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Are supportive work environments a myth?


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Between my partner and I we have worked in 4 different settings and specialties (both metropolitan and rural) across 4 years - we work in a state considered to be one of the best for PA practice. However, neither of us have felt truly supported, invested in, or valued in any of our positions. 
 

It is hard to imagine myself doing truly thankless work for the next 10 years. Are we in a slow spiral downward as a profession? Or have PAs always needed to fight tooth and nail for a modicum of respect? The amount of effort that I put into getting this far, ongoing learning, and bringing a positive attitude to the team is far too much to get a pat on the head for being a “good little PA” at BEST. 

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So there's a couple of things going on here:

1) All medical professionals (PA, NP, MD, DO, DPM, etc.) are being abused by administrators whose job it is to make money off the backs of medical professionals and from the wallets of patients.

2) Among those various medical professions, PAs are at somewhat of a disadvantage due to our dependent nature.

#2 we can do something about with effort and lobbying; #1 is harder.

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This is a very appropriate question right now

 

I think in the past we have always been siloed and forgotten

then cam covid and even the little scraps of dignity tossed our way got taken away - admin wants to pile "physican level stuff"  ie call, on us, but when we ask for pay for it they say "but physicians don't get paid".

Then in our reviews and time for a raise we are told, you are a PA and not a doc and we don't give pay raises, no productivity, and oh yeah her is more to do.

 

I have never felt like unions are the answer till about 3 years ago.

Now I think the only thing that will protect us and not have us abused and mistreated by admin is a union.

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I'd warn you, I've been in a union job (not in an healthcare setting). There are ups and downs and you trade one set of problems for another. Unions might be started by idealists, but they often wind up being run by the same kind of incompetent, self-serving morons that you currently work for. 

I'll confess, it is entertaining watching the two populations of morons when they go to war with each other. 

Edited by CAAdmission
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6 minutes ago, iconic said:

Everyone just looks after themselves these days. I get an occasional thankful patient and that’s fine. I wish I was compensated more appropriate for making a bank for my boss 

That was a big issue in my first job. Every doc drove a car that cost more than they were paying for my annual salary. 

Mr. Employer, I'll work to improve your lifestyle, or I'll work to make you a lot of money, but you need to reciprocate.

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my partner and I are realizing a couple things. 
 

1. Physicians are not actually incentivized to work closely with us and provide the mentoring / collaborative care that our profession was built on. This means under supported new grads and no one to go to bat for us. 

2. We are pushed by admin to act in the same capacity as a physician - at my first job as a new grad I could read the irritation on admins face when I put my foot down about limiting visits per day and my responsibilities. 

3. A combination of the above has lead to a very tenuous relationship between PAs and MDs and unfortunately is the driving force behind PPP and other movements. Any opposition from us and they double down. 

It feels like we are stuck between admin and the physicians we work with. Going to work every day just trying to keep my head down and receiving 0 respect in the process is not doable long term. I wish we knew all of this before PA school. 

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1 hour ago, coolbean said:

my partner and I are realizing a couple things. 
 

1. Physicians are not actually incentivized to work closely with us and provide the mentoring / collaborative care that our profession was built on. This means under supported new grads and no one to go to bat for us. 

2. We are pushed by admin to act in the same capacity as a physician - at my first job as a new grad I could read the irritation on admins face when I put my foot down about limiting visits per day and my responsibilities. 

3. A combination of the above has lead to a very tenuous relationship between PAs and MDs and unfortunately is the driving force behind PPP and other movements. Any opposition from us and they double down. 

It feels like we are stuck between admin and the physicians we work with. Going to work every day just trying to keep my head down and receiving 0 respect in the process is not doable long term. I wish we knew all of this before PA school. 

I hear you. It is a tough position to be in sometimes. I encourage you to take control of your situation and make your job work for you, e.g., schedule that allows you to do stuff you want to do, work the specialty you like, work in an area you like, work with people you like, etc. Not an easy task to figure out but might combat some of these things you describe. 

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I had several soul sucking jobs before I went 100% rural at places that are hurting for staff. These places are happy to have me and treat me well out of fear of losing me as they can't replace me with anyone except a residency trained and boarded EM doc at twice my rate of pay, if they can even find one willing to work hours outside a major metro area. In short, find a situation in which you are hard to replace.

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Everywhere I've ever been in life (including in other careers), there were coworkers who were unhappy but insisted that that is the nature of work: things suck everywhere and more or less equally. I've not found that to be the case. While there are trends and similarities, I've found differences and those differences have been critical to me. 

There doesn't seem to be a point to staying anywhere that constantly makes you unhappy for whatever reason. Sometimes you need to hang around to get trained, fulfill a commitment, make some money, or whatever. Then it's time to find someplace better.  Just the looking can improve your outlook, even if it takes time to find the right next move for you.

Edited by UGoLong
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14 hours ago, UGoLong said:

There doesn't seem to be a point to staying anywhere that constantly makes you unhappy for whatever reason. Sometimes you need to hang around to get trained, fulfill a commitment, make some money, or whatever. Then it's time to find someplace better.  Just the looking can improve your outlook, even if it takes time to find the right next move for you.

This!  Whether in medicine or any other situation in life: work, relationships, where you live - the reality is that you have fairly limited ability to make changes in place.  Being willing and able to leave the entire situation is the only real power you have.

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It's corporate medicine that is screwing things up. If you can find a decent doc or small practice group to work for, life can be great. I'm always nervous for folks that work for a solo practitioner, though. All your eggs are in one basket. I know a PA that got hung out to dry when their SP lost their license over unnecessary breast examinations. 

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Honestly small practices aren't all that great - everything is on a whim of a physician/owner. Benefits are usually terrible as they can't really get a good deal with health insurance, you don't really get much in a way of disability insurance, etc..  In my experience PAs working for larger organizations almost always have a better deal/benefits 

Edited by iconic
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On 12/6/2022 at 8:53 AM, EMEDPA said:

I had several soul sucking jobs before I went 100% rural at places that are hurting for staff. These places are happy to have me and treat me well out of fear of losing me as they can't replace me with anyone except a residency trained and boarded EM doc at twice my rate of pay, if they can even find one willing to work hours outside a major metro area. In short, find a situation in which you are hard to replace.

I truly lucked out with my first job out of school - I'm at a rural health clinic in eastern Oregon. My SP has been my biggest supporter from the beginning, but we also have an amazing staff that just works well together. We went through a bit of a crisis over the last six months due to a poor hiring decision on the part of the county (our big boss for lack of a better term). It took my SP and I submitting letters of resignation for them to see the light. We when laid all the facts out there for them, they corrected everything and I walked away with a more competitive salary, more PTO, and realization of just how valued I am. One of the biggest things that made this happen was that they knew that if I walked, it would shut the clinic down. We've had an open provider position for 18 months now, because it's a hard sell getting someone willing to move out to the middle of nowhere if you don't already have connections to the area. 

All this to say, there are really some hidden gem jobs out there. They're just not always easy to find.

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I work for a small EM staffing company that specializes in rural critical access hospitals.  The CEO called me (she knows everybody by name) to ask if I would be willing to change where they use me because of staff changes.  I mentioned to her that I'm likely to need surgery and may be off for awhile in the next few months.  Her two comments:

  • Of course we'll support you.
  • Please wait until after the 1st of the year if you can to when our new short term disability plan starts (btw, it's fully paid by the company)

I've already seen this company support folks and she made sure I had a job when we lost the site where I was, so I have complete faith in her and our company.

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I just left corporate medicine (UC) after three years. Before that I spent three years in a rural community health center (FM). In both jobs I was fortunate to have great support and respect from my SPs and colleagues but I can't say the same about our admin.

Now I'm a few months in to my new job in derm at a big company (40+ clinics in three states) but not corporate owned. I met the owner for the first time yesterday to assist him with Mohs and I was caught off guard the first time he introduced me to his patient as his "associate."

So to answer your question, I certainly hope it's not a myth because I have a long way to go before retirement. If this job isn't it, I might just have to leave clinical medicine completely.

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NOPE not here

 

I brought up wanting to cut back on hours - they declined with out a $125/hr pay cut for the 4 hours I was trying to decrease by

 

Now they are asking for a meeting to discuss my current schedule as I guess the 250 patients a month I am seeing are not enough....  yup CV is likely getting polished up..

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I think the thing that frustrates me the most is the amount of lip service "being supportive" gets while the core issues that fry us all gets ignored or exacerbated.

I currently have a system where every 30-minute appointment would actually take an hour or longer if everything were done the way the mandatory click boxes and checklists require. So, the system guarantees failure at some level but weekly another "it will only take a minute" thing gets added by people who have zero idea what actually takes place at the point of service. Then we either get flogged because all our boxes aren't checked in a timely fashion, or we aren't documenting complete H&Ps.

However, they will send us to counseling if we get burned out and they love bomb us with trivial things like a cake or pizza.

Its paradoxical madness.

Edited by sas5814
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1 hour ago, sas5814 said:

However, they will send us to counseling if we get burned out and they love bomb us with trivial things like a cake or pizza.

Heh, you are living like a king. None of my workplaces would do these things. If we wanted food, we did a potluck. It's just as well. I would not have wanted to provide an opportunity for the non-revenue producing C-suite dirtbags to feel magnanimous. 

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