EM PA entering Med School Advice

[jonathanlipniky]

Hello Everybody,

 

I have been a PA in emergency medicine for 2 years and will be matriculating into medical school this summer.  With my experience in EM, and as a paramedic prior to school, I have lately developed an aversion to actually talking with patients, lack of empathy and patience. I'm not sure if its the grind of generally being responsible for moving the meat (interacting with worried well, primary care complaints, angry/unreasonable patients, trying to pull a history out of someone with a 3rd grade education), in conjunction with meeting metrics, that has created this aversion in me, or if my personality would be geared towards specialties with less patient contact (pathology, radiology).  We recently went down cut down or APP staffing hours during the day, which may have something to do with it as well, but it is disconcerting for me.  

I'm wondering if there are prior EM PAs here that have made the transition, and into what specialties you have found yourselves in? Any advice or guidance would be appreciated. 

 

Thank you.

[EMEDPA]

Have not taken the leap myself, but know a few who have and those who don't do EM often do critical care, anesthesiology, or IR. 

[PAtoMD]

Congratulations! Wasn't working in EM before school but there is faculty at my program who is PA to MD and stayed in the ER after school.

I am entered wanting to go EM but have since switched to urology which is what i was practicing before school. 

[kettle]

EM PA here, medic for about a dozen years prior. Congratulations on med school!!! I went to PA school with about 10 paramedics/EMTs and only 2 of us are still in emergency medicine. The others went more into procedure specialities and ortho. You have a great skill set especially for IR. Myself personally I didn't know if I could do emergency medicine forever but I do a ton of counseling to work on my communication and to work through the highs and lows of EM

[SedRate]

On 11/21/2023 at 1:45 PM, jonathanlipniky said:

aversion to actually talking with patients, lack of empathy and patience. I'm not sure if its the grind of generally being responsible for moving the meat (interacting with worried well, primary care complaints, angry/unreasonable patients, trying to pull a history out of someone with a 3rd grade education), in conjunction with meeting metrics, that has created this aversion in me, or if my personality would be geared towards specialties with less patient contact (pathology, radiology

Unfortunately, this is the culture of our medical care and system nowadays. Finding a job that doesn't move the meat is key. And EM is hard because you tend to see the worst of all worlds... Also, it sounds like you have a bit of burnout -- changing things might help. I recommend seeing a counselor to work through some of this as it'll likely get worse with time. 

I'm curious: What made you decide to go to medical school? 

[Apollo1]

You may be more suited to something procedural based on your prior experiences. If you're burned out now after only 2 years in EM, it's not going to get any better as an attending.

*If* EM is your only practice experience, be prepared for the eventual questions as to why you jumped to med school after a very short time in practice as a PA. 

[CAAdmission]

On 11/21/2023 at 2:45 PM, jonathanlipniky said:

Any advice or guidance would be appreciated. 

Med school will do everything it can to turn you into an arrogant ahole. Resist. 

[PAtoMD]

2 hours ago, CAAdmission said:

Med school will do everything it can to turn you into an arrogant ahole. Resist. 

had no clue you went to medical school 

[sas5814]

I lurk in a few groups on Reddit for pre-med, med students, and residents (along with the emergency medicine group) and I have learned more about med school in a year or so than I learned in more than 20 years of dealing with physician groups while I was serving on PA boards. It gives real insight into the amount of work, the stress, the years of working crazy hours for crappy pay, and the eventual reward. You might check it out and ask a few questions there directly to people who are in the midst of it.

[PAtoMD]

2 minutes ago, Hemmingway said:

I lurk in a few groups on Reddit for pre-med, med students, and residents (along with the emergency medicine group) and I have learned more about med school in a year or so than I learned in more than 20 years of dealing with physician groups while I was serving on PA boards. It gives real insight into the amount of work, the stress, the years of working crazy hours for crappy pay, and the eventual reward. You might check it out and ask a few questions there directly to people who are in the midst of it.

There are a handful of very active PA to MD users on reddit as well OP. 

[iconic]

Not all specialties work crazy hours; In Psych I know it's rare for residents to work more than 50 hours and usually it's closer to 40. That's not to say it still takes a very long time for them. 

[CAAdmission]

On 11/29/2023 at 9:45 AM, PAtoMD said:

had no clue you went to medical school 

I've seen the output. It isn't pretty.

[EMEDPA]

On 11/22/2023 at 4:35 PM, SedRate said:

Unfortunately, this is the culture of our medical care and system nowadays. Finding a job that doesn't move the meat is key.

This is why I work 100% rural now. I did the inner city urban trauma ctr 3+ pt/hr thing for 15 years and got burned to a crisp. Now I average 1 pt/hr or less at a high rate of pay and am the happiest I have ever been since graduating from PA school. 

[SedRate]

2 hours ago, EMEDPA said:

Now I average 1 pt/hr or less at a high rate of pay and am the happiest I have ever been since graduating from PA school. 

I wanna be like you when I grow up. 

[EMEDPA]

1 hour ago, SedRate said:

I wanna be like you when I grow up. 

nah, you probably want to see your family occasionally.

[SedRate]

1 hour ago, EMEDPA said:

nah, you probably want to see your family occasionally.

I do. I thought you were cutting back?

[jonathanlipniky]

Thank you all for your responses. I decided to go back for a variety of reasons, but mainly because I felt a hard ceiling in regards to autonomy, scope of practice, type of patient I would be caring for. I lost some of these things going from paramedic to pa.  I feel like unless I practice in a rural environment, the role of the APP in the ED is to decompress the ED so that the docs can focus on the sicker patients - which is appropriate. I think the role that I envisioned myself having in medicine is more in line with being a physician.  I remember feeling this way in PA school as well, and the itch never really went away. 

[EMEDPA]

On 12/2/2023 at 7:10 PM, SedRate said:

I do. I thought you were cutting back?

down from 260 hrs to 186/month. Still do a lot of driving between sites. Working on it. Hope to be down to full time by age 60

[SedRate]

12 hours ago, EMEDPA said:

Hope to be down to full time by age 60

Just make it happen

[CSCH]

Congratulations on getting into med school! I really relate to what you said about the "itch."

You are describing very typical symptoms of burnout, and EM is a particularly high-burnout specialty. At some point when you are able to be a little more removed from the situation, it may be wise to consider what really burnt you out. Was it the staffing, was it the people, was it the terrible situations your patients were in, was it being at the front door of medicine, etc? You also need to ask yourself what you loved, because there is something that you really liked about it that drove you to apply to med school. What specialties get you more of what you loved and less of what broke you? Residency itself will offer you plenty of opportunity for burnout with the hours and expectations. You've already shown yourself to be a resilient person capable of making change by going from paramedic to PA and now PA to med student. You are capable of making other changes in the future if what you choose at first isn't the right fit.

[PAtoMD]

5 hours ago, CSCH said:

Congratulations on getting into med school! I really relate to what you said about the "itch."

You are describing very typical symptoms of burnout, and EM is a particularly high-burnout specialty. At some point when you are able to be a little more removed from the situation, it may be wise to consider what really burnt you out. Was it the staffing, was it the people, was it the terrible situations your patients were in, was it being at the front door of medicine, etc? You also need to ask yourself what you loved, because there is something that you really liked about it that drove you to apply to med school. What specialties get you more of what you loved and less of what broke you? Residency itself will offer you plenty of opportunity for burnout with the hours and expectations. You've already shown yourself to be a resilient person capable of making change by going from paramedic to PA and now PA to med student. You are capable of making other changes in the future if what you choose at first isn't the right fit.

I hope this cycle is going well for you!