Difficult situation, advice appreciated

[lizchao74]

Hello fellow PAs:

 

I am in a tough situation that I could use some guidance with. I apologize in advance for the lengthy post, but feel that a lot of this detail is necessary to best convey the details of my predicament.

 

Some background info: I have been a PA since 2005, and have worked in cardiac surgery, vascular surgery and anesthesia, always with a per diem gig on the side which has been in emergency medicine and gen surg (before going full time with them). First job in cardiothoracic was at a large academic center with abusive surgeons and minimal guidance/oversight, and I left after 4 months due to the abuse and concerns re: patient safety due to lack of senior PAs to help in a setting with 20+ patient census on a daily basis by myself, lots of turnover, etc. Next job was w/private anesthesia group which folded after 1 year. Next was at another large academic center in cardiac surgery, again w/abusive surgeon. After 2 years of being promised OR time and ICU care which never materialized due to their keeping PAs on a short leash w/ICU care/procedures, and "obstacles" to getting everyone trained on vein harvest, I transferred within the hospital to vascular surgery. Very disorganized service where I would make suggestions to the other PA and surgeons re: processes to help us be more efficient...one suggestion revolutionized how elective surgery patients were admitted (streamlined their 6 hour wait for a bed while sitting in admitting without any preop testing done to having them wait in outpatient lab getting tests while bed was made available, increasing patient satisfaction, minimizing wait times, allowing time to spot preop issues/potential OR delays, etc.). Somehow shortly after that I was accused of being "too administrative," that they did not have a place for an admin PA there, that I should focus more on day-to-day patient care even though those aspects of job were handled fine without issue. I left after 1 year, after burnout and frustration that my efforts to help our team improve fell by the wayside and were misinterpreted, and accepted a full-time position on nights in general surgery with the hospital I was working per diem at. I became very unhappy with the night schedule eventually, but stuck it out for 2.5 years, and recently started a job in vascular surgery in late October 2012, working at a community hospital that is closely affiliated with a large academic center.

 

The job involves primarily working with one female vascular surgeon, and also with 4 other vascular (these guys also do gen surg) surgeons that don't bring much business nor do they do endovascular cases. This surgeon is employed by the large affiliated academic center, whereas I am an employee of the community hospital. At the time of my start date, she had been in her current capacity for 2 years, on a 3 year contract. When first working with her, it became apparent that she was a nice, good person (refreshing to find in a surgeon) and was also a bit different and unconventional in her manner of speaking to patients. Her tendency to overshare and discuss personal matters with patients initially seemed to simply be unorthodox but since her outcomes were good, it seemed that this is physician's privilege to some degree. I was enjoying having a regular day time schedule, getting into the OR, and making a salary that was 20% higher. Since that time, however, things have changed dramatically in a multitude of ways that I could not possibly expect.

 

I began to notice that she was an oversharer, and that I was essentially being treated as her therapist, frequently being told many stories about her constant struggles as a single mother of two small children, her bemoaning about being broke (down to details about overdrawing her bank account and not being able to pay bills), how she was "taken to the cleaners" by her ex-husband (a device rep who she had a long custody battle/divorce trial), etc. She has a severe case of paranoia, a victim complex, and a significant obsession with gender bias. Again, having worked with surgeons in the past, I figured a lot of this was just something to endure when you work with quirky personalities, and since she seems essentially to be a good person, I took what you could consider the compassionate, understanding route. However, she is very quick-tempered and erratic; she is always late to cases and clinic and has a reputation for this, and keeps patients waiting for 1-2 hours to the point where people angrily leave but gets annoyed when you reminder her that patients are waiting or things of that nature.

 

As it pertains to me and my job, there is a lot of bad blood between her and the other surgeons. She is the chief of the division, but nobody shows up to any department meetings, and these are no longer even scheduled. It was understood when I was hired that I would be "split evenly" amongst the surgeons (I am the only PA), but would primarily be working with her. One of the other surgeons never uses me because he is the gen surg residency director and uses them for his consults/cases. Surgeon #2 was suspended for a year because of bad outcomes and allegedly hates her bc she oversaw the process of his suspension, surgeon #3 only does occasional fistula cases and angios (procedures which I am not involved in directly except to maybe write post-procedure orders), and surgeon #4 is somehow allowed to cover 5 hospitals at once, doesn't answer calls when he is paged for emergencies like ruptured AAAs (one which led to the patient's demise due to delay in care/transfers/intervention) and whom I have seen negligence leading to limb loss because of flippancy and lack of intervention in a patient with acute limb ischemia. These surgeons do not talk to each other, do not sign out to each other, and have intervened on some of her patients with amputations, etc., in her absence leaving her/us only to find out after chart review. I do not routinely get signout on any of the other surgeons' patients, but haphazardly get called to write orders when they are trying to run out the door, or to round on them without any established plan on how we will work together. She claims that she "makes me available" to them, but then at times insists that I call them back and tell them I cannot help them because I am in clinic with her (where she has told me she does not really need me; she does her own exams and her own dictated notes). I was told during my initial interview by one of the other surgeons that I would be contacted when cases are scheduled to assess my availability to 1st assist, however, I never get any calls in advance, and only get the occasional suggestion to operate with them (that same day) if I happen to see one of the surgeons in passing during one of their infrequent visits to our site. There is little to no surgical volume there, and what volume there is is tied up due to constraints by the physician groups, or the hospitalists choosing to consult their surgeon of preference rather than going by the call schedule (which she established when she came to the practice), and the requisite battling between the surgeons to steal patients from each other. Of note, there was no vascular PA prior to her joining the practice, and she specified a PA as a requirement in her contract. She has gone from having OR block time every Monday and Wednesday, to every Monday, to now every 2nd and 4th Monday, and most are vein cases (very little arterial work). There are MANY days when I have nothing to do all day.

 

Two months into the job, during an office visit with a patient, the female surgeon I work with spent over an hour talking to the patient and his niece (after a barrage of hugs and expressions of affection between all of them), telling them about how "she will not have a job in 8 months, because her contract is not being renewed," in a pleading, woe-is-me tone. I, of course, was flabbergasted and confused, because of the unprofessional nature of the exchange and because of the implications on my employment situation. I left the room and asked our secretary to clarify this, and she confirmed what my boss had said, and that she herself was freaking out because she would also be out of a job. I then asked my boss about this, and she expanded upon what she had said rather matter-of-factly, claiming that she was told this after I was hired. (It also turns out that the patient's niece is on the board of trustees for the smaller hospital, and she was trying to get her to help). The decision to not renew her contract came from the large academic hospital, through which I am also credentialed, but after multiple, daily conversations about this, it has become apparent to me that my boss had to have known about the contract non-renewal prior to my start date (3 months elapsed between the offer, credentialing and then the start date), and that she simply kept me on board because she WANTED a "helper," without having the surgical volume to really justify it. She has shown me financials indicating that the practice has always been in the negative, to the tune of -$125K. She claims that she was "never told about this" even when she would ask the practice administrator "how are things going." (Apparently she did not either ask to see the financials herself.) So she goes on and on about how she was set up to fail, nobody helps me, etc. Now that I see how she runs the practice, I am not surprised at this state of financial affairs. Also, someone anonymously reported her to the professionalism committee within the larger hospital, which I'm certain also led to their decision to get rid of her.

 

I have also been told that the large academic hospital is not planning on further developing vascular at our site, and since there was no vascular PA prior to me taking this job, my job will essentially be eliminated. However, I have not spoken with HR of the smaller hospital yet, mostly because of being sworn to secrecy by my paranoid boss (I have mostly been trying to figure out what is happening by talking to our practice administrator who is part of the larger organization). I also would not want to work with these surgeons anyway due to the horrible care of patients I have seen them carry out, which has kept me from going to HR any sooner (there are no other PA jobs posted now anyway, and my recourse as it may come from them appears limited).

 

Here is the problem: I am looking for another job, and most online application sites do not have a place to attach a cover letter where I could explain that my position is being phased out due to my supervising physician's departure. I have gotten only 1 request for an interview (within the larger hospital) after multiple, MULTIPLE instances of sending out my CV and applying for positions, both within the larger hospital (since I am already credentialed there) and elsewhere. Since mid-March, I have basically gotten nowhere with my job search. My feeling is that I am being passed over when recruiters see that I am leaving my current job after only being there since October 2012, and that perhaps my previous employment history (see above) is evidence of me being a job-hopper somehow given the average 1-2 year duration of each of my past jobs. And yet, 8 months ago, at the time I was interviewing and accepted my current job, I had no shortage of interviews and responses to my CV. I am still per diem at my old job, but they are not hiring in surgery, and only have jobs open in fields I am not sure I would be happy in. Also, they would likely not match the 20% higher salary I got upon leaving there (competitive in the market), so going back there would also likely involve a pay cut).

 

What do I do? She has repeatedly said she would give me a great reference, as she has frequently said she is very impressed with my work, knowledge base, etc. However, she freaked out on me when I gave her a heads up about the interview at the larger hospital, saying that I was "telling people she was leaving without her giving notice." She has not yet found another job for herself, and spends ALL day talking about how she's going to end up on unemployment, and cries all the time, and is basically an emotional disaster every day. This is why she lost it when I told her about the interview, claiming that the medicine guy I interviewed with was going to tell her chief (who already knows about her non-renewal), who is then going to tell her ex-husband (the device rep, who, incidentally, has not worked in 2 years) which will negatively impact her as she prepares to go to court against him again for another custody battle since she may need to leave the state (i.e., the rantings of a lunatic). She was very nasty in the ensuing days, and I ended up choosing to have a conversation with her to clarify that was not doing anything to hurt her, that I was merely looking for a job and did not "throw her under the bus" when explaining that she was leaving, etc., choosing instead to focus on the financial issues of the practice. Her response was some more frantic crying, etc.

 

Help! Any and all advice/comments are much appreciated, and again, sorry for the long post. Thanks for reading.

[rev ronin]

You need to find a sane surgery group to work with. This is probably already obvious to you, but your best defense against such situations is to have multiple people who are looking out for your best interest.

[KMD16]

In your shoes, I would switch specialty given that you're having difficulty landing a surgical position. Do not limit yourself.

 

Your surgical skills will be useful in an urgentcare or in the ED. You can start out in primary care, then, work your way up to the ED and still maintain your per Diem job.

 

A classic disadvantage specializing as a PA.

[problem child]

I can relate; I've had a lot of problems on the job and now have a "job-hopper"-appearing resume..and I sometimes wonder if I belong in this profession at all. I am out of work now -- I got let go by my last 2 jobs bc of friction between and my (surgeon) SPs over hours/salary. in the first instance, the surgeon didn't want to pay me the OT he had agreed (in writing, signed) to pay me when I took the job; he would hassle me every month over the 2-3 hrs I might submit, didn't want to pay me if he closed the office for some reason...and at my most recent job I was fired (in Dec) bc I could not do what turned out to be a FT job in the PT hours for which they hired me. I was hired for a 4 hr clinic every day -- for me a dream job -- but the responsibilities were great and could not be done in 4 hrs, so I was routinely staying 5, 6, 7, even 8 hrs sometimes/day...in that job, I had no mechanism to bill for extra hours -- no OT, no comp time, no nothing...so unfair.

 

I'm fine with part-time, I prefer it. but I have a problem when I'm hired and put on salary and then superiors act as though I'm committing treason when I expect to be paid for time I'm there, and have a provision for extra pay if days go long. I'm not slow, but I am good, and I am thorough, and my patients love me. Often things that keep me onsite longer are urgent care add-ons, helping a less-experienced co-worker, or just needing to document.

 

It bothers me that I am making these surgeons a lot of money by running their clinics, which allows them to spend their time in the (ka-ching!) OR, and then they nickle-and-dime me over a few hours of OT. Or shaming me when I want to go home on time.

 

I have been interviewing but I am really starting to wonder if someone has poisoned the waters about me in my professional community bc I am not getting offers. I have been passed over for a good 4-6 (maybe more) jobs so far for which I am well-qualified. I was fired from my last job in Dec, and have been interviewing and sending out applications and resumes since then, but still...no offers. I have a family and a mortgage, and if I could move to another area I would, but my husband's job is not portable.

 

I am discouraged bc I was told that being a PA would allow me to work PT and make good money, yet what I am finding is that even if I am hired for a part-time job, I am considered a (yep) problem child if I expect to actually keep those hours, or get paid extra $$ for going over. I can't even imagine taking a FT job...40 hours sure as hell doesn't mean 40 hours (more like 50-60) and that's expected. It's a given. Or you're not a "team player". Add a sh&tty commute to that, and well, you might as well kill me now.

 

I do expect to parent my kid, not work like a slave and hire a nanny. I am having a lot of trouble pretending to get excited during interviews which spell out just more of the same. So I realize that that might be coming through on my part in interviews. I don't know how to get past that and start to feel excited about a job. There is a job I want very much now, and I have taken some very nice extra steps to stand out a little and personalize my application...but I am so afraid to get my hopes up bc I think I'll be all excited thinking, "oh, this is PERFECT! I really want this job!". And then hearing they've selected someone else.

 

boooo....

[rcdavis]

I am trying.. But it must be a generational thing.

 

I want to relate, but I cannot.

 

Seems like waaaaaaaaaaaaaaaayyyyyyyyyyyyyyy too much drama, on all sides.

 

Take a job, work as diligently as you can, be appreciative of the job ( you are not "owed " one), and understand that, as hard as it is to accept, most employers do not want to hire you for those hours you can get away from Family responsibilities ad obligations..

Distasteful as it may be, they hire you (and expect you) to put their -the businesses , the clinic's, the hospital's issues first...

 

We are not alone in this.. The nurses are constantly being told they cannot have time off/go home on time...

 

I grew up when what you DID was to a great extent what you WERE. Pathetic as it sounds now.. But, in that system, there

Were never these sorta dramas..ever.

 

Surgeons indeed can be primadonnas.. But one universal attribute they respect is hard work.

[UGoLong]

One problem I see is hanging on with conflict until you get fired. I'm not sure that it's your resume or prior specializing that is doing you in but rather references from your previous jobs. I think you need to catch on somewhere and do a good job. Build a track record and then look for your dream job. Perhaps a job in a larger system (like for the hospital) might be better for you and give you more future opportunity.

 

All jobs have their downsides. If you are jailhouse lawyering it all the time with whoever hired you, it doesn't look good. Instead just start planning on moving on, and long before you get fired.

 

Good luck! Your life isn't ruined. It's just the next inning.

[problem child]

I am trying.. But it must be a generational thing.

 

as hard as it is to accept, most employers do not want to hire you for those hours you can get away from Family responsibilities ad obligations..

Distasteful as it may be, they hire you (and expect you) to put their -the businesses , the clinic's, the hospital's issues first....

 

rc, it might be a generational thing (although I suspect you and I are not that far apart in that regard), but it may also be a gender thing. not to be sexist, or generalize, or stereotype, I do think men have less problems pledging their allegiance to their jobs, and thriving both mentally, emotionally, and financially within that pledge. it's how men are wired. women -- by nature of our wiring -- are far more aware of and responsible for making sure the myriad domestic issues, tasks, and responsibilities of the home get done. so if a woman takes on the same "my work is my life" approach, we generally live under a far greater load of stress because our awareness of keeping the home fires burning (and nurturing our children, making sure the fuzz in the fridge goes away, bills are paid on time, etc) never goes away. if we (or I should only speak for myself, bc it is my experience), if I take on the same total work focus, plus a horrible commute, and satisfy my need to be sure domestic matters are running smoothly, it ends up equalling stress, mental duress, chronic emotional distress and conflict, and burnout.

 

I am trying to come to terms with this myself. young women (unmarried, without children) can live in the hospital. if I was 22, I would spend every minute in the hospital, too, and soak up every bit of knowledge I could. I am not 22. I am married, I own a home, and I am a parent. so the gremlin that whispers in my ear all day about the things they need doing never shuts up. and it can keep me awake at night, whispering in my ear, resulting in even greater duress, born of fatigue.

 

my ideal job is ~20-30 hrs in clinic, which gives me a lot of great patient contact and gives me a reasonable shot at getting out of work on time so I can tend to my family and still have some quiet time left over for me (essential for me). I happen to specialize in surgery, and I like it. I have no interest in primary care, ob/gyn, or family practice. I would work in behavioral health or palliative care if such jobs existed, but those are very rare and tend to be under the purview of nurse practitioners in the part of the country where I live.

 

so, the struggle continues. how I can put my all into my job, and do a great job, but also have the need met that I can sign out at the end of "my" day and take care of the other responsibilities I have, and still have a bit of me left at the end of the day. women are implicitly expected to wrap their lives around the needs of men -- whether it's a husband or a boss -- and make sure "everything else" gets done while the men do what they do. we operate that way. so if we have that dynamic at work and at home, it is really true that we can end up with nothing left of ourselves.

 

just MHO.

[problem child]

One problem I see is hanging on with conflict until you get fired. I'm not sure that it's your resume or prior specializing that is doing you in but rather references from your previous jobs. I think you need to catch on somewhere and do a good job. Build a track record and then look for your dream job. Perhaps a job in a larger system (like for the hospital) might be better for you and give you more future opportunity.

 

All jobs have their downsides. If you are jailhouse lawyering it all the time with whoever hired you, it doesn't look good. Instead just start planning on moving on, and long before you get fired.

 

Good luck! Your life isn't ruined. It's just the next inning.

 

good advice. blindsides do happen, however ;)

[KMD16]

rc, it might be a generational thing (although I suspect you and I are not that far apart in that regard), but it may also be a gender thing. not to be sexist, or generalize, or stereotype, I do think men have less problems pledging their allegiance to their jobs, and thriving both mentally, emotionally, and financially within that pledge. it's how men are wired. women -- by nature of our wiring -- are far more aware of and responsible for making sure the myriad domestic issues, tasks, and responsibilities of the home get done. so if a woman takes on the same "my work is my life" approach, we generally live under a far greater load of stress because our awareness of keeping the home fires burning (and nurturing our children, making sure the fuzz in the fridge goes away, bills are paid on time, etc) never goes away. if we (or I should only speak for myself, bc it is my experience), if I take on the same total work focus, plus a horrible commute, and satisfy my need to be sure domestic matters are running smoothly, it ends up equalling stress, mental duress, chronic emotional distress and conflict, and burnout.

 

I am trying to come to terms with this myself. young women (unmarried, without children) can live in the hospital. if I was 22, I would spend every minute in the hospital, too, and soak up every bit of knowledge I could. I am not 22. I am married, I own a home, and I am a parent. so the gremlin that whispers in my ear all day about the things they need doing never shuts up. and it can keep me awake at night, whispering in my ear, resulting in even greater duress, born of fatigue.

 

my ideal job is ~20-30 hrs in clinic, which gives me a lot of great patient contact and gives me a reasonable shot at getting out of work on time so I can tend to my family and still have some quiet time left over for me (essential for me). I happen to specialize in surgery, and I like it. I have no interest in primary care, ob/gyn, or family practice. I would work in behavioral health or palliative care if such jobs existed, but those are very rare and tend to be under the purview of nurse practitioners in the part of the country where I live.

 

 

just MHO.

 

Demonstrating some form of flexibility will serve you well. Do not rule out primary care or Urgentcare jobs.

[problem child]

Demonstrating some form of flexibility will serve you well. Do not rule out primary care or Urgentcare jobs.

 

that's a given ;)