Career Advice

[Hope209]

I'm almost one year into my first job out of school. I've been working my butt off, hustling (safely), and dispo'ing 2.5 pph, avg charge/hour $1200, with good turnaround to discharge/admit times and I've gotten good press ganey feedback from patient surveys. I get along well with the staff, but internally I'm struggling.

I love the pace of ED--I like doing things quickly, autonomously (but with support if I need help), and I love procedures. But the particular ER I work in is pretty toxic towards PAs. Nurses are outright hostile, the majority of the docs are unapproachable, the night differential is nothing, and there are no real productivity bonuses. The pay is ~$20/hr less than other EDs in the area in California. 

I'm going to fulfill my one-year contract but I'm starting to plan my exit strategy. Any career advice? Should I stick it out and keep building my clinical acumen even though I'm miserable? The patient population is very sick so I'm seeing and treating a lot of great pathology. Ideally I'd like to work in a field that offers some kind of productivity incentive. I'm burning myself out working quickly while some of my colleagues get paid the same but spend a majority of their time drinking coffee and reading the newspaper. 

[HMB]

Even though I am pre-PA (applying as we speak), this environment sounds toxic as you say. I would leave as soon as your contract is done, personally because if you're miserable at your job, you're not going to do the best job you can, which could hurt you in the future, honestly. Sounds like the ER is a good fit for you, just not this particular ER and there are so many others out there that I am sure would bring you on in a heartbeat. You have to do what's best for you, for sure. Burn out this early on is not good at all. And I also worry about the docs being unapproachable.... you need them to learn and to support you as well. And the nurses may not like taking orders from a new grad. It doesn't sound right to me at all, and I'd start interviewing other places around 3 weeks before your contract is up. 

 

Also, make sure to read your contract.... I had a PA tell me that if you do not resign before the end of the contract, some contracts automatically renew to the full terms. So make sure you exit under the parameters of the contract. 

 

Best wishes!

 

(on a side note... I've been working as a massage therapist for 13 years and a personal trainer for 18 years. I have heard too many clients over the years talk about how miserable they are at their jobs and it breaks my heart because I've always enjoyed my job. this might give you some background to why I say what I do. Of course, I am not speaking from experience as a PA specifically). 

[ohiovolffemtp]

Hope,

It takes close to 3 years of experience before you completely hit your stride and about 5 years of experience before you are typically considered an experienced ED PA and really attractive.  Still, if you work of a staffing company, talk to the recruiter who handles you site about other possibilities, including PRN shifts at another site.  That way you'll get a feel for what else is out there.  It can take as much as 3-6 months to find a new job and credentialing can easily take 3 months, so don't just leave without anything else in place.  Consider going to SEMPA and talking to the recruiters who are there - all of the major national firms and many of the regional will be there.  I'm not sure what PA contracts for ED offer productivity bonuses.  Most places are primarily if not exclusively hourly, with night differential not all that common.

Maintain a procedures log - that's always a part of credentialing.  Try to get credentialed for central lines, intubations, LP's, etc.

[EMEDPA]

alternatively, consider an EM residency if you really want to get up to speed quickly and create an awesome procedures log. Honestly, productivity is NOT the way to go in EM. it encourages sloppy work and poor documentation, because you always feel like you need to be faster and doing more procedures. I used to work at places that did this. now I work exclusively for hourly rates and much prefer it.

[Hope209]

Thanks for the feedback, guys. I hate to sound money-hungry, but the pay for the amount of work in this environment is primarily what's bothering me. I'm in the Bay Area, started $55/hr and the majority of other hospitals start at $70/hr. The night differential is 105% of base. I work for a private physician group. This specific ER is quite toxic with an extremely high turnover rate; no current PAs have been there longer for 5 years, and in general the PAs get treated quite poorly. They're constantly cracking the whip to see more patients and do additional things like callbacks, etc. The other night I triaged 70 patients, disposed 30  of 'em, during a 10 hour shift.

I've gotten a lot of procedures (minus intubations) and I feel like I work safely and my documentation is excellent. I worked as a scribe for a bit in the past, so my downcodes and missed ancillaries are almost always 0. 

Has anyone dabbled in different fields where you get a good amount of procedures? Derm, Plastics, IR? I particularly like soft tissue procedures like lacerations, I&Ds, nail removals, so I thought about possibly looking into Derm.  

Sorry, thanks for letting me vent

[qcheedude86]

Totally know that feeling Hope209. Started off working as a new grad in the ER in the Bay Area as well. I agree ER environment can be extremely toxic. Worked there for about a year and was so glad to leave. Tough learning as a new grad but the experience was gold. I knew ER wasn't for me long term and I got lucky enough to find a full-time gig in derm where I am LOVING everything about it. I dislike shift work (common in ER/UC specialty) and with derm, the hours are great and work life balance is attainable. Plus derm usually pays on the higher end which sweetens the deal . In regards to procedures in derm, they mostly consist of punch and shave bx, suturing, intralesional kenalog injx, cryotherapy, candida injx, electrodessication and curettage, and excisions if your SP is willing to train you. The big ticket item is MOHs surgery and if you get paired with a derm MOHs surgeon, it becomes a mix of some plastics/derm (wide defect repairs). We do lots of procedures daily but lacs, nail removals are not that common since those are usually seen in ER and UC settings. If you get into cosmetic derm, then theres a whole slew of other neat nifty procedures you can do. Hope this helps and best of luck!

[jmj11]

Let me just say, having been a PA for > 36 years and have left many jobs (more than I can count on one hand), I never left a job and then looked back with regret. The lesson I've learned, just like the girl or guy, that marries the abusive partner, you just can't fix them. I thought many time I could fix the attitude (once they see how great I am, wink) but social change comes in the speed of a glacier. On the other hand, I've worked with some PAs who came in, got frustrated and left in weeks. I tried to hang on to each job for one year (there was one except when I was working at a horrible job and got a great offer and left in six months). But, if you can't find mental peace and a happy place to work by the end of a year, it's not worth it. Your exit is also part of the pressure for the culture to change. If PAs keep leaving, finally the lights will go off for someone in the system. Life is short and there are better places to work (especially in this day). While salaries can be based on many factors, low salaries and low esteem toward the PA go hand n hand.