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Is there life after Urgent Care?


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I'm a bit concerned about the direction my career has been going in for the past year and I am seeking advice on how to proceed from here.

After graduating in 2013 I worked for for a large ER staffing firm for 3 years. My first job was in a rural 1 doc, 1 PA ER, which a baptism by fire if there ever was one. It was a very tough first job but by necessity I learned how to manage fairly complex, but non-critical patients. After about a year and a half I transferred to a ER closer to home at a larger suburban hospital, where I worked about 50% fast track and 50% main ED. After about 3 years of ER, I left for 4 months to do a locum tenens in northern California doing IM. I did this because I wanted to travel and also get experience in a different specialty. It was a great experience as it gave me a chance to flex my primary care muscles that I hadn't used since PA school. 

When I returned home, I took a job at an Urgent Care with the intention that it would be a temporary job until I found something more permanent. I was also picking up shifts at the ER I was previously working at, but those shifts began to dry up as they shored up their midlevel staffing (with NP's nonetheless). I left the Urgent Care after about a year because the practice was terrible... I'm sure you have heard about some of the horror stories with these fly by night urgent cares so I don't need to go into details. Needless to say I became increasingly concerned about liability and some other practices I thought were unethical. I then took a job a few months ago at a new clinic where I was told I would be doing primary care as well as urgent care. Well this didn't pan out because the IM doc left shortly after I was hired. I am now only seeing a few urgent care patients a day and it is clear this place is circling the drain and I need to get out. 

I'm worried my that past year working in Urgent Care has added essentially nothing to my skillset and I have stopped progressing in my medical knowledge. With my experience I could easily go back to ER or IM/FM but I'm not seeing a whole lot out there in my metro region. The market seems much more saturated than when I was first applying for jobs 5 years ago. I'm seeing a some bottom of the barrel jobs like Low T or weight loss clinics, which I think would be career dead ends. I do see postings for surgical specialties that will train, but they are invariably in remote locations where I am not prepared to work at this point in my life.

 Hopefully I can get my career back on track without leaving home, but the prospects are looking dim at the moment. I fear that taking the locum tenens job a year ago derailed my career, and I if I continue on this track much longer, I will become less and less competitive in this market. Any advice would be appreciated. 

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I have always said if you limit your options your options are limited.

If you are unable to consider relocation then your options are limited.

If you don't want to work in remote/rural/under-served areas your options are limited.

If you don't want to work in certain fields or specialties your options are limited

I'm not saying any of these things are bad. We all make choices based on our circumstances and preferences but with those choices comes limitations. The more you restrict your options the smaller your menu of choices.

 

As EMEDPA said you are perfectly employable. Make your choices and pick from your options and then get happy.

Edited by sas5814
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Thank you both for the reassuring responses. I'm aware that I may have to relocate, and fortunately that is an option for me, although I would prefer at this point to be near an urban area at this point in my life. Are you aware of any good metropolitan job markets for PA's right now? I have a friend working ER in Vegas making $90 / hr base. I've heard Vegas is great for PA's right now and the cost of living is low.

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Experienced EM PAs in the portland/vancouver WA are can make $90(fast track)-100(main)/hr. 

PM me if interested for contact info. The lead PA of this group is a good friend of mine. they staff 7 EDs. These are busy places with em physicians on site and presentation to attending requirements for certain pts. . I am willing to make less to not work that hard and not have to answer to anyone. 

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I've always seen Urgent Care as something to do after you have done everything else.  Some UC's are good and some are just awful.  I have worked for both.  UC requires a lot of experience and the ability to know what sick looks like before it crashes through the door at the ER.  Not man newbies have that kind of experience.  One of the UC's I work at will not hire you without 10 years of experience.

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Want metropolitan? Come to NY. With your experience you will get 5+ offers after a month with salary 110k+ in IM, surgery, etc.

People who claim NY is saturated or has low salaries have no idea what they are talking about. I work in a large academic hospital right in the city, 5 new grads I was a preceptor for had no problems getting jobs here, with salaries starting at 100k+. 

COL a little high, but you can find a place on the outskirts of the city and/or in NJ.

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4 hours ago, Cideous said:

I've always seen Urgent Care as something to do after you have done everything else.  Some UC's are good and some are just awful.  I have worked for both.  UC requires a lot of experience and the ability to know what sick looks like before it crashes through the door at the ER.  Not man newbies have that kind of experience.  One of the UC's I work at will not hire you without 10 years of experience.

yup, I have intubated, cardioverted, run codes,  reduced fxs, delivered babies, etc at urgent cares

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On 8/29/2018 at 10:04 AM, PACJD said:

Want metropolitan? Come to NY. With your experience you will get 5+ offers after a month with salary 110k+ in IM, surgery, etc.

People who claim NY is saturated or has low salaries have no idea what they are talking about. I work in a large academic hospital right in the city, 5 new grads I was a preceptor for had no problems getting jobs here, with salaries starting at 100k+. 

COL a little high, but you can find a place on the outskirts of the city and/or in NJ.

 

Yep, I've noticed to my surprise that NYC is a great market right now for PA's. It's kinda ironic, when I was younger I dreamed of living in NYC but couldn't afford it. Now that I am older and can afford the city, it sounds like a headache.

 

On 8/29/2018 at 9:25 AM, Cideous said:

I've always seen Urgent Care as something to do after you have done everything else.  Some UC's are good and some are just awful.  I have worked for both.  UC requires a lot of experience and the ability to know what sick looks like before it crashes through the door at the ER.  Not man newbies have that kind of experience.  One of the UC's I work at will not hire you without 10 years of experience.

 

ER teaches you to be paranoid and always on the lookout for the worst case scenario. Urgent Care can foster a mentality of complacency as you are encouraged to churn through a waiting room of low acuity patients. Always in the back of my mind are the ER patients I've seen who walked in the door with seemingly benign complaints, but turned out to be really sick. Developing this sixth sense through experience is crucial to screen out potential land mines.

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Update on my situation:

I have 2 potential offers in my area, one for an ER group and another for neurosurgery. I have a strong chance of getting both. The lead PA for the neurosurgery group called me "off the record" when she came across my CV and she recognized my name. A few years ago I was a volunteer anatomy TA with her at my alma mater. She says I would be a great fit for their group and they are motivated to train.

I would really prefer the neurosurgery job over ER, but I'm concerned my surgical skills have atrophied. I did my surgery rotation at Norwalk, but that was 5 years ago. Has anyone gone from ER to a surgical specialty, and if so, any advice? 

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  • 2 weeks later...

Update #2:

Neurosurgery interview went well, waiting to hear back. Downside is that I would not be assisting in the OR very much, at least to start. And it would be nights to start as well. Still better than what I'm doing now, so I wouldn't turn it down. Also setting up interviews with an ER group, but I would be splitting my time between a couple ER's and one of them is more of a commute than I would like.

And this just in: I have an interview for an IR position, my dream job. Banker's hours. They are willing to train. I'd start doing mostly clerical stuff but would train on the procedures with the other PA's until I'm comfortable with them. I hope this works out. I need this win. I'm afraid this would be too good to be true.

Prior to the interview, I want to study up on the procedures. I want to sound like I know exactly what I am getting into. Can someone direct me to some resources?

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  • 11 months later...
On 9/11/2018 at 12:33 PM, Acromion said:

And this just in: I have an interview for an IR position, my dream job. Banker's hours. They are willing to train. I'd start doing mostly clerical stuff but would train on the procedures with the other PA's until I'm comfortable with them. I hope this works out. I need this win. I'm afraid this would be too good to be true.

Did you get the job?

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