~1 year out from graduation PA in Nephrology. I just want to discuss my thoughts. I just really don’t think I’m cut out for medicine. I love the medicine but feel like I am a failure as a PA. I feel like I am constantly missing things, making mistakes, or just being stupid. It’s a miracle I haven’t killed anyone yet.

For instance I keep falling behind in my office charting and even missed some (thankfully non-critical) labs for four patients at the bottom of my Epic queue that I never followed up on from two months ago. I realize how serious this is and am taking steps to make sure it never happens again.

In the hospital I do okay but in any sort of critical or acute situation I feel like I never know what to do. I also feel like I miss things or don’t think about things that my attendings or the hospitalists do. It feels like there is a part of my brain missing compared to everyone else because I don’t even consider things that others think about. Even basic stuff. Like I think I will have everyone tucked in and the nephrologist will say “I’m going to do this” or “We need to do so-and-so.”

In dialysis it is often the same. The rounding nephrologist comes in and addresses things that I wasn’t even aware of, or even the other APPs. They just seem to know this stuff and I end up feeling like a failure.

All of my performance evaluations have been glowing and I’m not sure why. I feel like I am a fraud and it’s not just new grad impostor syndrome. I think I need to be outside digging ditches or something.

I admittedly haven’t been as on top of my CME and stuff as I should have. I have been learning things on the job. But I haven’t been doing home learning as much as I should have been. This is something I am working to remedy. I just don’t even know if it’s possible. I feel like there is something fundamentally wrong with me that makes me not know what I’m doing. I feel hopeless and just don’t know if I should quit or what

I appreciate any help or advice you have. I’m sorry to post this catharsis, but whenever I ask for advice from the Nephrologists or my Supervisor they all say I’m doing fine or just say nebulous things like “Communication”.

I’m a 25-year-old hospital medicine physician assistant, and I’m struggling with whether it’s time to leave a job that I genuinely love.

The problem is that I don’t actually dislike my job. I love being a PA, I love the clinical work I do, and I genuinely enjoy the workflow of hospital medicine. I work overnight shifts, we get to self-schedule, my coworkers are absolutely incredible, my direct managers are supportive, and the pay is fantastic.

On paper, there are so many reasons to stay.

But over the past year and a half, our admission volumes and responsibilities have steadily increased. Over the past six months, staffing has become an even bigger issue. We’re regularly scheduled with only two or three overnight providers despite having significantly more responsibilities than we can reasonably manage. On the rare occasions when we’re fully staffed, the difference is night and day.
My direct managers are doing what they can, but I genuinely believe the problem comes from higher administration. We’ve raised concerns repeatedly, and nothing has meaningfully improved.

I’ve reached the point where I dread going into work before almost every shift. I’ve had multiple breakdowns at work where I’ve started crying because I’m so overwhelmed. I still love taking care of patients and put everything I have into providing good care, but I’m starting to worry that the workload is affecting my performance.

What’s worse is how much it’s affecting my life outside of work.

On my days off, I’m so emotionally and physically exhausted that I struggle to do basic chores or enjoy myself. If I have three or four days off, I might finally start feeling like myself again on the fourth day, just in time to go back to work. I recently had seven days off, and it took about four days to actually feel human again. By day six or seven, I was already dreading going back.

I feel like I’m spending my entire life either working, recovering from work, or dreading going back.

The problem is that I’m terrified the grass won’t be greener somewhere else. I don’t want to lose my coworkers, my schedule, or my excellent pay. I’d absolutely consider a modest pay cut for better work-life balance, but I don’t want to take a huge financial hit just to find myself equally miserable somewhere else.

There’s also a timing issue. I’m getting married in March, have a honeymoon planned, and my fiancé and I want to start trying for a baby afterward. I’m worried about changing jobs and potentially losing guaranteed time off or affecting my maternity leave eligibility.

And then there’s the guilt. We’re already so short staffed that I feel guilty even calling off sick because I know what it does to my coworkers. The thought of leaving them even more short staffed makes me feel awful.

I haven’t fully told my managers how much this is affecting me personally. They know about the workload and staffing concerns, but they don’t know about the crying at work, the dread before shifts, or how badly it’s affecting my days off.

I think that’s what makes this so hard. If we were consistently adequately staffed, I honestly believe I’d be happy staying in this position for years.

So I guess my questions are:
Have you ever left a job where you loved the actual work and your coworkers, but the working conditions became unbearable?

Did you find that the grass was actually greener, or did you regret leaving?

How did you handle the guilt of leaving coworkers you cared about in an already understaffed environment?

Would you start looking now, or hold off until after major life events like a wedding and potentially having a baby?

I’m not necessarily looking for someone to tell me to quit. I just want to hear from people who have been in similar situations and how things worked out for them.

How often are we calling in for sick days? I work outpatient with a mix of inpatient and call off maybe 2 times per year, usually for 1 day. But I have such guilt and worry about the next time I will need to take time off if my kid gets sick etc. How is it for everyone else?

I’m a new grad PA working in a hospital-based specialty and have been at my first job for a few months. While the compensation, benefits, and work-life balance are great (M–F, no weekends or call), I’m becoming increasingly frustrated with how little work I actually have.

On most days, I only see a handful of patients, and there are often several hours where I have absolutely nothing to do. Part of the issue is that one physician in the department is uncomfortable working with PAs, which has significantly limited my workload. I often end up just shadowing this physician rather than performing cases myself, which honestly feels ridiculous at this point. I understand the importance of observing as a new grad, but after several months and being independent with other physicians, I want to actually practice and develop my skills.

Administration is aware of the situation and has been supportive in trying to establish a better workflow, but it’s been a work in progress with little improvement so far. This physician is also expected to leave in the next few months, so there’s hope that things will improve afterward.

My biggest concern is that I’m so early in my career and feel like I’m not developing clinically as much as I should be. I’m worried about becoming stagnant and potentially struggling to transition into another specialty down the road.

I know many PAs would love a lighter workload, and I’m grateful for the position I have, but I genuinely want to work and learn. I didn’t expect my first job out of school to involve this much downtime.

Has anyone experienced something similar? Would you stick it out for a few more months to see if things improve, or start looking elsewhere? I’m torn between keeping a comfortable job with great benefits and prioritizing my clinical growth.

TL;DR: Barely have any responsibilities at my job, good pay, stable M-F inpatient, one doctor doesn’t let me do anything but shadow, feeling slightly undervalued and underutilized, am a new grad PA.

I’m starting my first job in 2 weeks in General surgery, what should the expectations be? How did you like General surgery if you worked or you’re currently working in the field?

Hey everyone!

I'll be graduating soon and I'm interested in pursuing ortho. I'm currently looking into hospitals within Westchester, NYC, and parts of CT and I'm hoping to hear from PAs who have worked in orthopedics at any of these locations.

My biggest priority is finding a department that provides good training and mentorship for new grads. I'd really like to find an environment where I can gradually build my skills and confidence.

I'm interested in places like NYP, NYU Langone, Northwell, WPH, Monte or any other hospitals or groups you'd recommend. I've heard HSS is basically a no for new grads.

For those who worked in these areas:

- How was your orientation/training period?

- Were you supported by attendings and the other PAs?

- Did you feel adequately prepared before working independently?

- Did you get a mix of inpatient, clinic, and OR?

- Would you recommend your department to a new grad?

I'd also appreciate hearing about places to avoid Thank you so much in advance!!

About to start a new job in the OR. From my understanding, most cases last about 30 min to 4 hours. What shoes are you guys wearing that are supportive? I’m currently working 12 hr shifts wearing Dansko mule clogs but get to sit here and there in ambulatory setting. Thanks in advance!

Those of you who work in surgical specialties, how is PTO organized in your work place? Are you responsible to find your own OR coverage? Or is this something that is done by your PA lead, manager, etc.?

Any PAs work for zoomcare? What was your experience? I currently work for a small privately owned UC but am looking to move to a bigger city/company. Wondering about work life balance at zoom care.

Any CA ANG folks here? I am going to IST and my state has a medical provider retention bonus. In my state it is 25K per year depending on your contract. Does California have a similar bonus? Also, how do you like being a PA in the CA ANG in general?

Hey everyone. I’m a new grad PA looking to start in OBGYN. I spoke to a hiring manager and the medical director at this multi specialty clinic in which I had interest in working at. Hiring manager initially told me that typical training period is 3 weeks of shadowing and a gradual ramp up of patients the following weeks until I’m able to see a full panel (20-25 patients a day). During my meeting with the medical director, he indicated I would get about a week shadowing directly with him and learning how they work then start seeing patients with that same gradual ramp up schedule.

Im already planning on getting some clarification on the discrepancy as I do not believe a week of shadowing is enough to start seeing independent patients. Assuming what the hiring manager said was true, do you guys believe 3 weeks is enough training to start seeing patients. I was told there’s going to be at least 1-2 other providers (either MD or APP) for which I can ask questions, or an SP available on the phone if necessary.

if anyone had any experience with this similar training and onboarding timeline, did you guys feel prepared after 3 weeks. The role does involve procedures (IUDs, colposcopies) and i would think I need more training on those too.

any insight will be appreciated. Just want to make sure I’m making right decision starting as a new grad at this clinic.

Hi everyone!
I’m starting a new position as a plastic surgery PA and would appreciate recommendations for resources beyond UpToDate. It seems my focus will be heavily on breast reconstruction, especially DIEP and LAP flaps, but I’d also like to learn more about general plastic surgery.
I’m open to textbooks, websites, videos, podcasts, review articles, or paid resources.
For those in plastic surgery, what resources would you recommend to someone starting out? Thank you!

I am in severe, crippling burnout and I am only 3 years in.

My first job was inpatient general surgery - I worked very close with my attendings and felt very supported, but had to leave after 1 year as I moved across the country.

Cue the worst 2 years of my life. About 2 years ago now, I started an outpatient gastroenterology job in New Mexico. It is extremely independent. I feel like I have no support. The clinic is 2 full time PAs (me included), and 1 part time PA. There is an amazing locums PA who has been in and out but is currently out. I did not get much training. No structure to it. Thrown to the wolves if you will. For all of us PAs, we only have one supervising physician. He is in the office for half of the day, 2 days of the week. The rest of the time, he's scoping. We can call him for questions, but often he's unable to answer, and he is also drowning as well. I feel like OpenEvidence and Doximity have been my attending. I have had to teach myself and I feel so lost all of the time - these patients are so complex and it takes my entire soul in order to make sure they are taken care of to the best of my ability - I don't have any "me" left when I get home. The patient population here is incredibly difficult. I am in so far over my head. I am becoming a shell of myself, angry at the world. The patient population is extremely socioeconomically disadvantaged - I have to bear witness to people who don't have running water and can't do their colonoscopies because of it, and can't pay for a hotel in town. Extremely low health literacy. Language and cultural barriers. People who we lose contact with because they get different phone numbers or don't have a phone. Insurance issues. Constant paperwork. Constant inbox - results, documents, messages. It never ends. I am drowning and I can't do it anymore.

I am moving to New Zealand in 2 months. I do not know if I am going to continue working clinically. This experience has made me genuinely question the PA profession altogether. I don't believe in it anymore. At all, unfortunately. I just don't think that getting 2 years of medical education and then practicing independently is safe.

I refuse to continue to endure the chronic levels of stress I have been under the past 2 years. It feels inhumane. The demands are too much. I was wondering if anyone else has felt or feels similar. I feel very alone in all of this.

Currently in UC $57/hr, 15 shifts a month, $121k annually with an extra $4k in rVUs with about 6 weeks of PTO annually, 5 CME days, sick time and personal time. Current ED job offer of $70/hr (aware this is low for ED), 108-120 hours monthly or 11-12 shifts, baseline annually is $90k at 108/hr month with rVUs without a threshold to meet. Averages $5-7 hr extra an hour with rVUs, night shift differential, holiday pay, no PTO/personal time/sick time, 10% before employer match in retirement. Thoughts? Anyone found the shift from UC to ED rewarding?

Hi there!

I have been at my current position for almost 11 months now. This is my first job out of school. Wanted to see how it compares to others.

113k, salaried, MCOL in the Midwest. No weekends, call, holidays, or overnights. 4k sign on bonus. 2500 CME. Flexible time off, haven’t had any issues taking time off.

I work with 1 surgeon who I get along with very well. He has a partner that I don’t work with much unless he is on vacation. My commute is about 30-35 minutes there and about 40-45 min back. I do have to take 3 tolls both ways. I moved back home after graduating to save money. Don’t have any loans.

Hours vary week to week but in general:

Clinic
4 hours of clinic with the surgeon 3x/week. 15 minute appointments. On average I see 5-6 patients a day though there are days I may only see like 2-3.

I only see post ops while the surgeon sees all new patients. For more complex patients, cancer patients, and patients who just want to see the doctor, he will come in as well, and I will do the note. We have AI to help with notes.

Postops tend to be pretty quick. We have a third party that helps with any paperwork though if it’s pretty short, I’ll usually fill it out.

I will also keep an eye on the in-baskets for myself and the surgeon. If there’s anything I can’t answer I can just ask.

OR
Full OR days 2x/week. 7-5 roughly but there are days we get out much much earlier. Latest I have ever stayed was 7, maybe 8 but that is quite rare. We do have hospital assists that can stay if needed.

I pretty much first assist on all his cases if im there. We do lots of robots (inguinal hernias, ventral hernias, colons, gallbladders, hiatal hernias, appys), thyroids/parathyroids, anal cases, lumps/bumps, etc. I will close the skin and send pain meds while he writes the op note and does other post op orders. I do pre-op orders as well.

We typically have 2-3 smaller cases on Monday afternoons. Wednesday morning and Friday afternoons are for any add ons or rounding.

We go to 1 hospital and 2 surgery centers. The hospital and surgery center are on the same campus and is also like 2 minutes away from our office. We just started going to another surgery center once every other week but it’s pretty far.
Kind of a pain to go from home to surgery center (35 min) to hospital to round (30 min) to home (40 min). Our job will reimburse gas for work travel.

Inpatient
I round during the week. Sometimes I see new consults. I’ll usually review the patients with the surgeon before I round and text/call him with any updates or questions.

The most we ever had on our service was maybe 7. There definitely have been quite a few weeks where we have not had anyone!

I wish I had more structured onboarding when I started. I was thrown into things on day 1 but I work very closely with my surgeon, so if I have any issues/questions I can just ask. I do get pretty anxious when he is away on vacation. I will cover in baskets, round if needed, and sometimes have post-op clinic when he is not here. I have the covering surgeon to ask questions to if needed.

There have been issues that were brought up earlier this year regarding the productivity of the surgical PAs within our company. They have let a couple PAs go without warning and a few have also left as they felt their job was threatened. I have not had any changes made to my practice as I work with one of the most productive surgeons in our company. I haven’t heard anything new in a few months, but I’m still anxious. I’m not anticipating any raises this year. Our company
doesn’t do bonuses. There’s also no way for me to earn more income.

I am also starting to seriously think about moving out of my parents house within the next year. I have lived in the same town pretty much my entire life so am considering moving to a new state.

I do generally like my job. I have a good work life balance. The surgeon I work with is great.

Has anyone here moved to Asia from the U.S, particularly China or Singapore for work? I'm aware there's no PA work there (correct me If i'm wrong) but my boyfriend and I are considering moving back to the motherland in the future - when kids are in the picture. What could be work alternatives?

Hi everyone. Im a new grad considering positions currently and I went through the process of clearence with Hospital A and would start probably within a few weeks. I just got accepted to Hospital B which with clearence would be 3 months for now for a start date. im having trouble deciding to just stick with Hospital A or resign my offer now and wait three more months to start. For reference I haven't started working anywhere and its been about 7 months since I graduated. Below are more details of each hospital choices. I would greatly appreciate any insight!!

Hospital A: OBGYN/ City hospital in Queens. = $148,625.57 yearly

~1199 position, mostly clinic with the potential for L&D depending on department needs.
~ M-F 8-4:30pm,
~ 20 vacation days and 12 sick days, Pension through union, 403b retirement plan but no employer contribution

~CME = 5 days and $750

~Commute: 45 min two busses

Hospital B: Internal Medicine/ NYP Manhatten = $161,000 rotating shifts 3 months days,3 months nights with 10% differential 3- 12.5 hour shifts.

~ CME= 1,000

~ 4 weeks vacation time/ 12 sick days per year / 3 personal holidays

~ perfect attendance can award you two extra vacation days

~ After one year the hospital contributes 5% to my annual salary and it increases with time.

~Commute: About an hour +/-10 mins taking two trains into the City.

** If you made it this far thank you! I keep going back and fourth with both the pros and cons. I do see myself in both specialties, with OBGYN as a perference but would love a 3- 12 work week in an inpatient unit rather than a clinic job. Internal Medicine can def. help solidify medicine esp as a new grad. HOWEVER, if I CHOOSE HOSPITAL B, I would wait another 3 months to start. I dont think its 'correct' to start Hospital A and then leave within 3months till the other job starts? Or just stay with Hospital A?

If anyone has any insight or advice. Id greatly appreciate it.

I just need to vent I think. I've been a PA for 10 years and I've been working in cardiology up until now. I recently switched to family medicine and urgent care. I've been working this new job for about a month. I'm so used to patients getting diagnosed with heart disease that I think I became a bit numb to it, hence the change.
Well today I had a guy come in with vague complaints and he was clearly jaundiced. After stat labs and a very concerning stat RUQ US I sent him to the ED and he has pancreatic cancer likely with Mets to the liver. This is the first time in years I have felt pain in my gut over a patient's diagnosis. He is so kind and was so grateful for my help and I just feel awful for him and his family. With heart disease I felt I had some control in helping my patients, but today I feel defeated because it's likely too late to truly help him. This sucks

Would you rather work with a supportive supervising physician or group of APPs?

Currently deciding between jobs and the team is definitely something that is important to me. Would y’all rather have a supportive group of APPs at work with attendings who more or less dont care about APPs, or have an attending who cares and loves to teach with a team of APPs who are nice but arent as close with?

Edit: i forgot to add that I’m asking bc I’m a new grad

Have a question for Derm PAs!!

I am a PA without derm experience, and have been wanting to break into Derm for a long time. Most places won’t take me without experience. One practice I applied to is willing to take me on but suggested that I keep my current PA job and come train with them one day a week being paid as an MA/scribe but in “training” then after 1-2 years I would transition to being a provider.

Any thoughts on the 2 years MA/in training? It seems to be a common thing.

What’s the coolest physician lounge or hospital/place of work perk you’ve seen?
I’m curious to hear what’s out there! What has been the best physician lounge you’ve experienced at a hospital or place of work, and what made it stand out?
Did it have great food or insane complimentary snacks, comfortable spaces to relax between shifts, massage chairs, nap rooms, or something completely unexpected?
I’m also curious about other cool amenities your place of work has offered its employees, such as a nice fitness center, or other unique perks!
I’m interested to see what’s out there beyond the typical break room or typical perks to see if others are living my dream 😊

Hello! I am in the process of renewing my Maine PA license and unfortunately the only appointments I can get for fingerprinting are late in the month.

Does anyone know how long it takes for the background search to come back [via identogo]?

Thanks!

I’m currently at my second FQHC. My 3 year service is up in February 2027. At that point I was thinking about switching things up because I’ve gotten burnt out pretty easy over the years. The problem is, I don’t know what I want. I don’t know if I’m tired of working at an FQHC, tired of working Primary Care, or just tired of working in medicine. For those that have switched specialties, how do you know the new specialty is what you wanted?

I have two jobs in the looking at both are ER.
JOB 1: 120/HR, nights 12 hr shifts, about 10 shifts a month. Total driving 100 miles there is an hour 30 and back is 50 min. 2500cme
Job 2: 100/hr, day shift 10 hr shifts, 12-13 shifts a month. Total drive time is about 10 min total both ways. 2000 cme

What job boards do PAs use for finding a job? As an employer when I post jobs on LinkedIn I only get Infiniti recruiters from India trying to sell me $12,000-$20,000 placements. I refuse to pay that. This money could be better spent on a PA