Lack of precepting/ discouraged new PA

[marpac]

Hi all,

I’ve been a PA now for a little over 1 year, and I just left my 2nd job. I had originally worked in a private urgent care, but was unhappy as I quickly learned that the “1:1 new grad training program” they toted for new grad hires was really only 2 weeks (6 12’s) of being an additional provider on an already fully-staffed shift. I was told very early on that speed, patient volume, and patient satisfaction were top priority, and any extra learning I wanted was to be done on my own time. It was very stressful right out of school, having had the expectation that I would be mentored once I started. 

I left this job after 10 months to pursue what looked to be a reliable opportunity with a hospital-affiliated OBGYN group. 7 docs, 3 APs (2 of them PAs that were new to OB when they were hired!). They seemed confident when they hired me that they’d be able to onboard/train me like they had for the other 2 PAs. 

When I started there, the practice manager who was present at my interview was gone- left to go to another hospital. There was no central management presence when I came on, and none of the MDs felt it was their responsibility to manage/organize my training process. 

Eventually we got an interim manager, who sort of helped take the reigns of my training process. However, I was never assigned a physician preceptor/mentor, had no consistent chart review or directly observed/ precepted training, and was only seeing ~4-6 patients/day. This interim manager told me eventually I needed to  “take more initiative in my training”, so I did. I created my own OBGYN training checklist which I had approved by 4 other providers, and management. I consistently asked to see patients with the docs and observe procedures. I organized weekly check-ins with the interim manager to discuss my schedule/progress. 

One day, I ask to perform an endometrial biopsy (a procedure I told them I had much experience  with from school and had performed before). I was given the verbal OK by one MD, but the MD who observed me doing the procedure was “unaware that I was supposed to be doing procedures. Nobody ever seemed to be on the same page with my training status. With that doc guiding me, I performed the bx perfectly and thought all was well. Manager called me into her office the next day saying that i overstepped my bounds and am reaching too far. I asked her, “what about the initiative I was supposed to be taking?” And was met with I’m pushing too much/ asking too much....

After 4 months at this (what was supposed to be my dream) job, I resigned. I was given no direct oversight or preceptorship, no consistent feedback,  seeing <10 patients/day, and was then receiving mixed messages about how much initiative I should be taking, with no direct physician involvement at all. I felt that it was not a safe or supportive environment to continue to learn and practice in.

At this point, I’m feeling discouraged. Is this what being a PA in our medical system is? Or have I just not found the right office fit for me? I’m concerned that I’m looking for job #3 after 18 months out of school, although I fee my decision to leave both jobs was legitimate. I’m worried though that I may not find the supportive, safe practice environment I had hoped to have as a new training PA....

Sorry for the lengthy post, and any advice is super appreciated!

cheers, M

[sas5814]

Well you are 0 for 2. It happens and it can be discouraging. Sometimes they are bad jobs. Sometimes they are good jobs poorly run. Sometimes they just aren't a good fit for your personality or experience level. The right job is out there somewhere and these things can happen to any of us. 

A few years back I took a position in a Community Health Center. I took the job primarily because I knew the medical director well and liked him a great deal. In a word the job sucked. More accurately it sucked for me. I was miserable and made him miserable and, 2 years into a 3 year commitment, we agreed to part ways for everyone's sanity. 

Now I have a job I like with an organization I like (generally...corporate medicine sucks in many ways but that is everywhere), I'm paid well and treated well.

In the future drill down on what is important to you. Ask a lot of questions and pay close attention to the answers. Vague answers like "don't worry" or "we will take care of it when it happens" speaks to poor planning. For instance in your OB job interview did you spell out specifics on what training you would receive and who would be responsible for it? Had you asked that either the concept would have already been planned out and everyone's expectations understood OR you would have found they really didn't have a plan.

You'll be ok. Just keep plugging along.

[UGoLong]

Sorry for your luck. There are lots of different work opportunities and it can be hard to tell which ones are best for you.

I'm still working in my first PA job after 12 years (albeit part-time since I teach half-time and I'm old). I've also watched other PAs in other work settings.

What worked for me in the beginning was working for one doc who likes to train (unless he is overloaded). For a while, he had a partner who was also a nice guy, but no two docs work the same and it was confusing. From what I can see of PAs who go, for example, into the ED where they work with different people every shift, having an organized training program (or having done a residency) helps.

My advice for starting out (or, perhaps in your case, picking up the pieces): either find a situation where you will always work with the same doc or a larger place with a strong central management function that assigns and trains you. I never got to do #2, but I've seen it work. #1 has worked for me. I knew that that was what I wanted after my EM rotation in school taught me that working with lost of different providers -- at least starting out in a new discipline -- wasn't my cup of tea.

Good luck!

[newton9686]

Yeah I would keep your head up. It really is about finding the right fit when you are young. Also working with the same provider helps because you develop an understanding of each other. Also certain specialities are tougher on new grads than others. I didn’t cut it in ER right out of school, but I excelled as a hospitalist PA. Just don’t give up and keep trying. 

[cbrsmurf]

Probably an unpopular opinion, but how good of a PA you become really depends on your on-the-job training.  You could be an amazing PA student with a lot of prior HCE, but if you don't have someone teach you the in's and out's of the specialty, work life can be very difficult.

[marpac]

Thanks all so much for all of your input. To the above, I totally agree- which is why I ultimately decided to leave this job, because I felt that if I didn’t continue to learn on the job, my skills would grow stale. I really want to connect with a single doc and really forge a supportive and understanding relationship.

I really appreciate everyone’s perspective. Chin up for now, and I’ll keep on trying. 

Cheers

[6oo6le]

Strange how eerily relatable this post this....I'm right there with you feeling extremely discouraged with being a PA.  I just had to leave my job yesterday due to feeling unsafe as well, after only working for 5 weeks.  What was presented to me during the interview process and what was documented on the delegation agreement was NOT what was actually happening.  The supervising MD touted his skills and love of teaching and mentoring.  The delegation agreement said he would be having daily conference calls in order for good supervision.  The reality was that I was left on my own and was berated for asking stupid questions.  To add to that, I was expected to take calls for multiple other buildings for other docs I've never met, for other nurses and patients I never met, and to make snap medical decisions at 3 am without having full assessments by nurses, to beef up medical charts in order to meet requirements for facilities to make money, and to contend with sue happy family members.  When I asked to explain myself, the MD stated this was a one way conversation and that he had already given me a hour of his time LAST week for a talk.  The delegation agreement said he would be available for conference calls DAILY.  It also said that if he was off, then the PA would cease to operate medically.  Why were we informed via email to not bother him with questions while he's taking time off then?  I felt clinically unsafe, and that my license was up for grabs.  After having poor luck with finding work for practically 6 months, now I feel terrible about myself and am doubting whether I belong in this field.  I feel like giving up but I know that I have the compassion and skills and drive.  I am at a loss for words.