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New grad PA and the amount of “grunt work” involved


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I’m a dermatology PA mostly focusing on medical dermatology. I’ve been working in this office for a little over a year now

When I first started seeing patients my patient load was very light and I was able to handle the amount of prior authorizations, prescription refills, ordering my own lab work, patient phone calls etc. 

Throughout the year, my patient load has dramatically increased and with that, the amount of paperwork that comes with it. I of course, do my own charting. My supervising physician has his own nurse that does all the charting for him and all of his paperwork. 

I asked my office manager (who is my SP’s wife; a red flag- I know) for some help with doing my paperwork since I see my patients 5 days a week and do my charting (my SP only sees patients 3 days a week). She just laughed at my face and said that I need to “pay my dues” and “work for my paycheck” since I am a new provider and a PA and not a MD/DO.

Undoubtedly, I am in a bad office that is poorly managed. But is it usual for any new PA grads to do a majority of their grunt/paperwork? I certainly wouldn’t think so, but now I feel guilty for asking for help when the management and my SP makes it seem like I need to do everything because I am such a new provider.

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I worked for a time in a dermatology practice before PA school, and the PAs were treated the same as the physician practice owner. Each provider had their own MAs assigned each day to help with scribing (which dramatically cut down on charting time), assisting with procedures, and assisting in surgeries on OR days (each PA performed their own surgeries just as the physician did, with the exception of Mohs surgery).

There was also a full time MA whose job was to take care of prior authorizations and associated paper work. In sum, the PAs were given the same resources as the physician to ensure efficiency, which allowed them to spend more time seeing patients and less time doing paperwork. One PA was only a few years out of school and didn't see nearly as many patients as the physician or more experienced PA, and yet she was still provided with the same resources as the other two -- there was no "paying her dues".

It appears you are underappreciated at this practice, and that isn't likely to change. 

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Here's the dealio.  You make money for the practice.  Any time not seeing a patient- which includes doing vitals, pre-approvals, getting records, and whatever bullshit they want is A. Money lost and B. Something you are too valuable for.  They literally can't make money without you.  Time without a patient in front of you is money wasted.  A good office manager would recognize that, but it's obvious you don't have one.

You don't need to pay any dues.  You went to school to see and treat patients, you put in your dues.  Let the high school graduate get records or fill out pre-auths.  They can pay their dues.

Walk.

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They are disrespecting you. Even as a new grad, you deserve to be given the same support staff as any other provider, especially now that you’ve taken on a full clinic schedule. The derm practice I work at gives each provider (MD/PA/NP) 3 MAs per day to room our patients, scribe for us, turn over the exam rooms, etc. Each provider is also assigned an assistant to do all of our path and lab call-backs (other than MM or other complex cases). These assistants also handle all prior auths and field phone calls from our patients. 

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I was in a very similar situation to you as a new grad a year ago.  Didn’t have any help at all and had to room my own patients, clean rooms, draw up all my own medications, take vitals and update meds, prior authorizations, check patients out, schedule patients, answer phone calls, etc.  all this in top of taking first call with no extra compensation around 10 days a month. I went to Physician I worked with (who has two full time MAs) and was told something similar. Went to management and said PAs are like super MAs because they do all the work the MA does and can bill on top of it and see patients. It was terrible.

I left and got a new job that is 1,000,000 times better.  Dedicated nurse that works with me and is a life saver.  I’m now seeing ~25-30ish patients a day and doing fine where as my last job 14 has me there hours late.  Every provider is treated the same and PAs are really respected. 

Long story short, try to find a new gig.  Trust me it’s worth it.  I did the same thing with trying to justify it (I’m new, paying dues, etc.) but it was the best decision I’ve made to leave.  I encourage you to do the same.  It’s not going to change. 

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I was in a very similar situation to you as a new grad a year ago.  Didn’t have any help at all and had to room my own patients, clean rooms, draw up all my own medications, take vitals and update meds, prior authorizations, check patients out, schedule patients, answer phone calls, etc.  all this in top of taking first call with no extra compensation around 10 days a month. I went to Physician I worked with (who has two full time MAs) and was told something similar. Went to management and said PAs are like super MAs because they do all the work the MA does and can bill on top of it and see patients. It was terrible.
I left and got a new job that is 1,000,000 times better.  Dedicated nurse that works with me and is a life saver.  I’m now seeing ~25-30ish patients a day and doing fine where as my last job 14 has me there hours late.  Every provider is treated the same and PAs are really respected. 
Long story short, try to find a new gig.  Trust me it’s worth it.  I did the same thing with trying to justify it (I’m new, paying dues, etc.) but it was the best decision I’ve made to leave.  I encourage you to do the same.  It’s not going to change. 
Don't get me wrong, new grads need to "pay dues" but that's learning what you don't know and asking for help not being somebody's Rooty poot

Sent from my SAMSUNG-SM-G891A using Tapatalk

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You already pointed out one big problem...wife as office manager. Never never never work in a practice where the SO is the nurse or office manager. This is what happens.

Find another position. They don't respect you and clearly the office manager sees you as nothing more than a cash cow.

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15 hours ago, DermatologyPA said:

I asked my office manager (who is my SP’s wife; a red flag- I know) for some help with doing my paperwork since I see my patients 5 days a week and do my charting (my SP only sees patients 3 days a week). She just laughed at my face and said that I need to “pay my dues” and “work for my paycheck” since I am a new provider and a PA and not a MD/DO.

I'm not a proctologist, but I know an a-hole when I see one. 

If you feel like you are gaining good procedural experience that will eventually help you land a better job, you might stay as long as is tolerable. Otherwise, flee!

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I didn't read all of the replies, but as thinkertdm stated: any time you are not face-to-face with a patient costs the practice money.   I will never understand why medical practices want PAs to work as glorified secretaries or MAs.  It just doesn't make sense.  As for doing your own Prior Authorizations...just stop.  That is work for the MA, not the provider.  I have never, and will never, submit a PA.

Whether you should just jump ship, I believe this forum has a bit of a "knee-jerk" reaction to jump to that conclusion.  It may be the right answer, but you need to consider what is your next step, and whether your job is worth staying at.  If you are making the top dollar that many derm PAs make it may be worth it to put up with cra* until you retire in 5 years (only sort of joking).  If you are making a more normal salary, than that obviously changes things.

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8 minutes ago, mgriffiths said:

I didn't read all of the replies, but as thinkertdm stated: any time you are not face-to-face with a patient costs the practice money.   I will never understand why medical practices want PAs to work as glorified secretaries or MAs.  It just doesn't make sense.  As for doing your own Prior Authorizations...just stop.  That is work for the MA, not the provider.  I have never, and will never, submit a PA.

Whether you should just jump ship, I believe this forum has a bit of a "knee-jerk" reaction to jump to that conclusion.  It may be the right answer, but you need to consider what is your next step, and whether your job is worth staying at.  If you are making the top dollar that many derm PAs make it may be worth it to put up with cra* until you retire in 5 years (only sort of joking).  If you are making a more normal salary, than that obviously changes things.

Haha, I wish I could retire in 5 years! I live and work in a mostly rural area and lots of Medicare patients. No cosmetic dermatology, so not a lot of cash paying business here. Salary is below average or at least at the lower end of normal for dermatology and the amount of experience that I have.

I’m definitely considering my next step and have reached out to multiple drug reps that know other offices that may be hiring in the region. I’m not planning on staying in the same city. 

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The advice to move on is given often and I have given it myself. The choice to do that should be done thoughtfully and in a planned fashion. The other end of that advice is generally don't quit a job until you have some place to go.

Places where you aren't respected generally don't improve with time. The disrespect is a clear indicator of what they really think of you.

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28 minutes ago, mgriffiths said:

I didn't read all of the replies, but as thinkertdm stated: any time you are not face-to-face with a patient costs the practice money.   I will never understand why medical practices want PAs to work as glorified secretaries or MAs.  It just doesn't make sense.  As for doing your own Prior Authorizations...just stop.  That is work for the MA, not the provider.  I have never, and will never, submit a PA.

Whether you should just jump ship, I believe this forum has a bit of a "knee-jerk" reaction to jump to that conclusion.  It may be the right answer, but you need to consider what is your next step, and whether your job is worth staying at.  If you are making the top dollar that many derm PAs make it may be worth it to put up with cra* until you retire in 5 years (only sort of joking).  If you are making a more normal salary, than that obviously changes things.

Good analysis.

 

First off, people don't "deserve" anything other than some respect as long as you are respectful of other people.  If the practice wants a PA to waste time with prior auths or mop the floors, well they are going to lose money.  You have to decide if this is the type of work you want to do.  Obviously you should factor in financial factors such as whether you are paid hourly, salary, or receive bonuses.

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7 hours ago, mgriffiths said:

I didn't read all of the replies, but as thinkertdm stated: any time you are not face-to-face with a patient costs the practice money.   I will never understand why medical practices want PAs to work as glorified secretaries or MAs.  It just doesn't make sense.  As for doing your own Prior Authorizations...just stop.  That is work for the MA, not the provider.  I have never, and will never, submit a PA.

Whether you should just jump ship, I believe this forum has a bit of a "knee-jerk" reaction to jump to that conclusion.  It may be the right answer, but you need to consider what is your next step, and whether your job is worth staying at.  If you are making the top dollar that many derm PAs make it may be worth it to put up with cra* until you retire in 5 years (only sort of joking).  If you are making a more normal salary, than that obviously changes things.

Absolutely true.  You gotta do you.  A person can put up with a fair amount.  I've met PA's who basically did a H&P, then the MD did the thinking, and they were fine with that.  You don't want to bail the second someone looks at you wrong, or a patient calls his congressman, or a fellow PA calls you and dresses you down for your clinical opinion. 

However, keep light on your feet.  Take what you can- knowledge wise.  It's a learning experience.  When its time to go, you'll know.  And go with a light heart but a heavy brain full of knowledge.  Some specialties take some learning to get into; if getting that is sticking with a practice that is bearable, do it.  Only you can decided the cost vs the benefit.

 

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Hi everyone, 

Thank you all for your great replies. 

It is clear that I am in a position where I am disrespected and treated poorly. Everyday feels like I am drowning more and more and it’s difficult for me to catch up on all of my tasks. 

I have started to reach out to contacts in the region (drug reps, for the most part) to keep their ears peeled for offices that are hiring. 

Has anyone worked with recruiters before? I am on LinkedIn and I am starting to get a lot of connection requests for dermatology recruiters. 

I’m having a lot of anxiety about potential leaving the practice on a “sour note.” Especially when the main issue is that my SP’s office manager is his wife and it’s the main person causing all of these issues. I do have 1 year of experience down. But I’m just worried that this will not allow me to find another position due to putting down my place of employment. I’m worried that should my potential future employer will call her. My anxiety is just really high about this. 

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I have accepted a new position already and not even notified my current employer.  Interviewed at several different jobs and had no issues.  I just made it clear to anyone I interviewed with that they do not have my permission to contact my current employer for obvious reasons and will need my consent.  I've done that even before I became a PA and have had exactly zero issues ever.

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^^This. Anyone who has conducted interviews understands that speaking to your current employer might cause you problems. Just tell them no...please don't. It shouldn't require much explanation and shouldn't cause you any problems. I would, however, caution you to keep it fairly tight as to who you tell you are looking. Word has a way of getting around.

A bit of angst is normal. Just don't let it cause paralysis. Many many PAs have been in your shoes and did just fine. You will look back on this at some future time and see it as a learning experience. (You aren't a real PA until you get fired once.) ?

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I liked Scott's earlier answer about first finding another practice and then quit. Obviously this SP's wife is going to give you a poor recommendation and say that you are lazy and feel entitled. Start looking! I see this new generation of PAs has a new word for what we used to call "Scut Monkey" work.

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On 11/1/2018 at 2:35 PM, DermatologyPA said:

Hi everyone, 

Thank you all for your great replies. 

It is clear that I am in a position where I am disrespected and treated poorly. Everyday feels like I am drowning more and more and it’s difficult for me to catch up on all of my tasks. 

I have started to reach out to contacts in the region (drug reps, for the most part) to keep their ears peeled for offices that are hiring. 

Has anyone worked with recruiters before? I am on LinkedIn and I am starting to get a lot of connection requests for dermatology recruiters. 

I’m having a lot of anxiety about potential leaving the practice on a “sour note.” Especially when the main issue is that my SP’s office manager is his wife and it’s the main person causing all of these issues. I do have 1 year of experience down. But I’m just worried that this will not allow me to find another position due to putting down my place of employment. I’m worried that should my potential future employer will call her. My anxiety is just really high about this. 

You don’t have to leave on a sour note at all and you don’t have to tell people why you’re leaving, just make sure about and get in writing the things that are important in a new position.  You said you aren’t planning on staying in the area so for all anyone needs to know you are ready for a change in scenery.  No need to disparage your current office to offices you apply at.  

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^^ This. Never burn bridges. Also you don't have to wax poetic about your reasons for leaving. "I have decided to pursue other opportunities. Thank you for the experience here." 

My wife used to want to write novels about why she was leaving somewhere. I finally got her to understand...short..polite...simple. If they want to know more (and they rarely do) just give them more vague polite information.

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