Why I’ve contemplated leaving clinical practice/medicine

[pennylv]

For almost all of 2019, I’ve contemplated leaving the PA profession and medicine. I’ve been a PA for 5 yrs and feel like I’m fortunate enough to have realized this early on in my career instead 15-20yrs into the profession. I’ve decided to share my thoughts, which also include similar sentiments I’ve come across from reading blogs and forum posts. For those of you feeling the same, know you are not alone. For those of you asking what my next step will be, I don’t know. But what I do know that I would hate to continue feeling this way for the next 30+ years of my career if I continue as a PA.  

Why I want to leave:

-Constantly worried I’ll make a mistake (wrong dosage of a medication, abnormal lab report getting overlooked, etc.) and harm a patient. So much liability and stress is involved with the job. Our decisions affect whether a patient lives or dies and it’s so much to take in.

- Working in a healthcare system expects superhuman performance from humans under tremendous stress. It often seems blind to humanness, both providers and patients. 

- Hospitals, administrators, employers, and patients all seem to have a more powerful voice in the field of medicine than providers.

-The joy of medicine is being sucked out slowly by increased burdens of pressure to see more and do more, in turn earning more money for the organization and not to the benefit of the patient or provider. 

-Working at a pace that is superhuman, dealing with the tiniest of details that could kill someone if one mistake is made with the constant threat that if you are human and actually err, you will pay dearly for it.

-The healthcare system sets unreasonable standards for production and expect us not to make any significant mistakes. On top of all that, expects us to make every patient happy under penalty of our job.

-We see too many patients in very little time and the expectations are unreasonable.

-Healthcare is dictated by algorithms and is unconcerned with the human dynamics and acuity of illness.

-There is endless administrative paperwork and insurance requirements that make each visit less about the patient and more about getting items checked off the list. 

-It’s all about the money. Not for the people who provide the healthcare but for the investors, corporations, insurance companies, and hospital groups. 

-The average patient-doctor interaction provides just enough time to say a quick hello, get a run-down of symptoms, make a diagnosis, and prescribe a quick-fix drug to mask the condition. 
 

I would love hear your thoughts on this topic. 

Edited January 6, 2020 by pennylv

[Guest HanSolo]

This might be an unpopular opinion, but I believe there's a certain amount of apathy that, in my mind, is required to be a successful provider in the current healthcare environment. Sometimes you just have to not care.

Yeah, there is a lot of crap to deal with. Some days it can be overwhelming. However, it's not all bad, and there are some truly good places to work. If you've only been in one position over the past 5 years, consider switching specialties or moving outpatient to inpatient (or vice versa). That being said, no shame in getting out of the game and moving on to something else! Any thoughts on what you might like to do if you weren't in medicine? 

 

[GetMeOuttaThisMess]

I'm going to ask the same question that I ask a lot of folks with similar posts.  What got you into the profession to begin with, especially with required healthcare exposure before program acceptance?  I don't fault your thought process about the profession, I'm just curious how you got sucked in?

Edited January 6, 2020 by GetMeOuttaThisMess

[ventana]

get a different job

somewhere there is no insurance

 

ie corrections, VA, or something else

 

stop dealing with PIA companies, just focus on doing good....

[UGoLong]

1. Change jobs first and see how you feel; some places suck the life out of you.

2. That you worry about making a mistake is a good thing. As my SP says, "Go as fast as you can (see patients) but NO FASTER!"

3. Consider cutting back to part time so you have a chance to think and experience something different. New things crop up in your life more frequently when you make room for them.

 

Best wishes

[PAinPenna]

I hate to sound like a broken record on this forum , but switching from FM to Addiction Medicine was a game changer for me. I recommend getting your X waiver and maybe just try per diem somewhere to see if you like it. I think you'd be pleasantly suprised at how rewarding caring for this patient population can be. 

[CAdamsPAC]

Change is good, don 't allow yourself to suffer from stagnation.

 

[sailordeac]

I agree with all this. I've been a PA for close to 8 years now. Some of it is my current clinical setting, I think (employed by the hospital). We're constantly short staffed and asked to do more and more with the same number of PAs. There has steadily been more and more call added since I started, and I feel like I've been sold a false bill of goods in a way about how much call was involved when I took this job (been here about two years). It's like screaming into the void when I talk to my PA supervisor. If he takes something to admin, nothing gets done about it, so there's no use in complaining. I've literally had a surgeon tell me "well none of you guys leave so it must not be that bad" even though we all complain, all the time. Guess what? There's literally no other ortho jobs in the metro area because the market is saturated. That's why nobody leaves.

I had some different complaints when I was in private ortho practice at my prior job - it was definitely all about the money and I was miserable trying to see 32 patients in a full clinic day and never being able to chart on them all and spending hours of my personal time charting. Got paid better, though.

I've battled with if I want to stay clinical or not. I don't see an easy path out to transitioning to something non-clinical yet (clinical informatics maybe? consulting?) and I think my best solution is to try to work for myself. I've taken steps toward my own surgical first assisting LLC. It's a lot to set up, but the idea of having some control over my schedule and my vacation time and no call (I just work or don't get paid) sounds so appealing.

[ventana]

16 hours ago, PAinPenna said:

I hate to sound like a broken record on this forum , but switching from FM to Addiction Medicine was a game changer for me. I recommend getting your X waiver and maybe just try per diem somewhere to see if you like it. I think you'd be pleasantly suprised at how rewarding caring for this patient population can be. 

not bad advice for some

I do IM and addiction (per diem addiction ATS/CSS/IOP/PHP) but I would never want to do full time addiction.  I love the challenges of IM

BUT

If you are needing a break then X-waiver clinic might be good. 

A local PA and NP started an addiction consult service in the hospital that seems to be a good gig as well

[Meddeb]

Everything you mentioned is everything I’ve experienced in big corporation hospitals....you mean NOTHING to them and business is FIRST; patients are second. I have one suggestion for you if you love medicine and love helping patients....Direct Primary Care (DPC). Check it out. Don’t give up...

[pennylv]

On 1/6/2020 at 4:27 AM, HanSolo said:

That being said, no shame in getting out of the game and moving on to something else! Any thoughts on what you might like to do if you weren't in medicine? 

 

Nothing concrete but narrowing my list down. I wish the answer was crystal clear but unfortunately it's not. I've been in the medical field in some way or another since I was 18yo and its all I know. This is a plus if I decide to continue in medicine but not good in trying to transition to something outside of medicine. 

On 1/6/2020 at 7:23 AM, GetMeOuttaThisMess said:

I'm going to ask the same question that I ask a lot of folks with similar posts.  What got you into the profession to begin with, especially with required healthcare exposure before program acceptance?  I don't fault your thought process about the profession, I'm just curious how you got sucked in?

The same cheesy  answer as almost all PA prospects: I wanted to help others. I absolutely love those visits when I feel I've actually helped a patient however those are very scarce, even when working in family med. 

[SedRate]

5 hours ago, pennylv said:

The same cheesy  answer as almost all PA prospects: I wanted to help others. I absolutely love those visits when I feel I've actually helped a patient however those are very scarce, even when working in family med. 

Have you considered pediatrics, internal medicine or endocrinology? 

 

On 1/6/2020 at 1:40 AM, pennylv said:

- Working in a healthcare system expects superhuman performance from humans under tremendous stress. It often seems blind to humanness, both providers and patients. 

- Hospitals, administrators, employers, and patients all seem to have a more powerful voice in the field of medicine than providers.

-The joy of medicine is being sucked out slowly by increased burdens of pressure to see more and do more, in turn earning more money for the organization and not to the benefit of the patient or provider. 

-Working at a pace that is superhuman, dealing with the tiniest of details that could kill someone if one mistake is made with the constant threat that if you are human and actually err, you will pay dearly for it.

-The healthcare system sets unreasonable standards for production and expect us not to make any significant mistakes. On top of all that, expects us to make every patient happy under penalty of our job.

-We see too many patients in very little time and the expectations are unreasonable.

I was in a similar boat. Five years in Ortho trauma and it was getting to me. The company structure changed a bit, and although I made more money, I worked more, was doing less fun things and was doing more scut. The surgeons were checking out, too, which sealed the deal of my job change decision. I switched to CTS at a community hospital. Now it has its own set of inherent issues but at least I finish my work before leaving the hospital and have plenty of time to work out, cook, clean and put time into hobbies that I haven't had in years and even developed a new one at this new place. After reading posts throughout this forum and seeing how many people have multiple jobs and the benefits of such, I've decided that I want to try to have two, or hell, maybe even three jobs. I like the idea of doing some things for a couple days and then doing some other things for a couple days. It'll give me a chance to recover from one place while focusing on a new set of issues at the other place Now it may not be a permanent fix but I think it's what I want until I am financially independent and can afford to cut back to part time altogether and just work where I want to for the fun of it and not because I have to for the pay and benefits. 

Good luck in finding which way is best for you. You worked hard to get to where you are, so now make it what you want! And don't forget to exercise and take care of yourself. If you're not taking care of yourself first, it makes it harder to take care of others. 

[pennylv]

On 1/8/2020 at 5:34 AM, Sed said:

Have you considered pediatrics, internal medicine or endocrinology?

I have considered peds. Kids are fun. I would not want to do internal med or endo, just not appealing to me. Call me negative Nancy but I feel like regardless of specialty or employer, my reasons for wanting to leave apply to all. It’s just healthcare and medicine. A tiny part of me it’s still not completely done which is why I’m still practicing but just not sure how much longer that will last. I’m not giving up hope though. 

[Mayamom]

I did pediatrics & adolescents for over a decade.  Its hard work but at least rewarding.  You have a chance to make an

impact in their lives where adults the damage has been done  A lot of well visits, colds, asthma, rashes so the liability aspect is somewhat lower.  

[Guest JMPA]

6 hours ago, pennylv said:

I have considered peds. Kids are fun. I would not want to do internal med or endo, just not appealing to me. Call me negative Nancy but I feel like regardless of specialty or employer, my reasons for wanting to leave apply to all. It’s just healthcare and medicine. A tiny part of me it’s still not completely done which is why I’m still practicing but just not sure how much longer that will last. I’m not giving up hope though. 

Not offense directed to you, but this is why it is so important for PA programs to properly vet candidates, the training opportunity could have been used by someone whom would practice for life. With that being said, in pediatrics the majority of the time you are treating the parents.

[Cideous]

2 hours ago, JMPA said:

Not offense directed to you, but this is why it is so important for PA programs to properly vet candidates, the training opportunity could have been used by someone whom would practice for life. With that being said, in pediatrics the majority of the time you are treating the parents.

Boy do I disagree with this statement.  Utterly a low blow to insinuate that her PA slot should of been given to "someone who would practice for life..."  I mean come on.  Read her reasons again for her unhappiness with medicine, all of which are valid.  Life is messy, people go through health challenges, divorce, death, late emerging mental illness or addiction.  How are PA schools suppose to screen for those things???  Give me a break.

She earned her spot, period.  What happens after that is frequently subject to the mess that is called life.

[sailordeac]

^ Devil's advocate: sometimes you can be constantly exposed to it with parents working in healthcare while you were growing up, work in healthcare for several years yourself before going to PA school, be quite sure that's what you want to do with your life, and then actually get into practice for a few years and realize the state of American healthcare with all the numerous ways it can inflict moral injury...maybe it's not worth it and start thinking about other ways that you might be able to make money and be happier. 

I'm smart, and not to toot my own horn, but I'm quite competent and good at what I do. I am a good PA. But feeling like I'm just a cog in a wheel, the push to see more and more patients for less money, having no meaningful outlet to speak up and change what bothers me with my practice because I work for a massive institution, and not being able to find another job in my metro area that might possibly meet what I'm looking for, among other things...that all burns me out, big time. And life is just too short and precious to be distressed doing something that I spend anywhere from 8-12+ of my waking hours doing. I think some of it may certainly be that I'm more self aware and I've changed as a human too where my life goals and priorities lie over the past 10 years, but it remains to be seen how much longer I'll stay clinical too, as I replied further up the thread.

I'm so tired of this notion that "you're wrong and don't have the intestinal fortitude to practice for 30-40 years and you took up a spot for someone else." 

[Cideous]

^^^ Exactly.

[rev ronin]

It takes some doing, but it's possible, at least for now, to live outside the corporate medicine world, actually treat patients, and have some fun doing it.  Some people can't do things the way I have, others won't because they don't want to.

I hate medicine as an industry.  I love treating people as a calling.  Doing the latter in defiance of the former requires giving up a lot.  I don't plan on leaving medicine, don't plan on retiring before I am unable to practice safely, but what, where, and how I practice are all renegotiable.

[pennylv]

39 minutes ago, Cideous said:

Boy do I disagree with this statement.  Utterly a low blow to insinuate that her PA slot should of been given to "someone who would practice for life..."  I mean come on.  Read her reasons again for her unhappiness with medicine, all of which are valid.  Life is messy, people go through health challenges, divorce, death, late emerging mental illness or addiction.  How are PA schools suppose to screen for those things???  Give me a break.

She earned her spot, period.  What happens after that is frequently subject to the mess that is called life.

Thanks Cideous. Yes I did earn my spot and worked very hard to get it. People change, circumstances change, life happens. There is no way for a PA program to predict that. I know of someone who wanted to be a lawyer all her life, went to her dream school, in debt $200k and after practicing for a few years she realized it just wasn’t for her. Nothing wrong with that. Yes, someone else could have taken her spot but she earned it. All of us have earned it. Getting  into PA school isn’t easy.  Like the saying goes, you won’t know until you try it. 

[LT_Oneal_PAC]

If you really want to practice pure medicine, work in FM on a military base. No insurance, great formulary, get in good with your scheduler and can make certain appointments appropriate time lengths. Never shorter than 20 min. No one cares if you run slow to give good care. Broad scope of practice. Great resources (can get a same day MRI if you think it’s an emergency or same day consult). I’m always tempted to go back.

[jmj11]

1 hour ago, LT_Oneal_PAC said:

If you really want to practice pure medicine, work in FM on a military base. No insurance, great formulary, get in good with your scheduler and can make certain appointments appropriate time lengths. Never shorter than 20 min. No one cares if you run slow to give good care. Broad scope of practice. Great resources (can get a same day MRI if you think it’s an emergency or same day consult). I’m always tempted to go back.

I had the same positive experience there.

[Hope2PA]

9 hours ago, JMPA said:

Not offense directed to you, but this is why it is so important for PA programs to properly vet candidates, the training opportunity could have been used by someone whom would practice for life. With that being said, in pediatrics the majority of the time you are treating the parents.

Aren’t aren’t the majority of new PA’s older with a few years experience in another field? What about the PA who worked in business or other professions who later decided they wanted to work in medicine? Should those applicants be turned away because they were not dedicated to their original profession f? Even  someone who has worked in the medical field doesn’t alway see the recent changes in cooperate financially driven medicine. My only suggestion is to keep up with PA-C requirements. You never know where future may gonad some medical opportunity opens that peaks your interest.

[Guest JMPA]

10 hours ago, Cideous said:

Boy do I disagree with this statement.  Utterly a low blow to insinuate that her PA slot should of been given to "someone who would practice for life..."  I mean come on.  Read her reasons again for her unhappiness with medicine, all of which are valid.  Life is messy, people go through health challenges, divorce, death, late emerging mental illness or addiction.  How are PA schools suppose to screen for those things???  Give me a break.

She earned her spot, period.  What happens after that is frequently subject to the mess that is called life.

did you read and comprehend my first few words? sure lets waste valuable school slots on people that are not dedicated to practicing medicine, that sounds like a wonderful idea, how is the medical system going to survive with people wasting coveted schooling slots? think outside oneself

[Cideous]

22 minutes ago, JMPA said:

did you read and comprehend my first few words? sure lets waste valuable school slots on people that are not dedicated to practicing medicine, that sounds like a wonderful idea, how is the medical system going to survive with people wasting coveted schooling slots? think outside oneself

Yes...everyone who quits medicine after years of battling against the machine have wasted school slots...whatever that means.  Brother, I sincerely hope you are in for the long haul.  One of those 50 plus year PA's.  I hope you don't get sued, have family leave you, get sick, get addicted or just plain wake up one day and realize that life is just too short to keep it up.  I really do.  But in the meantime...step down from that horse upon high and have a little compassion.  80% of Providers surveyed state in no uncertain terms that if they had to do it over again...they would not go into medicine.  Are those all wasted slots???  Maybe, but I don't think so.  Or is there something fundamentally wrong with medicine.?  I'm going with number two.

I think we all know the answer.