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Totally Burned Out...and less than a decade in. What's next? [VENT]


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Sorry to bother y'all, not strictly a medical post.  Just wanted to get thoughts/ideas, and vent. I have another account here, but wanted to stay anonymous-ish.

I've been a PA less than 10 years, and I'm totally burned out. 

For the past bunch of years, I've been doing Urgent Care, and it's all I know how to do...but I think I'm done with it...and maybe done with PA, the way the industry looks.

I've watched the urgent care patient meter creep from 2.5 patients per hour, to three, to four...and I can't do it anymore. I had energy ten years ago. But now...it's just cold, after cold. after cold. after cold. before dawn to long after dusk.  40 of them a shift. 12 hour shift after 12 hour shift. with full documentation. click. click. click. over and over.  When I started in this field, the variety was interesting. And there was time to learn, ask, discover.   But now it's a patient mill...everywhere.  I come home from work exhausted, hungry, back aching, barely able to face another day of endless nonsense and endless charting that continues well into my home life.  Click. Click. Click.  Every ROS/PE the same enough to make me want to punch myself, but just different enough that I have to pay half-mindless attention which URI complaint i click on this time. Over and over. I've tried all the hacks for speed, all the macros available in the EHR, but there's just so much you can do to hack 40 charts a day.   I'm bored, exhausted, wiped out, and have lost my passion...helping people, personally, without feeling like the clock was going to crush my soul, or if not the clock, the boss doc ready to fire me for slowness.  It's not why I got into this profession.  Everywhere I look in my region, it's the same...four patients an hour, five, maybe six.  I'm sure half the high-energy folks here on PAForum can tear that to shreds that with no problem...blaze through twelve hours of four  dozen colds and hundreds of pages, dictations and clicks of doc.  I guess I'm the drained lunk.   

And high acuity is not my cup of tea...just don't have the brains for it, don't have the concentration, recall, and integrated, multi-directional multitasking thinking for it....and never did even in the ER.  So fast track it is, and always has been, for me.  And apparently, plenty of young, energetic PAs ready to blast through 150 patients a week as the hiring lines are out the door. But I am apparently not that person...the industry has hit the racetrack, but I only got older and more tired. And I'm only a quarter way though my career at best. I once thought I was in love with low acuity emergency medicine.  But I am out of juice.

And if that wasn't enough...due to life circumstances, i had to switch jobs a few times. My resume is filling up...six job switches in seven years, all for perfectly good reasons, (switched from a specialty to EM, then to UC, then one place downsized, then a locums job finished contract, moved across a state for another...a lot of happenstance mostly out of my control).  But my resume is getting longer, and if I quit my current place before it totally kills me....i'll almost certainly be unhirable.  Seven jobs in seven years..my PA resume will almost certainly be as good as trash. For good. 

Lost, don't know what to do next.  Looking for some thoughts and experiences (and empathy, unless that's asking too much). 

P.S. With all due respect, please hold off on the "four an hour? I see six an hour ,seven days a week!" comments. I'm happy you have the passion and energy.  I don't. 

 

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You are in the wrong place and you most certainly know that. Believe it or not, that's a really good thing to recognize. It doesn't matter how you got where you are or how many jobs are/will be on your resume. You'd be surprised how many people ignore their inner voice and come up with reasons they can't change course.

They may even decide that their crappy job is the only job in the world that they are qualified to do, or that younger, smarter people are on the way. Believing that is one consequence of staying in a bad place for way too long. And those thoughts are energy vampires, making you limit your own possibilities. No: It's just time to call your next play.

Maybe it is time to try a different career, but maybe not. Right now, all you know for certain is that it's time to find something that that honors you. Not the perfect job (whatever they are), but one you feel comfortable doing, makes you feel you are doing good work, and gives you more than some money at the expense of too much of your dignity. Some people -- including some PAs -- have those jobs and there is no reason you shouldn't either.  

I don't know if you need a sabbatical; not having a job can make some people feel desperate. Sometimes there is no better a time to look for a job than when you have one, even if it's a crappy one. I suggest you stop beating yourself up and telling yourself all the things you're not good at. Instead, start looking for something that would interest you. If you can't think of anything,  then consider spending a day shadowing a friend who has a job they like. Baby steps can sometimes help shake off the numbness you've developed from having a job that doesn't meet your needs.

Don't let yourself get slaughtered in the trenches; rise up and find a new direction. It's out there for you to find. The search may not be easy, but learning who you are and what you really want is worth the effort.

Been there: done that.

Best wishes.

 

Edited by UGoLong
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If you’re seeing your own patient panel in whatever specialty that may be, I’m not sure you can get any lower than 3/hr.  I think Rev’s got a gig where he doesn’t see that many though.  Maybe PM him and see what he’s got going on and see if it’s something of interest.  We’ve always been revenue machines for docs/practices since the beginning so if you’re not generating enough then as you pointed out, there are other fish in the sea.  When I used to do ED FT and they’d bitch about 3.5/hr. and yet I was doing my own splints, free typing discharge instructions, and setting up my own disposable lac trays; I finally told them “see you later, alligator” and left with one of our FM docs to open his own private practice.  No matter how much they blow smoke and tell you how great you are, it’s still about the dollars.

Check into IR.  Nothing but procedures.

Edited by GetMeOuttaThisMess
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I would have written the same thing, word for word, a year ago, when I was working a walk in. If you are feeling mentally unstable, make an appointment with someone, you should know who.

I returned to the va (which I never should have left) and am immensely happier.  It's a world of difference from the civilian bean counters.  Last week, a guy came in wanting me to admit me to admit him so he could get a break from his life; he claimed he had been having some chest pain but "nothing new".  EKG done in the office showed nothing, but I sent him down to our urgent care.  His nstemi probably gave him the break he was looking for.

My point is, reading between the lines of your post, you may be feeling trapped and out of options.  You have lots, as tired as you feel.  The VA changed my life.

Two issues with your post: one, y'all doesn't translate well when written, it makes you sound like mater.  Like tow mater.

Two, you claim to not "have the brains" or some shit like that.  Any one of us would feel that way seeing ding dongs with colds for a week, much less a year.  

Anyways, if you are near Illinois send me a message and we can talk if you want to know more about the VA.  I have no input into hiring at all, but I know that two primary care spots will be coming open soon.  

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Weeeeelllllll.... lets see what I can contribute. Until about 6 months ago I was pretty much in the same position. I've been a PA for about 30 years and after years of more or less being my own boss life happened and we had to move to care for aging parents and I entered corporate medicine. Idiotic rules made by people who don't understand medicine. The solution to everything is "see more patients with less support". No voice in anything. We don't even need to discuss patients.

Someone recommended "The Subtle Art of Not Giving a Fuck" to me to read so I did. Then I read it again. Then it was like an ice flow breaking up and moving off.

What I came to realize is we have no control over anything and nobody cares about  our opinion on anything. So I started not caring back. I don't give a thought to admin and crazy rules. I can't control them and they mostly just flow around me without any major effect. Patients? If they are morons I just shrug and move on to the next one. The ones that really needs something get all I have to give. Numbers? I go at a steady pace whether there are 2 people waiting or 50. If people leave without being seen...oh well. I can only go so fast and if they want more people seen faster we need more staff and resources. If they mention it to me I say "OK" and do what I was doing.

Basically if you get to the realization you don't have any control AND don't give emotional energy to things you can't control you will feel much better. I enjoy my work most days because I like the people I work with and help the people I can without getting tied up with fools. 

Read the book.....

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EKG done in the office showed nothing, but I sent him down to our urgent care.

It was precisely this statement that also made me realize very early on that the VA and I didn't share the same mindset.  ACC, which has no greater diagnostic capability than the clinics as well as set hours (which the nursing staff was quite quick to point out), resulted in situations where "I" would end up being the one to dump the patient on the ED physician.  Attendings in my clinic made darn sure to wash their hands of these cases as quickly as possible.  Maybe your facility functioned better than the one that I was briefly at.

 

Edited by GetMeOuttaThisMess
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19 minutes ago, GetMeOuttaThisMess said:

It was precisely this statement that also made me realize very early on that the VA and I didn't share the same mindset.  ACC, which has no greater diagnostic capability than the clinics as well as set hours (which the nursing staff was quite quick to point out), resulted in situations where "I" would end up being the one to dump the patient on the ED physician.  Attendings in my clinic made darn sure to wash their hands of these cases as quickly as possible.  Many your facility functioned better than the one that I was briefly at.

The UC downstairs has the capability to order stat labs, cxr, ct, and decide to move the patient upstairs (as we claim to be a hospital), send him home, or to a civilian hospital with better cardiac capabilities.  As we claim to be a hospital, but don't actually have neurology, true on call cardiology, they do what they can.  I would have done more, because I hate sending out these guys if they don't need to go, but if they do, I like to get what I can, or start labs, etc, before sending them down.

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Ok UC has some very real downsides but take a minute and try to see some upsides and the downsides of other positions. We all have different values and things that are important and the perfect job doesn't exist.

I am well paid and have good benefits.

I am never on call.....I hate call with a burning passion so that is a big one.

I work longer shifts and fewer days

I am lucky in that I work for an organization that values evidence based medicine. A patient complaint about not getting antibiotics for a cold gets no attention unless they claim they were mistreated somehow. Be polite at all times and never have a problem.

Downsides

Patients suck. They suck everywhere but they are forced on us in untenable circumstances. This can be ameliorated by not giving them any emotional energy

Admin sucks but they suck everywhere. I manage that by generally ignoring them, not doing stupid things they say have to be done, and doing the things that have to be done promptly and well.

Basically it can be a good gig if you manage it well and keep your emotions out of it. It isn't for everyone but it suits me.

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Man, I could have written that post myself 3 months ago. 

I finally had to advocate for myself and drop my FTE (hours). Our organization mandates  80:20 clinical/administrative time, so I dropped down to 36 hours per week and put my admin time as a block on the same day. What that equals is four 8-hour days a week. So, never more than 2 days in a row. So far it has been a game-changer. 

High volumes will kill you. I was seeing 4-5 an hour plus 1 Saturday a month, and was completely fried. Nobody cares, nor understands unless they are doing it too. Admin doesn't care nor will they ever unless you abruptly leave. And then they will just go into crisis mode until they find a replacement. You have to advocate for yourself if you want to last in this profession, especially FM/UC where all employers care about is volume. 

It may be that you cant do that at your current job---commercial urgent cares are meat grinders for providers. If you gotta leave, you gotta leave. Oh and any snot-nosed punk who says they're seeing 5,6,7+ an hour "no problem" just hasnt been working long enough. It will catch up to them.

One other thing: stop caring about people's problems. I care about making good decisions and not missing things---workmanship, so-to-speak. But IDGAF about patients' innumerable problems and their laundry list of needs. It's callused but you have to be to survive. If you just have the objective of making efficient, up-to-date clinic decisions you'll still do right by most of them.

Edited by BruceBanner
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Let me add my personal philosophy...all admin cares about is volume and patient satisfaction. When 7 people leave in a day without being seen someone finally notices. When cycle times go to 2 hours someone finally notices. They listen to nothing we say so I speak to them in the language they understand. 3 an hour....steady as a tug boat.

I needed to come back and add another thought. The problem for me personally was the amount of emotional energy I was giving to this stuff. There are still lots of things about this job I don't like but I'm spending more time thinking about the upsides and zero time stressing over the parts I don't like but can't change.

Edited by sas5814
spelling, fat fingers
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So, I don't think a seven-jobs-in-seven-years makes you unhirable.  Ten years ago, it might have, but the business of medicine has become the business of medicine; switching jobs is commonplace.

Yes, I do intentionally manage my employment such that I never am scheduled to see more than 2/hour. My advice is the exact opposite of much of the above advice, but that's because I came to medicine later in life from a background in both security and pastoral counseling.

When I did sleep medicine (I recently quit after 2 years; boss issue, not medicine issue) I would see about 20 per day, perhaps 8 new patients, and that was doable without MA support and really shoestring clinic staff. Sure, it was all the same, but unlike snot clinic, there were really only three CC's: "X thinks I have sleep apnea", "I have trouble sleeping", and "My insurance needs me to establish care with a sleep center so I can get CPAP supplies".  BUT, maybe 2-5% of the patients came up with something weird and different, like the married 20's year old guy who had wet his bed essentially his entire life and despite every intervention to date.

I also got into occupational medicine, and work mostly on long-term injured worker cases.  These are reimbursed well in my state, better than most commercial insurance, so I can see 2 per hour and still create much more revenue than if I were processing medicare patients through as fast as possible.  This is part of where I differ from the above:  I see the same patients month in and month out, working with them, getting to know their lives, and helping them manage the psychological, social, and spiritual consequences of long-term injury and consequent unemployment.  I work with a cadre of other professionals who are more than just referral targets, but who actually do team-based medicine even though we all work for different organizations.

Two very, very different worlds than Urgent Care, but ones that yes, I'm sure you can function well in, because I'm not that far from you in terms of never having done brain surgery (metaphorically, obviously) as a PA.  I couldn't do what you have done successfully--it would have driven me crazy before now.  Take heart, there are different jobs out there.  Not all are great, but there's more you can do with an UC background other than just EM.

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3 hours ago, EMEDPA said:

any interest in teaching? with so many new programs opening up, you basically need an MS and a pulse to get a job.

 

 

I would love love love to start teaching.  I think I could bring a lot to the table for young providers, but every teaching job I see requires experience.  I have taught in clinic tons of providers, including docs, but not formally in college so I have a big goose egg in that box :(  I'm not sure it's as easy to get into as eluded, but I might just be looking at the wrong programs.

 

On the UC thing....Yea, patients can suck and frequently do.  Every once and a while one will buck the trend and be nice or just simply thankful.  This is the exception though.  Pt's in corporate UC are hip to the game.  Bitch about anything and they will get their visit written off or sent a Starbucks gift card saying we are sorry for your bad experience.  The provider gets thrown dead ass under the bus and in several cases I have been asked to call a patient and apologize for whatever grievance they have.  The funny thing is, I have over a 9.7 out of 10 overall provider survey rating, but every once and a while you get a hateful patient and they destroy you on a review.  That's when the, "we need you to call this patient and apologize for their bad experience" request comes.  Frustrating doesn't begin to cover it.

 

And yes, this post could of been written by me....last week.

 

I'd say hang in there, but I'm not sure that's the right advice.  My wife and I have been looking for serious alternatives to medicine going forward.  Like I said, I would love to teach, but other then that we are planning on selling our house and downsizing mightily.  Taking the money and live like poppers to make it last until SS.  Drastic change calls for drastic changes. 

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I have been asked to call a patient and apologize for whatever grievance they have."

 

That one might cost me my job because my answer would be a hard "no". My dignity isn't for sale. Much like when I was told to run the front desk because the clerk went home sick....no. Or when I was told to room my own patients for 12 hours because they couldn't find a nurse or MA....no. I didn't get horsey... just said no. They looked at me like I had just started speaking Russian or writing in sanskrit. But it stood.

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30 minutes ago, Cideous said:

 

 

I would love love love to start teaching.  I think I could bring a lot to the table for young providers, but every teaching job I see requires experience.  I have taught in clinic tons of providers, including docs, but not formally in college so I have a big goose egg in that box 😞 I'm not sure it's as easy to get into as eluded, but I might just be looking at the wrong programs.

 

check here: A lot of these are entry level and require clinical, but not teaching experience. http://jobs.paeaonline.org/

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On 1/22/2019 at 3:21 AM, thinkertdm said:

Two, you claim to not "have the brains" or some shit like that.  Any one of us would feel that way seeing ding dongs with colds for a week, much less a year.  

I appreciate that, but no, I actually can't....tried doing main ER and simply could not keep up with the combination of multitasking and complex workups...could not keep my story straight and never, ever knew what to do next.   I've accepted it's not something I simply cant cognitively integrate. Luckily I did fine in UC thank god...at least when it was reasonable volume. 

On 1/22/2019 at 3:21 AM, thinkertdm said:

Anyways, if you are near Illinois send me a message and we can talk if you want to know more about the VA.  I have no input into hiring at all, but I know that two primary care spots will be coming open soon.  

On the East Coast...but thanks!

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On 1/21/2019 at 9:13 PM, PASamsOTHERacct said:

Sorry to bother y'all, not strictly a medical post.  Just wanted to get thoughts/ideas, and vent. I have another account here, but wanted to stay anonymous-ish.

I've been a PA less than 10 years, and I'm totally burned out. 

For the past bunch of years, I've been doing Urgent Care, and it's all I know how to do...but I think I'm done with it...and maybe done with PA, the way the industry looks.

I've watched the urgent care patient meter creep from 2.5 patients per hour, to three, to four...and I can't do it anymore. I had energy ten years ago. But now...it's just cold, after cold. after cold. after cold. before dawn to long after dusk.  40 of them a shift. 12 hour shift after 12 hour shift. with full documentation. click. click. click. over and over.  When I started in this field, the variety was interesting. And there was time to learn, ask, discover.   But now it's a patient mill...everywhere.  I come home from work exhausted, hungry, back aching, barely able to face another day of endless nonsense and endless charting that continues well into my home life.  Click. Click. Click.  Every ROS/PE the same enough to make me want to punch myself, but just different enough that I have to pay half-mindless attention which URI complaint i click on this time. Over and over. I've tried all the hacks for speed, all the macros available in the EHR, but there's just so much you can do to hack 40 charts a day.   I'm bored, exhausted, wiped out, and have lost my passion...helping people, personally, without feeling like the clock was going to crush my soul, or if not the clock, the boss doc ready to fire me for slowness.  It's not why I got into this profession.  Everywhere I look in my region, it's the same...four patients an hour, five, maybe six.  I'm sure half the high-energy folks here on PAForum can tear that to shreds that with no problem...blaze through twelve hours of four  dozen colds and hundreds of pages, dictations and clicks of doc.  I guess I'm the drained lunk.   

And high acuity is not my cup of tea...just don't have the brains for it, don't have the concentration, recall, and integrated, multi-directional multitasking thinking for it....and never did even in the ER.  So fast track it is, and always has been, for me.  And apparently, plenty of young, energetic PAs ready to blast through 150 patients a week as the hiring lines are out the door. But I am apparently not that person...the industry has hit the racetrack, but I only got older and more tired. And I'm only a quarter way though my career at best. I once thought I was in love with low acuity emergency medicine.  But I am out of juice.

And if that wasn't enough...due to life circumstances, i had to switch jobs a few times. My resume is filling up...six job switches in seven years, all for perfectly good reasons, (switched from a specialty to EM, then to UC, then one place downsized, then a locums job finished contract, moved across a state for another...a lot of happenstance mostly out of my control).  But my resume is getting longer, and if I quit my current place before it totally kills me....i'll almost certainly be unhirable.  Seven jobs in seven years..my PA resume will almost certainly be as good as trash. For good. 

Lost, don't know what to do next.  Looking for some thoughts and experiences (and empathy, unless that's asking too much). 

P.S. With all due respect, please hold off on the "four an hour? I see six an hour ,seven days a week!" comments. I'm happy you have the passion and energy.  I don't. 

 

I hear you and fully understand your position! PM me to speak out of the net.

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  • 1 month later...

Some more thoughts after some more work...

I think i finally realized what's missing, in large part. 

This place, which I am despising more and more daily, is really decent by most measures; good co-workers, good supervisors; honestly, really good supervisors.  Good schedule. Pay is ok. Supportive staff.

But, as the fast track person (it's structured so that the MDs here usually see the higher acuity Urgent Care), my job involves sitting in a little cubby hole, with no windows, not near other staff, all alone, seeing sinus infection after sinus infection after sinus infection after sinus infection, for 12 hours straight, sometimes with no more than ten minutes for lunch as there are too many callbacks and labs to review. 

The place varies over the course of a day from between three to four patients in an hour;  not much by or Urgent Care standards, but it's just barely enough when the patients always have more questions and new complaints they didn't mention at triage, charting gets more and more demanding, and I often end up five or six charts behind, further eating into my lunch half-hour; it's so frustrating that buy hour number 8, I literally start spacing out in front of the patients and get the urge to punch the patient in the face and tell them to shut up, let me explain to them what a virus is, and get them the hell out before I fall even more behind.

I've had crappy jobs in the past, but one thing kept me in them: coworkers. I say it again. Coworkers. I think that's what's missing.

I've never been this isolated at a job, sitting with no one to talk to; even in the rare occasion when I work outside of the fast track section, the docs are too busy to have small talk.  In previous jobs, we all sat together, providers and MAs and X-ray techs and whoever else, and an otherwise mundane day could be made much more bearable because of the relationships and chit chat.

Furthermore, and I'm not sure if I realized how much of an effect this would have, it's really an odd thing to sit in a windowless room for 12 hours. Most of the previous jobs had some natural light and natural outside life and movement coming through windows or streaming in from the waiting room, but this is like working out of a closet. Even my SAD lamp is no help.

I really feel guilty leaving a job that has the rare qualities of great supervisors, minimal middle management, and professional, kind coworkers, I certainly can't discount how vital that is...but at the same time, I can't even stomach the thought of spending my next shift in a dark cubbyhole, alone, for 12 hours, let alone the next week, month, or year. Honestly, the thought of going to work nauseates me every morning now.

I really am terrified to even ask my current job about going part time, or just asking for advice... I'll be seen as a complainer and weak in an industry dominated by endless-energy, hardcore ER trained "being it on and throw me more patients" types, ungrateful, and perhaps told, "sorry, it's 40 hours a week here, or there's always McDonald's".

And I don't want to appear unhumble and picky...And I feel like leaving an otherwise respectable job with good supervisors and decent pay because I prefer camaraderie and interaction at work, and having some connection to nature outside, is babyish and immature. But I feel like this the place is tearing my soul out, and is making me rethink if I even want to stay in medicine. If I have to document another sinus pressure chart, I think I'll cry... But I have to, all day.

I don't even know if I want to do UC anymore, as pretty much all the jobs in my region have a minimum of 4 patients per hour, and it's all the same URI crap. maybe I could hack it part time, with more "decompression" days, but I think the odds of finding a good part time job, with good hourly pay, with a window, and some co-workers to talk to, and a decent boss, are exceedingly low. And unfortunately, no teaching jobs or no-admin-experience-needed admin jobs within 100 miles last time I checked. And I'm getting to old for the prospect of having to beg someone to retrain me and hold my hand in my primary or family med...not that the patient load would be any better there.

Oh, and before anyone asks, why did I take this job? It was actually a little bait-and-switch... They showed me one of their other centers where all the providers sit together in a nice sunny area. Unintentional on their part, but makes all the difference to me.

My job makes me want to vomit... But what if it's only downhill from here?

 

Edited by PASamsOTHERacct
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