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Hi everyone,

I am looking for some help and advice.

I will preface this with a short about me. I am a PA with 8 years of experience in mostly primary care. I currently live in Michigan. I have no history of any malpractice claims against me and all reviews about me online I can find are positive or 5 stars. I went to a private school and have about 25k in student loans of an original balance of 180k.I am married with 2 young children. Being a PA is a second career for me after burning out as a teacher in AZ.

My current situation is this: My wife is a teacher who has had a hard time finding work In MI because of out of state certification finally found a job she liked but was far away from my job and caused a burdensome commute. We agreed to move in spring of 2020. Shortly after my contract would be over. My employer learned of this when discussing if I would renew contract and they found a replacement for me this ending my employment in violation of contract (I was supposed to be given 60 days) I chose not to fight it because I knew I would need them as a reference I the future.

I scrambled to find something in the 3 weeks I was given and was hired at an urgent care with no benefits no retirement. It is a newer clinic not part of a chain and less than a year old and I see about 10 patients in a 13 hour shift on average. I have been there 3 months now.

I have interviewed at a small nonprofit private school that is starting a PA program, am waiting to hear back and a different urgent care looking for people to start in 3 months that is part of a larger physician group. It offers benefits PTO and retirement. Have also applied to other family med practices or specialties etc with many sounding sketchy or too far away.
 

The whole situation has left me burned out and depressed. I feel inadequate as a provider and just disenchanted with medicine. Before the job change I was frustrated but primarily with the insurance bureaucracy. I do not think the current office has long term sustainability and think I need to find something better.
 

Teaching would be nice but I wonder if there are too many PA programs and if it is sustainable past 5 years.  Also I wonder if I am feeling so burned out and frustrated should I be teaching other students. Another urgent care would at least have benefits but sometimes I even just feel sick of dealing with the patients and trying to keep them happy. I need to at least be a PA for a few years more to pay off student loans. I really don’t feel like specializing much because a l have known too many that seem to push procedures and don’t listen to patients and I don’t want to get into that world. Not interested in doing insurance reviews because insurances are a lot of the problem with healthcare especially for low income people.

I am looking for any opinions or guidance on what I should do. Should I be teaching? Should I even be practicing medicine anymore? I have already gotten placed on Cymbalta. Waiting for it to kick in. I know now I should have just lied to my old employer and said I would be around forever and jump ship at my convenience. I can’t do anything about that. Need some opinions on what to do going forward. 

sorry for such a long post......thank you for any opinions

 

 

 

 

 

Edited by Brasspac
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First nothing in this post suggests you are inadequate as a provider. Life happens and somethimes when it does it comes with a kick in the Nards. The idea that you should just quit medicine because of a setback is probably more an extension of some reactive depression than reality.

The days of jobs everywhere and folks just falling all over themselves to hire you are gone. Some regions and areas are so over crowded employers have their pick and they know it.

The first thing I would suggest is make a plan and then get moving on it. Having no plan leaves you just wallowing and that becomes a self propigating thing so you just wallow more. On and on it goes.

Cymbalta may help but it isn't the fix to your mood. Start setting yourself up to feel better. Get out of bed at the same time. make your bed. Start your day by accomplishing something even if it is as simple as making your bed. Get some sun on your face. Be active. Take a walk. Eat healthy. Avoid ETOH.

 

Decide what you want to do. If you want to stay in medicine then make finding a job your job. Network, send resumes, fill out applications, and my favorite thing? Suit up and go door to door at potential employers. Ask to speak to the manager or hiring authority and leave your CV and cover letter everywhere. Have a prescribed number of these visits every day you can. By setting a number you are creating another task that can be completed successfully. 3 visits every day I'm not working? Done! Another small success.

I think we have all had some dark days professionally and personally. Success is moving from failure to failure without losing your enthusiasm.

and my favorite quote for these times? fatigue makes cowards of us all. As long as you don't quit trying you will bounce back.

Edited by sas5814
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These posts break my heart for younger PA's still riddled with debt and struggling with this profession and medicine.  It's a tough field and with recent events about to become tougher and a lot more dangerous.

My advice is to re-read Scott's advice.  I could not of said it better.  Just know one thing.  You are NOT alone in feeling this way.  

Edited by Cideous
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I can handle the depression aspect, but I feel like I just want to survive 5 more years and start doing something else. That is enough time to pay Dow my student debt and most of a house. I guess I am looking for any job ideas or something out of the box that will generate a decent income for 5 years then I can bail. I am 39 and I would like to enjoy some of my life before I turn 50.

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find a good buprenorphine job with a reasonable commute

 

simple, easy, should be well north of 120k per year for pretty simple

most patients appreciate you, and the medical community really needs it

talk to local MH and Sub Abuse counselors

 

a drive is not the bad if it is only a few days a week

 

 

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8 minutes ago, ventana said:

find a good buprenorphine job with a reasonable commute

 

simple, easy, should be well north of 120k per year for pretty simple

most patients appreciate you, and the medical community really needs it

talk to local MH and Sub Abuse counselors

 

a drive is not the bad if it is only a few days a week

 

 

Could you expand on that a little bit.  Describe what a typical day looks like with this job?  

Thanks

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9 hours ago, Brasspac said:

It is a newer clinic not part of a chain and less than a year old and I see about 10 patients in a 13 hour shift on average.

Fyi this may be a blessing in disguise.  10 patients per 13 hour shift?  Most urgent care jobs will have you seeing 3-4 patients per hour, which could burn you out even quicker.

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Yes but what is the minimum number to remain viable financially? I can take a guess but then again how much money does the physician owner expect to make? It’s been my experience that most of them just want you to make them a bunch of money. If you aren’t making them money consider yourself gone.

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18 minutes ago, Brasspac said:

Yes but what is the minimum number to remain viable financially? I can take a guess but then again how much money does the physician owner expect to make? It’s been my experience that most of them just want you to make them a bunch of money. If you aren’t making them money consider yourself gone.

Who cares...ride it until it's done.

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22 hours ago, Brasspac said:

Hi everyone,

I am looking for some help and advice.

I will preface this with a short about me. I am a PA with 8 years of experience in mostly primary care. I currently live in Michigan. I have no history of any malpractice claims against me and all reviews about me online I can find are positive or 5 stars. I went to a private school and have about 25k in student loans of an original balance of 180k.I am married with 2 young children. Being a PA is a second career for me after burning out as a teacher in AZ.

My current situation is this: My wife is a teacher who has had a hard time finding work In MI because of out of state certification finally found a job she liked but was far away from my job and caused a burdensome commute. We agreed to move in spring of 2020. Shortly after my contract would be over. My employer learned of this when discussing if I would renew contract and they found a replacement for me this ending my employment in violation of contract (I was supposed to be given 60 days) I chose not to fight it because I knew I would need them as a reference I the future.

I scrambled to find something in the 3 weeks I was given and was hired at an urgent care with no benefits no retirement. It is a newer clinic not part of a chain and less than a year old and I see about 10 patients in a 13 hour shift on average. I have been there 3 months now.

I have interviewed at a small nonprofit private school that is starting a PA program, am waiting to hear back and a different urgent care looking for people to start in 3 months that is part of a larger physician group. It offers benefits PTO and retirement. Have also applied to other family med practices or specialties etc with many sounding sketchy or too far away.
 

The whole situation has left me burned out and depressed. I feel inadequate as a provider and just disenchanted with medicine. Before the job change I was frustrated but primarily with the insurance bureaucracy. I do not think the current office has long term sustainability and think I need to find something better.
 

Teaching would be nice but I wonder if there are too many PA programs and if it is sustainable past 5 years.  Also I wonder if I am feeling so burned out and frustrated should I be teaching other students. Another urgent care would at least have benefits but sometimes I even just feel sick of dealing with the patients and trying to keep them happy. I need to at least be a PA for a few years more to pay off student loans. I really don’t feel like specializing much because a l have known too many that seem to push procedures and don’t listen to patients and I don’t want to get into that world. Not interested in doing insurance reviews because insurances are a lot of the problem with healthcare especially for low income people.

I am looking for any opinions or guidance on what I should do. Should I be teaching? Should I even be practicing medicine anymore? I have already gotten placed on Cymbalta. Waiting for it to kick in. I know now I should have just lied to my old employer and said I would be around forever and jump ship at my convenience. I can’t do anything about that. Need some opinions on what to do going forward. 

sorry for such a long post......thank you for any opinions

I'm sorry you are going through this. Take a deep breath: 5 seconds in and 5 seconds out. Now take another. 

"Burnout" (watch Zdogg MD's moral injury video on burnout) is a prevalent issue in medicine and I think most Americans in the general population to some degree. We go to school, get a degree, get a job, get married, have kids, and rinse and repeat the day-to-day grind until we retire in our 60s or 70s (!). Previous generations were ok with that -- and I think it's all they really knew -- so they made the best of it. But times are different nowadays. You got burnt out in your previous life and here we are again. Burnout is a culmination of things. Many threads on here also talk about it and how to combat it: get a new job, change your schedule, etc. There are plenty of websites with articles that also talk about. I encourage you to read a little bit about it to help you sort through what you're feeling and to know you're not alone.

I think your current position is ok for the time being, mainly because of the lighter work load. Like another poster said, this position could be a blessing in disguise. Keep at the job search but remember to be patient with yourself. You're a busy man, not only taking care of your patients but also your wife and kids. And don't forget yourself. Make sure you're not ignoring your own health needs: sleep, exercise, healthful foods, deep social connections, and stress reduction. Consider keeping this job until you work through all this, and once something better comes along, interview them to see if it's a good fit -- don't jump into another position. I'm assuming you're on your wife's benefits for the time being, so it sounds like you have the time to sort all this out. Consider seeing a counselor, therapist, or trusted and unbiased colleague in the community as an additional soundboard. 

Lastly, I urge you to read personal finance topics. I, personally, am a fan of Mr Money Moustache and his FIRE movement. It has given us a whole new perspective on how to live and "retire" early (i.e., not be financially dependent on a job for benefits and retirement but instead choose to work when and where we want). When I became a PA, I told myself I'd work 20 years and retire at 45. That goal has accelerated even more thanks to FIRE and adjusting our lifestyle (e.g., keeping our gas-efficient cars and not buying new, living below our means, spending more time outdoors and home doing free things and less on going out, reducing or eliminating our reoccurring expenses, etc). It has been empowering and liberating to know we no longer need to work until we're older to retire well. Now with that said, I'll probably still work a job once we're financially independent, but it'll likely be one that I like, don't depend on for benefits, and work at on a reduced schedule. 

Good luck to you. Please know that you're not alone and that many of us on here have similar battles, as well as battles of our own.

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13 hours ago, UGoLong said:

I’m a bit at a loss. You were planning on moving this spring I thought. So all you need is a job where you are for a few monrhs (which you have) and then find a job in a state where your wife can find a job?

What am I missing?


Sent from my iPad using Tapatalk

I must have miscommunicated. My wife is in a stable job and we are moving to be closer to her job in a few months. I have a job that is commutable but feels like it won’t last and given how things went down with my last employer I am feeling burned out and jaded. Given how long many of these places take to credential I am trying to make a decision now.

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1 hour ago, Sed said:

I'm sorry you are going through this. Take a deep breath: 5 seconds in and 5 seconds out. Now take another. 

"Burnout" (watch Zdogg MD's moral injury video on burnout) is a prevalent issue in medicine and I think most Americans in the general population to some degree. We go to school, get a degree, get a job, get married, have kids, and rinse and repeat the day-to-day grind until we retire in our 60s or 70s (!). Previous generations were ok with that -- and I think it's all they really knew -- so they made the best of it. But times are different nowadays. You got burnt out in your previous life and here we are again. Burnout is a culmination of things. Many threads on here also talk about it and how to combat it: get a new job, change your schedule, etc. There are plenty of websites with articles that also talk about. I encourage you to read a little bit about it to help you sort through what you're feeling and to know you're not alone.

I think your current position is ok for the time being, mainly because of the lighter work load. Like another poster said, this position could be a blessing in disguise. Keep at the job search but remember to be patient with yourself. You're a busy man, not only taking care of your patients but also your wife and kids. And don't forget yourself. Make sure you're not ignoring your own health needs: sleep, exercise, healthful foods, deep social connections, and stress reduction. Consider keeping this job until you work through all this, and once something better comes along, interview them to see if it's a good fit -- don't jump into another position. I'm assuming you're on your wife's benefits for the time being, so it sounds like you have the time to sort all this out. Consider seeing a counselor, therapist, or trusted and unbiased colleague in the community as an additional soundboard. 

Lastly, I urge you to read personal finance topics. I, personally, am a fan of Mr Money Moustache and his FIRE movement. It has given us a whole new perspective on how to live and "retire" early (i.e., not be financially dependent on a job for benefits and retirement but instead choose to work when and where we want). When I became a PA, I told myself I'd work 20 years and retire at 45. That goal has accelerated even more thanks to FIRE and adjusting our lifestyle (e.g., keeping our gas-efficient cars and not buying new, living below our means, spending more time outdoors and home doing free things and less on going out, reducing or eliminating our reoccurring expenses, etc). It has been empowering and liberating to know we no longer need to work until we're older to retire well. Now with that said, I'll probably still work a job once we're financially independent, but it'll likely be one that I like, don't depend on for benefits, and work at on a reduced schedule. 

Good luck to you. Please know that you're not alone and that many of us on here have similar battles, as well as battles of our own.

Previous generations (most of them) did not go to college nor a very intense Masters program. I agree about the burnout, but like my parents they did not go to college or a shorter form of college. This generation is going to college for everything now and you must have  a minimum of a bachelors degree to even get a interview plus the student loan crisis causes more depression, anxiety = burn out because how can you put food on the table, etc when I just went to school for 6-7 years, work my butt off in rotations and did everything we do in PA school, but I cannot even pay rent....? that is the main issue. I know the OP will do well and succeed cause I have thus far. Please go to counseling, do some self-work (mediation, dietary changes, vitamins, acupuncture, yoga, exercise, etc). The SSRIs are not going to do much for you as I know 1st hand, it takes a huge shift in health to help you through this. 

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3 hours ago, camoman1234 said:

Previous generations (most of them) did not go to college nor a very intense Masters program. I agree about the burnout, but like my parents they did not go to college or a shorter form of college. This generation is going to college for everything now and you must have  a minimum of a bachelors degree to even get a interview plus the student loan crisis causes more depression, anxiety = burn out because how can you put food on the table, etc when I just went to school for 6-7 years, work my butt off in rotations and did everything we do in PA school, but I cannot even pay rent....? that is the main issue. I know the OP will do well and succeed cause I have thus far. Please go to counseling, do some self-work (mediation, dietary changes, vitamins, acupuncture, yoga, exercise, etc). The SSRIs are not going to do much for you as I know 1st hand, it takes a huge shift in health to help you through this. 

This response ended up turning into a long-winded one (and a little bit of a vent), so sorry in advance!

Good points, especially about the stress with higher education and significant debt. Although it sounds like the OP is a second-career PA, which is not typical of the current generation of millennials who don't have a lot of previous work or real world experience. What I meant was the general concept of working the daily grind until you retire in your 60s-70s. While that is still the general consensus for most Americans, I was trying to elucidate a different path, especially for those burnt out on the stress of working these kind of jobs and feeling like a slave to the debt they incurred. 

Unfortunately, a lot of young college students don't prepare for their future. Such as, what are you going to school for? To get a degree just to get a degree? And then they choose to go to a private undergrad, incurring $60k debt before even getting a professional job or masters. And then once they graduate, they buy new cars, a house, etc, while having significant debt and can't find a job? Or go on to PA school, incur more debt, and graduate with six figures of debt? Whatever happened to living with roommates and renting a room that costs you $500/month? Or driving a POS car until it ran into the ground? Or working jobs while in high school and college? I'm a millennial and it really disappoints me to see many of my similar-age friends, PAs included, fall into these traps. And yes, I know, "I need to have a reliable car, I need my own space, etc," but what I mean is REASONABLE expenses, like buying a $8k gas efficient car vs $40k car that gets crappy gas mileage and has high cost of ownership. Or maybe renting a low-cost apartment if you can't fathom the idea of roommates instead of buying a $300k house within your first year of working. Or not buying a $1000 cell phone every year, monthly music or show accounts, and paying $60+ for a monthly gym membership, and the list goes on and on. When you start to break all these things down, it's not hard to see why young people (and for the most part, the general public) have gotten themselves into these situations. Those with debt should probably focus on paying down their debt instead of contributing to it by indulging... But hey, live your life! It's yours, after all, not mine. It sounds like the OP has made a significant debt in theirs, which is great but I'm sure that has contributed to their stress all the while taking care of a family and career. Hey, I was there. I had 125k in debt just from PA school, and that's from going to a private PA school AND a scholarship. But I made a plan and paid it off in 4 years. Probably could've paid it off even faster had we not had paid for our own wedding, bought two houses (sold one for profit), four cars (sold two, what a money suck those were, but you live and learn), redid our backyard (helped sell house for higher premium), and took some nice vacations. And now I've had the FIRE mentality for the past year and it's launched us even closer to financial independence and freedom from the daily grind. Just wanted to share some of what I've learned!

Btw, not everything requires a degree nowadays. Sure, for white collar jobs. But there are a lot of trade jobs out there hiring and don't require a bachelor's. And they can be lucrative. Our pool guy quit his job as a firefighter to run his own pool servicing company and makes six figures. He has more work than he can handle and has to constantly turn clients away so that he can keep to the schedule he wants. 

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1 hour ago, Sed said:

This response ended up turning into a long-winded one (and a little bit of a vent), so sorry in advance!

Good points, especially about the stress with higher education and significant debt. Although it sounds like the OP is a second-career PA, which is not typical of the current generation of millennials who don't have a lot of previous work or real world experience. What I meant was the general concept of working the daily grind until you retire in your 60s-70s. While that is still the general consensus for most Americans, I was trying to elucidate a different path, especially for those burnt out on the stress of working these kind of jobs and feeling like a slave to the debt they incurred. 

Unfortunately, a lot of young college students don't prepare for their future. Such as, what are you going to school for? To get a degree just to get a degree? And then they choose to go to a private undergrad, incurring $60k debt before even getting a professional job or masters. And then once they graduate, they buy new cars, a house, etc, while having significant debt and can't find a job?

yes, this. A good friend of mine has two BS degrees (fine art and anthropology) and can't find a job that pays more than $15/hr working at an amazon warehouse....my own kid is heading to college soon and I am trying to impress on them the importance of ending up with a marketable skill....cause I don't want them living in my basement until I die.....

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22 hours ago, Cideous said:

Could you expand on that a little bit.  Describe what a typical day looks like with this job?  

Thanks

It’s heavenly . 20 or so patients per day , managing medications for opioid and alcohol use disorders . Patients are much more thankful and respectful than the entitled people you run into in FM and UC 

 


Start with obtaining a Bup waiver then watch the job offers pour in - as many practitioners shy away from caring for this population . 

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I did not read all the responses so this may be redundant. I will say, there may be seasons in your career when things look like crap, then that passes and things go much better. I became disillusioned during one stretch when I took a job, and it was a disaster (slotted for 8 providers, I was # 5, but then quickly became the only one when the others quit), moved on to the Air Force (loved it) but then the base closed and they wanted me to go remote and I left. Next job my SP attempted suicide within 3 months of me joining them (problems in her love life) and her attempt left her disabled. Next job was a huge mess where they lied to me and I had moved my family to that city and started building a house. I sued them for breech of contract and won. I was damned depressed and thought about leaving the PA profession (wrote a book about that period called A Kernel in the Pod). But then I got a wonderful position at Mayo Clinic and the last half of my career was very positive. So hang in there. 

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7 hours ago, LPZ said:

How was / is it working for Mayo? I applied as a new grad with no luck. 

It was tough getting a position as I created one from scratch (first PA in neurology), so it took a whole year for that process. There was also resistance from some of the neurologists and the head nurse fought hard to keep me out and she resigned when I was hired. But once there, it was tremendous. My boss was as good as it gets and treated me like a physician. I left only because I could not stand the long, cold winters and the long hot and humid summers with nothing to do outside.

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On 3/2/2020 at 7:31 AM, jmj11 said:

It was tough getting a position as I created one from scratch (first PA in neurology), so it took a whole year for that process. There was also resistance from some of the neurologists and the head nurse fought hard to keep me out and she resigned when I was hired. But once there, it was tremendous. My boss was as good as it gets and treated me like a physician. I left only because I could not stand the long, cold winters and the long hot and humid summers with nothing to do outside.

What a coincidence, I applied to two neuro positions at Mayo! I now work in a outpatient private neuro clinic. Glad to hear the position itself was great once the difficult hiring process was over.

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      By Guest RDtwoPA
      Hello,
      Looking for shadowing opportunities in North Jersey willing to go into NYC. I am an experienced health care professional and am HIPAA training, up to date with flu shots, PDD. Looking for one time or ongoing. Any leads appreciated!
      Please and thanks! 
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