First year PA

[Annabananna]

Hey everyone,

For anyone who remembers being newer in their profession, is it just me or is the responsibility way more than PA school tells us? I am working in family Med, completely independent (SP in another town and very intimidating person), and I’m second guessing my decision to be in this profession. Part of it is my job and this specialty, but the uncomfortable feeling of this new responsibility...does this get better with time? Because it’s starting to make me hate the profession-and I loved PA school for the most part.

any advice would be appreciated! Thanks! 
 

 

[Joelseff]

Hey everyone,
For anyone who remembers being newer in their profession, is it just me or is the responsibility way more than PA school tells us? I am working in family Med, completely independent (SP in another town and very intimidating person), and I’m second guessing my decision to be in this profession. Part of it is my job and this specialty, but the uncomfortable feeling of this new responsibility...does this get better with time? Because it’s starting to make me hate the profession-and I loved PA school for the most part.
any advice would be appreciated! Thanks! 
 
 

You're independent in your first year?!?

[emoji15][emoji15][emoji15]

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[Cideous]

Ok, a little history.  I graduated PA school in the early 90's before the corporatist take over of all things medicine.  Back then and through the 90's into the early 2000's, doc's owned their own practices or were in groups.  They hired PA's to work with them in clinic and at rare times, cover the shop when they were not there.  In fact the vast majority of PA laws required the doc to be on site a certain percentage of the time.  There were 12-15 PA jobs for every new graduate, and my entire class had jobs before we graduated.  None of which were solo jobs.  Why?  Because doc's knew we were not ready to fly solo straight out of PA school and since they had a big stake in our success or failure as owners, they didn't want to put themselves or their practices at risk.

Fast forward to now.  Very few jobs will you work for a solo doc and the few who are still out there seem to be nefarious at best trying to compete with the big corps.  So today we are hired straight out of school to fill a doc slot, and we are not ready, certainly not in family practice.  But today, docs are just employees.  Whether the practice does well or not, as long as they get their salary, they don't really care. The last solo job I had, my new supervising doc told me to keep my head down and don't kill anyone.  That was it.

To conclude, while I love my PA brothers and sisters, new grads are NOT ready to fly solo.  Doing so is to invite a catastrophe.  We were created in our training with the idea of spending at least 3-5 years onsite with good supervision and training not to mention just good old fashion "exposure" to someone with experience.  The corporatists in their desire to make more and more money with less and less payroll now see us as that answer even using new grads to fill that role.  Corporate admins are not concerned with our training, as they know they will not be named in a lawsuit when things melt down. Docs are now just resigned to their fate as employees and know that if they don't go along, the corporate admins will replace them.

 

The takeaway:

1.  New grads should not work solo right out of school.  Ever.  PA school doesn't not prepare us for that.  Heck, Medical school does not prepare newly minted docs to work solo.  That is why they do residency even in family practice...which is how long?  3 years.

2.  You spent a lot of money not to mention time and energy to go to and get through PA school.  Don't muck it up by taking a job that is setting you up to fail just so some corporate admin or unscrupulous doc can make a buck.  Medicine is no joke, and the long term financial, mental and emotional ramifications of screwing up and getting sued can end a career before it begins.

3.  Find a good doc in your chosen specialty and stick to him/her like freaking glue.  Work for less, work harder, whatever you have to do to suck their brain dry of information and experience.  Do this for at least 3 years and preferable 5.  It might seem like a long time, but in the span of a 30 year career you will be thanking god you did.

4.  Or...do a residency.  Not a crappy one, but a real one.  My prediction is in less than 10 years it will be required by us for employment anyway.

 

Don't feel bad.  It's not you, it's the system that you just graduated into.  I feel bad for PA's today with all of the challenges they face.

 

Good luck friend.

Edited August 16, 2020 by Cideous

[Joelseff]

Ok, a little history.  I graduated PA school in the early 90's before the corporatist take over of all things medicine.  Back then and through the 90's into the early 2000's, doc's owned their own practices or were in groups.  Their hired PA's to work with them in clinic and at rare times, cover the shop when they were not there.  In fact the vast majority of PA laws required the doc to be on site a certain percentage of the time.  There were 12-15 PA jobs for every new graduate, and my entire class had jobs before we graduated.  None of which were solo jobs.  Why?  Because doc's knew we were not ready to fly solo straight out of PA school and since they had a big stake in our success or failure as owners, they didn't want to put themselves or their practices at risk. Fast forward to now.  Very few jobs will you work for a solo doc and the few who are still out there seem to be nefarious at best trying to compete with the big corps.  So today we are hired straight out of school to fill a doc slot, and we are not ready, certainly not in family practice.  But today, docs are just employees.  Whether the practice does well or not, as long as they get their salary, they don't really care. The last solo job I had, my new supervising doc told me to keep my head down and don't kill anyone.  That was it.

To conclude, while I love my PA brothers and sisters, new grads are NOT ready to fly solo.  Doing so is to invite a catastrophe.  We were created in our training with the idea of spending at least 3-5 years onsite with good supervision and training not to mention just good old fashion "exposure" to someone with experience.  The corporatists in their desire to make more and more money with less and less payroll now see us as that answer even using new grads to fill that role.  Corporate admins are not concerned with our training, as they know they will not be named in a lawsuit when things melt down. Docs are now just resigned to their fate as employees and know that if they don't go along, the corporate admins will replace them.

 

The takeaway:

1.  New grads should not work solo right out of school.  Ever.  PA school doesn't not prepare us for that.  Heck, Medical school does not prepare newly minted docs to work solo.  That is why they do residency even in family practice...which is how long?  3 years.

2.  You spent a lot of money not to mention time and energy to go to and get through PA school.  Don't muck it up by taking a job that is setting you up to fail just so some corporate admin or unscrupulous doc can make a buck.  Medicine is no joke, and the long term financial, mental and emotional ramifications of screwing up and getting sued can end a career before it begins.

3.  Find a good doc in your chosen specialty and stick to him/her like freaking glue.  Work for less, work harder, whatever you have to do to suck their brain dry of information and experience.  Do this for at least 3 years and preferable 5.  It might seem like a long time, but in the span of a 30 year career you will be thanking god you did.

4.  Or...do a residency.  Not a crappy one, but a real one.  My prediction is in less than 10 years it will be required by us for employment anyway.

 

Don't feel bad.  It's not you, it's the system that you just graduated into.  I feel bad for PA's today with all of the challenges they face.

 

Good luck friend.

 

Totally agree with@Cideous... I have always thought and said that we shouldn't have independent practice as PAs (or whatever we are called in the future) right out the gate... I have taught my PA and NP students that they should treat their first job in their chosen specialty as an informal residency for 3-5 years. And they should not take a job like OP mentions where the new APP is put in a position where there is no second set of eyes or a senior medical brain to pick.  

 

 

Edit: I DO SUPPORT independent practice after 3-5 years of practice AND demonstrable ability to practice independently...

 

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[ANESMCR]

Welcome to the party. I’m sure it gets especially worse when you catch up with your friends that have normal well paying careers, yet get to enjoy so much healthy freedom from responsibility and stress. Nothing to add. Description above covers every thing and more.

[Annabananna]

Hey guys,

thank you so much for the feedback. I appreciate the advice that really, it’s not supposed to be this way. But it is right now. I actually am looking into going toward a specialty. I also only got 2 weeks of training at the job because of Covid so I’m going to be so careful choosing the next job. 
 

do you guys know any specialties that are more collaborative?

Thanks! This platform is amazing-just found it this week. 
 

 

[Joelseff]

Hey guys, thank you so much for the feedback. I appreciate the advice that really, it’s not supposed to be this way. But it is right now. I actually am looking into going toward a specialty. I also only got 2 weeks of training at the job because of Covid so I’m going to be so careful choosing the next job.   

do you guys know any specialties that are more collaborative?

Thanks! This platform is amazing-just found it this week. 

 

 

 

 

Primary Care is collaborative for us if we need it to be but you just got into a bad situation IMHO. I would suppose surgical specialties you would be more supervised. I did GI for 2 years and it was collaborative for sure. Just too narrow for me since I have been in primary care/IM most of my career. On your next interview, make sure you ask about the level of autonomy expected of you and how much collaboration/supervision you would like to have. At this point in your career do not sweat supervision, welcome it! For the benefit of your patients and for your own sanity.  

 

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[ventana]

1 hour ago, Joelseff said:

  Edit: I DO SUPPORT independent practice after 3-5 years of practice AND demonstrable ability to practice independently...

 

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BINGO

that is the winne - although I think is should be 2-3 year or a fellowship..

and the 2-3 years can be mentored by a PA/MD/DO but not NP

[Joelseff]

 
 
BINGO
that is the winne - although I think is should be 2-3 year or a fellowship..
and the 2-3 years can be mentored by a PA/MD/DO but not NP

I can see that but there should be a way to "Certify" them perhaps a sign off by said supervising PA/MD/DO... And totally agree.... No NP supervisors!

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[Annabananna]

8 minutes ago, Joelseff said:

I can see that but there should be a way to "Certify" them perhaps a sign off by said supervising PA/MD/DO... And totally agree.... No NP supervisors!

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Ya my boss is an NP and is not the SP written in the contract. They both work somewhere else but my boss is who I’m told to call for questions because my sp doesn’t answer the phone usually

[Joelseff]

Ya my boss is an NP and is not the SP written in the contract. They both work somewhere else but my boss is who I’m told to call for questions because my sp doesn’t answer the phone usually [emoji23]

Aw hell Naw!

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[Cideous]

Yeah, I totally agree with you guys.  Independent practice is fine, but not until we pay our dues and I think a good supervisory environment for 3-5 years and/or a residency should be in order.

 

Great input.

[rev ronin]

2 hours ago, Annabananna said:

do you guys know any specialties that are more collaborative?

Eating disorders medicine is awesome.  Locally I collaborate with Dietitians, masters' level counselors, a psychiatrist who was doing telemed support for our team long before Covid-19, a yoga therapist... and an RN who is on site when I'm not.  Weekly medical team meetings from the state are typically 2 physicians and 2-3 PAs where we do our own medical case reviews and such.  It's a VERY interdisciplinary field.

[Annabananna]

17 hours ago, rev ronin said:

Eating disorders medicine is awesome.  Locally I collaborate with Dietitians, masters' level counselors, a psychiatrist who was doing telemed support for our team long before Covid-19, a yoga therapist... and an RN who is on site when I'm not.  Weekly medical team meetings from the state are typically 2 physicians and 2-3 PAs where we do our own medical case reviews and such.  It's a VERY interdisciplinary field.

That’s awesome! I definitely need to go into something like that. 

[ventana]

23 hours ago, Annabananna said:

Ya my boss is an NP and is not the SP written in the contract. They both work somewhere else but my boss is who I’m told to call for questions because my sp doesn’t answer the phone usually

ahhhhh nope

I would NEVER report to an NP - they are simply not in our chain of command for medical decisions.... period

I would report to an NP for administrative issues - ie scheduling and getting reimburse for CME

[Cideous]

On 8/17/2020 at 3:17 PM, ventana said:

ahhhhh nope

I would NEVER report to an NP - they are simply not in our chain of command for medical decisions.... period

I would report to an NP for administrative issues - ie scheduling and getting reimburse for CME

This!

[sas5814]

I seem to love tmelling stories that won't make OP feel any better so here goes..

I am an Army trained PA who graduated in 1990. The Army, being the Army, sends new graduates overseas(mostly) right out of school to assignments where you are generally a distance from any other medical support. This was also before cell phones. So I was sent to be the medical officer for a unit in Germany. Basically I showed up fresh from school and was given 350 soldiers and their families to take care of. There were a couple of other PAs in the area and a physician I saw from time to time but the nearest hospital was 60 miles away and the consultants weren't particularly friendly or helpful if I called. Unfortuntely I was also pumped full of "you're the greatests" BS and I was confident to the point of being foolish.

30 years later I am more conservative and enjoy the balance of a high degree of autonomy with all the support I need if I pick up the phone. I LIKE having backup and support.

That is a long way of saying you have exactly the right attitude. You understand you capabilities and your limitations. You just need the position that fits. Any of us at any point in our career who NEVER have a moment of doubt probably need to take a hard look in the mirror.