Time is Ticking

I am less than two weeks away from going into a probationary period.  If, when I enter that period, I don’t do anything actively about it (which includes paying extra money to the national certifying body for PAs, and logging 100 hours of continuing education credits) I will lose my active Physician Assistant certification.  I will no longer be able to claim myself as being a “PA-C”.

I suppose, I will always be able to claim myself as a non certified Physician Assistant.  After all, education is something that no arbitrary time line or lack of meeting requirements can take away from a person.  But the fact is, this rapidly looming occurrence is about to happen, not by accident, but by choice.

I haven’t worked as a PA in almost four years.  Prior to that, I spent five years rotating in and out of five different PA jobs…struggling to find a fit for myself in the world of medicine.  Not having found that right fit, and half way through my second of three pregnancies, I decided to put my work as a PA “on hold.”  That was four years ago this summer.  My PA work is still on hold.

The further away from the medical field I became, the more my devotion to staying home with my kids became.  But it wasn’t just the SAHM thing that further encouraged my choice to table my pre-children career.  It was what I saw happening within the medical field:

Our medical system, in the past 30 or so years, has moved into a situation in which money inconsistently dictates quality and depth of patient care.

In the worst of ways, the bottom line has prompted doctors visits to be scheduled on a fifteen-minute basis, and if you see a health care provider in a setting such as an urgent care center, that number of minutes may even be less.  Some health care systems dangle incentives in front of their providers–encouraging doctors, PAs and nurse practitioners to see more patients in less time than ever before.  The more patients pumped through a clinic in a day…the more health insurance reimbursement for the clinic…the more $$$ for the health care providers.  At one of the clinics in which I worked, it was not uncommon for us to see 60 patients in a single day.  60!  (That’s 7.5 patients/hour…an average of 8 minutes per patient)

In other ways, we are far too free with the expenditure of health care related dollars–other peoples’ dollars, that is.  In a culture where excess is our collective middle name, we order CT scans, MRI’s, sleep studies, EKGs, EMGs, VQ scans, blood pH tests, endoscopies, laparoscopies, x-rays and ultrasounds…JUST BECAUSE WE CAN.  Oh–and because, should there EVER be a lawsuit related to that particular patient on that particular day, we will have covered our you-know-whats.

And don’t get me started on the pharmaceutical industry.  Oh my, the drug rep.-sponsored dinners, lunches, golf outings, wine tasting evenings… would make your head spin!  And guess what?  Somehow, somewhere all of those dinners and lunches have to be paid for.  Ever wonder why prescription medication costs so much if you don’t have health insurance?

So, what does any of this have to do with motherhood, or being a writer?  It has to do with the fact that, as a mom, I need to put my money where my mouth is.  In this case:  I’m putting my mouth were my money is not.  And that’s in the bank.

Having chose, mid stream, to change career paths from being a surgical, emergency room and urgent care facility PA, to being a stay-at-home mom, childbirth educator and writer, means I’m earning a hell of a lot less money than I could have been, had I stayed in the health care biz.  Believe me:  it’s pennies on the dollar.

But when I look at–I mean really look at the prevailing attitude that SO MANY health care workers have toward their patients, and the surrounding systems that promote those attitudes (health care insurance, medical malpractice, etc.) I see a system that is so incredibly broken–one I can’t presently see myself participating in.

Take pregnancy, for example:  The way our system stands now (mind you, I’m talking about the allopathic, western-medicine philosophy of doing things) we treat pregnancy as a disease and childbirth as an emergency.  And 90 + percent of the time, this is NOT the case.  But we health care providers, who are trained to intervene and fix people’s illnesses, don’t know what else to do.  So we fall into the trap of assuming almost everybody has something wrong with them–even if it’s the parent of the child brought in for some ambiguous, unquantifiable symptom.  So we order tons of (expensive) tests, get the patient out the door in fifteen minutes or less, and move on to whomever’s behind the door in room number two.

My children, at some point, will figure out that this is my opinion.  And I can’t risk looking like a hypocrite in their eyes.  I can’t talk the talk if I’m not willing to walk the walk.

So I have, for most intensive purposes, hung up my stethoscope and put away my lab coat.  I have, instead, supplied myself with baby and pelvis models, posters of pregnant bellies, and armed myself with a lap top computer and a good thesaurus.  And I teach and write–realizing little financial gain for my efforts, but feeling a hell of a lot more satisfied with my career choices.

This all is not to say I will never, ever work as a PA again.  I may, just yet, find the right fit for myself, in a place where everyone cares about the true well-being of each and every patient that walks through the door as me.  But until I regain enough courage to look for that potential opportunity, I’m happy with what I’m doing right now.  I am part teacher, part writer, mostly mother.

What choices are you making in your career life?  Are you really, truly happy doing what you’re doing?

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4 Comments

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4 responses to “Time is Ticking

  1. Pingback: When to Quit « To Fatherhood and Beyond

  2. Jessica

    I am a PA and find my career wonderfully satisfying. I just had a baby 9 months ago and chose to go back to work full-time. I wish you had had the chance to work in a great office like I do. I work with providers who are all moms in an internal medicine office. I was encouraged to take a 3 month maternity leave and long lunches once I returned (for breastfeeding my baby at a nearby daycare). I have normal hours and get to have quality visits with my patients and form real patient-provider relationships. It is a truly gratifying career. I admire your decision, but should you ever decide to return to the healthcare field, I wish you the best of luck!

  3. Jessica,

    I am always glad to hear from others who ARE finding satisfaction in their health care industry careers. Two of my very good friends from PA school have also had great experiences.

    It can be very difficult to make the decision of “when to stick and when to quit” as delineated in my husband’s To Fatherhood and Beyond blog post and comment above.

    The industry still absolutely DOES need people working in it who love their jobs, the patients with which they interact, and the systems/offices for whom they work.

    I definitely do not plan on allowing my training and expertise to go to waste–I am just finding new and different avenues to apply my knowledge.

    Thanks for you comment.
    Keep them coming.

  4. liz

    I am one of the good friends Kimmelin talks about above. Its been hard as her fellow PA colleague to see her dissatisfied with the health care industry. I had the wonderful opportunity to work at Childrens National Medical in Washington DC. Here I witnessed people coming from all over the world to seek medical treatment for their child. Miracles DID happen on a daily basis.

    I now work in Urgent Care for a large HMO where first line drugs for treatment (the cheap, generic ones which still work!) are prescribed, lab/tests are ordered at a minimum, and we even keep patients overnight in a REAL hospital bed and private room to observe them instead of racking up the costs admitting them to the hospital.

    Kimmelin has a great point that the medical field in general orders too many tests (and antibiotics-don’t get me started). As a result, patients assume they will receive a test, a prescription and actually ask for it. Let’s turn to the law to blame, whereas there is no ‘cap’ mandated to what lawyers can sue in court in certain states. A hangnail gets infected, for instance, and the doctor who missed it can get sued-ridiculous. As a result, defensive medical practicing (and prescription writing) becomes the norm.

    Let’s turn to the pharmaceutical companies as well. The law (how ironic) DID put a stop to the excessive dinners, golf outings, limos to concerts, etc. But in turn, the pharmaceutical companies started direct to consumer advertising. I can’t tell you how many times patients will tell me they need the purple pill they saw on TV. They want the quick-fix. Again, thanks to Pfizer and GlaxoSmithKline!

    I see all the challenges our broken health care system struggles with. I am grateful, though, to continue to play a role in educating paients through conservative treatments and saving lives whether its controlling their diabetes or stopping the evolving heart attack. I am so grateful for PA’s like Kimmelin who have used their knowledge base to expand to ‘non-traditional’ PA roles like childbirth education. PA or PA-C, it doesn’t matter, we are both still making a difference in health care.

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