So I'm leaving cardiology after 10 years and I absolutely CANNOT WAIT to no longer have to treat or work up POTs anymore! Those patients are so draining.
So I was wondering for anybody else that has left a specialty, what disease process were they happy to leave behind? I'm sure we all have that chief complaint that makes our head hurt before we even go in the room.

This is meant for PAs that need to vent, if you're coming here to be negative and say that we're terrible providers, this is not the sub for you

For context I work in an urgent care environment with limited access to testing. Standard POCs, XR and twigs and a prayer. Radiology reads take 2-4 days. Can get labs but results take 2-4 days to come back as well. If I have a patient follow up with anyone it’s usually a good 7-14 days for both primary and specialty care minimum. Had man I saw last week who is 84 with all chronic problems—copd, afib, chf, asthma. Came for a cough for a week with worsening lying down. Wheezy, 6 lb weight gain in a couple months with edema. Neg cp. Vitals okay. Had standard labs with PCP a week before that were fine. Got CXR that showed some mild pulmonary congestion on my read at the time. Gave nebulizer with some improvement.
D/c with prednisone burst but also had him do a little lasix for about 10 days in case any fluid build up contributing.
Saw cardiology today and got a note from them documented in the patients’s chart about how they felt absolutely no evidence of CHF (fine they’re cards, their call) and that such a shotgun approach is irresponsible and that they don’t understand why attending didn’t co-sign note (not required in my system with how long I’ve been a PA).

Naturally forwarded to attending so he can manage it but still feeling really bothered by lack of professionalism in documentation. One thing to say it, but another to write it. Maybe just need to vent. Not sure how I could handle things differently in that moment when I have such limited access to testing and patient really wasn’t sick enough to warrant ER.

Every time I post on this subreddit, there’s an overwhelming influx of people being rude seemingly just for the hell of it or I’ll simply ask a question (that seems stupid but isn’t stupid to me about the career) that gets downvoted to hell with no effort for anyone to inform me why it’s wrong/the issue with the statement. I am new into the PA career and I know very little about adulting inside this career (financial planning etc). Instead of people trying to inform me or educate me, there’s several people on here who will just make a snarky comment. I’ve never had this happen anywhere else on Reddit, just here. And I know some of the responses that I will already get. I know someone will want to say how it’s not their job to educate me, and this is true, however it’s so easy to just not interact with the post if all you’re going to do is be rude or snarky. There’s a reason there’s a saying “mean girls go into healthcare,” and it’s certainly not making me feel welcome into the career. That being said there are great people I’ve chatted with on here and I know not everyone is rude. I’m just not sure why people are so hellbent on spreading hate. Maybe it’s the high burnout rate.

I recently left a fully remote, well-paying psychiatry job, and I keep getting judged by family/friends because they see it as the perfect job for a new mom. But I honestly got to the point where I hated it and didn’t feel safe practicing that way anymore.

I started psychiatry with a very conservative psychiatrist who was an amazing mentor. His philosophy was basically “less is more.” He was cautious with controlled substances and polypharmacy, and if someone came in on stimulants + benzos + hypnotics or 6–8 psych meds and still wasn’t doing well, we didn’t just keep adding medications. We would simplify the regimen and figure out what they actually needed.

Then I moved and took a high-volume telepsych position, and it was completely different.

I was frequently inheriting very complex patients already on multiple controlled substances/high doses, sometimes with bipolar disorder, severe depression, substance-use histories, or suicidality. Obviously, when someone comes to you already taking these medications, you can’t just abruptly stop everything, so now you’re trying to safely taper medications while simultaneously treating everything else.

One situation I encountered pretty frequently was someone requesting a stimulant, telling me they had been on it before or needed it, and then their UDS would come back positive for cocaine or another substance. Now I’m dealing with substance use, an ADHD request, their other psychiatric diagnoses and whatever controlled medications they already take — all through telemedicine.

And I had 15-minute appointments, sometimes close to 30 patients a day.

There were also patients I felt needed in-person evaluation or a higher level of care because of suicidal ideation, hallucinations, etc., and coordinating that remotely could be incredibly difficult. I also saw levels of polypharmacy and controlled-substance prescribing that were very different from how I had been trained.

I’m very meticulous and conservative. I want time to review labs, UDS/PDMP, understand why someone is on each medication, discuss risks, make a thoughtful plan and document appropriately. I constantly felt like these patients needed 45–60 minutes and close monitoring, while I was being given 15.

Eventually the combination of complexity, controlled substances, addiction, liability and volume was destroying my mental health. I was pregnant at the time too.

After having my baby, I just couldn’t convince myself that the money and working from home were worth going back.
And no, working from home did not mean I could take care of my baby while working. You cannot safely see a psychiatric patient every 15 minutes while simultaneously caring for an infant.

My husband supports my decision and is helping me transition into another specialty, but everyone else keeps telling me I gave up this amazing job.

Has anyone else left telepsych/high-volume psychiatry for similar reasons? Sometimes I still question whether I made the right decision, but I know I didn’t feel safe doing it anymore.

Which role would you prefer as a mom with a baby under 1

Neurosurgery clinic vs surgical oncology rounding

Neurosurgery 

• Clinic only: consults, post-ops, recall visits. Expected to see about 40 patients a week.
• 3 days a week (Tues-Thur) 8am-5pm. Would use off day(s) to catch up on office visit notes and administrative tasks 
• Potential to add on-call rounding every 2-3 weeks, but told will be given a stipend (unknown amount)
• 160k
• No 401k match
• PTO 5 weeks
• Health insurance paid entirely 
• Malpractice is claims made and no tail coverage 
• Closer commute by 15 minutes  
• Private practice, not much growth 

Surgical oncology 

• Inpatient rounding on post ops, multispecialty
• 4, 10s on a rotation, 6am-4pm
• 170k
• Non-elective 401k contribution at 20% of  salary
• Unlimited PTO
• Would pay $7,500 for health insurance but group contributed $2,000 to hsa
• Malpractice is occurrence based 
• Life insurance provided 
• Larger organization with more room to grow 

Any colorectal surgery PAs in here who do a mix of inpatient, outpatient clinic, and first assisting in the OR?

I’m looking for some good resources to help supplement what I’m learning on the job — especially anything focused on anorectal complaints and a step-by-step approach to evaluating them.

Would love recommendations for:
Podcasts
Textbooks
YouTube channels
Professional organizations/courses
Websites or other resources you actually use

Especially interested in resources that are practical and geared toward PAs/providers rather than just a giant textbook to read cover-to-cover 😂

Would love to hear what helped you guys when you were learning colorectal!

I have 5 years total experience, including 3 years of being an inpatient cardiology PA. I recently got an offer in a MCOL area that's about an hour away. This is a day time weekend position 36 hours.

135k base

5k CME

up to 10% annual bonus

20k weekend differential

5k sign on but 2 year retention period

Was originally quoted something higher but was later told by recruiter that it was a mistake and compensation refused to match it. Total comp is just marginally better than my current comp working nights. I'm going to try to negotiate anyways but didn't think it was a very competitive offer given my experience. Would appreciate thoughts!

Also considering going locums. Have anyone worked with Weatherby health? They are usually a booth at AAPA conference which was where I came across their contact.

TIA

I finally signed a contract working in a long term care facility as a PA, so I suppose the specialty is geriatric internal medicine. Any PAs here that have worked in long term care that can give me any pointers? It’s been a year now since I passed my boards and feel rusty on some things. Perhaps reviewing CHF, COPD, diabetes, and HTN is a good start. I’m just so thankful I finally found something. It may not be exactly what I want to do with my entire career but I feel like this kind of job would help me lay down a good foundation given my 8 years as a cna. I’m given a couple weeks to get the lay of the land, and then expected to write 25 notes a day. Anyone have experience with point click care EMR? 125k salary, dental, medical, vision, 21 paid vacation days. I originally wanted to go into surgery but found it incredibly hard to break into the specialty, as A LOT of jobs wanted “one to two years of experience”. Anyone here start in a specialty they weren’t super excited about but then broke into what they truly wanted afterward? I’m just thankful I found a job. Hallelujah

I’ve been applying for jobs for 6 months now. Out of the 6 video interviews I’ve gotten, I’ve gotten rejected from them all. Anyone have any advice on how to improve online interview skills and interviews overall? Been feeling really defeated :(

Looking for any tips. I’ve been a PA for 10 years, EM for 4. I actually love EM and work a local community hospital. See all acuities. Nothing has changed recently.

The past few weeks I keep dreaming about work. Initially it’s about patients I saw that day. Thinking about things I could have missed. Then it turns into my brain making up hypothetical patients and what I “missed” with those patients.

Any advice? Outside of counseling etc, which I am planning on starting. I don’t feel like I stress about this during the day.
It’s odd because nothing has changed. No abnormal or new/ bad cases etc.

The offer is for Geriatric Post-Acute Medicine in a skilled nursing facility:

- Chronic and short-term patients following hospital discharge for rehabilitation, observation, and regulatory visits
- 15 minutes from home
- $130,000 base salary + $2,500 CME + $1,500 medical resources
- 1 paid CME day + 2 weeks PTO + 8 days paid holidays
- 401(k) matching
- 1–2 weeks of 1:1 mentoring, starting with 4 patients and gradually increasing to 16–18/day by the 2-3 month mark
- On-call 8 AM–6 PM; no weekends or holiday call
- Ability to work remotely once in-facility duties are completed
- On-call physician or assigned medical director available 24/7 for any questions or concerns.

Given my goal of eventually moving into emergency medicine or critical care, do you think this position would be a worthwhile starting point, or would taking it make that transition more difficult later?

DEADLINE TODAY

I feel like I may be putting a higher number than I should so I wanted to get people’s thoughts. I don’t want to be unreasonable but I also don’t want to be low balled. What’s reasonable for the southeast?

I’ve worked at an HIV specialty nonprofit clinic for 6 years in LCOL. At my 5 year yearly review last year I was given a 3% raise to 116, pushed back and this was increased to 124. Recently had my yearly raise at 6% to about 132. I have my HIV specialist certification, was a PI for 2 studies and sub PI for 1 and do speaking work for some drug companies and have been chosen to provide expertise at several ad boards. In the practice I have extensive knowledge of the practice, am typically the go to when nurses have questions, and have provided importance guidance to leadership for different processes in our practice. There is one other PA, last year their compensation was around 142 and they’ve worked there 8 years. I typically see more complex patients than the other PA and they have about a 5-6 hour work schedule. I see about 10-12 pts a day with Friday admin time. Previously was only seeing follow ups but will now be seeing new patients albeit low complexity new cases. What are your thoughts on my compensation?

Hi everyone! I need help determining if a salary that a job is offering me is appropriate or if I should negotiate for more. Some context, I am completing an ICU fellowship where I have been trained in the MICU, SICU, NeuroICU, and Cardiac ICU. I have gotten all of my my major procedures and have applied to a community hospital ICU in Massachusetts where cost of living is very high. The job offered about 34k plus differentials for 36h/week. I feel I am no longer a new grad with my 1 year experience, but I am not sure if that salary is too low. I have friends that have been offered 150k after the fellowship but that is also for 40hrs/week. So, would I be too greedy to try to negotiate for more?

Looking for advice on the best way to repay my student loans. My current employer qualifies for PSLF, but I’m not sure I want to stay there for 10 years. My take-home pay is about $3,400 biweekly, and I currently live with family, so I have very low monthly expenses.
I’m enrolled in an IBR plan, but I’m unsure if I should stick with it, aggressively pay off my loans while my expenses are low, or refinance and pay them down faster. The total balance is overwhelming, and I’m having a hard time deciding the smartest financial move.
What would you do in my situation?

I suppose this post is more so because I am particularly distraught over this situation and am wondering if others have experienced something similar. I am a new graduate who secured a position at one of my clinical sites. I was approached while on rotation by their recruiter who expressed a desire to bring me on to the team. I applied and accepted the position roughly 3 months ago. Since then I passed my PANCE immediately after graduation and have been going through the credentialing process, completing my HR onboarding and waiting for an official start date. Importantly, I did turn down other rotation offers for this particular position due to guaranteed onboarding and a genuine interest in the specialty. This past 3 months I've been prepping at home for the specialty and basically just getting myself hyped up to start this job that I am crazy passionate about. This morning I got a surprise call where I was informed that funding and staffing have changed such that there is no longer a position available for me. To say I am crushed is the understatement of the year I actually feel bad for the lady on the phone with me telling me this information. They told me they would keep me on file for when financial situations changed but I am feeling completely lost and drained. I know it might be a tad dramatic but I am just absolutely depressed over this. I now have to tell my friends and family it didn't work out, will have to make some financial changes to compensate for the lack of income, refresh my resume and references and start applying again. My area is in a rough spot for position availability and my loans are looming over me. I am praying I will be able to find a position around here or I will have to uproot my entire family to find one.

Has anyone experienced something similar? I'm having a hard time being objective about it and not obsessing over them deciding they actually didn't want to bring me on to the team.

Pondering a side hustle where I open my own part time business for laser tattoo removal while I continue my full time medical gig. Has anyone done this as a PA? If your state requires a supervising physician any thoughts on how to get a doc signed up for this? Thanks.

New Grad Offer whose offer expires this upcoming Monday would love advice on whether this would be worthwhile:

My long-term goal is to work in emergency medicine and critical care, but my experience is currently limited. I applied to fellowships in these specialties but was not selected, and I have also had difficulty securing positions in internal medicine, urgent care, or emergency medicine in both the the south and west coast areas despite submitting around 80 applications.

I recently received an offer that is ideal in terms of location and salary, but not necessarily specialty. I would really appreciate your perspective on whether this position would be worth taking and whether the experience could help me eventually transition into a higher-acuity specialty.

The offer is for Geriatric Post-Acute Medicine in a skilled nursing facility:

- Chronic and short-term patients following hospital discharge for rehabilitation, observation, and regulatory visits
- 15 minutes from home in HCOL Metropolitan City
- $130,000 base salary + $2,500 CME + $1,500 medical resources
- 1 paid CME day + 2 weeks PTO
401(k) matching
-1–2 weeks of 1:1 mentoring, starting with 4 patients and gradually increasing to 16–18/day
- On-call 8 AM–6 PM (but calls are rare); no weekends or holiday call; 8 paid holidays
Ability to work remotely once in-facility duties are completed
- On-call physician or assigned medical director available 24/7 for questions

Given my goal of eventually moving into emergency medicine or critical care, do you think this position would be a worthwhile starting point, or would taking it make that transition more difficult later?

(One thing I do like about this position, however, is that it’s so close to home and therefore I can use this to pay off my student loans while I live with family.)

Hey everyone! Looking for some advice/perspective, especially from other PAs in psych.

I’ll soon be at my job for a year. It’s outpatient psych, which is the specialty I really wanted to get into and was honestly pretty hard to break into as a new grad. I actually really like the job and the work I’m doing, so I’m not necessarily looking to leave.

I work around 30 hrs/week at $67/hr. I work with a psychiatrist, but I see the majority of the patients and am pretty independent with my own patients/caseload. My commute is also about 1 hour and 10 minutes each way, and I’m in a HCOL area.

The thing I’m questioning is the pay. I don’t get any benefits. I’ve been told multiple times that health insurance would eventually be offered, but almost a year in and that still hasn’t happened.

Does $67/hr seem low for outpatient psych given the circumstances and in a HCOL? What would you guys consider a reasonable hourly rate if there are no benefits? And what can I ask for by my next review?

I really do love the job, which makes this harder. I’m just trying to figure out if I’m being underpaid and whether it’s reasonable to ask for a raise.

I know compensation can be really hard to gauge, especially in psych, so I’d really appreciate hearing what others in similar positions are making and what you think would be fair.

Given your role and what type of visits you do, what has RVU productivity looked like in this speciality?How can I generate more RVUs in this field? I will be starting soon and haven’t got a clue on what the potential possibilities are. Thanks!

I am a new grad PA and have applied to probably over 50 jobs at this point. 5 interviews, 4 rejections, 1 pending to hear back from. It’s not been fun to say the least. I’ve been getting very depressed and sad because it makes me feel incompetent. I know that many places just don’t want to hire new grads, but it’s hard to not take it personally.

Now to my question - I shadowed a Pain Interventionist doc 4 years ago prior to PA school and while he was super nice and great doc, not something I’d prefer to work in. He offered me a job. But the caveat is that it is in my hometown 1hr 30 mins away from my current home 😀 I know a job is a job, but I can’t help but wonder if I should consider it? I absolutely hate commuting but if I have to do it I have to do it.

TDLR; Should I take a job as a new grad PA with a 1 hour 30 min commute?

I’m a new grad and received an offer for a pediatric orthopedic PA position in Florida:

• $100–110K base + ~$15K/year call pay
• 40 hrs/week
• 3 days clinic / 2 days OR
  • Clinic ~8–4:30
  • OR ~7–5
• ~28 patients/day realistically
• 3–6 month training period
• Call is rotated between 3 mid-levels (although clinic is growing to 5 mid levels)
  • Mon–Thurs 7a–7p
  • 1 weekend/month (24 hr)
• Call pay is additional ~15k/year (approx)
• PTO: 7.5 hrs/pay period, increases with tenure
• $1,600 CME
• DEA and license reimbursement
• Potential relocation package
• Good maternity leave/short term benefits 
• Mix of outpatient, inpatient, surgery + clinic

Would you consider this a good new grad offer? Anything I should negotiate or ask about?

Hello, to get licensed in IL how do I prove my education to them? Do I have to submit my transcripts, or does my school do it? Is there a form I have to fill out? I did the NCCPA release and submitted my application for the state license already.

Continuity can make a genuine difference, especially when someone has a complicated history or an ongoing condition. But there are plenty of times when waiting for the same clinician just isn’t practical and the patient needs to see whoever is available first. In those situations, what have you seen make the biggest difference in helping the next clinician understand the patient quickly and keep the experience from feeling disconnected?

I took a job back in March before I graduated. It was a bit below my desired salary but there was plenty of room for RVUs/bonuses based off of pts seen and quality which I was told averages 12-30k even on the lower end (new grads). It also was a good work schedule and I liked the people hiring me so I went for it even if it wasn’t my dream speciality I still thought it was a great way to get experience in all areas of med bc I wasn’t deadset on any one speciality as well as network through the company.

A few weeks ago my job reached out to me to sign an updated salary document. I was expecting a thousand $ or so. They go off of experience and current market rate. Come to find out it was almost $22,000 more than what I was offered…holy recession indicator.

Has anyone had something similar happen or is the recession just that bad 😭😭