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dottie7

What should a new grad do?

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I'm just curious to hear what everyone's thoughts are...... is it better for a new grad to specialize (think derm, IR, surgical subspecialty), or go general (fam med, rural med, primary care) for their first job? Would you recommend new grads look for jobs in bigger cities or more rural areas? Is the pay usually better in big cities? Is a better pay in a rural area worth being "isolated" so to speak, esp. if you're in your twenties? Just want to see what other's opinions are!

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1) don't do anything you can't survive.  Seriously, it doesn't matter if rural is better if you have no idea how to live outside of a big city.

2) Look for mentoring, not for money.  Money will always be "OK" (except in NYC), and never enough to pay off your loans instantly.  More money usually means the job sucks, with questionable ethics or ridiculous demands.

3) Figure out what's wrong with the job, and make sure you can live with that.  No job is perfect, especially a job for a new grad.  My Occupational Med job has a lot of paperwork; that would be a death knell for some people, but I don't mind it.  Figure out WHAT the sucking chest wound in your possible job is, and make sure that's not going to be something you can't stand.

4) Don't sign a non-compete or anything else that limits your ability to leave.  Just don't. Bad enough if you're stuck in loan repayment shackles, anything beyond that is unjustifiable.

Overall, my personal preference was for family med first, and I love it, and I have branched out into other outpatient work.

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1 hour ago, rev ronin said:

 Figure out what's wrong with the job, and make sure you can live with that...Figure out WHAT the sucking chest wound in your possible job is, and make sure that's not going to be something you can't stand.

 

Any tips on how to best do this?

Aside from spending time in your future work environment, how can you get honest feedback from employees? 

My biggest fear is accepting a job that I find out, too late, that I cannot stand.

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2 hours ago, LPZ said:

Any tips on how to best do this?

Aside from spending time in your future work environment, how can you get honest feedback from employees? 

My biggest fear is accepting a job that I find out, too late, that I cannot stand.

Heh.  No, I've always done mine trial and error.  7 years and 5 jobs in (3 of which I still have), I have much better insight into what I need, what I can't stand, and what I can live with in a medical setting.

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Network - most PA's talk to other PA's - so there's probably some information out there about most jobs.  As part of the interview process, or at least after you've received an offer, request a meeting with 1 or 2 of the PA's (or NP's) who currently work there.

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As a recent new graduate (1.5 years out of school) I would say that the best choice you can make as a new graduate is taking a job with good mentorship/APP leadership.  I have had a fair amount of classmates switch jobs not because it was the wrong specialty/city, but from reasons secondary to poor guidance or not having a supporting member to help them through the many challenges of starting in a new career.  Your first job will likely define what kind of provider you are going to become: your work ethic, practice patterns, patient interactions, etc...  You can build these core career skills in any job.  Having the right team to help build your career will ultimately prepare you to take on any job setting/specialty/city that you may wish as you continue to grow.  As a bonus, having good mentors/co-workers will end up increasing your pay in the long run in the form of year end evaluations, job recommendations, and future reference letters.

Good luck with your search!

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I think it really just depends on your situation and previous experiences. Lots of good information above. 

I started at a private surgical subspecialty practice (Ortho trauma) right out of school in a large metro area without any PA co-workers or mentors. My attending was never paired up with a PA before, so I had to teach them how to work with a PA partner. They were otherwise great mentors and it was nice being paired up. I learned a lot about communication, trust, and self-learning. It was really great for a few years until it wasn't. Now I've moved on to an entirely different surgical subspecialty, CT surgery, but for a big rural hospital. Specializing right out of the gate limited my practice and I lost a lot of skills. However, Ortho trauma exposed me to very sick people as well as very healthy people. I learned a lot about being a medical provider, how to look things up, critical thinking, etc. And now that I've moved on to something that I haven't really been exposed to in a while, it's been kinda fun re-learning. Yeah, a little painful at times I'll admit, but it's nice to feel challenged again. And I really enjoy the small town life, which is a welcome change from the big city. My new job also doesn't have any co-workers and mentors, (I'm the first PA the hospital hired for their revamped program), but the attendings have been very grateful for my joining and open to teaching. I'm comfortable working independently and self-teaching, but something I looked for when interviewing was how involved the attendings were. I wanted to make sure I wouldn't be left high and dry. A place I interviewed at had very tired-looking PAs. They also didn't do much outside of work due to limited time off and seemed cynical. The surgeons also didn't rush to interview me nor did they even wait around for my interview, which said a lot. This was for a very busy large metro private practice. I would've learned a lot and had two mentors who seemed like nice people, but I would've been run into the ground. 

I would not recommend doing rural right out of the gate unless there is some sort of teaching/support structure in place or if you have a lot of prior HCE. 

Pay can vary. You will find money anywhere, but look for the good mentoring options first.

"Isolation" in a rural setting can be good or bad. Good to allow for lots of time for training and focus, especially for someone like me who's having to learn things all over again. Bad because all work and no play makes John a dull boy. And probably very frustrated and lonely, too. But once again, it kinda just depends on your situation.

As a new grad, you need to find a place that will foster your learning style. Also, if you don't have a burning desire to be in a particular speciality, I would go the more general route to help maintain your skills. You can always move around or specialize later once you find something you really like. Good luck!

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I know it’s made to sound as if you, as a new grad/future new grad, has the opportunity to choose where to go and what you want to do-it’s simply not true anymore. Without a residency you will likely have to take what you can get. That means settling into a speciality you’re not particularly interested in, but available, or remaining unemployed for an extensive period of time after graduation to get what you actually want. 

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On 11/4/2019 at 7:42 PM, bike mike said:

Do a residency and you'll be golden

People keep saying this, but last time I checked, there were dozens to scores of residency slots, vs. thousands of new graduates.

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I'd stress the importance of students in clinical year treating each rotation as if it were a working interview and also building those networking relationships early. As a new grad, if you had one or two rotations that really stood out to you as being great learning experiences with a good environment, it wouldn't hurt to contact your preceptor or the office manager and hand them your résumé. If you do this, make sure to follow up in a week or two. That's how I landed my current job.

I feel specialising right away is a great option if you have a burning passion for one area of medicine over all others. Otherwise, if you're on the fence, I'd recommend starting in primary care.

 

Agree with Rev, everyone pushes the idea of residency, but the reality is that most PA training is still done on the job, and given the right working environment, you'll also be golden. Residency positions are limited, though expanding in the future I'd imagine.

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1 hour ago, rev ronin said:

People keep saying this, but last time I checked, there were dozens to scores of residency slots, vs. thousands of new graduates.

So this is exactly right and a real issue, and it's going to become even more of an issue going forward as the competition for jobs reaches a fever pitch (which it already has in multiple regions). 

I believe that within 5 years if you don't have a residency or 7+ years of experience, it is going to be hard to get a job.  We need to increase the number of residency for PA programs....significantly. 

If I had to do it all over again.....(shudder).....I would go Derm.  Even if I had to work for peanuts for the first few years.

Edited by Cideous
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30 minutes ago, Cideous said:

So this is exactly right and a real issue, and it's going to become even more of an issue going forward as the competition for jobs reaches a fever pitch (which it already has in multiple regions). 

I second this. I think the fever pitch has reached more regions than not in just the last year. And only getting worse going forward. Programs are not making adjustments or preparing their students for this whatsoever. 

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2 hours ago, ANESMCR said:

I second this. I think the fever pitch has reached more regions than not in just the last year. And only getting worse going forward. Programs are not making adjustments or preparing their students for this whatsoever. 

It's funny, whenever I bring this up on these boards I get the "chicken little" defense.  "Ahh that must just be in your region,we are fine out here in rural X-Y-Z....!"

Us older PA's are doing the younger ones a disservice by not addressing this.  When a doctor goes to medical school, he does not stop after he graduates....he does a residency.  We are rapidly approaching this scenario as a profession as I said above.  Telling new PA students to prepare for anything less is being disingenuous.

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7 hours ago, pa-wannabe said:

I'd stress the importance of students in clinical year treating each rotation as if it were a working interview and also building those networking relationships early. As a new grad, if you had one or two rotations that really stood out to you as being great learning experiences with a good environment, it wouldn't hurt to contact your preceptor or the office manager and hand them your résumé. If you do this, make sure to follow up in a week or two. That's how I landed my current job.

Same here. In fact, I gave resumes to each one that I could see myself working with on my last day. Even after I got a job offer, I still kept handing out resumes to keep the networking going (although telling them that I have accepted an offer but I would like to stay in touch). Some preceptors keep files of students and their resumes (two of mine told me they do), and then reach out to those students when they're hiring. In fact, even as a practicing PA now, I have received calls from two preceptors over the years asking if I was in the market. 

Network network network!

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