New grad regretting taking this job- advice?

[nts19]

I'll try to keep this as concise as possible. Took a primary care position in a small private practice with just the MD and a part-time PA. Didn't receive any kind of onboarding or training, nothing so much as filling out any documents for payroll, benefits, 401k, etc. I got thrown straight into seeing patients on my own and learning the EMR system all on day 1. Was told this MD "loved teaching new grads" when I took the position. It's been 3 days and I can't tell you how many times I've heard "this put extra stress on me" or "I don't have time to go over this" or "I'm sick of repeating this" every time I'm unsure about something and ask for clarification or don't do it correctly. She interrupts, talks over me and cuts me off in every conversation I have with her. I'm being rushed through encounters because we are constantly 2+ hours behind due to overscheduling and the MD consistently showing up 45-60 mins late. MD is telehealth only on Weds (which I wasn't told in interview) so my only communication with her was over video call in front of patients all day. No access to UpToDate or any kind of resource for when I need to look something up, at least until I can afford a subscription for myself. Some of these patients are complex internal medicine patients that I do not feel equipped to handle alone. Basically I don't feel I'm getting the right support as a new grad, or even the support I was promised. I feel like a liability every time I enter a room. I know I've only given it 3 days, but at the same time, I feel like they given me less than that.

I guess my question is, is it better to just continue aggressively trying to learn as fast as possible and taking the constant reprimanding until I get better? Or trust my gut and find something better suited for a new grad?

[DiggySRNA]

Quit. 

Life's too short.

 

[iconic]

No physician that has ever claimed to like teaching, has in-fact turned out to like teaching, in my experience. 

This sounds like a job that would be better to cut your losses from sooner than later.

For future, definitely pay attention to the general demeanor of the physician and if there are red flags upfront, they will only get worse once you start working. Also, ask to speak to other PAs at the practice. 

Edited February 8 by iconic

[SedRate]

10 hours ago, nts19 said:

is it better to just continue aggressively trying to learn as fast as possible and taking the constant reprimanding until I get better?

In this case, hell no. Get out of there and do it as professionally as possible.

10 hours ago, nts19 said:

Or trust my gut and find something better suited for a new grad?

Yes, and be more cautious on your job search and next interviews. Actually talk to these MDs and ask them directly about their experience teaching new grads. See if you can shadow for a day. Etc

[sas5814]

Move on. If they promised this and didn't deliver then this is the nature of the practice. I love the quote "when someone tells you who they are... believe them the first time."

Edited February 8 by sas5814

[CAAdmission]

It seems like you found out the reason this job opening was available. 

[Boatswain2PA]

Others have given advice of one flavor.

I will give advice of another flavor.

You have done HARD things in the past.  This is HARD.  You have been thrown to the wolves. 

Rise above it.

UpToDate is $559 for a year.  With your first paycheck buy the subscription (or whatever you FP types use).

Work harder.  Review your patients after the day is done.  Look up what you might have missed, and then call them back if necessary.  Or better yet, call them and schedule them for another appointment for you to fix what you missed.  The good news about FP (correct me if I'm wrong someone) is that USUALLY missing something for a few weeks isn't catastrophic. 

If they look bad, or vital sign abnormality (NOT HYPERTENSION!!!!) then send them to the ED.

CONNECT WITH YOUR SPECIALISTS. 

The front side of a learning curve is hard.  CLIMB IT and LEARN.   You can do it.

Keep us updated.

[SedRate]

11 hours ago, Boatswain2PA said:

Others have given advice of one flavor.

I will give advice of another flavor.

You have done HARD things in the past.  This is HARD.  You have been thrown to the wolves. 

Rise above it.

UpToDate is $559 for a year.  With your first paycheck buy the subscription (or whatever you FP types use).

Work harder.  Review your patients after the day is done.  Look up what you might have missed, and then call them back if necessary.  Or better yet, call them and schedule them for another appointment for you to fix what you missed.  The good news about FP (correct me if I'm wrong someone) is that USUALLY missing something for a few weeks isn't catastrophic. 

If they look bad, or vital sign abnormality (NOT HYPERTENSION!!!!) then send them to the ED.

CONNECT WITH YOUR SPECIALISTS. 

The front side of a learning curve is hard.  CLIMB IT and LEARN.   You can do it.

Keep us updated.

I appreciate your alternate perspective and agree that developing and practicing mental toughness are worthwhile pursuits.

[rev ronin]

13 hours ago, Boatswain2PA said:

UpToDate is $559 for a year.  With your first paycheck buy the subscription (or whatever you FP types use).

Substantially less than that with AAPA and multi-year discounts. I ended up paying for mine out of pocket (well, as a business expense) for the first time this year. UpToDate is still among the most cost-effective CMEs out there.

Having said that, I don't know that that is all I would have needed to thrive as a new grad in a world like the OP describes. 11.5 years into practice, I am much more self-directed in my CME than I was as a brand new PA.

[Reality Check 2]

I would not stay because this practice sounds horrible and quite risky from a medicolegal standing.

If you haven’t filled out a W-4 - will you get paid? Will the govt get your withholding when tax time comes?

Do you actually HAVE medical malpractice insurance in place? Are you properly licensed per state regs? 

Hard STOP on doing anything until I know these things and have some sense of control over my destiny and sanity.

Solo docs are a hard go. MD does NOT mean business sense, personality or leadership capacity.

Who is the business manager? If related to doc in ANY WAY - RUN NOW, don’t look back. NOTHING a good comes from family in the office.

Protect yourself, LEARN constantly, DO NO HARM, and ask more questions when job hunting. Ask to job shadow for a random day to see the office flow and politics. 
 

Best of luck!

Edited February 12 by Reality Check 2

[nts19]

Quote

1 hour ago, Reality Check 2 said:

If you haven’t filled out a W-4 - will you get paid? Will the govt get your withholding when tax time comes?

I did finally fill out a W-4 on Thursday and got paid on Friday so I'm covered on that front now. Still unsure about benefits and 401k, but at this point I've made up my mind that I won't be staying here so I'm not sure if it's even worth clarifying with the MD.

1 hour ago, Reality Check 2 said:

Do you actually HAVE medical malpractice insurance in place? Are you properly licensed per state regs? 

I have my state license, still waiting on CDS and DEA but she is aware of that. I am now realizing though that we never talked about malpractice insurance. I might have assumed it was included because I saw it included in 99% of job listings that I looked at. Going to have to talk to MD about this ASAP now. I know I'm in a state that doesn't require it but obviously I don't feel comfortable without it especially now.

1 hour ago, Reality Check 2 said:

Who is the business manager? If related to doc in ANY WAY - RUN NOW, don’t look back. NOTHING a good comes from family in the office.

So I know there's no family working in the office on a day-to-day basis, however there is a sign outside with a few names on it that share her last name and I think they may be involved on the business side, or at least used to be.

 

Knew this seemed like a red flag going in but I felt pressured to take a job because I wasn't finding anything else. Finding a job as a new grad in a somewhat rural area has been a struggle, I wasn't finding very many opportunities, had a few prospects that fell through, and felt pressured to take the first offer I finally got. I definitely realized this wouldn't be an ideal job when I took it, but I didn't think it would be THIS bad.

 

Overall updates: Turns out she's telehealth Weds AND Thurs, didn't find out about Thurs til I showed up for the day. At least Weds there was another part time PA in the office, but Thurs I was completely alone and terrified. She does join most of my encounters at the end via telehealth and is checking my charts but I still don't feel comfortable enough here. My plan is to buy UpToDate to help myself out while I start applying elsewhere. I have to give 30 days notice per my offer letter so it'll be a while before I can get out of here unless I just go back to being unemployed for a bit. 

Edited February 10 by nts19

[rev ronin]

3 minutes ago, nts19 said:

 I have to give 30 days notice per my offer letter

And what are the contract-specified penalties for just walking away? I can guarantee you that 30 days notice would be less comfortable than what you are experiencing now.

[nts19]

Also, would appreciate any advice on how to approach leaving this job and potentially explaining this situation in future interviews. Do I have to put it on my resume? If I do, how do I explain leaving so soon? If I don't, how do I explain passing the PANCE in October and having no job experience still in February?

[nts19]

3 minutes ago, rev ronin said:

And what are the contract-specified penalties for just walking away? I can guarantee you that 30 days notice would be less comfortable than what you are experiencing now.

Just says "either party may terminate this agreement by providing the other party with 30 days written notice."

[rev ronin]

8 minutes ago, nts19 said:

Just says "either party may terminate this agreement by providing the other party with 30 days written notice."

So, you have nothing much to lose, really, by walking away. If you decide that it's more hazardous to your career to stay and give 30 days than it is to walk, there are, per you, no designated financial penalties for simply giving 0 days' notice. Now, that's not ever a nice thing to do, so before you consider it, I would encourage a lot of introspection about whether that would be a good option... but realize that it IS an option.

[SedRate]

2 hours ago, nts19 said:

how do I explain passing the PANCE in October and having no job experience still in February?

Only you can answer this. Spend some time self-reflecting and speak with trusted, respected colleagues/friends who know you and can provide insight into where you can improve.

2 hours ago, nts19 said:

I know I'm in a state that doesn't require it

Malpractice insurance is not a state mandated thing (at least in the states I've worked). You should have malpractice insurance to protect you and your license. You should not be practicing medicine at all without it or else you are taking a huge risk. Do not touch, examine, nor treat a patient until you receive a Certificate of Insurance (COI) for your policy naming you as a covered individual. 

[Reality Check 2]

Make sure you are licensed with your state WITH THIS PHYSICIAN if it is required.

Follow all state regs and don't assume ANYONE in this office is doing it for you.

If your state requires a delegation agreement or scope of practice, you better have one on file with all the right signatures and dates or you are practicing medicine outside of state regs.

Having a license and being set up properly are two vastly different things.

IF you don't have any of this set up then you should walk away 30 days or not.... you are exposing yourself to liability and trouble.

Never assume a physician or clinic knows squat about PA licensure or regulations. Always protect yourself.

 

[Reality Check 2]

Do you have a UPIN and Medicare number and NPI?

Did you credential with insurance companies and have proof of that?

Sneaking suspicion that your doc is billing under herself at higher rate since she joins your visits via video at the end.

You need a ton of information and documents.

That Certificate of Insurance for malpractice is vital to your future. I have every single one for 20+ years and had to use them for every job and insurance credential ever.

And in the situation you are in now, you need your own insurance to protect yourself.

And maybe an employment attorney.

Edited February 11 by Reality Check 2

[nts19]

55 minutes ago, Reality Check 2 said:

If your state requires a delegation agreement or scope of practice, you better have one on file with all the right signatures and dates or you are practicing medicine outside of state regs.

I do have a delegation agreement with this MD. 

 

20 minutes ago, Reality Check 2 said:

Do you have a UPIN and Medicare number and NPI?

Did you credential with insurance companies and have proof of that?

I do have an NPI. Not gonna lie I have no clue what a UPIN is, don't know anything about a Medicare number...

Not sure what credentialing with insurance companies entails, I guess that's something I assumed an employer would talk to me about if they needed information from me for it.

22 minutes ago, Reality Check 2 said:

And maybe an employment attorney.

What would that be for?

 

This is starting to look like I need to leave this job immediately.

[Boatswain2PA]

I'm gonna float another idea here.

Your doc is checking your notes and touching base with every encounter.

Are you doing great and don't even know it?  Is this all fear?

Has your doc said anything inferring you ain't cutting it?

Perhaps, just perhaps, you just aren't aware of how the big boy leagues work.  You have a graduate degree, a solid education, and are a professional.  Maybe, just maybe, you are being TREATED like a professional but you don't know what that looks/feels like.  Professionals are expected to be able to rise up, find what they need, and make the decisions.

Maybe you are sinking, with patients flocking to the ED with DKA, PEs, thyroid storm, ACS, etc.  Maybe you are actively killing them with your medical malpractice.  Maybe your doc is calling your patients back every evening telling them NOT to start the hormones, to adjust their insulin, etc.  

 

Or maybe you are doing okay, your doc is providing top cover, and you are on the frontal cliff of a massive learning curve that is SCARY.

I wouldn't quit until you had a meeting with your doc/owner.  

Call/text them asking for a meeting this week.  Tell them it's very important but not urgent.  If they blow you off, repeat that you need to meet with them sometime THIS WEEK, and it's important.  

Go in, tell them you feel as if you are failing, and ask if they feel the same.  

 

If they agree, then "whew"....work together to find out how to leave the practice.  Good recommendation, you will work another 2 weeks (or whatever) and everyone agrees this wasn't the place for you.

If Doc stays "yeah, you're struggling but keep swimming", then keep climbing that steep learning curve.

And maybe Doc will say "what are you talking about?  I've read your charts and met with your patients, you're doing fine!!"

 

Edited February 11 by Boatswain2PA

[Ty2PA]

9 hours ago, Boatswain2PA said:

Go in, tell them you feel as if you are failing, and ask if they feel the same.  

 

If they agree, then "whew"....work together to find out how to leave the practice.  Good recommendation, you will work another 2 weeks (or whatever) and everyone agrees this wasn't the place for you.

If Doc stays "yeah, you're struggling but keep swimming", then keep climbing that steep learning curve.

And maybe Doc will say "what are you talking about?  I've read your charts and met with your patients, you're doing fine!!"

This is some of the best advice. Great way to approach it in a respectful yet sincere way. Just be ready for the "we all agree this isn't working out" part of the conversation which might have you leaving the job before you have another lined up. However, all things considered, I would take this advice and have this conversation very soon.

[CAAdmission]

18 hours ago, Reality Check 2 said:

Who is the business manager? If related to doc in ANY WAY - RUN NOW, don’t look back. NOTHING a good comes from family in the office.

You mean it's a bad idea to work in an office where the doc's wife is the office manager? Whatever could give you a crazy notion like that? 

[rev ronin]

8 hours ago, CAAdmission said:

You mean it's a bad idea to work in an office where the doc's wife is the office manager? Whatever could give you a crazy notion like that? 

Uh-oh. I'm working in a practice where the owner's wife is the MA/office manager. Funny, I'm having the time of my life here...

[Aunt Val]

Your situation sounds terrible.  I'm sorry you're going through all this.  My experience with trying to tough it out in a somewhat similar situation as a new grad was that it never got much better and in some ways got worse over time.  As a new PA you need teaching and support, not to be thrown in and expected to immediately function like an experienced provider.  Yes, I learned stuff through being in a tough situation--one of the lessons being that I would never put myself in a similar situation again!--but there can be a huge toll on physical and mental well-being.

Just a suggestion--you may want to try DynaMed as an alternative to UpToDate.  It's much cheaper and still provides what you need for clinical info and CME.

[ohiovolffemtp]

Medscape is free and I find it much more focused and easier to use than UpToDate.