job concerns, first PA in a private practice

[KMKPA]

I want to bounce this off of you all.  I am a PA with 9 years experience in CT surgery, EM, Ortho, and Hand surgery.  I took a new position with ENT close to home about 6 months ago because I needed a shorter commute.  Everything seemed great when I took the position, however, I have some issues.  They are a male dominated super conservative practice who have never had an APP.

1.  I am their first PA and they don't seem to know how to effectively utilize me despite my suggestions.  They mainly hired a PA because they want me 'available' in the afternoon to see consults at our 4 hospitals to help off load the on-call doc.  (they hate going to see consults after their office day) Which seemed fine initially, however, when consults don't come in, I have nothing to do.  The physicians use up all of the afternoon office space so there is no space for me to have an office (unless someone is out).  Initially, I was shadowing the different physicians, but that is getting super old, super quick.  I am bored and hate just shadowing.  Sometimes there are 2 or 3 consults to see which keeps me busy, however, a lot of times, just one or none in a day. 

2.  I do have the ability for a morning clinic, however, my schedule isn't booking up.  I get anywhere from 1-3 patients max in a morning.  The physicians don't want me seeing anything surgical and typical cerumen impactions and acute things are supposed to go on my schedule, however, the patients continue to request the MDs (or MDs aren't booked fully so they prefer to have the patient go to them).  So, my mornings are slow.  I typically help round after my patients are seen, but, it's just so...SLOW.  I email the doc's nurses and our front desk staff weekly to let them know of my open schedule and usually nothing changes.  One morning, a doc even asked to see all of my (2) patients because he was slow.  He stated it was so he could bill for them and get the 100% reimbursement (for the practice) vs. the 85% if I just saw them....because it is a slow time for the practice.  It was super annoying...why was I even there then?

3.  They also don't have a medical assistant for me or support staff, which is fine now, because I'm not busy, but they want me to precert all of my own tests, etc, which I think is a misuse of my time.  I mean...if they want to pay me a PA salary to sit on hold with an insurance company...so be it...but, I just think it is stupid.

4.  They do not utilize me in surgery.  I have 5+yrs of surgery experience and I have probably been in the OR 6 times since I started because the docs prefer to assist each other for thyroidectomies, parathyroids, parotids, etc.  I keep telling them that I am available and want to help, but they are super conservative and seem to prefer each other vs. me. 

Overall, I'm used to being busy and feeling useful.  I try to help out in the docs clinics, but, I end up just shadowing and it is driving me nuts.  Lately, I have been just going home for part of the afternoon (or sitting in the hospital doc lounge) and coming back to the hospital  if I'm called unless a specific doc asks me my plans for the afternoon.  I feel that is unethical, but, I absolutely cannot stand sitting around. 

I am seriously thinking about going back to ortho...I have a ton of contacts in the ortho world and I know I will be utilized well in that specialty.  any thoughts on how to talk to this group?  I know they would be super disappointed if I resigned (they keep saying I'm wonderful and great....and they want me there forever) but, I also am at a loss about how to change things.  I am bored and somewhat uninterested...It was a risk to change specialties...and I know it sometimes takes awhile...but, are these normal 'growing pains' or when should I look elsewhere?

Thanks in advance!

[mgriffiths]

Obviously this is all personal choice: there are those who would kill for a "low stress" job like yours, while others would be frustrated (like yourself).

Me personally, my concern would initially be focused on how secure I felt my job was.  It sounds like your job is secure, but it doesn't sound like you're doing much billing, which potentially would put you in jeopardy if the docs ever put 2 and 2 together.  Secondly, interest is a major factor for me.  I would try to meet with the practice manager and/or the docs as an evaluation, and discuss the frustration.  But, it may be prudent to have some things working on the side toward a new position, because you are basically pointing out that you aren't doing anything.

[KMKPA]

thanks for your insight.  I guess I am just an overachiever who feels like they have to be busy and have a purpose all day vs. someone who is ok having a lot of downtime at work with nothing to do. 

I feel my job is secure at this point, however, I do wonder if at some point they will do the numbers and realize I'm not paying for myself.  One of the partners said they did not hire me for those reasons, but, when push comes to shove...$$ talks. 

The partners don't have a clear plan for me...(I keep hearing different ideas from different docs about what they want me to do, etc)with the exception of me covering their consults so they don't have to spend more time at night away from their families.  I guess if I do point out what I'm (not) doing, and they think continuing to shadow a physician in my afternoons is reasonable, I will have to get out of there...it just isn't worth my time to follow someone along.  It is just plain boring and I have too many skills (surgical, in-office procedural, knowledge of post-op care management, acute care) to just watch someone else work.

I have never been in this position before and I want to give it a chance, but, alternatively, if this doesn't pick up....I don't think I can see myself there long term.  I just want to be productive work. 

[ALC0313]

How long have you been there? Is this a private practice or hospital-owned? Do the docs know you're bored? What about the practice manager?

[Guest Paula]

I'm pretty sure they think you are a medical assistant. 

[ort890]

Very, very similar situation I'm currently in at my first job out from school. Been here for 1.5 years in ortho. Had enough of it and I'm leaving in two weeks. Sitting around doing nothing, shadowing at times mainly because the clinic is sinking and just not busy enough to warrant a PA at this time. I'm sure it's hard to pull the trigger and leave so soon but its difficult not doing what you're meant to do and what we all went to school for. Hope it all works out for you. 

[mooredc]

18 hours ago, Paula said:

I'm pretty sure they think you are a medical assistant. 

Haha. I was reading that thinking wow this sounds exactly what I did as an MA. 

[KMKPA]

On 11/1/2017 at 2:57 PM, ALC0313 said:

How long have you been there? Is this a private practice or hospital-owned? Do the docs know you're bored? What about the practice manager?

I have been there since April of this year.  This is a well-established private practice (40yrs old) that is affiliated but not owned by a larger hospital group.  Some of the docs in the group know that I feel that I don't have much to do.  I have also communicated that to the president of the practice with concerns that I don't think shadowing in the afternoon is a sustainable use of my time.  He didn't really address that however, he reiterated how wonderful I am because I am able to see consults when they are on call (making them not have to go see them at the end of their clinic day).  Honestly, part of me thinks that they hired me because they don't like their call burden, but didn't really think how else to utilize me other than that.  I'm not sure he really gets that sometimes, I don't do ANYTHING.  Lately, I have stopped showing up in the afternoon clinics to shadow if there is nothing "interesting" or different on the schedules because I just don't want to follow someone around.  I stay in the hospital physician lounge or in the doc's room in the office unless someone specifically asks me to be present somewhere.   I'm not saying I know everything, but, also, it gets REALLY BORING to follow someone around.  

One of the higher up partners and I also had conversation about boosting my #s and I explained to him things I was doing to try to increase productivity and also asked to be in the OR more in order to boost my charges.  He stated that the physicians are less likely to have me in the OR because even when they first assist each other, they get credit towards their productivity and so it doesn't give them an incentive to give up their assist time either. 

They hired a new physician at the same time as they hired me, plus, it seems to be a slow time of the year, which complicates things even more.

The practice manager can be tricky... I have worked in another private practice and I know from experience that you have to be careful about what you say to them because you have to remember, they are paid by the partners of the group.  I do not trust that they hold anything I say in confidence, so, I do not plan to lay everything out to her unless I am really ready to speak to the physicians about it.  

I just don't know how to change the situation...it's like they want an PA but they didn't necessarily think it  through all the way.

[KMKPA]

On 11/4/2017 at 10:32 AM, mooredc said:

Haha. I was reading that thinking wow this sounds exactly what I did as an MA. 

hi, yes, sometimes I feel like that, however, I do see patients (although a limited amount) and do see consults in the hospital and perform procedures as necessary...but in the office setting, yes, they want me to be the PA/MA/nurse, etc.  they literally pay me to sit on hold and precert my own CT scans that I order.  crazy.