The Great Debate

what do i want to be when i grow up? i kind of hoped i'd already answered that question. but now, when faced with all the possible disciplines and settings in which to practice medicine as a PA, i'm again feeling uncertain. the range of facilities is astounding, the quality of care each place provides, the hours, the scope of practice the PA gets, the benefits and salary...everything varies job to job. it's like comparing apples to kumquats. so i have to look at what i'm passionate for (like i LOVE and feel energized by obgyn but HATE and feel like throwing myself into a bus by pediatrics), quality of life, and money.

location: first of all, i hate commuting...so i'm sticking within a 30 min radius of my house. but my house is pretty central, so that leaves a lot of possibilities. there are positions both in swanky suburban spa-like clinics and in the ghett-o. (see it's less offensive if you call it "the ghett-o" with some flare...it's all about how you spin it). for example, i interviewed last week for a women's health job in a place with bars on the receptionist's window and a strip club 2 doors down....which might mean lots of business, but isn't very confidence inspiring.

mission: what kind of service do i want to provide? the folks in the low income clinic might have more need and be more vulnerable, more requiring my advocacy, education, and kindness. but i can do a lot of good in this discipline regardless of socioeconomics. and i will have more resources and maybe feel more safe in higher income areas. PLUS, with the position mentioned above, i happen to be from a totally different culture and speak a totally different language than the patient population there...when my goal is to really reach and teach folks, would i have that impact coming from such a different place?

scope of practice: how much will i be able to do as a PA in each job? are there other PA's? how will i be treated? i've heard tell that some groups that have never had a PA before don't really know what to do with their first one...and since i'll be a first-timer, that might be difficult. on the other hand, if you're the first, you set the contract. as far as ob/gyn goes...some hospitals allow their PA's, with many hours of supervision, to deliver on their own, 1st assist in C-sections and other surgeries, etc. and in other hospitals you're in triage, just ruling out labor and prescribing tylenol, rest and fluids. and in the clinic setting, you're doing prenatal and annual visits, maybe some colposcopies (takes some skill- this is a cervical exam w/ a microscope, looking to abnormal tissue to biopsy)...but no deliveries or surgeries. it just all varies.

passionate pursuit: i know that i love ob/gyn but there aren't many jobs in it and i might not be able to find the perfect one right now....so i got kind of a miraculous call the other day from a surgical dept looking for a general surgery PA and although i had to quickly amend my resume to read "surgery is my life" instead of "obgyn is my life" it's not too much of a stretch, since i love being in the OR and it would still be really good training for eventually working in ob/gyn. but then i also got a call from a labor and delivery dept looking for a PA to work nights....

hours: this also varies extremely. if you're salaried and work for a busy cardiologist, for example, you'll likely be working 60 hr weeks....but if you're hourly and working at a clinic or a hospital that's strict about overtime, you get your 40 in, and that's that. now because hospitals are open 24/7, this means there has to be night, weekend, and holiday coverage. sucks. in a clinic, it's usually better, but still weekends and evenings are often required. stupid health care. why can't people get sick from 9 to 5? so i'm considering working nights to get my foot in the door to a great ob/gyn job. it would be hard- i hear you lose friends and personality when you lose that much sleep over time and you're schedule is backwards from everyone you know...but i might find that i like it. and since it's 12 hr shifts, you only do 3 or 4 of them a week, and always have several days off each week.

income: PA's make good money for not a lot of schooling. it's just a fact. we make roughly 1/3rd of what the MD makes in our discipline. so since surgeons receive an ungodly amount of unmarked sacs of cash each year, surgical PA's also do really well....ob/gyn is less, but still good money, depending on the situation. it's very likely i'll get job offers that range in salary by 10's of thousands of dollars. eck. have you seen the "spongebob square pants" movie? every time i say the word 'money' i want to say it like mr. krabs does. "what's important to you in finding a job?" "why it's MONEY of course!"

training/further education: then, of course, i'm still thinking about a residency program that will beef up my ob/gyn skills...but will take my family across the country and completely disrupt our plans. most PA's are trained on the job and become "experts" in an area simply by having worked in it over time...while getting paid ("MONEY"). there's something appealing in that.

so....lots to think about. lots up in the air. but finally some really solid options that i'm extremely excited about. i flash between terror that i'm about to be released into the wild as a real life PA and excitement. i'm ready to not be a student anymore, i tell you that. on friday i almost backed my car over a nurse (i would have had to drive it into the hospital and to her department to do it) because she didn't trust that the orders i'd written were kosher from the MD i'm with and since i can't sign anything as my signature has no value/license behind it, we were squaring off in the nurses station.

and this is my 99th blog post! i'll have to find something super cool for my 100th one. stay tuned for that. thanks for hanging in there with me, being my sounding board, and laughing at my horrible jokes. :)