New Derm PA Advancement?

[Treebles]

Hey all;

Derm PA here with 1.5 years of experience; lucked out and got a great derm position with fantastic salary, benefits, wonderful supervising MD, patient load and schedule. Recently I've been having some unsatisfactory thoughts regarding my position regarding how "well rounded" I will be if I stay in this position; even in the short term. My practice is essentially 90% medical derm, and 10% first assist (basically retracting/suction/cutting sutures) with no closures. I made it clear during my interview with this practice that I had intentions of becoming well educated in all aspects of derm, not just medical. I feel my medical dermatology training has been wonderful and I have zero qualms about it; however I often feel unsatisfied when I know (or at least feel) I could do a simple and non-complicated standard excision for small lesions. The problem is, I want the formal training from my MD rather than just being all gung-ho. I sat down and discussed it with him earlier this month; and he basically shot me down stating "we don't have a surgical access problem; and I am happy to teach you, but you have to find the right patients to start surgical training on;" secondarily; he also threw the "we're not an academic institution" where training is inferred. Beyond this issue; I feel he does treat me well and respects my opinions, with the caveat that I am a new, and very much so still learning, PA.

Some recent revelations at the practice have also made me generally unhappy over the past few weeks; including a lot of intra-office drama with clashing personalities (my MA and I are a fantastic team and I wish I could bring her with me for my entire career!) I am at the point where I am considering leaving once I complete two years of experience in, just so I can qualify for applying or being considered for other derm jobs. My contemporaries in derm say that they are already doing excisions solo and only bring in their supervising physicians when trouble arises.

Conflicted as to what to do; but more and more the needle points to leave once at two years of experience, even though I am treated very well at my current practice with the exception that I feel educationally stunted with my only source of education at this point holding the restrictions.

Would appreciate any thoughts. Thanks!