New grad. Vein Clinic. Thoughts?

[PAFL12]

Title basically says it all but I’m a new grad in South Florida, where it’s well-known the market is horrific. Positions are very hard to find.

I graduated in August and have been looking for positions since. I’ve had a few offers, but none were good fits. Recently, I was offered a position in a vein clinic. It’s a family owned, small practice where the SP is an interventional radiologist. He primarily does sclerotherapy and needs a PA to help and also run the mini-cosmetic clinic he also has going which consists of Botox/Fillers. The pay isn’t good (70k) for the first year, but I truly like the doctor and he would provide stellar training. Historically, he’s had two other mid-level providers who were with him for 10 and 6 years respectively, and his office staff have all been with him long term as well, which I take to be a good sign. 

I’m strongly considering this offer for several reasons. Not only because the pickings are slim where I live (and I cannot relocate), but despite being an excellent student, I don’t feel ready to practice. This would be a good opportunity to get established in a niche sub specialty where they cater to new grads and love teaching. The atmosphere is very supportive.... but I’m scared of pigeonholing myself. My goal would be to eventually also do volunteer work in a free clinic on weekends to keep my general skills sharp. 

Any thoughts? Is this a terrible idea? The farther out from graduation I get, the more desperate I feel. I don’t want to make any rash decisions, but I’m painfully aware of my inexperience and personal limitations as a new provider. 

[rev ronin]

Two thoughts:

As a profession, our salaries are going to be driven down by people who cannot relocate.  Not saying that's good or bad, it just is.

Having said that, if it truly is a good work environment--and I don't necessarily grant that you know what you're really getting into, but you could well be right--the money isn't the biggest thing about a job.

Ok, one more: I really liked going into family medicine first.  Having done some specialty work, I really do like the diversity of primary care.  I cannot imagine what it would have been like to go straight into specialty.

Best wishes making the right choice.

[jeepgirl]

Hey,

I'm a fellow new grad.

I would pass on this offer - low pay and super niche specialty are my reasons why. 

I will reiterate what has been posted in your other dicussion topic.

1. Your feelings of not being ready to practice are not uncommon. Impostor Syndrome is a legit thing. Your thoughts seem to be almost paralyzing, though, and impeding your progress and growth. You would probably benefit from talking with a therapist to work through it all.

2. If you want training, consider a residency/fellowship.

3. Consider moving for better job opportunities. 

Good luck.

[sas5814]

"I don't feel like I am ready to practice"

 

How will you feel about your core skills after a few years of injecting spider veins with no other experience on top of your school training? I suspect you will feel even less prepared and will be stuck in a tough spot where, if you want to change jobs, you don't have the skill and experience to go somewhere else or try another field.

You NEED broader hands on experience.

Think hard about "can't relocate" and decide if it might really be "it would be difficult/inconvenient to relocate." If you limit yourself by specialty and/or geography you limit your opportunities.

Don't settle.

Good luck

[beattie228]

You're taking residency pay without getting the perks of a residency (formal teaching environment, networking opportunities, certificate of completion). You're going to end up doing underpaid scut work in a very niche sub-field. My PRN job is exactly what you're describing, vein procedures in an IR practice. Unless you demonstrate confidence and a level of comfort in the procedure suite (confidence that stems from prior work experience), you're not going to be given the green light to do the procedures. You'll end up doing pre-procedure/post-procedure follow up and possible Botox injections. As a new graduate who is already feeling shaky, having your skills atrophy will be a big disservice to you.

 

As was mentioned in your previous posting, post-PA residency is your best bet. I'm not sure what you're home life situation is in terms of not being able to move, but a year residency is a drop in the bucket in terms of length of time for your overall PA career.

[PAFL12]

19 minutes ago, sas5814 said:

"I don't feel like I am ready to practice"

 

How will you feel about your core skills after a few years of injecting spider veins with no other experience on top of your school training? I suspect you will feel even less prepared and will be stuck in a tough spot where, if you want to change jobs, you don't have the skill and experience to go somewhere else or try another field.

You NEED broader hands on experience.

Think hard about "can't relocate" and decide if it might really be "it would be difficult/inconvenient to relocate." If you limit yourself by specialty and/or geography you limit your opportunities.

Don't settle.

Good luck

I agree and my plan was to work in a volunteer clinic or UC part time to keep my general skills sharp. Moving unfortunately is absolutely not an option at this point in time, so I have to make the most of what I have. It truthfully is tremendously depressing. I’ve been hustling to find opportunities and there just aren’t many. 

[PAFL12]

26 minutes ago, beattie228 said:

You're taking residency pay without getting the perks of a residency (formal teaching environment, networking opportunities, certificate of completion). You're going to end up doing underpaid scut work in a very niche sub-field. My PRN job is exactly what you're describing, vein procedures in an IR practice. Unless you demonstrate confidence and a level of comfort in the procedure suite (confidence that stems from prior work experience), you're not going to be given the green light to do the procedures. You'll end up doing pre-procedure/post-procedure follow up and possible Botox injections. As a new graduate who is already feeling shaky, having your skills atrophy will be a big disservice to you.

 

As was mentioned in your previous posting, post-PA residency is your best bet. I'm not sure what you're home life situation is in terms of not being able to move, but a year residency is a drop in the bucket in terms of length of time for your overall PA career.

While I don’t feel ready to practice, I think much of this would be alleviated by having a supportive SP willing to train. Until I found this position, I wasn’t able to find anything remotely close to a supportive environment. I mentioned in another comment that I plan on working in a volunteer clinic that provides free care to the underprivileged. Similar construct with supportive, seasoned providers but no opportunity for full-time work. Would this be a good starting point (short of just finding another job) to offset some of the pidgeonholing I’m doing here? 

[sas5814]

Working in a clinic for the underprivileged will give you a lot of exposure to a lot of sick, complex patients. It would be a great way to grow your skills. I worked in one with better than 20 years experience (at the time) and it was a very challenging position. It is multifaceted in that they are often poorly educated, have few resources, and have horrible lifestyles health-wise. Trying to improve the health of someone who has no resources, doesn't understand a lot of what you tell them, and can't/won't make lifestyle changes will be educational.

[beattie228]

17 minutes ago, PAFL12 said:

While I don’t feel ready to practice, I think much of this would be alleviated by having a supportive SP willing to train. Until I found this position, I wasn’t able to find anything remotely close to a supportive environment. I mentioned in another comment that I plan on working in a volunteer clinic that provides free care to the underprivileged. Similar construct with supportive, seasoned providers but no opportunity for full-time work. Would this be a good starting point (short of just finding another job) to offset some of the pidgeonholing I’m doing here? 

The volunteering position likely won't have much teaching or support if it's as busy as other free clinics I've worked with earlier in my career. Paid urgent care or Primary Care work supplementing the vein job would be ideal for you. A lot of SPs will claim to teach, but when push comes to shove, they're about the bottom line of making money so you end up pigeon-holing yourself into doing what you initially are good at. This often means the pre/post-procedure patients as I mentioned above.

 

Only you can answer if it'll be a good opportunity for you. Biggest pieces of advice I have:

• don't sign for any time obligation
• have a clear understanding of the pay structure once you're up and running
• have a clear understanding of procedure training. Becoming comfortable with the ultrasound and sterile technique takes time and you want to make sure that's known up front
• identify a calendar of learning objectives and set up monthly sit downs with the SP to ensure you're actually getting some teaching and not just doing the scut work
• keep looking for the next gig because this likely won't be your be-all/end-all

 

Hope that helps.

[PAFL12]

1 hour ago, beattie228 said:

The volunteering position likely won't have much teaching or support if it's as busy as other free clinics I've worked with earlier in my career. Paid urgent care or Primary Care work supplementing the vein job would be ideal for you. A lot of SPs will claim to teach, but when push comes to shove, they're about the bottom line of making money so you end up pigeon-holing yourself into doing what you initially are good at. This often means the pre/post-procedure patients as I mentioned above.

 

Only you can answer if it'll be a good opportunity for you. Biggest pieces of advice I have:

• don't sign for any time obligation
• have a clear understanding of the pay structure once you're up and running
• have a clear understanding of procedure training. Becoming comfortable with the ultrasound and sterile technique takes time and you want to make sure that's known up front
• identify a calendar of learning objectives and set up monthly sit downs with the SP to ensure you're actually getting some teaching and not just doing the scut work
• keep looking for the next gig because this likely won't be your be-all/end-all

 

Hope that helps.

Absolutely helps! Thank you for this very valuable input! 

[thinkertdm]

"family owned"- what is the contribution of the spouse?  Having the bosses spouse as office manager - or really any other position -may not be a good idea.  

[PAFL12]

57 minutes ago, thinkertdm said:

"family owned"- what is the contribution of the spouse?  Having the bosses spouse as office manager - or really any other position -may not be a good idea.  

Spouse is not involved, but other family members are. 

[sas5814]

Run away. There will be the occasional person who will have a great story about working in a medical practice with family members as office manager or nurse or billing but hearing those stories is about as rare as spotting a Yeti riding a unicorn. If anything goes wrong...if there is any disagreement about anything it will always be them against you. I could tell you stories but just trust me.... avoid the headache.

[MT2PA]

10 hours ago, beattie228 said:

The volunteering position likely won't have much teaching or support if it's as busy as other free clinics I've worked with earlier in my career. Paid urgent care or Primary Care work supplementing the vein job would be ideal for you. A lot of SPs will claim to teach, but when push comes to shove, they're about the bottom line of making money so you end up pigeon-holing yourself into doing what you initially are good at. This often means the pre/post-procedure patients as I mentioned above.

 

^^OP, this is the part you need to pay attention to.  Even urgent care jobs aren't going to be great at teaching/training/etc because many of them are just money factories these days.

You mention that there may be decent opportunities with SPs willing to teach but are only part time  - I would consider that a better option than being a botox machine working full time with sub par pay.

[Hope2PA]

Getting other experience Such as in Family med would definitely be a plus for you professionally. .... however, Have you attempted negotiating? Sorry if I overlooked it in comments.  Say, 70,000 first 3-6 months then increase to possibly 85,000 and another increase after a year.......in writing on your contract. Are they offering PTO, prof dev time and pay, health inc, etc... maybe  you could offer to work X number hours, like 30- 32,  for 70,000., That could free time up to do the volunteer work you mentioned. 

[Believe]

terrible, decline, don't think twice. Im a new grad who is 6 months into my specality and i still feel like i don't know what I'm doing....its normal. That job sounds like a place where ZERO medicine will be taught other than injections. 

[Hopeful2015]

I know how you’re feeling. Two questions.

How long is this contract for? 

What penalty do you face if you break the contact early?

 

The skills you’ll learn at this job are certainly valuable and you can potentially use them for the rest of your career to make very good money on the side, so I wouldn’t totally discount this position. If you’re starting to get desperate and need to bring in some dollars, take the job and continue looking for other gigs. The market in south Florida is insane. Ideally it’d be awesome to work in a broader field right out the gate to hone your medical skills, but sometimes we gotta do what we gotta do.

[PAFL12]

20 hours ago, Hopeful2015 said:

I know how you’re feeling. Two questions.

How long is this contract for? 

What penalty do you face if you break the contact early?

 

The skills you’ll learn at this job are certainly valuable and you can potentially use them for the rest of your career to make very good money on the side, so I wouldn’t totally discount this position. If you’re starting to get desperate and need to bring in some dollars, take the job and continue looking for other gigs. The market in south Florida is insane. Ideally it’d be awesome to work in a broader field right out the gate to hone your medical skills, but sometimes we gotta do what we gotta do.

No contract, so no penalty for leaving.