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So I got fired last month...


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So, I’ve had some job upheavals lately, and I think there are some good enough reasons to share in terms of lessons learned:

First, in late summer I was prepared to move to rural Alaska, where I’d been doing short-term Locums work before, with excellent rapport with the staff and patients. This is for a non-profit FQHC, but not a native corporation. I was offered a salary at the 25th percentile; I countered with agreeing to that salary... if converted to hourly and non-exempt. They said “no, we don’t do that” and offered a 50th percentile package instead, which I agreed to. The week after that, the CEO texts me to tell me that he has been let go by the board, and HR confirms my (signed) offer is “on hold” Cue essentially a month of silence, but before they actually confirm that they’re looking elsewhere for a cheaper provider, I hear of this through headhunters with whom I have a preexisting relationship. Cue some more weeks of waiting, and I am paid a modest settlement for their reneging on a signed offer for no particularly good reason. My house, for what it’s worth, is still partially packed up for the Alaskan move.

Observation #1: Most nonprofits are managed incompetently. Do not expect them to know how to negotiate, or to be able to follow through with what has been negotiated.

So, I un-resign from my various Washington jobs, but a few weeks later, my family/occ med job fires me via email, with the stated justification that I refused to see patients... which were scheduled outside my working hours. Flimsy, stupid pretext, but not an overtly discriminatory one, but neither was it one that attacked my patient care. So, this is a consistent, ~20 hr/week job, so I need to replace that income, because I can’t keep paying all the bills JUST on my eating disorders 1099 job.

Signs I should have seen this coming? MD proprietor had fired the practice manager without a replacement, MA who’d been with this doc for 30 years quit on the basis of how the practice manager was treated, NP in talks with the doc to buy the practice.

Observation #2: Sometimes, making money hand-over-fist for the practice isn’t enough to keep your job secure.

So, I bit the bullet and let my extended networks know I had been fired—first time in my life, BTW: almost made it to 50 without being fired. Ended up with 3 leads inside 48 hours, had a signed offer letter in 9 days from an interventional pain clinic, which actually offered full time, but I’m doing 2-3 days/week through the end of the year, at pretty much the same pay I was getting in family/occ med... and they’re letting my long-term occ med patients continue to see me.

Observation #3: Sometimes, having a diverse “box checking” CV is really helpful.

Observation #4: Networking is life.

Things that I believe helped me slide over into interventional pain: previous experience with tapering opiates for high-MED occ med patients, DEA X-waiver in hand, point of care ultrasound and joint injection experience, and that I’ve been credentialed multiple times with all the major local insurances through my various jobs--In addition to the family/occ med from which I’d been fired by email and the eating disorders work I mentioned, I fill in at a sleep center occasionally. They needed someone because their current PA is taking a VA job, and someone in my network knew that.

So, in my experience, switching specialties is easiest to do when the specialties overlap in practice, if not so much in theory. Family med at first, then adding occupational med in year 3 of practice, adding sleep med in year 5, moving into eating disorders in year 7, and now interventional pain in year 8. Each employment shift brought my existing practice to bear, and yet prompted me to add something new to the toolbox.

Observation #5: Maintaining a situation where you can “walk away” from a toxic employment environment if necessary is a matter of perpetual CV polishing and personal readiness.

Just when you think you have everything balanced well for you, something, somewhere, changes: The SP you love retires and closes his practice. A practice implodes due to mismanagement. Covid-19 hits. Keeping a strong CV, staying debt free, keeping multiple state licenses, keeping up on your “merit badges” like ACLS, and not being dependent on any employer’s benefit packages are also keys to minimal family disruption during an unexpected job change.

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Sorry that happened Rev. You’re a man of many talents, so I’m not surprised you pivoted on a dime. 
 

Totally agree on a diversified skill portfolio. I’ve never been fired, but in the 2008-9 financial crisis I couldn’t find a job to save my life. Now I’m always looking for that CV booster or skill expansion to keep different specialties open.

great points.

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12 hours ago, Rose66 said:

Very True and congratulations on your new job. You are very lucky.

Just keep in mind that "ALL JOBS ARE TEMPORARY" 

Including retirement.  Think about it...

Congrats Rev.  What I found over the years was that my contacts and I grew apart and my docs either retired or died.

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Everything you've said is definitely true in EM.  Volumes can go down and PA's will have hours cut, be furloughed, or let go to preserve doc hours.  Staffing companies can lose contracts.  Getting credentialed can easily take 2-3 months and you can't count on emergency temporary credentialing.  So, being credentialed with multiple employers and at multiple facilities is key.  It's easy to go from PT to FT at a site if the hours are available.  Also, it's very important to monitor conditions at each employer to be able to jump before the axe falls.  I got out of my old job just before they cut the PA/NP coverage from 50 hours/day to 35, and it's now 27.  It's a rare employer that's going to be loyal to their PA's, especially if they're a large EM staffing co.

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23 hours ago, rev ronin said:

So, I’ve had some job upheavals lately, and I think there are some good enough reasons to share in terms of lessons learned

Observation #1: Most nonprofits are managed incompetently. Do not expect them to know how to negotiate, or to be able to follow through with what has been negotiated.

Observation #2: Sometimes, making money hand-over-fist for the practice isn’t enough to keep your job secure.

Observation #3: Sometimes, having a diverse “box checking” CV is really helpful.

Observation #4: Networking is life.

...switching specialties is easiest to do when the specialties overlap in practice, if not so much in theory. 

Observation #5: Maintaining a situation where you can “walk away” from a toxic employment environment if necessary is a matter of perpetual CV polishing and personal readiness.

Just when you think you have everything balanced well for you, something, somewhere, changes:

Yes to all. The job climate is much different nowadays, and your observations are spot-on, at least in my opinion and recent experience. 

Congrats on getting through it all and adapting. Good luck to you. 

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14 hours ago, LT_Oneal_PAC said:

Sorry that happened Rev. You’re a man of many talents, so I’m not surprised you pivoted on a dime. 
 

Totally agree on a diversified skill portfolio. I’ve never been fired, but in the 2008-9 financial crisis I couldn’t find a job to save my life. Now I’m always looking for that CV booster or skill expansion to keep different specialties open.

great points.

How did you finally end up finding on job during the 2008-09 financial crisis? I'm a new-grad and am in a similar boat (can't find a job during COVID-19 to save my life). Any tips/advice? 

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1 hour ago, nsvalsad said:

How did you finally end up finding on job during the 2008-09 financial crisis? I'm a new-grad and am in a similar boat (can't find a job during COVID-19 to save my life). Any tips/advice? 

Turned tricks on the street corner.

seriously, though, I never did find another job. I was an RN at the time my old ICU graciously let me come back as part time. Couldn’t even get a job as an EKG tech. I cashed out my savings to pay off the the difference on my mortgage after short selling my house I could no longer make payments on. I moved in with my mom on her couch to be close to my part time nursing job I had, try to get another job, and finish classes I was doing for Med school. I slept on her couch and my wife moved in with my dad 3 hours away. Finished up prerequisites I was already doing for Med school, but couldn’t afford the rest. After I finished classes, I moved back to my home town of 7k people to work as a part time ICU RN in their “ICU” that could barely be called a step down. They probably only hired me out of nepotism with my dad being a the CMO, but I had to swallow my pride on that. Applied late in cycle for PA school, which accepted me and quickly applied for the Navy collegiate program. Moved to my school area and worked at Best Buy selling computers over the summer until school started and found out I was accepted to the Navy program and money started flowing again. 

Not much help, but my answer would be find a training program that pays, like a residency or fellowship (a legit one), be willing to move wherever, pull whatever favors you have, swallow pride, wait for something better to come along.

 

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Congratulations Rev! Interventional spine/pain is such a great specialty to work in.  Although I do not perform spinal intervention, I do almost every other procedure we offer. It has served me well in the past 12 years. It's an interesting blend of neurology and MSK medicine as well as the psychosocial issues that go along with chronic pain. 

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1 hour ago, wilso2ar said:

Congratulations Rev! Interventional spine/pain is such a great specialty to work in.  Although I do not perform spinal intervention, I do almost every other procedure we offer. It has served me well in the past 12 years. It's an interesting blend of neurology and MSK medicine as well as the psychosocial issues that go along with chronic pain. 

Yeah, so can you recommend good resources for the first two?  Dealing with psychosocial issues I have reasonably well down, but my MSK and Neurology aren't particularly strong.  I'm always trying to smooth the learning curve...

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9 hours ago, LT_Oneal_PAC said:

Turned tricks on the street corner.

seriously, though, I never did find another job. I was an RN at the time my old ICU graciously let me come back as part time. Couldn’t even get a job as an EKG tech. I cashed out my savings to pay off the the difference on my mortgage after short selling my house I could no longer make payments on. I moved in with my mom on her couch to be close to my part time nursing job I had, try to get another job, and finish classes I was doing for Med school. I slept on her couch and my wife moved in with my dad 3 hours away. Finished up prerequisites I was already doing for Med school, but couldn’t afford the rest. After I finished classes, I moved back to my home town of 7k people to work as a part time ICU RN in their “ICU” that could barely be called a step down. They probably only hired me out of nepotism with my dad being a the CMO, but I had to swallow my pride on that. Applied late in cycle for PA school, which accepted me and quickly applied for the Navy collegiate program. Moved to my school area and worked at Best Buy selling computers over the summer until school started and found out I was accepted to the Navy program and money started flowing again. 

Not much help, but my answer would be find a training program that pays, like a residency or fellowship (a legit one), be willing to move wherever, pull whatever favors you have, swallow pride, wait for something better to come along.

 

You touch on a possibility very few consider...the military. I was already on active duty when I was accepted into the Army program. It was a tough program in the first place...ranked in the top few in the country at the time. Combine that with required Army training like doing PT in the morning before school, range qual, field problems, mass casualty training etc it was pretty intense.

However the entire time I had a salary, housing, health, dental etc etc. When I graduated all I owed was time I planned on giving the Army anyway.

Jon I'm glad you landed on your feet. You said it....network network network. I was in a similar position and someone here suggested I apply for my current position.... a type job I would have never even imagined.

So for folks still struggling....keep chugging and network anywhere and everywhere you can.

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36 minutes ago, sas5814 said:

You touch on a possibility very few consider...the military. I was already on active duty when I was accepted into the Army program. It was a tough program in the first place...ranked in the top few in the country at the time. Combine that with required Army training like doing PT in the morning before school, range qual, field problems, mass casualty training etc it was pretty intense.

However the entire time I had a salary, housing, health, dental etc etc. When I graduated all I owed was time I planned on giving the Army anyway.

The military is a great option. I hesitate to recommend it for 2 reasons:
 

Foremost, it’s neither easy or quick to get into the military as a PA. The Army gets most of their needs met by the IPAP program. The navy and AF get a few and make up the rest with collegiate programs. The Navy takes a few direct commissions, but this takes 6 months to a year, not helpful for the person in acute need of a paycheck with a professional degree. 

Second: while it was more of a necessity for me, I had always wanted to join and financial burden just made it palatable for my wife, but joining out of desperation usually does not breed the best. They end of hating their job, life, pay, skirt work, and usually patient care suffers. Seen it too many times. Obviously not an absolute contraindication though.

 

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On 11/13/2020 at 10:31 AM, rev ronin said:

Yeah, so can you recommend good resources for the first two?  Dealing with psychosocial issues I have reasonably well down, but my MSK and Neurology aren't particularly strong.  I'm always trying to smooth the learning curve...

Check out Jon Jacobson's fundamentals of musculoskeletal ultrasound book. I found it very helpful as I was getting started. Actual injection courses are very expensive.  Reading the book and a good mentor is how I learned. 

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What a story , depressing, realistic and a happy ending with fine conclusions. It's painful to write something like this as it should never happen but unfortunately it is all too common today. Your final analysis had seeds of faith and vision and one cannot steal either of them. The seeds of faith are always with each of us but they often require a crisis to both nourish and encourage their growth. I wish you good fortune, Rev.

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