What is like to work for large organizations such as Mayo Clinic or Cleveland Clinic?

[BayPAC]

Since graduation I've been working for small private clinics, usually working solo. I'm thinking about looking for a job at large organizations, where, maybe, I can learn more by interacting with others. At this point I feel too comfortable doing what I'm doing and would like to challenge myself so I can grow.  Would that be a good move? Some insight would be greatly appreciated!  

[LT_Oneal_PAC]

Going to a large, academic FM practice can help expand your skills. I learned a lot reading other peoples notes and the patient pool is often more complicated. Academic FM tends not to drown you as much in patient load as private practice, in my limited experience. I really liked my time in FM with the clinic associated to the FM residency. Was also military, so could be different from civilian academics, but I found a lot of similarities at the university where I did my residency. Could also try another specialty all together. 

[SedRate]

On 12/7/2019 at 4:14 PM, BayPAC said:

At this point I feel too comfortable doing what I'm doing and would like to challenge myself so I can grow. 

This was part of my reasoning for switching jobs. I went from orthopedic trauma at a private practice to cardiothoracic at a large rural hospital. I am glad I switched. New field, new people, new challenges. I miss my old life in some respects but don't miss others. 

[DizzyJ]

I worked at the Clinic before...once my NP manager told me I "wasn't ordering enough cultures" and her response to my question of why we need to order all these cultures was "I don't know, it is just what we do here"...I knew it wasn't for me.  I've had mixed responses from PA friends about working for the Clinic.  

Edited December 13, 2019 by DizzyJ

[greenmood]

I love it. There are parts of the job everyone hates, but that’s true everywhere. I’ve only ever worked for large hospital systems so I can’t help you with the comparison to private practice or smaller clinics. I will say that I practice at the absolute top of my licensure and I don’t think I could go to a place now where that wasn’t the case. I’ve been ruined by all the respect and fantastic culture.

[kargiver]

Pros and Cons working at institutions of this size...

Pros:

You learn A LOT.  In the right setting ( I worked at an ED at a major Level 1 tertiary/trauma system that covered all subspecialties) you learn what other folks want when working folks up in the ED.  This is invaluable later on when working in smaller/solo gigs as sicker folks often get transferred, you know what needs to be seen by various subspecialties in a timely manner, etc.

You have access to academic education - our education never ends, but learning daily in an academic environment is much different than learning on your own in a small/solo department.  Someone always knows more than you, everyone has their own area of expertise, and growth is not only expected, its encouraged.

There is a lot of power in anonymity.  Coming and going sometimes as a cog in the machine really does mean leaving it at work, not taking it home with you, and it makes work/life balance easier to achieve (IMHO)

Cons:

Institutional Memory is real, it is long, and its a pain in the arss to deal with.  You are locked into your role as evolution of roles in healthcare takes a while to catch up at large institutions.  They don't do disruptive innovation well, so no matter how good you are you are always limited to the least common denominator in your group.  

You are limited a lot of times to cerebral work only - consultants do a lot of the hands on stuff in the ED setting.  For example, I work in ski country (have since I graduated) and do more ortho trauma than I can recall.  Doing my own reductions, splinting, seeing rare fractures (Segond for example) is par for the course.  At a large institution, having the junior resident see the patient, then the senior, then the attending just to splint a distal radius fracture can get tedious as it eats up rooms and time.  There are times when it is beneficial (spinning many plates at once) but overall, I found it limiting.

The divide between administration and front-line workers is real.  And they just don't get it.  It really is a business to them (of course it is, it is to me as well... but I tend to remember the human element in the equation) and decisions they make are far too often penny wise, pound foolish.  This leads to frustration for many, bad morale, and turnover becomes a real thing.  Which sucks.  A lot.  

 

All in all, I prefer smaller institutions where I am a name and my word matters.  Makes me feel like what I do actually matters (of course, that's a matter of philosophical debate.  But I wouldn't trade the experience I got working at "the mother ship" for anything.  It makes what I do now so much easier.

G

[Kaepora]

I prefer small to medium sized health systems.  I currently work at two hospitals - one is a bit less than 400 beds, and the other is around 150.  Like the poster above me, I feel like I make more of an impact.  Bigger fish in a smaller pond, I suppose.  But I do think as PA/NPs we are generally on a bit more of a level playing field with physicians in smaller systems.  Our opinion matters more, and typically, we can actually do more.

Edited December 21, 2019 by Kaepora

[BayPAC]

Valid points, everyone. Thank you for the insight.