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All,

Has anyone experienced being undermined as a PA? I have been a Cardiothoracic surgical PA for 2 years now. And in this new hospital I work at, PAs are not represented much. I believe most of that’s because management is not familiar with what PAs can do, how they can bill, their autonomy, etc. Due to this, their structure has always been having NPs on the floor to round on the post op patients, and RNFAs (nurse first assists) in the OR. The surgeons don’t get involved as much because they‘ve compartmentalized the two groups, and have a head NP and head RNFA who leads their counterparts. 

But since I’ve joined, and my credentials give me the ability and knowledge to do both parts of the job, I’ve been dealing with a lot of power trips and a lot of them seem to be threatened. And I can’t seem to find a median between being respectful and being assertive. (Especially since I’m still fairly new in my career) I want to work here but I don’t want this to be the issue why I can’t enjoy my job. Thoughts? 

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I started my career in an academic center advanced heart failure/transplants/CCU position. I was the only PA there for years, they had never worked with a PA, and in all of cardiology there was ONE other guy, who did amazing stuff in EP and had been there for forever. This is an academic hospital with an extremely well known and established PA program.

It took me quite a while to establish myself, but I did so by demonstrating my knowledge and effectively crushing everyone else there, while at the same time being helpful, educating others and being the absolute best provider I could.

The lack of knowledge NPs have regarding our profession is ridiculous. They receive little to no information regarding our training, regulations, background etc.

It's going to be a slog but assert yourself, be the smartest person there, and work to the top of your license. CTS is where PAs can truly shine.

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24 minutes ago, Chasingdreams said:

All,

Has anyone experienced being undermined as a PA? I have been a Cardiothoracic surgical PA for 2 years now. And in this new hospital I work at, PAs are not represented much. I believe most of that’s because management is not familiar with what PAs can do, how they can bill, their autonomy, etc. Due to this, their structure has always been having NPs on the floor to round on the post op patients, and RNFAs (nurse first assists) in the OR. The surgeons don’t get involved as much because they‘ve compartmentalized the two groups, and have a head NP and head RNFA who leads their counterparts. 

But since I’ve joined, and my credentials give me the ability and knowledge to do both parts of the job, I’ve been dealing with a lot of power trips and a lot of them seem to be threatened. And I can’t seem to find a median between being respectful and being assertive. (Especially since I’m still fairly new in my career) I want to work here but I don’t want this to be the issue why I can’t enjoy my job. Thoughts? 

Yes. The most undermining I've received as a PA was in CTS despite almost 6 years experience in another surgical subspecialty field. 

CTS is a different beast, especially when you have the dynamic of admin, surgeons, floor NPs and FAs. You are in quite the position, similar to one I was in and it didn't work out. 

If you really want to do this, follow the advice above. Make every effort possible to get into the OR, do trainings, see patients, do procedures, etc. Read up and become an expert. Be a "yes man," show up early, stay late, and show your versatility. Do not settle for just "gopher" tasks, and discuss with your clinical supervisor that you want to advance and practice at the top of your license by doing X, Y, and Z. Continue to show and prove your capabilities as a PA. It may pay off eventually but understand that CT surgeons are a special bunch and some will not want to relinquish control. Add to that the complicated setup your program has by being employed by the hospital and having a separate administrative boss to answer to (one who has NO IDEA what you are capable of nor what you do on a daily basis) as well as floor and FA leads. In my opinion, that setup just doesn't work out for a PA and it's not going to be pretty. Buckle up and be ready to assert your way in.

Best of luck to you. 

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I was in the similar situation as a new grad PA. My department has never seen or heard of a 'PA' so much so that they could not even figure out how to out Physician Assistant on my employee badge. SO I settled for only my name as my ID. Anyways , my CT surgeon played a classic bait n switch on me about giving me training and all. He completely backed off his promises the day I started and barely had any communication with me . The NPs on the floor were super hostile and threatened. they keep questioning my training and knowledge. To their amusement , I had little exposure to critical care in my school and hence failed miserably . 

 

Long story short , I did not feel safe in that environment and quit yesterday. Not sure , when will I be able to find another job but at least I am not on the verge of loosing my sanity and my license.

You can't win with these NPs. 😞

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5 hours ago, dream2pa said:

Anyways , my CT surgeon played a classic bait n switch on me about giving me training and all. He completely backed off his promises the day I started and barely had any communication with me . 

Yep, same here. I left a successful practice in hopes of advancing my career but instead ended up getting dicked around. Ya live and learn and move on to the next. 

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In my current position there are RNFA’s that help is most specialities, but I had 4 years of surgical experience coming in. So I did the above recommendations; I arrived early, stayed late, if a case was added on I would stay, I would read about the pt’s to see why they needed surgery, educate the surgeons about a PA and what I can do, and always asked questions. The RNFA’s were hostile, I tried to be as professional as possible, but now that my hospital understands the true potential of a PA they’ve hired a lot more in almost every speciality. 
 

A big ++ for us is that our services are billable, a RNFA is not...at least not in CA. Do your research, check your state, and bring that up to the surgeons, admin, and anyone else that will listen. Once the hospital realizes they can bill for you instead of paying a RNFA extra and not be able to bill, you have their ear. Good luck!

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As others have said, this isn't uncommon.  I am the third PA to enter the surgery world of our small hospital, an area previously dominated by RNFA's.  One of the main reasons this occurred was a new, younger ortho surgeon was hired a few years ago and she actually included in her contract that the hospital would hire a PA to work with her.  When the other surgeon saw her completing more work and working far less, while producing tremendously more RVUs he wanted a PA as well.  I have since replaced the second PA who left for supposed greener pastures.  I still get hated on by the RNFAs, but they also understand that they aren't going to take back their territory because it is helpful having a first assist who will also be part of the followup care.  Plus, their utility is more limited as they can't bill for their time (as opposed to a first assist PA) and their role is more limited in surgery also due to laws requiring surgeon presence.  A few of them at my facility are collegial and willing to learn/teach.  Interestingly those who are collegial are finding they are being asked for more frequently by the surgeons who don't have PAs and those who are jerks are sitting on the sidelines grumbling.

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1 minute ago, dream2pa said:

Well , as a new grad I couldn't put up a fight. I was told by the hostile NP that I have to learn hospital politics. Right now , my main priority is to learn practicing medicine and not be involved in petty games. 

Another reason I quit working at bigger centers. The only politics where I work is what keeps the doors open.

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Thank you all for your well thought out responses and insight. 
It’s a definite battle between honoring our profession and exemplifying our worth while dealing with the hospital “politics” but it’s also figuring out how much we are willing to tolerate. 
Regardless, we as PAs have strived to reach where we are today, and no one should try and take that privilege away from us.

I figure that it’s usually lonely at the top, but it’s forums and places like these where we know that there is support and that we are in it together. 

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The best advice in the history of this forum, circa 2014:

"If you are on top of your game ( or want to be), find a Cts Which utilizes their PAs to do more than harvest vein/artery, and become studly"  --rcdavis

Insert whatever specialty you want and it works. Point being, excellence isn't the kind of thing that goes unnoticed for long and as corny as it sounds, I do think that you can overcome a whole lot of "politics" by being a badass.

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2 hours ago, fishbum said:

The best advice in the history of this forum, circa 2014:

"If you are on top of your game ( or want to be), find a Cts Which utilizes their PAs to do more than harvest vein/artery, and become studly"  --rcdavis

Insert whatever specialty you want and it works. Point being, excellence isn't the kind of thing that goes unnoticed for long and as corny as it sounds, I do think that you can overcome a whole lot of "politics" by being a badass.

Great quote! 

Regarding your last comment, while I do agree with your sentiment, unfortunately, I do not think this is always possible given that some facilities are just stuck in their dysfunctional ways and/or have a difficult time keeping excellent providers due to various reasons such as poor leadership or pay. Now, if the facility is a well-run one (do any still exist?), then yes, excellence can overcome a lot of BS and having good leaders who take notice goes a long way. Then again, you'd think that well-run facilities with good leadership would actually run low on the BS scale and therefore have minimal BS politics, right?

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