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Hello folks,

I'm currently a PA-S graduating in a few months.  I'm posting in the general discussion since I wanted to get opinions from PA-C's, particularly w/ urgent care experience.  I've applied for a number of EM jobs, and am in the process of applying to urgent care positions as well.  I've decided work life balance is very important to me, and Urgent Care seems to fit the bill from what I've seen. 

My question is, do you guys think Urgent Care is an appropriate field for a new graduate? I will have had 2 rotations in EM by that point, and will not be solo at any of the UC locations.  However, I've heard some members stating it is a poor choice, since you have more "autonomy" and need to have a good sense of what is high acuity and what isn't (which comes from experience).  Given that it fits the lifestyle I want, should I still consider it?

Thanks!

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There are plenty of new grads who start off in urgent care.  I started in a FM/UC/Occ Med clinic when I had 2.5 years of FM under my belt, and worked there for a bit more than two years.  I went into solo evening coverage right away, and did fine with it, but I honestly don't know how I would have handled things as a new grad.  Frankly, I think my training well prepared me to deal with DM II, HTN, etc., but not nearly so well basic URIs/UTIs/BV/etc., which I had picked up pretty thoroughly in FM.

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Having worked UC after a job in the ER, I might say UC might be a better choice than ER at least, for a first job, as long as you have at least some good experience from your ER rotations (i.e. you used them wisely).  My ER job was not great, and i'm much happier in UC.  It's not terribly difficult and especially if you have some support.  There are some great UC youtube channels out there (John Bielinsky and others), and I'd also throw in Dr. Paul Thomas's pediatric channel, it's great for basic peds stuff that you will see. I'd absolutely get a copy of the book "Minor Emergencies" and read it front to back a few times, get the EM BASIC podcast archive (downloadable), and get yourself an UpToDate subscription.  

Some UCs are insanely busy, and that's probably not a great place to start, but if you can find a reasonable place that has an OK load so there is time for you to learn and the other provider to teach, that should be OK.  As for clinical acumen a.k.a. gestalt a.k.a. the sixth sense, that comes with experience in any field, so you will have to ride it out and learn.

Edited by quietmedic
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I would love to eventually work in EM or UC as well. I am very interested in 12hr shifts.

What would you recommend for a new grad or should everyone start in FM?

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3 minutes ago, ajames said:

I would love to eventually work in EM or UC as well. I am very interested in 12hr shifts.

What would you recommend for a new grad or should everyone start in FM?

Toughest part of UC is knowing when someone doesn't fit the mold of a typical UC case. That knowledge of sick vs not-sick really only comes with experience. If you can find a good UC willing to train (and doesn't have you work solo!! You can read up on many case studies of this throughout the forum), you don't necessarily need to work FM prior to working UC.

 

UC and EM are great gigs for PAs in the right shop, especially when you get to the level of autonomy you desire. I do my own thing, see patients without presenting them and go home when my shift is done. I work significantly less than most of my PA friends and make a lot more than them. What I sacrifice in terms of in-depth medical care I make up for in dividends in my work/life balance.

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I don't agree that UC is a good place for a brand new grad.  In most cases, you're the only provider.  No one else to turn to for help.  Too many people bring emergent issues to an urgent care, hoping for a smaller bill.  Even if you are smart enough to send them to an ER, you had to at least provide an initial assessment.  How are your x-ray skills?  You may be interpreting alone, at least until they are reviewed the next day.  How about your suturing skills?  What was your previous HCE?

If you get an ER job, at least you're probably not going to be the sole provider in those early months before you get some experience.

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^^ This. As I sit here with my second radiating chest pain patient of the day with 2 abdominal pain patients waiting to be seen I think....would I have been OK doing this when I had zero experience? No.

Yes a new grad can work in UC but not as a sole provider and, even then, should be in an environment where there is good mentorship and teaching.  I have been the second provider in a UC that routinely saw 100 people a day and had a non-experienced NP dumped in with me just because she was cheap to hire. After a day or 2 I told her she would have to sink or swim. I couldn't hold her hand for 12 hours every day with those patient loads.

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this is one reason why HCE is so important...I think people should be able to make the sick/not sick decision day 1 of PA school, not after the first year in practice...

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And this is where REAL healthcare experience before enrolling into PA school comes in handy. A comparison would be would you expect a MS3 to make such an assessment at the end of the year?  I wouldn’t.

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1 hour ago, GetMeOuttaThisMess said:

And this is where REAL healthcare experience before enrolling into PA school comes in handy. A comparison would be would you expect a MS3 to make such an assessment at the end of the year?  I wouldn’t.

Agree completely that the emphasis needs to be put on high quality HCE, but a lot of my sick/not sick skills have come from seeing the patient as their provider, not from my background prior to becoming a PA.

 

My background: I did 6 years active duty Army medic, multiple combat tours and then another 4 years as a full time EMT/CNA while knocking out my undergrad degree. Not sure there are many applicants with higher quality HCE. You need the PA training to have the medical understanding of what makes them sick/not sick to have something to hang your hat on. My $0.02 anyway.

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my sick/not sick radar was pretty good after 10 years as an er tech and 5 years as a 911 paramedic. a good paramedic should know the look of someone having an MI, circling the drain, in resp distress, etc

To those of us with experience this seems obvious, but I not infrequently walk into the ED at shift change and realize someone looks like crap and no one else seemed to notice yet. 

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Thanks for the responses...might it be reasonable that emergency medicine is a more appropriate first step, unless the urgent care  position always has a second provider?

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SARs....something ain't right syndrome. An ER variation of FLK....funny looking kid. It is when something tickles your lizard brain but you can't quite explain it.

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2 minutes ago, Salesian said:

Thanks for the responses...might it be reasonable that emergency medicine is a more appropriate first step, unless the urgent care  position always has a second provider?

yup. don't do solo coverage as a new grad. that is inviting badness. 

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Well, just got an offer at a UC location, 12 12's a month, physician present at location at all times. 

Anddddd they are offering "close to 40 dollars per hour".  Meaning possibly less than that.  Barely $80k for a busy urgent care setting?  Based on AAPA reports/local averages, 90k-105k is much more reasonable. 

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1 hour ago, Salesian said:

Well, just got an offer at a UC location, 12 12's a month, physician present at location at all times. 

Anddddd they are offering "close to 40 dollars per hour".  Meaning possibly less than that.  Barely $80k for a busy urgent care setting?  Based on AAPA reports/local averages, 90k-105k is much more reasonable. 

I would laugh at them as even in a low COL that pay sucks. What is wrong with these people? I really feel like all these new PA/NP grads are ruining it for us as the market is getting saturated and those new grads will take any job screwing us all. Please counter offer them high and if they don't accept then tell them why. I literally laughed at a guy on the phone a few weeks ago as we offered me $38/hr PRN weekend only UC without shift diff. and then went up to $43/hr. He was not happy about it and I told him why. Our conversation ended in about 15 seconds after that. BTW he called me for the position as they thought I would the most qualified candidate. I told him I had another offer down the road that was given me mileage reimbursement $110/day plus at least $50/hr (which is good for my area). He then said well we are not a huge corp. hospital and that is why they offered you that much. I then told him no they were a solo private UC ran by a solo physician and his wife (RN). He pretty much had nothing else to say about that and was shocked that they were offering that much.  

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3 minutes ago, camoman1234 said:

I would laugh at them as even in a low COL that pay sucks. What is wrong with these people? I really feel like all these new PA/NP grads are ruining it for us as the market is getting saturated and those new grads will take any job screwing us all. Please counter offer them high and if they don't accept then tell them why. I literally laughed at a guy on the phone a few weeks ago as we offered me $38/hr PRN weekend only UC without shift diff. and then went up to $43/hr. He was not happy about it and I told him why. Our conversation ended in about 15 seconds after that. BTW he called me for the position as they thought I would the most qualified candidate. I told him I had another offer down the road that was given me mileage reimbursement $110/day plus at least $50/hr (which is good for my area). He then said well we are not a huge corp. hospital and that is why they offered you that much. I then told him no they were a solo private UC ran by a solo physician and his wife (RN). He pretty much had nothing else to say about that and was shocked that they were offering that much.  

I totally agree.  I've decided at this point that I'm not willing to accept an offer that does not reflect the amount of training and responsibility we as PA's hold.  Not to mention, the AAPA salary report has breakdowns by field and experience, and while I don't expect a 90th percentile salary in a low cost area, I'm not going to take an insulting wage well below the 10th percentile for new grads.

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Kind of related...

Whereabouts are there urgent care centers willing to hire new graduate PAs? In my region every urgent care wants 2 years of experience. In other states where I've considered moving, they also want 2 years. 

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8 minutes ago, lostzebra said:

Kind of related...

Whereabouts are there urgent care centers willing to hire new graduate PAs? In my region every urgent care wants 2 years of experience. In other states where I've considered moving, they also want 2 years. 

Here in Texas there are vast areas that are under served and very rural. Not as many people want to live and work there compared to bigger urban areas. There are scads of places in these areas that will take a new grad. Whether or not that is a good idea....well look at the preceding conversation.

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I have read about half of the responses on this topic and therefore my remarks are not an epiphany. six years ago I took a job in Urgent Care as I knew I had over forty years in surgery which means I would not fail to diagnose surgical problems and I had sixteen years in emergency medicine and trauma and had written books on both subjects. I guess I am saying that although I was a year over sixty, that I felt none threatened because I had experience. To my surprise, there were areas that were somewhat perplexing because I lacked the pediatric medicine aspect and had to study this area as well as pharmacology related to both pediatrics and Geriatrics. 

I think it is possible to start in this area but you need to be absolutely truthful with your hiring physician that you are a neophyte who has just graduated or you may find yourself and your clinic culpable for many "failure to diagnose" cases as the supervision in UC is somewhat lacking.

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