Jumping too many jobs?

[jrapa86]

So I am becoming increasingly worried now that I am 1 year out of PA school and still unhappy with what I am doing.

 

I started a job in ICU/Critical care, which ended up not going very well. I was the first PA hired for the floor, and I felt in over my head with 6-7 hours of rounding every day and becoming increasingly unhappy with that kind of pressure on a new grad. I was asked to recommend a second hiree, and I did - my best friend (same graduation date and school) She came aboard, and within a month I was let go and she was kept.

 

I began working in an "urgent care" however they state they are by definition only family practice - however its run urgent care. I'm extremely unhappy here. There is a high volume of patients as there are no appointments. I need to know if this is normal, or if it is just me.

 

The computer system with the high volume is a nightmare. It is implemented by a non clinical lady that just simply worked as a manager with a high school level education for over 20 years. She does not take suggestion and is highly emotional over everything. The computer system requires us to do certain unrelated steps in certain orders which highly slows us down, and is increasingly frustrating ( there are multiple steps in a specific order in order to perform a simple task that could be simplified to 1 click but will never happen).

 

It is a requirement that we must do the computer chart with the patient still in the room, and must be signed and completed before the patient leaves. The computer is placed in a way where my back is faced toward the patient. The steps involved with the "need for speed" means I cannot interact with my patient during this time. Specific rules must be applied to put in orders based off every different insurance plan, there is no quick reference. Every selection is modified (which lab to send to with certain modifiers) based off every insurance company. These certain multiple selections must be made before you can put in your first lab, and if you miss a step and you have put in all your labs, you must delete and all start over.

 

Even if you write paper prescriptions you must also put in the digital Rx and have it sent to the pharmacy, or at least listed on the chart - the rx templates usually need to be changed and do not conform to normal Rx's. The medical coding levels are usually wrong, and code too low, but you cannot go back and change it. Once the orders are in you have to go thru a process of placing a chart on a certain table with a certain color clip in for the different cma's or nurses to know what to do.

 

For X-rays-- only certain insurances will cover in office, and therefore, you must go through 6-7 computer windows to view a a scanned copy of what their insurance is (only), You must memorize which ones are in and out of office. If they must be sent out, then depending on the insurance a yellow slip, a white enlarged piece of paper with my supervising physicians name on it, or my prescription must be used. Each one is different. Then it takes 2 -3 days of pre authorization to be completed before they can go. Xray imaging reports by the radiologist take 1 week to return, labs take 4 days to return, MRI's take 2 weeks, as well as CT's. Ultrasound takes 2 days. However the physician does not want me to sent abdominal pains to the hospital however theres no such thing as stat ct.'s because there needs to be pre authorization.

 

The patient education must be printed and provided to the patient prior to signing the note. Then a paper billing router must be filled out. If the patient becomes inpatient and walks to the front after my examination, the girls will run to the back and ask "where is the note!". The supervisor stands behind them. All of this must be done to see up to 4 patients an hour or else you are penalized.

 

Am i just complaining and just went into the wrong field?

 

There are just too many steps and ridiculous processes I must go thru to see patients I feel. And I feel i am at an increased liability with certain things. Oh and X-rays - if u do ur own wet read and its positive only certain insurances will pay for a non cast medical supply before you refer to orthopedics. Otherwise u have to just write a prescription for a brace.

 

I want to leave but I can't because I left the ICU after 4 months, and I'm on month 5 at this urgent care clinic. If i leave now, I'm told no one will hire me due to being a "jumper" from job to job.

 

I feel nauseous every morning going in, i hate my job, and I'm becoming miserable and nasty - someone I never wanted to become. The sad part is, the practice likes me and has no idea. I even had a successful CPR resuscitation last week in one of the examination rooms on a young girl. But I just don't know what to do. And apparently I'm under a 1 year contract which is grey on if i can break it early.

 

Can I get advice from someone on if I am being unreasonable? Im becoming worried medicine just isn't for me because this is job two and not doing well.

 

Thanks for reading. Your response will likely be a huge impact for me.

[bgdog]

Attitude.

 

Resolve to know that computer system so well they will label you a super-user.

 

Put the pt in front of you while you chart, explaining you like to see em, you can do this with a joke and a smile.

 

Know the labs and insurances very well, make your own charts and crib notes.

 

Figure out the bottlenecks and find work-arounds.

 

Take care of bizzness.

 

Walk in there everyday with goals to get better, faster and more bada$$.

 

Attidude!

 

Make that system do what you want it to do, not the other way around.

 

Knowldge is power.

 

The more I can't do something the more determined I get to do it.

 

That's how the big dogs roll.

 

good luck

[Guest JMPA]

Don't give up on your career. I would recommend sticking it out for a year. You don't want to look as if you cannot hold a job for more then a few months. With that being said, I believe that your biggest problem is not researching positions before accepting. We all have our limits. I recommend that after a potential interview to request a "walk through" of the expected work environment. Most employers will be happy to show you around. If they dont then it is a red flag and should be avoided. Do not hesitate to turn down a job at interview, but certainly try to honor a contract and keep best available connections.

[Contrarian]

Since EMRs and electronic Rx-ing is here to stay and EVERY clinical job will have its share of substandard folks and cumbersome processes and a few poorly concieved policies & procedures... YOU may as well quit medicine and go work at McDonalds...

 

Or

 

Stop being so critical, recognize and realize that YOU are but a small cog in a much larger wheel, and make lemonade out of those lemons.

 

:wink:

[chatcat]

I feel nauseous every morning going in, i hate my job, and I'm becoming miserable and nasty - someone I never wanted to become. The sad part is, the practice likes me and has no idea

 

Obviously you view your work as a major stressor in life. Although you might think your employers have no idea of your workplace angst, in reality they are probably feeling your pain

also.

You won't be able to continue with this level of stress before something goes very wrong either at work or in your personal life so changes must be made.

 

Am i just complaining and just went into the wrong field?

 

I think we all experience the frustrations you mention in our daily professional lives. There will always be the frustration of having administrators who have no clinical expertise, the process of enduring electronic medical records that aren't user friendly and the inevitable insurance hurdles to jump through. We all have to find our way in a heap of "other stuff" that

can distract from good patient care. This is the reality of medicine for PAs.

It sounds as if there is a big gap in your expectations versus the reality of practicing medicine.

 

The question is ....how to turn things around for you?

 

OPTION 1: Get support within your practice.

Start by your attitude about your other team members. That "emotional " clinic manager & the support staff can make or break you in your daily environment.

Not all team members in a medical office are going to have the same education or experience but they are part of your team so foster good relationships with them all. Sit down and

talk with your SP about solutions to improve your work flow & ask for any caveats that he/she might share to make you more efficient.

You might also bring constructive ideas to the table .....be part of a solution to areas that could be improved.

Admitting that you are struggling with the ancillary administrative challenges isn't a sign of being ill suited for this professional~ it just shows you need support to find a way to navigate such challenges which will ultimately make you a better clinician.

I would bet that if your clinical skills are solid this practice will support you to become better versed in juggling this part of your job. No practice wants to loose an otherwise solid clinician and face the task of retraining an unknown.

Open the door to frequent communications with your SP about your job performance and be open to suggestions of needed improvement as well as the positive feedback you receive about your skills.

 

OPTION 2: Do nothing...find another job and face the same scenario again with different players. (Note: whatever new job you apply for will ask for references of the old practice and

they will most probably be candid about both your clinical performance and

your role as a team player)

 

Good luck as you find your way to a more satisfying professional role. I think you probably are going through that learning curve that all new Pas encounter in the reality of practicing

medicine.

[Just Steve]

If you do decide to jump ship PLEASE practice some due diligence. The story that you shared with us, in the style that you shared it, sounds like you are getting into jobs that are over your head at this point in your career. ICU straight out of school is not an easy job at all. Then to do that job PLUS blaze the trail as the first PA on the floor is doubling an already crushing work load. So they kept your friend.. are they happy and fitting in well? If so, what is their secret? Different background? Different attitude?

 

From the ICU you went into a practice and appear surprised at the volume of patients. You do not mention how many providers are working, you do not mention any peers/supervisors that you can bounce things off of. The story you share makes it sound like you are on your own, without support, with a demand from somewhere to produce numbers, no matter what.

 

If you slow down your patient encounter, but dig deeper into their medical history, could you make up the loss income from decreased numbers by doing more complex exams and increasing their RVU?

 

Knowing what insurances will pay for what X-rays is simply memorization and as already mentioned, a crib aka: cheat sheet. While I am only a PA student, I used electronic medical records for the past 8+ years. I realize the amount of unnecessary drop down menus that require input, no matter how obsolete it may be, is staggering. I haven't found one provider yet that likes their EMR. I haven't found one EMR program that was actually written by a provider. But, through repetition you can learn the short cuts and speed up your charting. The computer location in the room...well.. sounds like it sucks. Have you walked into your office manager's office with an extra cup of coffee and sat down with them asking what the feasibility for an extra hour or two of training would be? Offer to attend the training on your own dime. The couple of hours of not being paid while at work may increase your overall productivity. Have you talked with the manager about the feasibility of using a computer tablet or laptop, linked to the local clinic network to do your charting? This way you can move the computer to a better access for you.

 

How do the other providers of the clinic manage? You have been there for 5 months...What were there learning curves? How did they succeed? Are they happy? If not, why do they stay? How does the senior provider approach the "emotional" office manager? Who hired the manager and why are they allowed to stay? Find the backstory to help you understand where they are coming from.

 

I get the fact that you are emotionally, mentally, physical exhausted. That is very clear in your post. What I don't understand is 1. Your background, so we can get a better idea if the jobs you are picking are logical 2. What you are doing in your workplace to improve your working conditions. 3. Why are you taking jobs without doing a better investigation into the job description, your supervisory support, so on and so forth. 4. What are you doing to relieve stress during your off times?

 

If you decide to jump another job,I suggest you have that job in hand BEFORE leaving your current one. Negotiate a 90 day start date so that you can give your current employer a decent heads up and depart under the best terms possible.

 

Good luck

[jrapa86]

Thank you all for your replies and taking the time to read my post. I am very much ready to take your insights and apply them because I want to make it work, and turn my career from a major stressor to something positive. I just needed to know if this was me, or if this was the place I am employed (and if they were being unreasonable). I think the answer is - whether they are unreasonable or not - the only thing that I can do about it is adapt my ways to make something of it and roll like the big dog. Thank you all again.

[jrapa86]

That is good insight on what to do for future jobs. Thank you.

[sunny2spot]

I agree with Steve. You can't take the first job that gives you an offer. Did you shadow either of these places before you took the job? Shadowing before you accept a job offer is hugely important especially for a new grad who sounds like they're unsure of what they want to do. I'd recommend it to anyone who receives a job offer and feels like they need a little bit more information before they accept.

[PAs Rock]

So I am becoming increasingly worried now that I am 1 year out of PA school and still unhappy with what I am doing.

I feel nauseous every morning going in, i hate my job, and I'm becoming miserable and nasty - someone I never wanted to become.

 

Hi there. I just wanted to give you props for being honest. Our jobs are very demanding and you are certainly not the only PA who has felt this way. I'm a recent grad in my first job and am having similar issues. I think many of our colleagues have given you sound advise. I do believe that the "power through it" approach can work but there are days when it doesn't and those days are hard.

 

The best advice I ever received during my training came from a close friend who was a medical resident. She advised me to take care of my mental health above all else and that's exactly what I did. I exercised daily, ate regularly, got enough sleep, kept in touch with loved ones, but the most important thing was I found a counselor who specialized in working with health care providers. He helped me tremendously when times were tough and I was ready to quit. I continue to see him for support during this first job because, honestly, it's stressful and I still have days when I want to run out the door. But I don't. I'm now in month 10. My work life is improving steadily day by day and it will for you too.

 

Take heart in knowing you are not alone. Take care of yourself in whatever way works for you. You're gonna make it.

[Teasip]

Darn folks, give the kid (assuming a young adult) a break! First off, this job isn't for everyone. I for one can relate to how an incompetent, or out-of-place administrative person can make a professional's job miserable. Second, I DO agree that it is possible to be in over your head and as such the stress can be overwhelming. It has been noted in at least one other thread that a mentor, if one can be identified early on within a practice, can make a huge difference. As far as going in everyday with a "positive attitude" approach; I personally think that is bunk. It makes no difference how positive your attitude is walking in the door when you get "shoveled on" within the first half-hour or hour of every work day. That being said, I don't believe that going in grouchy makes things any better but a pig with lipstick is still a pig. I've seen these same type of expressions over my 30+ years of doing this, and it's the same in every career field. Welcome to life as we know it.

 

OP, maybe it's time for a break/self-assessment. You know what your choices are and they are quite simple. Either stick with it or move on, maybe even outside the realm of patient care. Only you can make the educated decision based on whatever your personal situation may be (married, kids, financial obligations, etc.). Just by checking out other threads you know that you are not alone in your feelings. If you do choose to do something else it in no way implies that there was anything wrong with yourself, but instead it was just one of life's lessons (not an inexpensive one) and there must be something else out there for you. If you just look at the news you see stories of people doing a complete 180 degree turn even in their 50's to try to find something that they enjoy doing more. Just realize that these feelings aren't isolated to medicine only, which brings me to a basic question that I keep asking folks again and again. Why do you think that the health care industry has the job availabilities that it does?

[PACProvider]

Look for inefficiencies in your own practice. Ask other providers how they handle certain tasks. I found that the biggest problem that I had was that I wasn't delegating. No nurse or medical assistant is going to find you and offer to take on some of your work. They'd prefer to enjoy their extra free time chatting about when they'll retire or texting their boyfriends about date night. So, put more work on your team. I never return patient phone calls now. Never! If a patient leaves a message that says "call me" without an explanation, the MA who took the message is going to call the patient back to find out what they wanted. Let the nurse speak to your patients after you review the message. Do not ever call a patient. We are required to write a letter with every lab. I used to write paragraphs. Now I simply write "nothing concerning" or "we'll discuss at your next visit." I do everything possible to minimize future contact with the patient. I used to write a scrip for 30 days and bring the patient back for an appointment for followup. At followup, I'd have to write for six months or one year. Now, I write a one year scrip for everything and bring the patient back in a month. Minutes saved add up to hours. Learn the power of your EMR and use it to your advantage. If you can configure lab orders for your top office orders, it will save time. Get your medical assistants to do more work when triaging so you can walk in the room and know precisely why the patient is there and what you have to do. Most MAs simply want to get the patient roomed so they can goof off in the nurses station. They don't really care if they made your job easier by asking about the patient's chief complaint and supporting you with other admin tasks. You have to manage the staff. Don't let them manage you. Order less tests, not more. The less tests you order, the less your interpret and less you respond to. Don't ever waste time talking to patient to educate them. If you are in urgent care, the majority of your patients will never understand what you've told them after you've told them. Just get the H&P, make your treatment plan and print the education materials. I found that it's better to avoid explaining the diagnosis and treatment plan. Saves enormous time. I leave the room after the H&P and write the orders, treatment plan and print educational material. Then I give it to the MA to return to the room to discharge the patient. Minimize conversation with the patient. The patients will destroy your efficiency. Don't let them ruin you.

[Neurosurg PA-C]

Look into FP, not the "critical" nature of ICU and less hectic compared to an urgent care setting. You didnt set yourself up for success by choosing the jobs you did right out of school. Get some experience first and maybe come back to those particular specialties later in your career and I have a feeling that you may not feel so overwhelmed. Good luck.

[Cideous]

I'm curious what if any updates to this story have occurred. There is so much to add to this thread, but I don't have enough time to write it all. I will say that you guys are "harsh". Everything the poster listed wrong with their practice is what's wrong with medicine in general. I would like to tell you that yours is an isolated incident....it is not. I would like to tell you that your job there will get better. It probably won't. Medicine is run by non-medical people that have NO liability skin in the game. They don't give a flip if you are tagged in a lawsuit. Their only concern is their next productivity bonus. My advice would be to look for a job that was not 100% profit driven as many smaller practices are. Look into non -profit county clinic jobs. The patients will be lower on the socio-economic scale, but the profit expectations will be less. Also check into VA jobs. You might just remember why you went into medicine. Good luck and feel free to pm me if you need to talk or just vent. I've been doing this for almost 20 years

[Contrarian]

... Everything the poster listed wrong with their practice is what's wrong with medicine in general. I would like to tell you that yours is an isolated incident....it is not. I would like to tell you that your job there will get better. It probably won't. Medicine is run by non-medical people that have NO liability skin in the game. They don't give a flip if you are tagged in a lawsuit. Their only concern is their next productivity bonus...

 

Which is WHY I wrote ...

 

Since EMRs and electronic Rx-ing is here to stay and EVERY clinical job will have its share of substandard folks and cumbersome processes and a few poorly concieved policies & procedures... YOU may as well quit medicine and go work at McDonalds...

 

Or

 

Stop being so critical, recognize and realize that YOU are but a small cog in a much larger wheel, and make lemonade out of those lemons.

 

 

The practice of medicine is likely to get much more depersonalized and much more centralized and run by "business people" with NO clue as to the difference between Azithromycin and Zomig... except for the cost...

 

Once they (MDs/DOs) are ALL employees... the days of PA-Cs simply sitting down with your SP to hammer out difficulties and make on the spot practice changes/improvements will be GONE. Look forward to the days when your SP has to seek approval from a series of "Nurse managers" to implement "medical" P&P.

 

My prediction is that the whole of American Medicine will be as dystopian as the Military Medical system where both physicians and PAs are regularly directed and supervised by nursing.

[SocialMedicine]

Why do you have to finish a note during each patient visit? that sounds like alot of unnecessary pressure. I finish my notes throughout the day/lunch/ and i usually stay about 30 minutes beyond my last patient to review them

[Cideous]

Why do you have to finish a note during each patient visit? that sounds like alot of unnecessary pressure. I finish my notes throughout the day/lunch/ and i usually stay about 30 minutes beyond my last patient to review them

 

 

 

It's probably the computer system dynamics. Until he actually finishes his note and "closes" out the chart, the front end can't check the patient out. The last clinic I worked at had the same system. It was idiotic.

[Hemegroup]

It is definitely a challenge being dropped into systems which are not as adept at the efficiency that for the most part your University experiences have shown and given you over the years.

[familygal]

In my first job, I found that many of my frustrations with the office, the system, the practice, etc. were somewhat resolved once I put in my time there. I learned how to utilize the EMR, learned how to delegate a little bit more, and just getting a grasp of the medicine in general helped resolve a lot of my initial fears/discontent.

 

I would recommend anyone to stay at least a year in your first job. Its amazing to see the changes that happen at a year.

[whoRyou]

Jrapa ... Breathe!

[villa6]

Wow... How did this attitude get past the adcoms? While I am sure medicine in the real world vs schoolhouse requires some ethical compromises, I felt these statements are completely the opposite of what I have learned (and feel) makes a caring compassionate provider.

 

I never return patient phone calls now. Never! I do everything possible to minimize future contact with the patient.

 

Order less tests, not more. The less tests you order, the less your interpret and less you respond to.

I believe one should order a test or not based on if it is in the patient's best interest, not yours.

 

Don't ever waste time talking to patient to educate them. I found that it's better to avoid explaining the diagnosis and treatment plan. Minimize conversation with the patient.

 

The patients will destroy your efficiency. Don't let them ruin you.

This came off sounding as if one has accepted the corporate assembly line concept (the bean counters must be really happy with this) and abandoned the ideals of this honorable profession.

 

Sorry OP, I'm aware I'm off topic, but after not having the right to freedom of speech while I served, I now use it extensively.

[Fat Albert]

Look for inefficiencies in your own practice. Ask other providers how they handle certain tasks. I found that the biggest problem that I had was that I wasn't delegating. No nurse or medical assistant is going to find you and offer to take on some of your work. They'd prefer to enjoy their extra free time chatting about when they'll retire or texting their boyfriends about date night. So, put more work on your team. I never return patient phone calls now. Never! If a patient leaves a message that says "call me" without an explanation, the MA who took the message is going to call the patient back to find out what they wanted. Let the nurse speak to your patients after you review the message. Do not ever call a patient. We are required to write a letter with every lab. I used to write paragraphs. Now I simply write "nothing concerning" or "we'll discuss at your next visit." I do everything possible to minimize future contact with the patient. I used to write a scrip for 30 days and bring the patient back for an appointment for followup. At followup, I'd have to write for six months or one year. Now, I write a one year scrip for everything and bring the patient back in a month. Minutes saved add up to hours. Learn the power of your EMR and use it to your advantage. If you can configure lab orders for your top office orders, it will save time. Get your medical assistants to do more work when triaging so you can walk in the room and know precisely why the patient is there and what you have to do. Most MAs simply want to get the patient roomed so they can goof off in the nurses station. They don't really care if they made your job easier by asking about the patient's chief complaint and supporting you with other admin tasks. You have to manage the staff. Don't let them manage you. Order less tests, not more. The less tests you order, the less your interpret and less you respond to. Don't ever waste time talking to patient to educate them. If you are in urgent care, the majority of your patients will never understand what you've told them after you've told them. Just get the H&P, make your treatment plan and print the education materials. I found that it's better to avoid explaining the diagnosis and treatment plan. Saves enormous time. I leave the room after the H&P and write the orders, treatment plan and print educational material. Then I give it to the MA to return to the room to discharge the patient. Minimize conversation with the patient. The patients will destroy your efficiency. Don't let them ruin you.

 

Wow...unreal.