How long to feel comfortable?

[ThisIsIt]

Just curious, a question for the seasoned PAs, how long did it take for you to feel COMPLETELY comfortable and confident as an independent practitioner? I know we are all constantly learning but after how long did you go to work and not question your decisions or feel the need to look things up often 

[UGoLong]

Just curious, a question for the seasoned PAs, how long did it take for you to feel COMPLETELY comfortable and confident as an independent practitioner? I know we are all constantly learning but after how long did you go to work and not question your decisions or feel the need to look things up often 

To me it’s a matter of degree. I still check myself whenever I feel uneasy; I just don’t feel guilty about doing it.

I’d say it took me a few years to get to this point.


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[DizzyJ]

As a new grad in EM, I was pretty comfortable with routine ER patients in about 2 years.  This was routine fast track, CP, SOB, abd pains, etc..I didn't handle traumas or codes. While I felt completely comfortable seeing any patient, I was also completely comfortable asking for an opinion from another provider.  

I've switched specialties over the years and my comfort level developed quicker.  Most likely just because I was more experience with medicine.  

I would say 2-3 years is a good average.  

[ohiovolffemtp]

I was about 3 years into EM before I felt comfortable handling most things.  Then I took ATLS, a difficult airway course, and an ultrasound course and starting picking up the hard level 2's.  It took another year or 2 to get comfortable with this class of patients, especially because they didn't come along all that often.

[Cideous]

About 8 years for Urgent Care and this was after doing ER for 3 years.

[CAdamsPAC]

When or if you become 100% sure of every case, you are heading for trouble.

[ThisIsIt]

Thank you, I ask because I am starting a new job soon in internal medicine and really want to thrive and be an excellent PA. I’ve had some not so great jobs over the years, made mistakes, had SPs that made me feel inadequate for not knowing certain things.and have lost confidence and just want to start fresh and be the PA I know I can be. How do you recommend getting this confidence back and utilizing my knowledge to the fullest?

[UGoLong]

Thank you, I ask because I am starting a new job soon in internal medicine and really want to thrive and be an excellent PA. I’ve had some not so great jobs over the years, made mistakes, had SPs that made me feel inadequate for not knowing certain things.and have lost confidence and just want to start fresh and be the PA I know I can be. How do you recommend getting this confidence back and utilizing my knowledge to the fullest?

Not feeling like every correction is a direct attack on who you are.


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[DarwinStarwin]

Thank you, I ask because I am starting a new job soon in internal medicine and really want to thrive and be an excellent PA. I’ve had some not so great jobs over the years, made mistakes, had SPs that made me feel inadequate for not knowing certain things.and have lost confidence and just want to start fresh and be the PA I know I can be. How do you recommend getting this confidence back and utilizing my knowledge to the fullest?

For me it has been helpful to keep my circle of PA school friends close. Do you have any friends or past colleagues who you do trust enough to call up and talk to about those feelings of doubt? For me just having it be normalized is so helpful. Our state has a call line that providers can access free of charge for consults too, which is super helpful. It is a service put on by the university.

[SedRate]

On 6/24/2020 at 2:02 PM, ThisIsIt said:

Thank you, I ask because I am starting a new job soon in internal medicine and really want to thrive and be an excellent PA. I’ve had some not so great jobs over the years, made mistakes, had SPs that made me feel inadequate for not knowing certain things.and have lost confidence and just want to start fresh and be the PA I know I can be. How do you recommend getting this confidence back and utilizing my knowledge to the fullest?

Good working relationships with your colleagues, maintain professionalism, lots of reading (look up cases before/after), talking with trusted colleagues, learn from your "mistakes" and grow as a person and provider, take on students (they keep you on your toes and make you accountable), learn from other healthcare workers (PT, RT, RN, social workers, etc), and don't assume. When in doubt, look it up or discuss. 

I've also found that being a genuinely kind person goes a long way. The world of healthcare can be so stressful and you never know what burdens others may be carrying.

Physicians also practice medicine. Their training and experience are different than ours as PAs, but they are also people who make mistakes. Don't let past experiences hold you back; learn and grow from them. 

You can also try some self-help stuff to build confidence if that's your jam.

[SedRate]

On 6/23/2020 at 12:27 AM, ThisIsIt said:

Just curious, a question for the seasoned PAs, how long did it take for you to feel COMPLETELY comfortable and confident as an independent practitioner? I know we are all constantly learning but after how long did you go to work and not question your decisions or feel the need to look things up often 

I'm not seasoned but I think this video might help: 

 

[kargiver]

One can never know it all... that being said:

I practice full scope rural EM.  I felt "comfortable" after about 2-3 years.  By comfortable I mean I could work my way through the nuances of issues that would come up.  Still did a fair amount of consulting for ultimate disposition, etc.  By consulting, I mean talking with specialty services at the "local" tertiary center 40 miles away.

At 5-6 years, I felt like I was coming into my own.  I had already been working nights by myself for years at this point, so it wasn't a question of process.  It was more a question of - is this right?  the sick/not sick meter tends to be pretty honed at this point if you are paying attention, have done your studying, and let the ego go (let others guide you... for it truly is a team sport).  

After more than a decade now, I am very comfortable doing what I do.  To be fair, learning medicine in the streets for a long time before doing this really helped with the early years, particularly in solo rural practice, but it takes a long time to be comfortable doing what you do.  By comfortable, I mean the medicine is second nature and the human relations go pretty smoothly.  Because when you are comfortable - and it shows - people trust you more.  They believe you.  And this is ultimately the whole point of what we do.  Care for the sick and injured the best we can, such that not only are you providing good care for folks, but that they believe it as well.  

You'll come into your comfort zone when you are meant to... don't try to rush it.  It will show.  Others have given you solid advice on this.  You'll never know it all.  Don't think you will.  But learn the process of learning and how to adapt and you will do just fine...

G

 

[surgblumm]

For some, a few years for others 5-10 years. We are all learning after every patient encounter and after every error . I will go back to an old cliche that my mentor from Johns Hopkins told me and I have repeated a hundred tmes. When asked of Dr. Loch when he did his last perfect case the reply was that he has never done a perfect case and when he does, it's time to retire.

[Will352ns]

I was "comfortable" after a few years working pretty much full spectrum EM, I don't respond to trauma alerts...the trauma folks have their own PA. By comfortable, I mean I had the ability to figure out most presentations without help but knew when I needed to consult without feeling like I was being burdensome. I felt comfortable knowing what I didn't know. 

Now...most of the time when I get my MDs involved they end up scratching their head as well. We work together to figure out the safest course. 

I still read constantly and review basic concepts that I feel I'm getting fuzzy on often. That never stops.

[wamucc]

On 6/23/2020 at 12:24 PM, DizzyJ said:

As a new grad in EM, I was pretty comfortable with routine ER patients in about 2 years.  This was routine fast track, CP, SOB, abd pains, etc..I didn't handle traumas or codes. While I felt completely comfortable seeing any patient, I was also completely comfortable asking for an opinion from another provider.  

I've switched specialties over the years and my comfort level developed quicker.  Most likely just because I was more experience with medicine.  

I would say 2-3 years is a good average.  

 

This answer makes me feel so much better. I am a new-grad (6 months) EM provider and *most* of my attendings are fantastic, there are a few who are brusque at best (and I'm being generous there), because they feel, apparently, I should know more. I've talked with several of the attendings who are generous teachers and they've all told me I'm "right where I should be" but it's hard not to feel like I am falling short. That's a long-winded, self-centered way of saying thanks haha!

[ohiovolffemtp]

If those ED attendings are board certified/board eligible, they did a 3-4 year EM residency.  So, in an OJT environment, you should expect a learning curve at least that long.

[ventana]

honestly, in the primary care realms there is 3 different levels of comfort

 

1- 1-2 yrs out - confident that I was not going to kill someone

2- 3-10+ years out - comfortable, doing fine, but sometimes still wonder what I don't know

15+ years out - now totally comfortable, I don't know the answers but I know what I don't know, how to get answers, where to look, red flags, and can extrapolate pretty decently

(I am coming up on 20 yrs out and have worked in IM/UC/Occ Health/IR/ER/Chronic Pain/Office based UC/ Geriatrics and now full primary care for 18+ and LTC.....  Yes I support mandatory 1 yr hospital based fellowships for all PA's, followed by a second year of specialization to allow for salary to be 85% of the doc's. enough of this 100k a year when the doc's are getting 300-400k.....)

 

 

[wamucc]

2 hours ago, ohiovolffemtp said:

If those ED attendings are board certified/board eligible, they did a 3-4 year EM residency.  So, in an OJT environment, you should expect a learning curve at least that long.

Now just to get *some* of my attendings to see it that way ... sigh. (Fortunately, most do ... but those who don't can be demoralizing to use newbies).

[CAAdmission]

A lot of it if depends of the culture of the place you work. If you work in a teaching institution in a department with residents you can be comfortable relatively quickly. Everyone is always teaching, learning and questioning. I'm not saying this automatically makes you competent, but it creates a safe place to learn and explore. 

Unfortunately a lot of new grads go into things like a solo practitioner office where all they care about is churning through patients. You could probably work there for years and never be really comfortable.