What do seasoned PAs think of my job role?

[tdpand]

Hi everyone,

I would love to hear the thoughts and opinions of experienced PAs out there. I graduated last August and didn't start working until this June (currently 27 y/o). I originally was supposed to start a job in Cardiothoracic Surgery in Wisconsin in January 2019, but due to many difficult circumstances I was forced to turn down that job and stay at home to look for another job instead of relocating for that first job. Since then, I interviewed for another CT Surgery job in February and was hired a week later. For whatever reason, the hospital was not able to credential me and I couldn't start until late June. So here I am, about one month in to this CT Surgery job. Insofar, there was only one other PA in the group who put in their 2 week's notice a day before I started. It took the hospital an entire week after my first day before I had any EMR access, so I basically spent my first week being useless, standing around observing the PA's job, trying to soak in all I could in order to function on my own when this PA departs. Much of this PA's job seems very administrative/secretarial.

Since then, I have taken on the same roles minus vein harvesting. Outside of prepping one patient for surgery on some mornings, putting in orders (only per the CT fellow and/or attendings' requests or already outlined algorithm), and doing notes, most of my day consists of rounding (alongside fellow +/- attending, intern, med student) scheduling patients for surgery, keeping records of clinic visits, making phone calls, and sitting around waiting for images or tests to come back and then reporting that to the fellow or attending. Now, I share these tasks with the intern and there is always an intern on the service. Between the two of us, these tasks truly don't take up a whole lot of time. Since the other PA's departure, I have been in the OR more often and thus these tasks, except scheduling and record keeping (that still falls on to me), are done mainly by the intern.

When I'm in the OR, I first assist for maybe about 20 minutes while one attending works up on the chest and harvests the LIMA while another attending or fellow is below harvesting vein. Once the vein harvester is done, they go up and act as first assist and then I become 2nd assist. Thus far, the attending whom I work directly with in the OR does not seem to have the patience nor desire to get me to the point that I will be competent at either vein harvesting, first assisting, or even closing. There may be one or another attending who does want to expand my skillset and job role, but this person does not work mainly out of this hospital and, as such, is only present once in a while and has no real impact on my day to day functions.

When I interviewed, I was told by the team that they had more than enough capabilities to train me (a new PA, whom they knew at the time was a new graduate whose most pertinent experience was a 6 week rotation of CT Surgery) and would make sure that if I decide to leave for somewhere else some years down the line that they would make sure I'd be the best applicant anywhere I go. I was very sold on that idea and I just really wanted to do CT Surgery and I was told that the job would be a mix of everything (i.e. OR first assist, vein harvesting, clinic days, inpatient management). A month in and I do not see my role progressing beyond that of mostly the aforementioned administrative work. I'm convinced that I'm in the OR now being able to first assist minimally and some 2nd assist mainly because there is no other PA on the team now other than myself. I've been told that someone overheard the attendings talking about how I won't have any real OR time. I've been told by one attending that they're working on hiring someone with EVH skills so that this person can teach me and the subsequent PA starting later this year to perform EVH. However, I'm convinced that if and when they hire this PA with EVH experience, they will utilize this PA solely for the OR and I will really never see the OR again (As mentioned earlier, I do not see any signs or reason whatsoever to believe that any of the attendings have any desire or patience to work with me to help me garner meaningful experience and reach a point in my career that they previously told me that they would help me achieve. I may get to throw 3-4 sutures in before the attending gives up and finishes the rest).

Basically, I feel that my current job duties and foreseeable job duties are extremely incongruent with what I was led to believe at my interview. There is absolutely zero structure and foresight as to how I should be trained. I have just been figuring out the logistics on my own for the most part and rolling with the punches. I'm not convinced that there's any real communication and agreement between the team as to how my job duties will grow, if at all. The most guidance and learning I've received have come from the fellow and it isn't even this person's direct responsibility to train me. And because the fellows rotate in and out, my experience is basically at the mercy of the fellow- something which I don't think I can deal with. I love this particular field of medicine, don't mind the long hours that are needed, and enjoy reading up on the topics. However, less than a month into this job and my motivation and desire to learn have already been shot. Given that it has already been such a long time since I've had any clinical experience, if I'm not given any real responsibilities I feel that I will just continue to hemorrhage knowledge and skills with each passing day.

What would you all do in my position? I've spoken with the department chair and his desire is for me to get used to doing things on the floor before I do anything in the OR however he has not clearly expressed what he means by floor work. With there being fellows and residents managing patients on the floor, I sincerely doubt he means inpatient medication management. I keep being told that there is a method to the madness, but I'm not sold on that idea. I've spoken with the APP supervisor and, although this person agrees with my concerns and said that s/he will push to ensure my role progresses further and appropriately, I highly doubt this person's opinions will have much of an effect on apathetic and apparently stubborn CT surgeons.

Although I am looking for a new job, I am having difficulty trying to figure out how to approach potential employers if I'm asked about a) my employment gap since graduation (very, very legitimate reasons by the way) and b) why I would want to leave a job after having just been there for a month. What are your guys' thoughts?

I didn't have a single malignant or egregious experience in any of my surgical rotations throughout PA school. Yet now I'm left with such distaste for surgery that I don't think I even want to go back. I would be sufficiently happy doing urgent care where I can work up patients independently for the most part and still be able to perform procedures and be able to spend more time with family and friends. I feel like a severely overpaid administrative assistant and not a PA. And although that may fly very well with a lot of people, it's not for me. I've even heard attendings say about me and the previous PA that we're secretaries not PAs. But am I wrong to think that when a group takes on a new PA grad that there's a level of expectation on the attendings' end to ensure that my skills will be brought up to par in one way or another? Must I need to try to figure out everything on my own including medication management and working up consults all on my own in a field as specialized as cardiac surgery?

If you took the time to read all of this, I thank you so much from the bottom of my heart.

Edited July 20, 2019 by tdpand

[Guest HanSolo]

My initial feeling is that you are only a month in, so it's highly likely your role will expand with time. It's too soon to tell. Why do you doubt what your Chair is telling you? Yes, there are fellows and residents managing patients on the floor, but you should be able to manage them, too. 

Give it at least 6 months to a year. You may have built this role up in your head to be a lot more than it is. Things move slowly at times. Unless you absolutely can't handle the personalities of the other people on the team, then I would not look for another job yet. 

[tdpand]

Hey, thanks for the response. I definitely get that it might be too soon to tell. I've not had such strong reservations about anything I've done in the past. Honestly, I've had more eager mentorship and more job responsibilities in many of my rotations than I have so far here in this actual job. I also believe I should be able to manage them too. But when I saw that the previous PA who has been there for 11 years doesn't get to manage patients on the floor, I seriously have my doubts. And I have several reasons to doubt my chair actually,

1) I was told by someone who knows the chair really well that he actually doesn't quite understand the role of a PA. He believes that a PA is a glorified intern and truly doesn't understand what we do or our education.

2) There's constant disagreement between the chair and another attending regarding what they want me to do. One wants me to be in the OR, the other doesn't yet. And again, I'm sure I'm only in the OR in the interim until a more experienced CT Surgery PA is found.

3) I was told by the PA who left that the role is mostly administrative, that despite the fact that this PA has been there for 11 years, there is not much real medical/clinical responsibility outside of harvesting vein. Otherwise the job is spent almost entirely in front of the computer making phone calls, writing up pre and post op notes, and ordering labs. And this PA has only able to vein harvest because previous leadership many years ago allowed her to garner that skill, but with time, the role has changed to become increasingly more administrative and less clinical because of new leadership. In fact, I was told by the PA to not trust the chair for a slew of reasons- one of the strongest reasons causing this PA to leave the group.

4) My entire experience so far has seemed to lack direction. I've been chastised multiple times for not having done something that I was supposed to do but was never clearly outlined to me, told to me, or shown to me. There's no mentorship whatsoever outside of the fellow who enjoys teaching. I've figured most of this job out on my own simply by looking in the EMR to see what the previous PA does for each patient and replicating that.

[sas5814]

I have never worked in a specialty so my understanding of the forces and egos is pretty limited though I have found surgeons and sub-specialty surgeons have egos the size of Montana.

You may be in a position to create your own space. By that I mean you have docs who don't really seem to understand the role of a PA. Imagine the looks of wonderment if you could show them how much you could bring to the practice! Help them generate revenue, relieve them of common medical tasks so they would be free to do those amazing things only they can do (direct appeal to big ego).

It will be work and it will take time and pereserverance and repetition and probably some advocates in the department but it could be done. If it works you will be a pioneering PA in your hospital(s) and in your specialty.

[GetMeOuttaThisMess]

Hey, thanks for the response. I definitely get that it might be too soon to tell. I've not had such strong reservations about anything I've done in the past. Honestly, I've had more eager mentorship and more job responsibilities in many of my rotations than I have so far here in this actual job. I also believe I should be able to manage them too. But when I saw that the previous PA who has been there for 11 years doesn't get to manage patients on the floor, I seriously have my doubts. And I have several reasons to doubt my chair actually,
1) I was told by someone who knows the chair really well that he actually doesn't quite understand the role of a PA. He believes that a PA is a glorified intern and truly doesn't understand what we do or our education.
2) There's constant disagreement between the chair and another attending regarding what they want me to do. One wants me to be in the OR, the other doesn't yet. And again, I'm sure I'm only in the OR in the interim until a more experienced CT Surgery PA is found.
3) I was told by the PA who left that the role is mostly administrative, that despite the fact that this PA has been there for 11 years, there is not much real medical/clinical responsibility outside of harvesting vein. Otherwise the job is spent almost entirely in front of the computer making phone calls, writing up pre and post op notes, and ordering labs. And this PA has only able to vein harvest because previous leadership many years ago allowed her to garner that skill, but with time, the role has changed to become increasingly more administrative and less clinical because of new leadership. In fact, I was told by the PA to not trust the chair for a slew of reasons- one of the strongest reasons causing this PA to leave the group.
4) My entire experience so far has seemed to lack direction. I've been chastised multiple times for not having done something that I was supposed to do but was never clearly outlined to me, told to me, or shown to me. There's no mentorship whatsoever outside of the fellow who enjoys teaching. I've figured most of this job out on my own simply by looking in the EMR to see what the previous PA does for each patient and replicating that.

Sounds like my first job back in the early 80’s. If there are residents/fellows in the system who would you reasonably expect to get the OR time? Been there, done that, and moved to cardiology.

[sas5814]

BTW the right job is one you are happy with. I met a PA who did intakes for plastic surgery who had never written a prescription in her career and was happy as she could be.

I have a few tropes I trot out frequently. Change your attitude or change your circumstances is among my favorites. Get happy or get gone.

Edited July 22, 2019 by sas5814
Fat fingers 2 fingered typing bad spelling

[MediMike]

Academics can be tough but as mentioned above...it's been a month.  I started off as a new grad in the CCU of a top ranked heart transplant center and believe me, I wasn't operating at high capacity right out the gate either.

Reading your posts there are a LOT of "I was told" or "Someone told me" and none of that means jack unless you hear it from the individual's mouth. 

If you want this field talk to the attendings one-on-one and tell me you want to optimize their production and your learning.  Use the fellow/residents on service as a resource, they teach, that is how academic medicine works.  Everyone teaches someone.  Most of them enjoy it especially if you are able to make their lives easier with more knowledge. 

If the role has been more administrative in the past it very well could be because your prior colleague didn't want it to be more than that.  If that is the expectation then have the conversation that this isn't what you were hired for and start looking for another job. 

I don't have any nice tropes as above but fight for what you want (or at least vocalize it), utilize the resources at hand, or get on out to where you're happy.