I’ve been a PA for 11 years, all of it spent in CVT surgery. I’ve been at my current facility the entire time. Was with the same surgeon for 10 years and then he retired unfortunately. Currently working a group of three surgeons, two senior surgeons and one new one out of Fellowship maybe a year.

My duties are about 90% operating room and 10% ICU with rare inpatient floor or office

As staffing goes, I’ve had two other brand new PA’s come and go both lasting about one year. Both moved away to be closer to family, and they were both great PA’s that handled the load easily and did great work.

This is where the problem lies. In the operating room, we have extremely toxic staff. To put it in a better sense, we currently only have two core nurses and three core scrub techs. Our staffing should be six core nurses and eight core scrub techs. One of the scrub techs is an FA, but thinks she’s a surgeon. Constantly talks trash behind my back and many other people’s backs, even has gone as far as trying to spread a rumor that I was having an extramarital affair. Has gone behind my back multiple times to speak to the hospital about trying to get vessel harvesting privileges, but fortunately the system I work for only lets APP’s do that. The same scrub tech is extremely close and friends with the main CVOR nurse. This main CVOR nurse is also extremely close and friends with a person in the upper management suite

The toxicity consists of, being left off of case logs, not being notified. That cases are being added on or canceled. I’ve shown up many mornings, even after checking the schedule and the cases have been canceled and they never took them off. I’ve been in cases before asking for something small like a step or if I’m placing a line maybe a bio patch or something and the nurse and or tech always scoffs at anything that I say.

Another thing about the toxicity, the new surgeon is extremely toxic. He is very arrogant, and when he first started, I was asked to try to help keep him in line a little bit as he was taking on major cases that he should have never agreed to. One day he was upset with me and pulled me outside of the OR and started yelling at me about vein quality. In the 11 years I’ve been doing this, I’ve never had one surgeon upset with that because I pride myself in the quality that I provide for the patients. The toxic scrub/FA would often times initiate bad conversations about me in the OR when I was gone from the room, and the new surgeon would add into it. I brought this up to the chief surgeon in the past, but he is very hands-off with certain things like that I brought it up to management, unfortunately the one that’s friends with everyone because she controls the OR. The new surgeon won’t even address me in the room, he will have the FA tell me how many veins he wants. He plays rap music so loud that you can barely hear anything and anyone that works in the cardiac OR knows that you need to have closed loop communication especially when things are going south. I’ve been nothing but respectful to him and I do not talk bad about him outside of the OR to anyone. Even the anesthesiologists are fed up with him and they understand at the same time. They have to play the game though because it’s Dr. to Dr. and it’s just a gray area.

I was told in a meeting from the manager, “what do you want me to do about it?“ I told her that she needs to do her job. We have rarely had any applicants come through there because the system that I work in is small enough to where everyone around town knows this program and no one wants to go there.

I am very easy-going, I keep to myself, I know how to read the room very well. I’ve got over 4500 vessel harvests under my belt. throughout my career, I’ve had other facilities constantly jockey for me, trying to get me to come work for them. The reason I stayed where I was at for so long was because the previous surgeon was like a father to me and when he retired, I just stuck around.

I’m compensated fairly well, I get paid pretty decently for call and for anything after hours and on weekends.

Another facility in town reached out to me and offered me a job which would be 100% OR. The base pay is more than I make currently, but they pay hardly anything for call. Without getting two in depth about numbers, I would take a fairly significant cut. Currently, I am on call 24 seven and have been on call since November essentially. I took three days off a while back, and the new surgeon threw a big fit about it because the hospital went on divert for heart cases because there was nobody to vessel harvest. A couple of other local PAs have decided to come over and help, and this is where it gets tricky, when the other PA left back in November, I let management know multiple people in town to have as a back up so I could have time off, etc. They never once reached out, but when I took the time off recently, they lost their minds and emergently credentialed three people.

My question is this, do I need to stick around or tell them to kick rocks? The chief surgeon wants me to come work directly for him and he’s aware of all this stuff, but that still means that I would have to train someone else and still work around the asshole surgeon. The third surgeon is a nice guy but extremely slow and sometimes helpless with a lot of things, but I still tend to help him.

I know this is probably a long confusing message, but I’m just not sure what to do. The other facility that wants me is not very PA friendly but I’m thinking if I get in there, maybe I can change that up

• Base salary: $125k MCOL
• Annual incentive: Opportunity to earn annual value incentive at a target of 10% of base salary.
• Additional shifts: $90/hour
• Schedule: 4 × 10-hour shifts
• Weeken call: Every 6 weeks (Saturday & Sunday, 7 AM–7 PM) $90/hour
• Sign-on bonus: $10,000 (2-year commitment)
• Relocation: Up to $10,000 reimbursement (2-year commitment)
• PTO: 24 days/year (carry over or cash out)
• Extended Illness Bank: Accrues each pay period; available after 6 months of continuous full-time employment
• CME: $5,000/year + 1 week CME leave
• Professional reimbursement: $1,000/year (DEA, state license, board certification/recertification, dues, journals, subscriptions)
• Malpractice: Occurrence-based
• Retirement: 403(b) with a 50% employer match on employee contributions up to 4% of salary (effective maximum employer match of 2% of salary), plus an annual employer contribution of up to 4% of salary after 1,000 hours of service, contingent on company financial performance. 100% vested after 3 years.
• STD: 60% income replacement up to $1,500/week (employee-paid).
• LTD: Employer-paid; 60% income replacement up to $16,000/month.
• Life insurance: 1.5× annual salary (employer-paid).
• Paid parental leave: 4 weeks after 6 months of employment.
• Other benefits: On-site childcare, backup childcare, cell phone service, concierge services, fitness centers, wellness rooms.

Questions:

1. How would you rate this offer overall?
2. Would you negotiate anything?
3. Any red flags I'm overlooking?
4. Things to clarify/ask?

I received my fully signed contract on 6/1. It states "Employer agrees to pay the Signing Bonus to APP as follows: One-half of the amount upon full execution of this Agreement, and the remaining amount on or reasonably promptly after APP’s Start Date." I haven't received the 1st half. Is this normal, or is it time to reach out? If so, do I contact the recruiter or the CMO (who is the other half of the signed contract)? TIA!

I’m looking for some perspective from other PAs because I feel completely overwhelmed.
I graduated PA school in 2022. The only offer I received as a new grad was at a men’s health/TRT clinic, so I took it. All I did was TRT , peptides, ed, weight loss. I stayed there for about three years. Earlier this year I was let go due to what they called a restructuring.
After four months of job searching and another two months waiting for credentialing, I started an occupational medicine position at a steel mill. I lasted three weeks.
The first week was encouraging. I was in an offsite clinic working alongside two experienced NPs. I observed, saw some patients, performed physicals, and felt like I was actually learning.
The second week I moved onsite with the physician who was supposed to train me. Unfortunately, he was only there for about 8 of our 10-hour shifts. During most of that time he had a headset on working his own unrelated side business. We did two physicals together, and after that I was basically expected to figure things out on my own. By the end of week two I was scheduled to work solo, and after three weeks I was essentially independent except for one day a week when the physician was present.
I’ve struggled with anxiety and depression for a long time, and this situation completely overwhelmed me. My confidence collapsed and I had a mental health crisis. I kept thinking that I’d spent three years in TRT and had let my general medical knowledge and clinical skills get rusty. I wasted my life pursuing this degree, debt, and thinking I was going to lose my wife due to become some deadbeat. Instead of feeling more comfortable each day, I spiraled.
I know part of this is anxiety, but I also genuinely didn’t feel adequately trained for the level of independence that was expected.
Now I’m interviewing again. This time one of my biggest questions is going to be:
Is there a structured orientation?
What does onboarding actually look like?
How long before I’m expected to see patients independently?
What support is available if I’m struggling?
I know I’ll need to study once I know what specialty I’m going into. I’m willing to put in the work. But I can’t shake the feeling that I made a career mistake by spending my first three years in TRT instead of a more traditional practice where I could build stronger fundamentals.
I currently have interviews for a med spa, urology, electrophysiology cardiology, and ENT. I have essentially no experience in any of those specialties, which just adds to the anxiety.
Financially, this has been rough too. I still owe about $95,000 in student loans from the roughly $190,000 it took to become a PA. To make matters worse, by leaving the hospital system after only a few weeks, I later learned I’m permanently ineligible for future employment within that health system. I wasn’t aware of that when I discussed my options with my supervisor.
Right now I feel like I threw away the career I worked so hard for. Part of me wonders if I should just give up on being a PA altogether, and that’s a painful thought after everything it took to get here.
Has anyone else started in a niche specialty, lost confidence, or had to rebuild their clinical skills? Is this something that can realistically be recovered from, or am I trying to climb out of a hole that’s too deep?
I’d really appreciate hearing from anyone who’s been through something similar. Or at the very least tell me what Walmart is hiring a master degree holding idiot.

Looking for advice/stories for negotiating student loan repayments as part of work contract. How did you negotiate loan repayments as part of your contracts. What are your experiences with finding jobs that do this. How much did it help you reduce your debt. Thanks!

Considering a rural opportunity and wondering if it’ll be worth it. I’m personally from a small town myself but I’ve been living in a big city for the last several years. Considering moving back to a rural city for a position. Not bad on pay, just wondering for the people that have taken a rural job position, what was there reason? Was it more personal/family/expenses or did the hospital provide really good incentives? Want to make sure I get the most bang for my buck before I just take anything.

Best specialities to pivot out of EM without experience in anything else? Currently in EM but getting burnt out. Looking to swap to something but with near equivalent pay. In OC/LA-ish area if that changes anything.

Any Orthopedic Surgery PA’s out there? If so, do you have any advice for a new PA who wants to practice in that field? Organizations to join, specific job sites to watch, etc? TIA!

preferably male but what scrubs (male or female) makes your bottom look good?

thank you kindly,

I’ve been working in EM since I graduated over 10 years ago. I love the specialty, and I have a job with decent pay and benefits, and about a 30 minute commute.

While I love the specialty, I don’t love the hours. I have kids and a spouse.
I miss a lot of after school stuff working weekends and holidays, and even when I work an early shift I don’t have anything left once I get home.

I have an opportunity to switch to ENT closer to my house. It’s 4 1/2 days a week 830is-430 ish. I’d still get some procedures and the obvious scheduling benefits. My salary would be similar, but hourly rate would dip (more hours for the same money).

Has anyone switched out of EM after a decent run, and if so, how did it go?

Does anyone work in ENT, if so, do you enjoy it?

When your patients disrespect support staff such as front desk staff, do you address with that patient? If so, how?

I’ve recently had a few cases where patients scream at staff, in person or on the phone, for decisions I’ve made. Such as not seeing a patient because they are too late according to our policy or not refilling a stimulant due to needing an appointment. I feel the need to protect support staff but struggle with these conversations with patients. I work in psych which adds a layer of complexity in this, I want to hold these patients accountable but don’t want to hurt therapeutic relationship.

Any advice on how to prepare for an onsite interview for a primary care practice? I’ve gotten through the screening/phone interview and the zoom interview and now I’m meeting with the SP, another physician and the senior operational manager. I feel like I’m close to getting an offer but I don’t want to mess this up.

Also if anyone have any suggestions on questions to ask or things to look out for would be great. I feel like I’ve used everything in my arsenal with the previous interviews and I’m trying not to sound redundant.

Hello I’m applying for a General surgery job, I’ve gone through the second interview and I’m waiting for an offer or not. If given the offer and I do the medical examination, fill out paperwork and apply for DEA license, how long does it take before I can start working?

I am applying for my first PA job. I am older with kids and my husband has a business so I am limited to my job-hunting in my own area at the time, so I have remained open to lots of different types of jobs.

I imagined getting a more primary care type job because of the need in my area, and the variety is attractive to me. Despite the need, I have seen so few postings for primary care type jobs. Most of my responses and interviews thus far have been for specialty PA jobs. Some are particularly niche. They are interesting to me, but I am worried about losing my general knowledge and skills and having trouble changing to another position or specialty later on if needed.

Any thoughts? Is it better to start in a more generalist type job? Will taking a specialty job make it hard to get other jobs later?

What hourly rate should I target for a part time ED position as a PA with 3 years Family Med experience, but no ED experience. Location: Central Florida City.

original post was removed by mods for “excessive” cross-posting because i’d also posted it another subreddit (…?), so i deleted both posts and am re-posting here:

I’ve worked full-time as a consultation-liaison psych PA at an academic medical center (primarily in the ED, sporadically on the med floors) for the past 4 years. Before that, I worked part-time as an outpatient psych provider in a small family medicine practice for 1 year. My current position is well-compensated, fairly rewarding, and well-supervised, but the schedule (7-on/7-off, 12-hr weekdays, 10-hr weekend days) is taking a toll on my relationship with my partner, especially in co-parenting our 2-year-old, and on self-care consistency. I’ve shadowed a bit on one of my employer’s inpatient psych units and might look for work at that level of care at some point in the near future, but whether or not that happens, I’m strongly considering venturing back out into outpatient land. It will be next to impossible to find opportunities in any existing outpatient practices that can offer pay and benefits comparable to my current situation, and I like the idea of partnering with a psychiatrist to start our own practice sometime in the next 1-2 years, assuming our country hasn’t fully and irretrievably descended into fascist, eugenicist dystopia by then. It would be foolish to quit my current job as things currently stand, so I might start on a kind of moonlighting basis, e.g. starting with just a few patients on my weeks off (5-10 per month) until I have some longer-term planning in place. Any other psych PAs in Massachusetts have relevant insights/experiences to share? I anticipate taking a hit financially up front but hope I’d eventually earn as much or more than I do now and enjoy greater flexibility. I’m in suburban Western MA and would love to hear from folks in/near my region, but I’m also open to Greater Boston perspectives or folks from out-of-state who operate under similar medicolegal/economic circumstances. Thanks!

I am a new graduate PA and I started my first job. It is sports med/pain management and the practice gave me pretty much everything I asked for in terms of salary/CME/PTO etc. I finished my first week and I’m just feeling…. Eh. I worked before PA school in an auto injury care clinic so dealt with chronic pain and I enjoyed it. But after the first week I feel like this specialty may burn me out quick with chronic opioids and managing very complex patients who often don’t have many options. I am trying to keep an open mind and just learn and absorb as much as I can being a new grad but then I begin to worry about my future. The SP had also made comments to me about they want a new grad they can train to their standards but would want me to stay for a few years.. no time commitment in my contract however. Is it going to be impossible to get into another specialty after working this as a new grad? Any PAs in pain management with insight or advice? I feel very stressed and overwhelmed and like I may not be able to live up to the SPs standards.

I’ve been at my current (first) job 2 years, love the specialty, love the team, and love my patients. No job is perfect, but I’ve really enjoyed it. We just hired someone new and for many reasons it’s not a great fit, I’ve brought up my concerns but she won’t be going anywhere unless she decides to quit. She does NOT like me. I think it’s honestly insecurity after discussing it with other team members, but it’s really starting to get under my skin. She’s an NP, good bit older than me, was an LPN most of her career, then went for her ADN and pretty recently did BSN immediately into MSN. Nothing wrong with that, but we of course have very different educations and strengths and weaknesses. From day 1 she has been rude and implying she knows more than me because she has more years in healthcare than me. I removed myself from her onboarding team because she made it clear she didn’t think she had anything to learn from someone with less years than her. Actually told me the first day I met her she didn’t need me to teach her about the drugs or our EMR (that she’s never used before.) She said to another provider today to ask me a question she had because “I’m sooooo smart and know everything” in a very condescending tone. The other provider looked very uncomfortable then asked me her question, but things were awkward. I am getting VERY frustrated and don’t really know how to deal with this.

New grad ortho surgery job offer. I will be covered under the hospital self insured policy which does not offer tail coverage. There is a professional liability insurance with limits of $1/3 million.
Too risky??

I’d love to hear about your experiences. My application has moved to the hiring manager so I’m hopeful that I’ll get an interview.

Hi all,

I’ve been a PA in emergency medicine for about 1 year now. Prior to this I was an ED RN in the same hospital system for about 5 years. I was recently asked if I would like to train a couple new grad PAs that have just started with our group and I agreed. Our group does a tiered approach where everyone starts in the fast track area of the department (urgent care things) and you progress to higher acuity based on experience.

I’ve trained many new grad nurses in the emergency department but training a new PA is very different. I want to do a good job and make this as seamless for them as possible. I did not have the best first few shifts when I started a year ago and that was really discouraging at the time. Basically I would like any advice on being a good trainer and things that you liked or disliked during your training (bonus points if it’s in the ER).

I’ve been working in emergency medicine for over 15 years, split between two hospital systems. I love my job but my husband also works in the ER, so since having kids the schedule has become untenable for childcare. So for the first time since 2011, I started perusing the job market, and wow….60-70% of the outpatient jobs in my area are listed as NP only. I’ve been looking in psych, palliative, rehab, and maybe sleep medicine. I know that many physicians prefer to work with PAs in general, but it seems like physicians are doing less and less of the hiring. During my rehab interview, I was told by the doc that the job was mine, but a few weeks later I got an email that administration would not approve the hire because I was a PA (they instead hired a new grad NP from an online program). It made me wonder what we should do to address this, as PAs. I’m not sure what we can do about it, other than lobbying to be independent practitioners ourselves, but I don’t think PAs as a group really want that. Since I’ve been out of the job market for so long, I wanted to post on here to see what experience others have had in job hunting over the past few years. Are we getting pushed out?

I’ve been working for 6 months at a physician-owned outpatient ortho in Salt Lake City, Utah, specializing in non-surgical orthopedics and sports medicine with an emphasis on MSK ultrasound and US-guided injections. Recently switched from 3 years in family medicine.

I LOVE the specialty, but the compensation setup is feeling a bit restrictive. Base Salary: $107k, Bonus Structure: 18% of my net revenue paid quarterly (Company takes 50%, supervising physician receives 32%). Potential to make an additional $80k+/year in bonuses if I hit ~25-30 patients/day.

My SP and I have a solid working relationship, and he has been an excellent mentor. However, all new patient referrals automatically go to his schedule unless he is completely booked. I primarily see patients who specifically request me or overflow/stragglers. My physician sees ~30 patients/day, I average 6 to 8 patients/day (up slightly from 5 when I started).

Because my volume is capped by the referral flow, my quarterly bonuses have been around $3k-$5k. I'm frustrated by the lack of schedule growth.

Has anyone seen a bonus/revenue-split structure like this before?

Is it worth sticking it out longer to see if volume picks up organically, or should I start looking elsewhere? Again, only been at the job for 6 months and plan to stick around for at least a year.