r/physicianassistant • u/WhitecoatWander • May 04 '26
Hello, all!
It’s been about 4 months since my family and I have moved abroad to practice as a PA in New Zealand. There was a fair amount of interest with my initial post, so I thought it would be good to provide a short term update for anyone interested.
First want to get some FAQ out of the way:
“What does getting certified abroad look like if I want to work in New Zealand, but I work in [US/UK/Canada]?”
As of now there are no talks to recertify. In theory you just find a job, apply for a visa, and you’re good. I’ve known other PAs that pick up, move, and start practicing abroad all within 3 months. That *may* change in the future, but I don’t believe it’s on the horizon. With that being said, as of November 2026 there are going to be changes that will affect those currently working and those who intend to immigrate thereafter. Under the proposed changes, you will likely be accepted under a provisional license that will require more supervision under a year or more, and thereafter your GP basically vouches for you where you can work under a “normal license.” This is all provisional, however, and it will change in the months to come.
“How do you find a job in NZ?”
I went through a recruiter; I would HIGHLY recommend going through her since she knows the PA landscape very well. DM if you want her info.
“I have [x] years of experience in [insert specialty]. Can I apply with that?”
Maybe. Most of the efforts right now seem to be focused on primary care/urgent care needs in smaller towns/cities and rural areas with bare minimum 3 years experience in those fields, but many preferring 5 years of experience.
“How much are you making now? Is it less than your US salary?”
Yes, it’s a pay cut. People immediately hear that and become nauseous at the potential for making less money, but it does not mean I am living on scraps. Living in a smaller town, my expenses have also gone down considerably. Our main expenses are rent, groceries, and travel (because we want to see as much as we can here). We’re not eating out nearly as much as we were in the States; we shop a lot less; we basically pay a small fraction of what we were previously paying for childcare (where before it was basically a second mortgage); we don’t have to pay for medical insurance. Those things add up considerably, and it really helps the money go further. With that being said, yes, I still make less, but I’m sustaining my family of 4 just fine for now on a single salary. It’s doable and it’s fine. Not to mention that there are so many perks here that positively affect my mental health, so that pay cut is still worth it for that alone. I can breathe easier here and my kids have a bright future.
——
Four months in to this adventure, and I am happy to say that doing this move was the right choice. It has not come without its drawbacks or challenges, but I wake up happy every single day that I did this for myself and my family.
As soon as I walk out the door I am greeted by beautiful, green nature. This is a big deal of me as someone who has only ever grown up in the Sonoran Desert and has lived in large cities the past 15 years. Everything is green, there’s so much rain, and there’s truly peaceful moments (in between my two children screeching at each other). There’s also a warmth and friendliness to people here that I have not felt in a long time. It feels normal to give a little nod and a smile to strangers as you pass each other on the sidewalk. People here are generally happy and want to share their happiness with others. There’s definitely a strong sense of community here (so much so that at times it’s hard to establish yourself in a friend group because many of these friendships go back several generations). The people within my community are happy to invite newcomers in, and they’re particularly happy to know medical professionals are coming to town. On the other hand, though, you have to be careful not to come off as bragging of your profession since that is fairly frowned upon. There seems to be a stronger emphasis on equality, and humility.
There are other benefits as well. I don’t mean to make this into a political post - and I won’t - but a few months before we left the States my 4 year old was telling us about how his class and his younger brother’s class were practicing their gun shooter drills. It made me physically nauseous hearing that, and knowing we don’t have to worry about that any longer has brought me so much peace since I’ve been here. Not to mention that there are many other things here that make me think it’s a better environment for them, which could be its own post. Kids feel like they could be kids here. They are able to walk on the street alone or with their friends to a park, school, or a grocery store without any issues; it’s not uncommon for kids to be playing outside on their own without mom/dad having to watch them like hawks. This all stems from just being around a safer area where people take care of their own in the community, and you don’t immediately need to assume that stranger equals danger. Since moving here I have really noticed that my parental instincts have been trained to be on fight or flight and am retraining myself to
relax more, which is good myself and my kids. If my kid gets lost in a grocery store I can more or less count on someone else helping bring them back to me rather than kidnap them (not that that was a regular occurrence back in the US, but if you’re a parent you probably know what I mean). That’s not to say you can totally let your guard down, but it certainly feels more relaxed here in several aspects.
Speaking of which, I feel like there are more outlets here for myself. Working as a PA here has its perks, but no matter where you go working in medicine will still feel stressful. However, now I at least feel like I have better ways to cope with that stress. Had a bad week at work? Doesn’t matter when the beach is just an hour away. Feel stressed? Cool, there’s a beautiful lake nearby that you can walk around to disconnect. Imposter syndrome got to you again? Damn, well I’m too busy riding my mountain bike to care right now.
Not to mention there seems to be a healthier relationship with work here. I’m actively encouraged to take my breaks (which I get two a day), get out on time, and if I ever want to work less it’s never an issue with management. I feel like they would get excited if I told them I only want to work 32 hours per week (too bad my finances wouldn’t allow for that 😅). They genuinely care about my wellbeing and want to make sure I don’t burn myself out.
Now for the clinical bits, which may interest you all more.
Working as a PA here is definitely not what I was doing in the States. As of now we don’t have prescribing rights, nor can we order our own tests, so everything I do has to be signed off by my GP. In practice it doesn’t matter a whole ton, because my supervising GPs know me and my clinical decision well enough to where they just sign off on my orders, and every once in a blue moon they might recommend a change in plan. This may change in the future, though, as we are continuously advocating to get those prescribing rights, and we have a core group of physicians that are helping in achieving that as well.
Which brings me to my next point: the PA profession is fairly controversial here amongst physicians here. New Zealand is part of the commonwealth, and as such there is a fair amount of overlap between the UK and New Zealand, including how PAs are viewed. The recent drama in the UK with PAs has leaked here as well to the point where you have an outspoken group of physicians - particularly residents - advocating against us. Since our profession was made official through regulation in 2026, PAs are not going anywhere, but it does remain to be seen what our scope will be in the next few years. Personally, however, I can say that all the GPs I work with in my clinic have been nothing but wonderful and incredibly supportive of PAs.
Patients are gradually learning about what PAs are, and once I explain to them who we are, what our role is to improve access to care, and how we work as a team with GPs they are usually very receptive. Given that New Zealand’s healthcare system is fairly strained, patients are very pleased to hear more medical professionals are practicing here. I have also found the patients population to be rewarding to work with. In the US there is a fair amount of distrust in the medical system, which to be fair I don’t necessarily blame individual people for it. Here, however, people are more likely understand you have their best interest at heart and are more likely to take your recommendations seriously. It makes the patient-provider relationship much more fulfilling and rewarding.
Speaking of which, learning how to work in the New Zealand system is very different than the US. On one hand it’s incredibly refreshing not having to worry about prior auths, or insurance denials, but on the other hand, having wait times of up to 12 months to see high demand specialists and not being able to order your own CTs or MRIs within a primary care setting can be fairly limiting. This is a complete speculation, but I think this largely originates from a supply and demand issue: we just don’t have the necessary number of radiologists available to help with radiology reads, nor do we have the necessary amount of specialists to take on the referrals. This will inevitably mean that many referral requests get denied with a note, “Sorry, we are at capacity, but it sounds like your patient has [X pathology], considering starting [X interventions]” which translates to PCPs managing a fair amount in primary care, not unlike other rural positions in the US. It’s ultimately a challenge that involves making judicious use of available resources to prevent overburdening an already stressed system.
Sorry for the long post, but I hope it was insightful. I am happy to answer any questions you all may have. If I can convince more of you to come practice primary care here I would be happier for if, but if not I’m also happy to have you tag along and experience this vicariously. 😁
I will also include some pictures I have taken during my travels.
r/physicianassistant • u/Babyblue_77 • Nov 10 '21
Would you be willing to share your compensation for current and/ or previous positions?
Compensation is about the full package. While the AAPA salary report can be a helpful starting point, it does not include important metrics that can determine the true value of a job offer. Comparing salary with peers can decrease the taboo of discussing money and help you to know your value. If you are willing, you can copy, paste, and fill in the following
Years experience:
Location:
Specialty:
Schedule:
Income (include base, overtime, bonus pay, sign-on):
PTO (vacation, sick, holidays):
Other benefits (Health/ dental insurance/ retirement, CME, malpractice, etc):
r/physicianassistant • u/nbell1998 • 8h ago
Second week at my new job. I have a phone in my office. No one has told me I need to address anything on this phone as of yet. There is a “leave a message for the PA” button that patients can press and it will go to my phone. The phone is currently showing that I have 98 missed calls… this can’t be normal.
r/physicianassistant • u/Lonely-Knowledge2072 • 7h ago
Hey, graduating PA program this December. I feel a lot of things, and browsing through subreddits like this is kinda just making my head spin more. Sorry if this is unorganized.
Looking for advice on specialties/things to look for when picking a job, or if I should be looking for jobs at this stage. So how soon did you start looking? Or did you take a lot of time after graduating?
I'm terrified about finding a job, or picking the right field, and I sometimes curse my 17 year old self for picking this path just because I know the burnout rate is so high. Just being on clinical I can see it. Not to say it isn't as high in much harder jobs where you are paid much less, I am so grateful for the opportunity to get to be a PA. I guess its just all so very daunting.
I thought by this point I would feel more confident about the whole thing but I'm just, scared. Looking for anyone who feels similar. Because I pass my exams, I do well in school, but I still feel like I just don't know enough to actually help anyone.
And I have a lot of debt, I'm scared I'll fail as a PA and be stuck with the loss and nothing to show for it.
It might be too early but I've been applying, one rural pcp wants to set up an interview, one outpatient endo said no. The rural sounds intriguing but I've heard horror stories of the high patient load for little compensation, aside from that the medicine and location sounds like what I want. I'm going to a career fair this week.
I should be studying for exams but all that I can think about is what comes next. Help.
r/physicianassistant • u/Cautious-Process-198 • 1d ago
The textbook vs real-world contrast between didactic and clinical year has been eye-opening. With PA onboarding/OTJ training quality deacreasing, it’s a concern for me as a soon-to-be new grad how school is preparing me for the real deal. Obviously good OTJ training still exists, and PA school was never meant to be terminal training. But I wonder if PA education should shift gears to take up some of the burden of the lower quality onboarding.
So, as a fun thought experiment (maybe) I had, for you all practicing, would it have been helpful for your training to drop (not necessarily eliminate) certain courses like professional practice, biostatistics, behavioral medicine (hot take but my entire BM course could’ve been a block in one of the clinical medicine courses), etc., and add “medically complex/managing a patient” courses?
Like, I can memorize the GDMT for HFrEF and the COPD GOLD recommendations and the prophylaxis for afib (not that I have) but man when I show up to my rotations and I get that patient with all three and 14 medications I feel so unprepared.
TLDR: should PA school teach more complex medicine and ditch the extra fluff like making students write papers for potential JAAPA publications?
r/physicianassistant • u/Old_Assumption_232 • 7h ago
Wondering if any of the addresses I submit in my initial license application will be public information? It has home and mailing address, which I assume might be private, and then practice address.
r/physicianassistant • u/Not_Dana196 • 11h ago
I am a recent grad who has had a bit of a delay in job hunting because of some significant life changes. I have sadly lost access to any online sources I was using to stay on top of what's new and upcoming in the medical world.
Does anyone have suggestions on reputable, broad-topic sources for helping me stay up to date on things while I'm out of work?
For context, I'm coming up on a year, so not ages and ages but still.
r/physicianassistant • u/theanxiousPA • 1d ago
6 yrs experience, located in Raleigh NC through large healthcare system
Sleep medicine Tele-health $130k base. Will not budge on salary. $10k sign on bonus. no other bonuses
20 patients daily (all patients 20mins) only for sleep apnea. Other sleep complaints are referred out
M-F 8-4pm. 1 hr admin time daily with 1 hr lunch
$2k CME, 5 CME days. 24 days PTO a year
thoughts?
r/physicianassistant • u/cryptikcupcake • 23h ago
You guys were right and I didn’t want to listen because I was poor and desperate, also immaculate timing being that my grace period on loan repayment is ending this month. I moved to my rural town to be 5 min from work, just finished unpacking my last box and I friggin dread my job. The only days it is tolerable is when my SP is not present and it’s just me and the other APP. I bought my own personal liability insurance to protect myself bc I don’t feel good about my decisions, not sure how much of this is imposter syndrome vs just not being good and knowledgeable yet.
2.5 month in outpatient rural internal med. I mistakenly went in 2-3 times per week over the summer for free (even though clinic was a 40 min drive) to learn the ropes with other students 🤡 my SP genuinely likes to teach which is the only positive but everything else about them and about my other boss stresses me the eff out.
I’m all alone out here. I bought a cat to keep me company. I’m not close with much of my family but I had to contact them more just to keep myself sane here. I’m not sure if I’ll be able to move back home or ask for money.
Like what do you mean you want me to close my charts right away so that I can only type 3ish sentences ? And be good enough to quickly know exactly what to do in the moment. While also being handed near end stage CKD patients that idk what I’m doing with (15 minute appts mind you) while also being scolded for not keeping up with my billing mismatch fixes and constant labs and every other week call (for one week). Genuinely how can I be on call while I’m already with patients.
Not even giving me a day off to take the DOT exam that THEY wanted me to take and then not paying for it. They scheduled me patients on that day anyways and then I basically couldn’t say no to coming in after the exam.
Not being able to go to two different birthday parties for my friends bc on the weekends instead of having a weekend to rest I finally have time to catch up on admin and reviewing labs, adjusting and researching treatments… I work 70 + hours a week sometimes
Not to mention my SP just randomly without telling me going on vacay out of state for a week. We already have a skeleton crew and only 1 maybe 2 MAs that have been here long enough to know what to do… bc of all the firing that takes place
I don’t feel like a human. Granted I had a rough past so I’m very familiar with this feeling but I thought by now at 28 I could start enjoying my life and being happy for once 😂
How do I have time to even apply for job apps? If I leave by the second week of September I believe I’ll be able to give a 20 day notice versus a 3 month notice. I signed a 2 yr contract.
What do I do if not medicine? I just feel like sitting in some grass and painting all day
r/physicianassistant • u/Ill-Tangelo-1084 • 21h ago
PA for five years and currently on my fourth job in Los Angeles. i stuck with pediatrics and really enjoyed my last two jobs. I left my prior job because I was pregnant and my locum tenens company screwed me over in terms of obtaining certain state benefits. My current job has been great but recently I’ve felt the managing NPs have been micromanaging my work and refusing to graduate me off trainee status even though I literally do all the work when I am on shift with another provider and havent been misdiagnosing or creating unsafe situations for patients. It sucks because I already send my baby to daycare and I dont want to spend my time at a job I hate instead of being with my kid. But of course california is too expensive for a one income household…
My spouse is originally from Michigan and we may have an opportunity to relocate there if he gets a good job offer there. In addition to affordability and family support for our kids I’m wondering if this would be good for my career as a PA? I’ve changed jobs so much I wonder if I hate medicine or the LA/cali big city work culture is just screwing me over.
I love the work I do and my patient experiences tend to be positive but I’ve constantly felt like my managers(particularly NPs since they seem to be everywhere) tell me I suck at my job. Also I know a lot of NPs that are great coworkers so this is in no way trashing them. I’m just wondering is this is my career choice or my location that’s a problem?
r/physicianassistant • u/happyhedgehog53 • 22h ago
Has anyone left working in the ED due to feeling burnt out, working another specialty like primary care but then going back to the ED and feeling more prepared with more experience under your belt?
I started the ED as my first PA job but got overwhelmed/burnt out after 2 years and wanted to start a family so I got a Mon-Fri gig but now considering going back having been out of the ED for over 9 years now.
Trying to figure out if I’m just feeling “the grass is always greener”
r/physicianassistant • u/Witty_Management_621 • 1d ago
I’m a PA-C coming from psychiatry and considering transitioning into aesthetics. I worked extremely closely with my supervising psychiatrist, and I honestly loved that part of being a PA. Having an experienced physician mentor me and gradually give me more independence is a huge part of why I eventually felt confident managing my own patients.
I now have a 6-month-old daughter and am taking some time off to care for her, so I’d love to use this period to properly develop my skills in aesthetics.
What I’m struggling with is the training model. I really don’t like the idea of taking a 1-day Botox/filler course, getting a certificate, and then essentially being expected to figure things out on my own. I’d much rather have ongoing mentorship, shadowing and supervised hands-on experience until I genuinely feel competent.
For PAs who went into aesthetics, how did you get your real-world training? Did you find an MD/PA willing to mentor you, get trained through an employer, or pay someone privately? If you were starting over, what route would you take?
r/physicianassistant • u/Secure-Mood-6796 • 23h ago
New grad starting family medicine and I’m really excited however, my start date is two weeks before the year ends. I got the offer late July. I know credentialing can prolong start time but if I’m already licensed and certified, what else could make my start date so far away? I’ve already asked if there was potential to at least move the date up a month but I’m still waiting on a response. Does anyone have any experience with asking for a new start date? What does credential comprise of? I’ll be working at a private office for reference. I know people will argue to enjoy my time cause I won’t have any once I start working but I can’t enjoy life financially and it’s becoming stressful. Yes, I’ve gotten a job in the interim but the only place that would hire me is a part time retail job so as you can imagine it doesn’t pay much. Any helpful advice/thoughts is welcomed!
r/physicianassistant • u/Ardichokie • 1d ago
I have been at my first position for 3 months and hate it, and my mental health is tanking. I know I should wait until I find another position but I genuinely don’t think I can wait. I’m nervous that other companies won’t hire me if they see I quit after 5 months (after my notice time). Any experience?
Also, will I be able to lower my monthly loan payment since I would now be at 0 income?
Thanks in advance
r/physicianassistant • u/Vegetable-Chef7503 • 1d ago
I was interviewing for a job position that I was really interested in over the summer. It checks all the boxes of specialty, location, salary, job description. It is in the same specialty that I’ve been in for the past 2.5 years, and it is a relatively niche specialty for an APP (one interviewer said they were not expecting to get any candidates with experience in the specialty). There are actually 2 job openings within this specialty for slightly differing roles. They got me in for interviews very quickly, and they all went well. Follow-up emails after sounded positive as well. I thought I had it in the bag until I never heard from anyone again. For some context, it seems the main person of contact was “A” as designated below, and they were away on vacation during some of the interview process, which naturally halted it.
Timeline:
- applied for job early July
- had phone screening interview on 7/9
- had first interview with “A” on 7/14
- “A” leaves for vacation on 7/15
- had second interview with “B” on 7/20
- had third interview with “C” on 7/22
- “A” returns from vacation on 7/28
- sent follow up email to “A” on 8/10
My application in their portal still says “in process.” Furthermore, BOTH job listings remain up. Not to be arrogant, but what are the odds that there are two better candidates than me when they weren’t even expecting someone with experience?
After our interview, “C” said they would speak with “A” on their return and be in contact with next steps. “A” had told me prior that there would have been at least one more interview I needed to go through. Do I bother emailing “C” as a last-ditch effort or is it “if they wanted to they will”? I know I’m over-analyzing and spiraling a bit, but for me this was a unicorn job.
r/physicianassistant • u/nbell1998 • 1d ago
I recently left my first PA job, which was in spine and interventional pain, because I felt like I wasn’t learning enough. The work was interesting at times, but there were definitely some challenging patients, especially with chronic pain.
I left because I wanted to see if the “grass was greener” somewhere else. I thought pursuing a more internal medicine-type role would be a better way to broaden my knowledge and build a stronger foundation as a new grad.
However, I’m finding myself really missing ortho/spine and the type of work I was doing. Would I be crazy to reach out and ask for my old job back? Or is this just part of figuring out what specialty is actually the right fit for me?
r/physicianassistant • u/ArmadilloOdd4657 • 1d ago
I am currently a PA student set to graduate in December. I have submitted a few applications over the summer (about 7-8) and I have heard back from 2 of them. I had a series of interviews and was offered a job in rural MN.
The job is family medicine / wound care with hospital calls. Clinic hours are 8-5 Monday-Friday (my FTE would be 1.0). The on- call schedule is once every 6 weeks. Regular clinic hours are worked while being on call. Hospital acuity is low - about 5-6 patients admitted at a time with some of those patients being OB/baby. Overnight, tele-hospitalists cover patients 18+, so I would be responsible for admits/discharges/rounding from 7AM-7PM for adult patients (24 hours for pediatric patients). I also would be the second assist for complex deliveries, or complex fetal needs.
The clinic manager told me that the schedule typically works out that a family medicine OB provider is on call while I would be on call in the hospital so I would be able to ask questions.
This is a critical access hospital with a Level 1 hospital partner just 45 minutes away.
Per clinic staff, training would be 5 days with shadowing and seeing patients independently and then starting by myself after 1 week. I would see 1 patient per hour and then have weekly meetings to check in to see where I can shorten appointment times.
For hospital call training, I would be sent to the larger facility to get more reps of admission/discharge. I would also spend time at my facility with a colleague or supervising physician to shadow. I would not be on call for about 2-3 months independently.
The pay is $126,000 / year with an increase to 130k after 1 year. There is no RVU. PTO is a set number of 288 hours (based on FTE) that does not pay out or carry over. There are some other additional benefits. I would get a large ‘sign on’ bonus (if I stay less than 3 years I would have to pay a portion back).
I am just unsure if this is the right job for a new graduate. I discussed supervising physicians and they don’t have one picked out for me yet which worries me that whoever would take me on doesn’t understand that I might need a little bit more hand holding. I am getting a lot of mixed opinions from my mentors (professors and preceptors) about if this is good or not. I know I would get a TON of experience and stay up on my skills, but I am worried about not getting enough mentorship. Everyone keeps telling me to trust my gut, but my gut keeps changing its mind. I do want to work in family medicine and I do enjoy wound care, so I feel like overall this is a good fit but I am concerned about the call. I also know that the job market is TOUGH for new graduates now and I don’t want to pass up on this opportunity to end up being unemployed for months after graduation.
Any help/advice would be most appreciated
r/physicianassistant • u/user7709 • 2d ago
And if so, did you have to go through a formal interview process? What steps of the hiring process were different?
r/physicianassistant • u/nomocomment • 1d ago
I’m making the switch from primary care to an oncological subspecialty, which I’m very excited about.
Obviously the learning curve is going to be very steep, so I’d like to start tackling it now. We really don’t learn very much at all about oncology in school.
Does anybody have any recommendations for resources to build a strong foundation before starting? I plan on knowing the NCCN recommendations for the subspecialty but I’m looking for a textbook or something guided to build a good pathophysiologic understanding of cancer.
r/physicianassistant • u/South-Finger-3021 • 2d ago
Hello all
I will be starting my first job in hospital medicine in ~2 months. I will primarily being on nights with cross covering and responding to rapids. No codes. I have a 2-3 month training/onboarding. I feel like in this gap between graduating and beginning I am losing some of my skills/knowledge. I wanted to ask what would you all recommend I do over the next couple months to prepare myself? Any specific resources, content review recommendations or other tips?
Thanks
r/physicianassistant • u/Old_soul_12345 • 1d ago
Hi everyone! Just wanted to get some advice. I graduated back in December and have been applying to jobs since feb/march. My area is very oversatured and most offers I’ve gotten so far are either zero training, poor pay, or an awful commute. I currently have an offer for an fqhc with not the best pay, bad area, but 1-2 wks training, a big team, and decent benefits. I am waiting to hear back about a dream ent job, 4 8s, 5 min commute, and incredible dr committed to training, but it’s an unsure start date possibly mons out and wouldn’t be pslf. Is it worth accepting the fqhc if I don’t hear back from the ent soon? I’m just worried about accepting the job and then hearing from the other within a few weeks and not wanting to break that contract before even starting. I feel like I really need to start working and get experience but also I’ve waited so long I don’t want to settle. Would love your input, thanks!
r/physicianassistant • u/qwarkled • 1d ago
I am absolutely thrilled to be a PA one day, I know I will love the work, but one concern I’ve been having recently is that I may not make enough money. Don’t get me wrong, 120-130k is solid money, but I am hoping to earn 200-300k. What advice do you current PAs have for earning this high of a salary as a PA?
r/physicianassistant • u/tundao330 • 3d ago
My wife and I started watching The Pit, and I was wondering if any PAs operate in that specific kind of emergency medicine. I’ve heard some PAs work at an urgent care or the like, but didn’t know if full trauma emergency medicine was possible/common for a PA.
r/physicianassistant • u/Fearless-Track-6643 • 3d ago
I’ve been looking through this thread for a little while now, and I’ve seen a decent number of PAs, specifically emergency medicine PAs, with 6 to 8+ years of experience who decided to go back to medical school. A common reason I’ve seen is wanting to gain a deeper understanding of what they’re doing in the field.
I’m genuinely curious about this because I’ve always thought that experience in the field itself is invaluable. I completely understand the importance of residency, especially for someone coming straight out of medical school, internships, etc. But I would imagine that after 8 years of practicing in a specialty, you’d become pretty competent and develop a very deep understanding of what you’re doing clinically.
I’m not criticizing the decision at all. I’m genuinely curious for those who have made this transition. What did you feel was missing from your PA training or practice that made you want to go back to medical school after several years in the field?
r/physicianassistant • u/StretchiToutYO • 3d ago
Hello All,
Long time lurker but first time poster to this subreddit. This is a long story of my progression through this company so I hope it is written in a way that engages you as much as possible.
I graduated from PA school in 2021 and upon graduating I immediately started a job in general outpatient urology in a VHCOL area. You could say I got lucky because I actually discovered this office as a patient with a certain painful issue that needed to be addressed.
The first thought I had as a patient while waiting to be seen was how busy the waiting room was. Easily 30+ patients just sitting and being told to drink as much water as possible. I remember thinking, “I can't wait to get out of here.”
After waiting nearly two hours to be seen, I was brought into a room and told to urinate into a bucket. I was then given a bladder scan to evaluate my post void residual. “Why are they doing this if I am only here for a pain issue?” I immediately thought to myself while waiting.
When the doctor finally arrived, I was evaluated and given an antibiotic for my issue. While reviewing my intake form/HPI, the doctor saw that I was in PA school. He also noticed, strikingly, that I spoke a certain foreign language (that I won't disclose due to privacy concerns). He also noticed that I speak Spanish.
Around 70% of his patient population falls into patients who primarily speak these two languages. The doctor enthusiastically announced, “you should come and work for us, you would be a great fit”.
Despite the unfavorable experience I had as a patient there, I did have a positive first contact with the doctor, and I could see his practice was booming.
Considering the competitive job market in my area, I did ultimately apply for the job and I was soon offered a substantial starting salary of $150,000. As a new grad in 2021, it was hard to pass up so I did ultimately accept the position. Something that stuck with me was when he exclaimed, “if you stay with us long enough, you will make doctor money”.
This is a very large privately owned corporation with thousands of employees. They are a reputable company on paper. However, I am still shocked at their negligence and misconduct when it comes to patient care.
One thing you need to know about this company is that it is all about the numbers. We are expected to see 30-40 patients a day, and we are not given a lunch break.
Oftentimes, I am not able to eat anything except breakfast for an entire day.
These are not simple cases either. I’m bouncing between seeing prostate cancer patients, testospel insertions, and plenty of foley catheter changes, amongst many other general urology cases. These eat away at my time, and I am constantly running from patient to patient.
There is rarely a moment I have to myself to chart. As one patient is leaving my office, there are usually 2-4 patients in the queue ready to be seen. One after the other. I got used to it, and I must say I was trained well which I do give my SP and other APP colleagues credit for.
My SP expects us to schedule multiple procedures for every patient that comes in. New patient, 24 years old here for testicular pain? Lets check his urine flow and scan his bladder just because. Young patient with UTI symptoms and microhematuria? Schedule a CT scan and cystoscopy, even if the microhematuria resolves after treatment with ABX. Bad medicine. It's just taking advantage of patients who don't know any better.
Guess what? Oftentimes insurance does not cover these extra procedures and the patient is left with an exorbitant bill after their visit.
We accept virtually all insurances, with a hefty portion of our patient population on medicaid plans, so many of them don't have to worry about these charges, but the patients on private insurance plans? Oh boy. The amount of complaints I received from patients really began to eat away at me. The whole thing just felt like one big scam after a while.
I’ve seen up to 15 new patients in a day. Churn and burn.
I am very much into my health and fitness, normally working out 4-5 days a week. The stress and exhaustion from work soon ate into my ability/desire to exercise at all, and the burnout soon set in, and only worsened over time. Neglecting the needs of my body and mind.
Work became my life. I was challenged every day. Working as an independent clinician did provide significant meaning to my life which dramatically changed me as a person and I did grow in many ways. Especially because my SP was rarely available to ask questions or get an opinion after he deemed me ready to practice independently. I was mostly on my own to figure things out. Luckily I did have access to UpToDate, which is an invaluable tool.
Another important tidbit that ties into this is that I was recently diagnosed with MS, which really threw a monkey wrench into my already frazzled mind. Luckily it was found incidentally, I am not experiencing any symptoms and I'm already on an immunosuppressant medication to stop the progression of the disease.
This is not why I went to PA school. Not to make some money hungry asshole richer. Well, I suppose you’re always going to be working for the man, but at least there should be compassion and emphasis on patient care, which falls second to profit at this company..
When other providers are off, or if the boss decides to leave early for the day, I am expected to take on their patient load, and sometimes I end up seeing up to 60 patients in a day. I’m not kidding. And I realize how much this eats into quality patient care. There is no quality. Just frustrated patients who want to leave after waiting 2+ hours to be seen, some even leaving without seeing the MD, and a provider who is so frazzled he can barely orchestrate coherent thoughts. It’s the definition of a shit show.
This company takes advantage of their patients and performs unnecessary procedures just because they can.
I did pick up on these questionable practices relatively quickly and it soon made me question my position in the company,
After 2 years at this company, I decided enough is enough. I spoke to my SP and told him that I plan on leaving the company by the end of the year.
He did not accept no for an answer, and ultimately gave me an offer I could not refuse. “You want to work less hours? Fine, you can have Monday off. Oh and by the way, here's a raise. I'm offering you $230,000 and a 4-day work week to stay…” As a relatively young PA at his first job this seemed like an amazing offer, which I recognize it is, and I would imagine most people in my situation would not refuse this type of offer.
The money pulled me right back in. I continued to hone my skills, always trying to look out for patients first and foremost. I tried not to schedule unnecessary procedures for my patients, but I was soon pulled to the side and told by my boss “just schedule more procedures, the patients feel like we're doing more for them.”
It has now been five stressful years with this company, and I just submitted my letter of resignation. I had enough. The week leading up to my resignation I woke up every morning in agony, I've never felt such dread or anxiety to continue working. It all came crashing down. The closest thing I've ever felt to a mental health crisis.
I submitted my resignation on a Thursday, and the next day was my last day. The company handbook states PAs must give at least 90 days notice. I said fuck it, Im done with this place.
My SP called me and told me I'm always welcome to come back if I decide I want to return, even part time.
The thing is I'm fundamentally done working for a company that practices medicine this way. He could have offered me $300,000 to stay and I would have said no. Even working 4 days a week, I was faced with extreme burnout.
I am officially done working for them and here I am, body and mind in shambles just trying to reflect and see where my life is going to take me. Music is starting to sound better again. I know this is where I need to be.
I suppose I'm just looking for insight into whether I threw away a unicorn job, or was following my heart the right decision.
With all this being said, my fellow redditors, if you were in my position, what would you have done? Stay and grinded it out for the fat paycheck, or follow your gut and seek another path that aligns more with your ideals?
I'm not questioning my decision to leave, I'm just kind of lost wondering where to go from here? Any insight would be much appreciated.
Thank you for reading my long ass story.
Details are highlighted below
Job details
Specialty: Outpatient Urology
Salary $230,000 working T-F, normally working 8a-6p
4 weeks PTO (bumped to 4 weeks after two years)
5 sick days
Free health insurance, dental, vision for a small fee
401k with automatic 5% contribution
No call, fully outpatient clinic with minor in-office surgical procedures
No CME
On paper, I would say this is a very nice package, one that is hard to pass by, however given what I disclosed above, is this a job that you would walk away from?