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Graduated May of 2023, got my first job and it was in a big city hospital in Internal Medicine. After 3 months I was let go because I wasn't good enough at the job. Then I got a new job at a private clinic, the two months were extremely rough. Eventually I gained some skills and confidence. Just tonight (5 months into the job) my boss tells me that he normally lets PA's go if they come in as untrained as I was. He said if it wasn't for my work ethic and the fact he could see I was spending time outside of work learning what he was teaching me he would have let me go already. 

 

So, is it just me or are PA schools and clinical rotations just not that great at training us for our first job? I feel like I was barely given a chance to succeed in this career and barely made it out alive here. Anyone else with a similar experience?

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This is a not uncommon occurrence; we see it posted here quite often. My impression is that there are far more new grad PAs than there are new grad friendly PA jobs: everyone wants a fire-and-forget cash generator, not a developing medical professional with growth potential.

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19 minutes ago, rev ronin said:

This is a not uncommon occurrence; we see it posted here quite often. My impression is that there are far more new grad PAs than there are new grad friendly PA jobs: everyone wants a fire-and-forget cash generator, not a developing medical professional with growth potential.

Can’t imagine all those new grad PA’s who didn’t luck into a situation I lucked into (and even in my situation I feel like I barely made it through). And having all that debt to pay off

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Consider the fact that physicians who graduated from a 3 or 4 year medical school do a residency of 3-8 years to learn their trade.  PA school prepares us to be beginners.  Our first 3+ years of practice are learning our trade.  That's why there's a 2 tier job market for PA's.  That's why finding a new grad friendly job is so important.  There's no way a new grad PA can function like an experienced PA or similarly to a doc who's completed residency.  That learning curve has to be paid.

Even if you did all of your elective rotations in a specific field and then work in that field you'll still have lots to learn.

I became an EM PA after decades doing 911 response as a firefighter/medic and have worked in EM my entire career.  Like all new PA's, I had a massive learning curve to pay as a newbie.  It was 3+ years before I was comfortable with the routine EM complaints.  11 years in, 6 doing solo coverage with a doc on call, and I'm still learning.

Try to stay in one place for several years so you can pay the steepest part of that learning curve.  At less than a year in, you can be glad that the doc is recognizing your work ethic and still investing in you.

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The issue is multifactorial. Not saying this applies to you, but IMO one of the biggest ones is PA schools taking applicants with little-to-no healthcare work experience to buttress the education. PA school wasn't designed for the current climate of grades over experience (although we understand the rationale why); on-the-job learning fills in the gaps, but we all can see why some employers aren't looking for people essentially out of undergrad to be dictating care for their patients.

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1) says a lot about you that your boss recognizes your work ethic

2) is your boss a physician or an admin?

3) if you know the field you want to be in long-term (e.g. surgery, EM, IM, CC) and don't want the stress of having to generate revenue and know everything, consider a fellowship

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at best PA school teaches you just enough to not kill someone - your first 2-3 years gets you truly trained

in the past 20 years PA employment has become just filling a licensed provider for any slot - irrespective of experience

HR in big companies is illogical

 

 

So what has occured is HR (who doesn't know crap) just plugs in a PA like a new boarded doc (who finished residency and can pretty much fly a day one).  This lead to almost immediate failure of the PA as they are not a doc and need mentoring.

HR doesn't give a crap case they are saving $200-500k/year over having a doc on board so they feel great.

The new grad PA is overwhelmed, the care team ends up having to train the new grad PA and if they are not into it they also hate the new PA.

All to save a buck......

 

I see it changing in my local area.  Driven by the fact HR is loosing so many hires by bad decisions(costs around $75-100k to onboard a PA) and the ongoing need for providers.  There is not enough Doc's so they continue to hire PA and NP.

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11 hours ago, Apollo1 said:

one of the biggest ones is PA schools taking applicants with little-to-no healthcare work experience to buttress the education

Unfortunately, there's no evidence to support this belief. Studies of experience vs PA school outcomes don't reveal a significant difference between applicants with different levels of experience. 

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1 hour ago, CAAdmission said:

Unfortunately, there's no evidence to support this belief. Studies of experience vs PA school outcomes don't reveal a significant difference between applicants with different levels of experience. 

What's the O in PICO? Success in graduating from PA school and/or passing the PANCE? How about longevity in the first post-PA school position? That would seem to be a better metric to me.

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14 hours ago, ohiovolffemtp said:

 

I became an EM PA after decades doing 911 response as a firefighter/medic and have worked in EM my entire career. 

and this is what set you and most older PAs up for success.  the trend to taker smart kids with no medical experience into PA programs IS the problem that no one wants to talk about. The whole idea of the profession is building on a solid base. back in the day as an EMT with 4 years of ER tech experience, I was told I needed to be a paramedic/RT/RN for several years prior to applying. 

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2 hours ago, CAAdmission said:

Unfortunately, there's no evidence to support this belief. Studies of experience vs PA school outcomes don't reveal a significant difference between applicants with different levels of experience. 

"PA school outcomes" means they can pass PANCE. It doesn't mean they know their way around a clinic or hospital. 

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1 hour ago, rev ronin said:

What's the O in PICO? Success in graduating from PA school and/or passing the PANCE? How about longevity in the first post-PA school position? That would seem to be a better metric to me.

agree. how about ability to function to a satisfactory level their first year out of school with appropriate, but minimal oversight? Who judges this? This docs and PAs the new grad works with....

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1 hour ago, rev ronin said:

What's the O in PICO? Success in graduating from PA school and/or passing the PANCE? How about longevity in the first post-PA school position? That would seem to be a better metric to me.

 

14 minutes ago, EMEDPA said:

agree. how about ability to function to a satisfactory level their first year out of school with appropriate, but minimal oversight? Who judges this? This docs and PAs the new grad works with....

All great questions, but until someone figures out how to study it, it's all just speculation. One of the hands-down worst students I ever precepted was a former paramedic. Couldn't teach them anything because they already knew everything. Documentation was like a bad run report. 

Good luck!

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Just now, CAAdmission said:

All great questions, but until someone figures out how to study it, it's all just speculation. One of the hands-down worst students I ever precepted was a former paramedic. Couldn't teach them anything because they already knew everything. Documentation was like a bad run report. 

Good luck!

Longevity in first PA position is something that could be reasonably surveyed. I agree it would be subject to recall bias and PAs not wanting to admit how brief their first position was. It might be possible to objectively discern from payroll records, but that would be a massive and complicated undertaking.

As far as paragods... shame someone didn't filter him (it's almost always a him) out in the interview process for that attitude.

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17 minutes ago, CAAdmission said:

 

 One of the hands-down worst students I ever precepted was a former paramedic. Couldn't teach them anything because they already knew everything. Documentation was like a bad run report. 

Good luck!

Worst student I ever had was a PhD microbiologist. He refused to learn medicine. We failed him on the rotation and I think his program allowed him to repeat it elsewhere. (Rev, I think he might have been in your class, if not the one after). 

this is why medical experience is only part of the whole package. the "ideal" PA school applicant:

1. has significant medical experience

2. has good grades

3. knows what a PA is (and isn't) (this is from working with PAs, not 8 hrs of shadowing)

4. has an attitude of humility in regards to what they know and don't know

5. can interact with anyone, regardless of beliefs, politics, race, religion, etc

6. can speak to people at the level they need to understand what is happening to them(they can teach...)

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2 minutes ago, EMEDPA said:

Worst student I ever had was a PhD microbiologist. He refused to learn medicine. We failed him on the rotation and I think his program allowed him to repeat it elsewhere. (Rev, I think he might have been in your class, if not the one after).

None of my cohort had PhD's. A couple had MPHs, one had a masters in Traditional Chinese Medicine, and I had an MDiv, but we didn't have anyone who had a doctorate already before PA school, unless they were reeeallly quiet about it.

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4 minutes ago, EMEDPA said:

6. can speak to people at the level they need to understand what is happening to them(they can teach...)

Of all the things I didn't realize would help me be a successful PA, my undergraduate education as a computer systems analyst really helped me in patient education. Systems analysts make a living by translating between business geeks (MBAs) and computer geeks (programmers) so everyone knows what's going on despite having two sets of incompatible jargon in play. Not so hard to plug in 'English' and 'Medical-ese' and do the same sort of on-the-fly interpretation and perception checking.

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4 minutes ago, rev ronin said:

None of my cohort had PhD's. A couple had MPHs, one had a masters in Traditional Chinese Medicine, and I had an MDiv, but we didn't have anyone who had a doctorate already before PA school, unless they were reeeallly quiet about it.

this dude was NOT quiet about it. 

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Years of prehospital medicine only taught me a small portion of the medicine I had to learn to be a good PA.  Frankly, PA school only did a bit of that, but it did set me up to be a beginner.  What my pre-PA experience did teach me was:

  • how to interact with scared and altered patients and families
  • how to lead teams and interact with other pieces of the medical system
  • how to recognize sick, about to be sick, and to be calm while sorting this out and starting care

This was way more important after my 3rd year or so practicing EM.  Those first years were focused on learning the medicine.

 

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28 minutes ago, ohiovolffemtp said:

Years of prehospital medicine only taught me a small portion of the medicine I had to learn to be a good PA.  Frankly, PA school only did a bit of that, but it did set me up to be a beginner.  What my pre-PA experience did teach me was:

  • how to interact with scared and altered patients and families
  • how to lead teams and interact with other pieces of the medical system
  • how to recognize sick, about to be sick, and to be calm while sorting this out and starting care

This was way more important after my 3rd year or so practicing EM.  Those first years were focused on learning the medicine.

 

Yup, sick vs non-sick is a valuable skill. How to talk to all kinds of people is an important skill. Knowing the difference between P.T, O.T, R.T, and XRT helps one function in the hospital or clinic.

Knowing the language and patterns of the medical system...priceless

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On 5/31/2024 at 9:32 PM, rev ronin said:

This is a not uncommon occurrence; we see it posted here quite often. My impression is that there are far more new grad PAs than there are new grad friendly PA jobs: everyone wants a fire-and-forget cash generator, not a developing medical professional with growth potential.

I disagree with this "not being uncommon".  This is a hard question to answer online without knowing the PA's circumstances first.  We all are supposed to graduate with essentially the same core knowledge of medicine. and passed the PANCE, so I would refer this person back to their PA program to discuss whatever the issues are that have caused him to be let go from his first job and hanging on by his teeth to the second one.  Is it lacking knowledge, confidence, anxiety, etc.  The second year of school is all hands on, were there issues then?  This PA needs to speak to people that know his personal situation better than we do.  Just my thoughts.   Finally, maybe medicine isn't a good fit for this person, period.

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1 minute ago, TWR said:

I disagree with this "not being uncommon".  This is a hard question to answer online without knowing the PA's circumstances first.  We all are supposed to graduate with essentially the same core knowledge of medicine. and passed the PANCE, so I would refer this person back to their PA program to discuss whatever the issues are that have caused him to be let go from his first job and hanging on by his teeth to the second one.  Is it lacking knowledge, confidence, anxiety, etc.  The second year of school is all hands on, were there issues then?  This PA needs to speak to people that know his personal situation better than we do.  Just my thoughts.   Finally, maybe medicine isn't a good fit for this person, period.

While these are all possibilities, I am reading this posting through the lens of my own experiences in 2012-2015, my first three years of practice. I got things wrong. I had to be guided--as in I needed help to pose the problem correctly, mentally, first before I could search resources for the result. I learned how to talk to patients, which jokes did not land well, and how to bring up sensitive topics sensitively.

I'm operating on a totally different level now, and I really like that. I think there really is something to the 10,000 hour rule, which probably approximates what is covered in a three-year residency with no work-hour limitations.

PAs with 10k hours of experience are vastly more valuable than PAs without. Even though we know NPs aren't as well trained as we are out of the gate, an NP with 10k hours is a lot closer to a PA with 10k hours than a new grad NP is to a new grad PA. It's doing the job that makes us better at it, and you can add arbitrarily more classroom requirements, but it's the time in rotations or in the first job that will be polishing the neophyte professional.

Most HR departments want "already polished" and you can't get that without expanding PA rotations such that they become residencies-lite, which defeats the purpose of the profession.

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2 hours ago, rev ronin said:

 

PAs with 10k hours of experience are vastly more valuable than PAs without. Even though we know NPs aren't as well trained as we are out of the gate, an NP with 10k hours is a lot closer to a PA with 10k hours than a new grad NP is to a new grad PA. It's doing the job that makes us better at it, and you can add arbitrarily more classroom requirements, but it's the time in rotations or in the first job that will be polishing the neophyte professional.

Most HR departments want "already polished" and you can't get that without expanding PA rotations such that they become residencies-lite

Agree with all of this. I think a 12-18 month internship would be appropriate for all new grad PAs and NPs. Lateral mobility as a concept is really going away. BS+MSPA+ an additional year(which maybe grants the DMSc) is still only 7 years, compared to a minimum of 11 for physicians, a 4 year "savings". 

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I think the trend to let younger smarter applicantants in is not bad as long as the older more mature are not pushed to the wayside. 

 

That is pretty much the mantra for Md/DO schools and doc's certainly are smart enough.....  PA may bring a different set of skills to the table, but the learning of basic medicine and what looks good or bad needs taught then instilled in all PA.

The real problem is that when us older PA came out a doc or group of doc's would  take responsibility for making sure we were learning.(as it was their practice).    Now with mostly employee docs they don't care, not as invested.  

 

Then add in the HR and Bean counters trying to wring out more productivity and profit without knowing/understanding what a new grad PA needs and you have our current situation.

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@PACtastic You're definitely not alone.  This (the issue of inadequate training to transition into practice for new grads) is a topic I've been thinking about a lot lately.  My first job out of school was terrible, and my employer made it seem like it was all my fault for not being able to keep up with an insane amount of patients and having to ask a lot of questions, especially at the beginning.  My boss promised a lot of training and mentoring during the interview process, which is why I took the job, but those promises went out the window very quickly.  The clinic was all about "productivity," and I was constantly berated for not being able to perform like an experienced MD from the start.  I'm still realizing how toxic (and dangerous) that environment was.  A recipe for burnout, and it really made me doubt my knowledge, capability, and fitness to be in the field.

On 6/2/2024 at 2:39 PM, EMEDPA said:

Agree with all of this. I think a 12-18 month internship would be appropriate for all new grad PAs and NPs. Lateral mobility as a concept is really going away. BS+MSPA+ an additional year(which maybe grants the DMSc) is still only 7 years, compared to a minimum of 11 for physicians, a 4 year "savings". 

I'm coming to agree that a 12-18 month internship or residency would totally be appropriate for all new grads.  I was talking with an MD friend last week about this very thing.  She is pro-PA (and not pro-NP), but a critique of the PA profession from her point of view is that we don't have a time of dedicated supervised learning in a practice setting like a residency.  She said that she really learned how to practice medicine as a resident, not in school.

I understand the attractiveness of lateral mobility, but would an initial primary-care type residency really limit mobility into other fields?

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