Burnt out ortho PA

[rubytuesdai]

Somewhat new grad here (graduated in 2020). My dream has always been to work in EM but applied to many EM positions and got a few interviews here and there but never got hired with anyone. So I kind of settled with an ortho trauma position with a level 1 trauma center doing mostly clinic based medicine. I am about 6 months in and feel truly miserable. The hours are long, all the patients are extremely complex, I feel inadequate at my job and like I’m just not learning as quickly as expected and I can’t figure out if it’s because it’s not truly my passion, because I’m depressed, or because I’m just not smart enough. I keep telling myself things will get better with time but things have not seemed to improve much at all. Ive asked for feedback multiple times but it seems like everyone is too busy or overworked themselves to make time to sit down with me and have basically been told “no news is good news”. 
 

I’m basically looking for advice at this point. My job pays very well and is hourly so even though I work a lot I get fairly compensated. I still feel like I’d be happier in an EM position and am trying to figure out if it’s worth trying to apply for jobs again now or stick out the ortho job longer to gain more knowledge/experience. Ideally I’d love to switch to the ED in the hospital I’m currently at but I’m worried about burning bridges since I would still have to consult ortho for things. 

Edited November 26, 2021 by rubytuesdai

[kargiver]

Although the average length of time for 1st PA job is 7 months, it would benefit you to do at least a year.  Particularly if you want to do EM.  You are still green, learning what you know and don't know, and ortho trauma will be immensely useful in the future if you switch to ED.  Also, a year will show you can stick it out, and it will give you some experience to put on the resume for applying to any ED position.  

G

[sas5814]

When I was leaving to start PA school an old PA I worked for for years told me...it takes about 3 years to get your head out of your butt and start practicing good medicine. 

I am sure that isn't a hard and fast rule but I found it to be a pretty good guideline. You are still new at this position and it is a challenging one. Don't be too hard on yourself. 

If its time to move on...move on. Just make sure you are doing it for the right reasons. You may find changing jobs or specialties isn't any kind of panacea if you don't do it thoughtfully.

As for getting guidance and feedback.... I'm finding a lot of places/specialties/practices are overwhelmed and people don't have time to give feedback. Its a sad truth. 

[MediMike]

Have you thought about doing a residency?

(I had to say it before someone else did, feels like a race sometimes)

What percentage of people in this world do you think have a job that they are passionate about? I think this is an idea that can skew anyone's perception about their current role. You think the guy/gal working a factory job is passionate about pushing that button q7 seconds thousands of times a day? Changing your current mentality to you are working to live rather than living to work may be important at this time.

Agree with above that this experience will be greatly helpful moving into an ED role, and don't worry about burning bridges. Unless you bounce out on them with no notice nobody should be holding anything against you.

Last bit of advice: Medicine is notoriously bad at feedback, unless it is negative. There is a large nugget of truth in "no news is good news". This is not a career field where you can expect attaboys or pats on the back. (And I'm not trying to sound like a tough-ass here, I absolutely LOVE attaboys and pats on the back). People are too busy and the culture is just different.

Keep applying, keep looking!

[rev ronin]

You're treated well, paid well. Those are two big things I would think VERY long and hard about giving up in this climate.

You're still working toward the magic 10,000 hour mark, and probably only a bit over 10% of the way there.

Given that you're paid and treated well, the big third question in my mind would be, "Are you learning?"

It was 3 years into my PA career when I ran into long-term workers comp population. I love caring for these people, occasional fraudsters and all, but I had no idea this would become a calling 6y ago.  Likewise, I just started treating eating disorders populations 2.5y ago, and I love working with them so much I'm writing a DMSc capstone about how the rest of medicine mistreats them.

You don't know what else you can learn at this job yet. It may be nothing, but it may be that you will run in to THAT THING that defines your career.  Getting paid well and treated well, even if they're not giving you a lot of feedback, is a good foundation upon which to learn, grow, and build.

[sas5814]

Let me piggy back on Rev. Sometimes you have to find the diamond in the dung pile. I work at the VA which is a cumbersome clunky machine that can be maddeningly overrun with rules and regs that makes no sense.

BUT I came here because I was getting burned out with what I had been doing and needed to be somewhere I could have a bit of passion about. I'm retired Army. My oldest and dearest friends are people I served with. I care about wounded warriors particularly the suicide rate among veterans. So every week I slog through the mundane, the maddening, the bizarre, and the folks who never did squat (I have piles of patients who somehow became disabled vets without finishing basic training) to find the real wounded warriors who need help. Sometimes I can do something meaningful about their health. Sometimes I can get them to the right people. Sometimes I just listen...which doesn't happen much in over crowded health care systems. It seems to matter. Those are the diamonds in the dung heap. It makes the rest of it worth the work.

So before you look outward...look inward and see if there is something meaningful about what you do. Sometimes it just takes a shift in perspective. Concentrate on the good stuff and let the bad stuff go.

Edited November 26, 2021 by sas5814

[rubytuesdai]

Really appreciate all the responses. I’ve been struggling a lot with the “stick it out” part. I know it will be good for me but as time passes I have this suspicion that some people are getting a little frustrated with how I’m progressing. I just overall don’t feel like I fit in with this group of people and as time passes it feels like I’m losing all other aspects of medicine as I’m so hyper focused on ortho and don’t even think about any other systems. I guess I’ll just keep trying to push through and change my outlook. I did recently reach out to my insurance about getting set up with therapy because I’m at a particularly low spot with how I feel at work. I spent my whole life working jobs where I felt like I was valuable and this is truly the first job I’ve had where I feel like I want to disappear and that I have nothing to bring to the table, and that no one appreciates my help.

[sas5814]

That is a horrible feeling. I encourage you to get a bit of therapy. I have from time to time over the years and my wife swears we all need a tune up every few years. Keep looking for the bright spots. Best of luck with your journey.

[rev ronin]

In my pre-PA career I was actually getting to be someone. Switching jobs put me back at square one, and it is NEVER fun to have to build back towards being treated as a professional and an adult by your peers.

[GetMeOuttaThisMess]

On a lighter side, it doesn’t end in retirement.  Do you know how hard it is to assimilate into the early afternoon grocery store community?  “Who is this new, younger whipper snapper?”

On the the serious side, you probably ARE inadequate at six months.  i still remember how a spinal surgeon in our spine group made me feel right out of school.  Looking back, he DEFINITELY wasn’t anything special and had more complications than the other two partners combined.  When i left the group after 4 1/2 years my doc (nationally respected) said i could assess a spine patient better than any PCP.  I came around, and you will as well if you give it time.  Everyone expects to come out of school present day knowing everything and it just isn’t possible.

[justanotherperson]

I felt the same way when I was newer to ortho trauma. I definitely felt more like a burden or a fraud for the first several months. For better or worse, what you're going through is normal--but it gets easier. I'm now a bit more than a year into ortho trauma, and feel like things are starting to fall into place more. I actually look forward to going to work.

On my first week on the job, my incredibly bright and experienced PA colleague said something that made me feel my experience was normal: "It took me 1 year before I stopped feeling like an idiot every day and 3 years before I started feeling confident" 

You're not stupid. It's just as Kermit the Frog says: "it isn't easy being green" lol.

That said, don't give up on chasing your dream specialty! You put all the work to get into this profession for a reason and if EM is what you want, you should definitely go for it when the timing is right

[SedRate]

IMO, what you're experiencing sounds pretty normal for a new grad, especially in a field like Ortho trauma. The patients are complex, the work is draining, and there's a lot to learn. If you like the actual work, give it some time, read, learn, ask questions, attend OTA. If not, try to do a full year and then take the great experience you gain and put it toward ER or trauma.