Recently handed out contract amendments to all of the APPs to remove key bonus language without negotiation.
    2. Will not negotiate pay increases during the annual contract renewal period, despite stating otherwise during the initial contract negotiation.
    3. Mishandled privileging so that many APPs cannot perform procedures. The Director of CC, when confronted with this fact, said that it's all crap and we should go ahead and do the procedures because any liability ultimately falls on the SP. Obviously, this is not acceptable and would not hold up in court.
    4. Will not complete the paperwork for PAs to be able to prescribe.
  4. Schedule:
    1. Random - you will flip-flop days to nights back to back. Even if you have blocked shifts, you'll be moved unit to unit. There is no continuity to your schedule or the care you provide.
    2. You may be assigned to an outside facility to cover a one-off night shift. You will not have an attending in-house. You are expected to stabilize critically ill patients, even if you are not credentialed to do so (See above.)
  5. Morale: Probably the worst I've ever seen, and I worked in some truly toxic environments prior to PA school.

My question to you all: Is this normal? Is that just what comes with the territory for CC and working for a large hospital group? If I have solid relationships and feel, in some ways, valuable, should I just suck it up and make the best out of it? Or is this, as I suspect, absolute lunacy and I should run as fast and far as I can to save my sanity and license?

 

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Get out while you can. I fear for the patients being cared for at your facility (no disrespect to you), but most of that sounds like a recipe for disaster. What do you do when two patients crash at once?

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No, not normal. I work CC, large group covering multiple campuses/units and during day shift I generally have 5 patients (maximum 9) and at night generally 7-9. It is manageable, but still busy. 

It is not acceptable to do unsupervised procedures for which you are not formally credentialed.

I do feel like I spend a significant amount of time documenting - if I charted less, I might be able to take care of more patients - but charting helps me get perspective on the bigger picture for each patient, and also detailed notes make handoffs safer.

So I agree with the other posters, take your hard-earned (and valuable!) skills elsewhere. There is definitely demand for experienced CC people.

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On 10/17/2017 at 8:55 PM, dchampigny said:

Get out while you can. I fear for the patients being cared for at your facility (no disrespect to you), but most of that sounds like a recipe for disaster. What do you do when two patients crash at once?

No offense taken. The running joke at work is that if any of us should keel over from an MI/PE/CVA/etc that we request to be taken to our competitor's facility.

In terms of what I end up doing - say a short prayer while I'm running to the code and start calling attendings from other units to come and assist if it's out of hand. Nights are even worse. I split 68 ICU beds with the attending. When two codes occur simultaneously, it's a disaster.

 

 

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