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8 years in, still regretting becoming a PA (in response to someone else's old post 4 years in...)


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I really hate being a PA.  I've tried multiple specialties over the last 8 years.  With each switch, I'm not asking to derive happiness from my work, just to not be miserable.  Here I am again in a new position.  Miserable.  I struggle  thinking I'm not good enough, not smart enough and this drives me to be really great at what I do, most of the time.  Occasionally, I am an idiot, and my memory is not superb.  I know a lot though and I find answers even when Western Medicine doesn't have them.  I treat each patient like an individual.  I listen.  I have implemented massive amounts of self care, meditation, eating healthy, exercising, etc in hopes that if I work on my inner joy that maybe I can find some joy in my work.  The more self care I do, the more I hate this work.  Does anybody else feel this way?  Does anyone else feel like the only people enjoying this work are asleep?  

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This is a version of an oft discussed topic....satisfaction with the profession and the work. At nearly 30 years I am suffering some of the same feelings but it isn't the work as such but rather turning patients into customers and us into shoe salesmen. After working in small rural areas most of my career life and family circumstances provoked a move and I am now in the employ of a giant corporation(like many of us).

It has been (and I anticipated a lot of this) a difficult transition. My days are now ruled by administrators and bean counters and the ever present patient satisfaction survey (and seemingly unending patient complaints). Decisions are handed down from on high by people who seem to have no idea what we actually do at the point of delivery. The rules change frequently based on who is complaining about what.

The problem becomes circular. This doc is stressed and unhappy so he/she takes it out on staff or PA or NP. That person gets stressed and unhappy and shares the misery. Something happens at the point of care that causes a complaint or bad satisfaction survey. Staff complains about staff or providers. Physicians complain about everyone who isn't a physician. It becomes days of waiting for the other shoe to drop...wondering what complaint you will have to address or what missive will be handed down that makes little sense or will have bad results.

I don't have an answer...not even close. If I did I'd be a rich consultant. I, and other in my situation, have to do our best, care for our patients, try and sort the wheat from the chaff, and find our own happiness. If push comes to shove we may have to find another line of work.

I remember a dentist I met when I was in the Army. He had grown to hate dentistry and knew it. He made the decision to leave the Army, leave the profession, and start his own totally unrelated business. I don't know how it came out but I was impressed with the insight and bravery it took to make such a choice. I have been exploring some possibilities myself but so far haven't been able to stick the landing. Between now and then....I have 6 years to semi retirement. Shoulders in the harness, eyes down, push ahead.

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1 hour ago, sas5814 said:

It has been (and I anticipated a lot of this) a difficult transition. My days are now ruled by administrators and bean counters and the ever present patient satisfaction survey (and seemingly unending patient complaints). Decisions are handed down from on high by people who seem to have no idea what we actually do at the point of delivery. The rules change frequently based on who is complaining about what.

 

This is the real issue I have with the profession. At some point patients became customers. I remember an undergrad college I attended actually taught and used the word "customers" to their nursing program.

I feel there is no solution to this in our country. I truly believe it is a fault that reflects our country, not just our profession. I think the only cure would be practicing in another country which focuses on outcomes and statistics instead of completely BS surverys.

 

I dare anyone to look up any hospital associated FP, UC or ED and find survey scores of over 3.5. Patients feel entitled (part culture, part TV ads about medicine) to the medicine "They want" because they "think it works".  When they dont get it, the negative reviews come out, adminicritters get angry and all focus on evidence based medicine is gone.

 

Perhaps working in an ED for a company that doesnt really care about surveys or in a specialty which is the only regional option for patients is the only option left in america

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1 hour ago, ravenspac said:

Perhaps working in an ED for a company that doesnt really care about surveys or in a specialty which is the only regional option for patients is the only option left in america

This, and doing frequent volunteer work domestically and internationally renewed my faith in the practice of medicine.

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2 hours ago, ravenspac said:

I feel there is no solution to this in our country. I truly believe it is a fault that reflects our country, not just our profession. I think the only cure would be practicing in another country which focuses on outcomes and statistics instead of completely BS surverys.

Patients feel entitled (part culture, part TV ads about medicine) to the medicine "They want" because they "think it works".  When they dont get it, the negative reviews come out, adminicritters get angry and all focus on evidence based medicine is gone.

I think the customer vs. "patient" idea is the result of capitalism.  Everything is "business."  I like/love capitalism, and applying it to medicine isn't a problem because if a clinic isn't profitable it can't exist and therefore can't help anyone...but there is a famous quote about capitalism without morality...that is the issue.  Insurance companies, bean counters, large institutions have no morals.   I don't necessarily mean they are actually evil (but sometimes I think so), it's that they are large corporations and  do not have the ability to focus on individual situations.  In the past, if someone couldn't pay - they made payments in eggs, chickens, whatever.  I don't accept livestock or similar goods as payment, but I have several patients who owe thousands of dollars to the clinic and they just have to pay $1 per month to continue seeing me as a patient.  The interesting thing is that those are the patients I enjoy seeing the most!

 

Entitlement...it is the bane of my existence.  In my experience, medicaid and medicare patients are by far the worst...and it's the medicare patients who used to be on medicaid but aged out - just like their food stamps and other freebies.  At least 1-2 patients per day who can't believe I won't just order a test/procedure/whatever or write an antibiotic/narcotic/whatever when they ask for it - "it doesn't cost anything!"  They won't listen to reasoning, they want it therefore they should get it and they aren't concerned because they're not paying for it.

The reality is that most of my commercial insurance patients are probably like that as well in their mind, but because of their deductible they don't want the cost because they do have to pay.

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Employee Health is the way to go if you can find it. Everyone had the same employer, it’s low cost to the employee (and employer, if large enough), and if someone is unhappy you just tell them to go see their own PCP. No paperwork, no narcs, no call/weekends/holidays hopefully (as I have it). No PCP? Fine, send them over to the contracting SP group.

 

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I'm growing concerned about my outlook on this career.  Will not echo the above complaints but, not particularly enthused with where I am after more than fifteen years.  Maybe I just haven't found my happy spot.  I was telling my wife just last night, that I am seriouly considering taking an RN refresher course, to get my nursing license reinstated (required course in Texas if license has been expired more than four years).  I allowed it to lapse a few years after becoming a PA.  I have many nursing friends pulling down an easy $120k/yr working ER with a bit of overtime, or admin type positions.  It's hard work I know, because I've done it but, these days it seems it would be a lot less stress than where I am.   I seriously should have listened to a nurse anesthetist friend of mine way back when I told him about applying to PA school.  He tried his best to push me toward becoming a CRNA.  At the time, I couldn't see myself parked at the head of an OR table for hours on end, even though I was scrubbed in on a lot of cases with him.  Figured I would be bored out of my mind.  Stupid me.

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22 minutes ago, ral said:

I seriously should have listened to a nurse anesthetist friend of mine way back when I told him about applying to PA school.  He tried his best to push me toward becoming a CRNA.  At the time, I couldn't see myself parked at the head of an OR table for hours on end, even though I was scrubbed in on a lot of cases with him.  Figured I would be bored out of my mind.  Stupid me.

Didn't know enough about this when I was looking into different routes...money isn't everything, but it's d*** important.

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I'm growing concerned about my outlook on this career.  Will not echo the above complaints but, not particularly enthused with where I am after more than fifteen years.  Maybe I just haven't found my happy spot.  I was telling my wife just last night, that I am seriouly considering taking an RN refresher course, to get my nursing license reinstated (required course in Texas if license has been expired more than four years).  I allowed it to lapse a few years after becoming a PA.  I have many nursing friends pulling down an easy $120k/yr working ER with a bit of overtime, or admin type positions.  It's hard work I know, because I've done it but, these days it seems it would be a lot less stress than where I am.   I seriously should have listened to a nurse anesthetist friend of mine way back when I told him about applying to PA school.  He tried his best to push me toward becoming a CRNA.  At the time, I couldn't see myself parked at the head of an OR table for hours on end, even though I was scrubbed in on a lot of cases with him.  Figured I would be bored out of my mind.  Stupid me.


I had started down the CRNA road as well but backed out after finding out about the PA profession in the late 70’s. Looking back, it wouldn’t have been a bad gig. Had a RN colleague who functioned as a PA in my old spine group who later went the perfusionist route and was happy with the decision.
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If seriously unhappy consider depression as an issue or start looking at other careers.

No benefit to you or patients if you stay in a PA job/career you loathe.

Not trying to be all out mean but don’t do it if you hate it. It will affect your work.

I would much rather see a burned out cop, doctor, PA, lawyer being a chef or running a fishing guide service than hating their first profession so much.

Consider professional counseling to evaluate the situation.

Been there, survived...

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9 hours ago, Reality Check 2 said:

If seriously unhappy consider depression as an issue or start looking at other careers.

No benefit to you or patients if you stay in a PA job/career you loathe.

Not trying to be all out mean but don’t do it if you hate it. It will affect your work.

I would much rather see a burned out cop, doctor, PA, lawyer being a chef or running a fishing guide service than hating their first profession so much.

Consider professional counseling to evaluate the situation.

Been there, survived...

It's been thirty five years and I'm still trying to figure out what I want to do when I "grow up".  For those who might wonder, yes, it does get harder as that finish line gets closer, at least for me.  I'm just thankful I'm in an almost no stress environment to finish out this race.  OP, I'm serious about the Emp. Health route.  The secret is to find that slot where you aren't the PCP for these folks.  If one is young and/or gets bored easily then this wouldn't be the spot.  There'll be a slot where I'm at in almost exactly two years here in N. Texas.

Edited by GetMeOuttaThisMess
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