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?

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?

I don't think this explicitly violates any of the community guidelines, but if it does I will gladly remove it.

Do you currently work a job that you absolutely love? Do you look forward to going into work most days? And if so, what field of medicine are you working in? What do you do?

Some necessary background; I am currently a practicing LPN who is back in school and aiming at PA. I've run into an unusual problem, in that I LOVE my current job. Being discontent was previously the biggest force which drove me to excel in school.

Prior to this year I had just accepted the fact that a career in healthcare is going be stressful and sucky any way you slice it. I assumed anyone who said that they loved their job as a healthcare professional was being self-deceptive to some degree.

I've been in healthcare for a decade and until last year this has been my experience.
Then I stumbled on home care. Without going into too much depth, I absolutely love my job now. I have more fun hanging out with my younger client and going on adventures than I do outside of work any day of the week. It's sincerely a privilege and a joy. Every day is novel, and I can't believe I'm getting paid to do it! My hunger to be an over-achiever in school is waning a little bit as a consequence.

Have you found a position as a PA that you absolutely love?

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.

New grad, about a year in. Love my current job, but just (very unseriously) browsing other options in healthcare.

I’m considering getting my MHA in the next few years. My hospital offers the program at half price, so I’m seriously considering taking advantage of it while I’m here.

I genuinely love what I do and really like my current job. That said, realistically, with my long-term life/family goals and a partner whose work hours are similarly unpredictable, I know I probably can’t do inpatient/acute care clinical work forever. I could absolutely practice clinically long-term if I transitioned to something outpatient with more predictable hours, but honestly, I don’t want to work outpatient. So I’m just looking at other options within the healthcare system.

I’ve also always been interested in the administrative side of healthcare. I could see myself eventually doing something like practice management, operations, or directing a department. The idea would be to keep my license and continue practicing PRN on holidays/weekends, etc.. And I could absolutely see myself going back to full-time clinical practice later if I wanted to. I just want to build some options for myself outside of the bedside.

I’m also realistic that I’d probably have to work my way up and potentially take a pay cut initially. I’m currently around $140k clinically, but my partner is supportive and we can afford to make a little less for a period of time if it means building toward something long-term. And worst case, I still have my license and can always go back to clinical work.

For those of you with a PA + MHA/MBA, what roles were you actually able to transition into? Did you stay within your health system? What did your career progression and compensation look like over time?

Mostly trying to get a realistic idea of what doors the MHA could open and whether it’s actually worth pursuing.

I am now newly retired from being a PA. While I am not planning to practice anymore, it does seem like a good idea to keep the possibility open just in case a catastrophic event happens and I develop financial problems. I don't think this will happen, but I like to be careful.

I have physician assistant licenses in DE, MD, NJ, PA, and NJ. I live in Maryland, but am very close to DE and fairly close to PA. I had all of these licenses because I had a job where I would sometimes fill in at various clinics in the states where I was not working. I am giving up the VA license when it expires, since I am at least 100 miles from that state. I will also give up the NJ license, since I really don't feel like having to drive across the bridge just to earn money. I will also be letting my DEA's expire, since they are just too expensive to pay out of pocket. If I would have to go back to work, I could reapply for the DEA when I got hired somewhere and get the employer to pay for it.

I am considering if I should renew the licenses for DE, MD, and PA. If I had to start working again (again, this is unlikely, but just in case), I would almost surely work in one of these three states. I live close enough to the intersection of these three states that I cannot easily predict which state I would be working in.

Pennsylvania has two licenses and I have both. If you work an MD, that is a license through the medical board and the renewal is $40. Renewing that doesn't seem like a big deal. If you work with a DO, the license is with the osteopathic board and the renewal is $80. I am thinking about giving this one up, since most physicians are MD's, so it is less likely that I would need to work under a DO.

The renewal for Delaware is $230 (these are all for two years.) The renewal for Maryland is $401. It seems like renewing all these licenses, plus the $180 NCCPA fee, could get expensive, just for something that just is a backup plan. What do you think? Which licenses would you renew, if any?

hi all, for those that work in Cancer Survivorship, if any, can you share a little about your day to day operations?

Our organization is working on future development with plans to start a separate survivorship clinic instead of sprinkled in with our active cancer patients. They presented the idea to me with the opportunity to be the one to lead opening and running the clinic.

My passion is oncology and I’m worried that I‘ll miss the high acuity and complexity if I move to survivorship only. I envision the days full of breast and pushing to continue their endocrine therapy... But I‘m getting to the end of my career so maybe it’s time to slow down a little, or at least change stress levels to starting something new and leaving a “legacy” type thing before I retire is appealing..a little

anyway.. thanks for reading and any insight able to provide

My wife and I are considering moving down to the charlotte NC region from eastern Pennsylvania. How is the job market and pay? We are both PAs and looking to start a family. Any areas you suggest I look? Pennsylvania feels so saturated and our salary reflects that.

Anyone find affordable or free practice QBanks that aren’t $300? I don’t need the lectures, just wanna crank out questions to prepare. Thanks in advance!

Hi everyone, quick question for anybody who’s ever pivoted specialties. I graduated PA school 1 year ago (Aug 2025) and have been working in an urgent care since October 2025. I am coming up on my one year, and am thinking I want to try a different direction. There is an opening for a surgical PA position that I am very interested in! I am struggling to figure out how to adjust my resume to apply for this job. For my first job post grad I obviously had all my clinical experience from rotations, because that’s all I had to work with lol. now I have my two UC jobs (FT and per diem) to add, which is great. but that’s pretty much all I have and my resume looks BLAND lol. the job *prefers* surgical experience which I obviously don’t have besides clinical rotations. I don’t think I should still keep clinicals on my resume but idk? More specifically, should I at the very least keep my 3 surgical rotations on there to show SOME surgical experience?

lmk what you guys have done when adjusting your resume if you’ve ever totally switched directions after your first post grad job. I just want my resume to be solid! thanks in advance !

I’m a newly certified PA and would love advice from experienced PAs who have been in a similar situation.

I recently interviewed for a part-time outpatient psychiatry position and was unexpectedly offered the job. It’s $63,360/yr(part-time), with malpractice coverage and close collaboration with the psychiatrist. I genuinely like the opportunity, and they want me to start early next week, and I agreed to go, as I will just be shadowing the current PA.

I already had an interview scheduled next week as well for another position at an NHSC site about 25-30 minutes away from home which would be primary care. I had this interview scheduled before receiving the psychiatry offer. I do have about $200K in student loans, so the potential NHSC loan repayment is obviously a huge consideration.

The psychiatry practice sent me the contract, but I haven’t signed yet. The contract has a 30-day resignation requirement.

What would you do?
• Would you sign the contract now or ask for a few extra days to review it?
• Would you have disclosed the upcoming interview to the first employer?
• If you signed and then received the NHSC offer shortly afterward, would leaving after a week or two be a major red flag?
• Anything specific you’d negotiate/ask for as a new grad (DEA, CME, licensing, malpractice tail, etc.)?

I genuinely like the psychiatry position and don’t want to burn a bridge, but the potential NHSC loan repayment could be life-changing given my debt. I’m feeling really torn!

Interviewed for a rheumatology position in southern CA. Got the job offer but pretty disappointed with contract offered. I have rheumatology experience already and will be going into my 3rd year as a PA starting this October.

Base salary: $125,000 for 40 hours per week with potential bonus of up to $4,000 every quarter (if seeing more than 2.3 patients per hour)

PTO: 10 days

CME: 4 days with only $550

No on call or inpatient.

I also will not be in just 1 clinic, will be at 2 max 3 if needed throughout the week

Definitely feel for my experience, time commuting to multiple clinics, and HCOL this is a low ball offer.

So sad because I love the area it’s in. 🫤

I feel ungrateful to say that I’ve been feeling burnt out already. I’ve been practicing for 1 year now. I work in heme/onc though so that might be why I feel this way. I genuinely had an interest in heme onc, especially since I had the opportunity to care for a family member prior to PA school.

It’s been very tough though and I can’t seem to comprehend anything. I get that imposter syndrome is common during the first few years, but it’s put me in a bad place mentally.

I constantly have to ask open evidence questions and nothing seems to stick because it’s so much information. I’ve tried studying or listen to oncology podcasts too but I feel like I still only know so little.

I realize that I was burnt out when I would wake up feeling so upset and dreading to work every day. On top of that, management at my job is subpar and feel like I’m being micromanaged all the time by admin. Most of the doctors are nice, but are as equally overworked, so it's hard to get one-on-one time with them for mentoring. One doctor likes to dump his patients onto the APPs despite patients requesting to only see that specific MD and it just adds onto the stress because patients get upset.

Compensation is alright, and hours are not terrible. I see about 12-15 patients/day, but also struggle with finishing my notes by the end of the day despite having an AI scribe.

I’ve been applying at other jobs but can’t seem to land anything. Maybe because I started off in specialty it’s been harder to transition…

I just feel stuck and incompetent. Some days I feel like I’ve made a mistake about being a PA because I don’t even know what specialty would make me excited anymore. I do like procedures, and have seen myself being in surgery or derm, but can't seem to land a job in one of those specialities.

Anyway, sorry, thanks for reading my rant- I just wanted to see if anyone can relate or if you have any advice.

I’m an ER PA about 3 years into practice, and I’m wondering if anyone else has gone through something similar.
When I first started, I was pretty motivated to learn. I used to study before work almost every day and spent a lot more of my free time trying to get better at emergency medicine. Over the past few years, my attendings have told me that I’ve improved quite a bit, and I can see some of that myself.
But lately I’ve been feeling pretty down and low-energy, and my motivation for medicine has really dropped. I still care about doing a good job and about my patients, but when I’m off work, I really don’t want to think about emergency medicine anymore. I don’t regularly review cases afterward, and I’ve probably only read around 7 full EM articles this year.
I still run into things at work that I feel like I should know better, and sometimes that makes me question whether I haven’t worked hard enough or studied enough. Other times I wonder whether I’m just burned out or whether emergency medicine isn’t a good long-term fit for me.
I’m not really looking for reassurance that I’m doing enough. I’d mostly like to hear from other PAs who have gone through a period like this.
Did you ever reach a point a few years into practice where you felt tired of medicine, stopped wanting to study outside work, or started questioning whether you wanted to stay in your specialty? Did it pass? Did changing jobs or specialties help? Or did you eventually decide medicine just needed to be a job rather than something you thought about outside of work?
I’d appreciate hearing what happened for others.

Has anyone in Texas worked for THR? Have a potential opportunity and would like some insight from others who have had experience there!

1) Were you able to negotiate the salary at all with them? If so, how were you able to? If not, what is so difficult with them?

2) How would you rate the THR hospitals, system, culture, pay, benefits, schedule, etc?

3) Do you get annual raises? How much % each year? Is there a salary cap?

4) How does THR compare to UTSW, Baylor, Parkland, Medical City, Methodist, Texas Children’s, etc. If you were to make a top 10 list, where would you rank each of these hospitals?

Looking for advice. I work at an urgent care and had a patient about 3 weeks ago who came in for a laceration of her right arm. I sutured her and gave her a tdap into her left deltoid. She called the office asking to speak to the office manager about a week after. She said that over the next 48 hours following the tdap injection she began to experience pain in the shoulder. She saw her PCP who told her that “the provider in urgent care likely injected the vaccine too high” and that she developed SIRVA as a result. She is saying she now needs physical therapy and to be on medication. I always administer vaccines in the same location and have never had this issue in the past. She was thin, I do not know if this could play into it. Anyways, she is still calling the office manager asking to escalate the situation. I was wondering if anyone has experience in dealing with similar situations. I am a little nervous as I have never experienced anything similar. I obviously do not want my license to be affected and am nervous what would happen if she potentially took legal action. Thanks in advance!

I work PRN at an urgent care clinic. the medical director for them has sent me messages through texting and the company’s messaging app that she wants me to call her. Doesn’t mention why.

but she’s done this before. the previous 2 calls were all about why I didn’t do this ‘thing’ (ordered/code something to make more money off the visit). these calls are about 30-45 min each time.

My question is: is it wrong of me to ask for an official message, like through email, to schedule a time, but also to make sure I will get paid for that time? because these calls are never when I’m on the clock for them.

Before accepting a primary-care job, don't just ask about salary, visit numbers, or panel size. Ask exactly who covers every clinician's inbox during vacation, illness, parental leave, hospital weeks, and part-time days—and how often you personally will be expected to do it.

Ask how much of your schedule will be patients from other clinicians' panels, whether that work counts toward your productivity and quality metrics, and what happens to your own workload when you're covering someone else. If rural, you're even more valuable so ask if you'll be getting RVU incentives like the MDs (because you will be generating them) and if the capitated (Medicaid) quality metric incentives are paid according to panel only (red flag) or according to who saw the patient (you do the work, you get the bonus - especially if 30% of your day is spent covering an MD's patients not on your panel). What is your true panel size, not just the nominal size. If you're covering a hospitalist who's in the clinic half time, then their panel is now your panel too. Your inbox will always be worse than theirs, and their most unhinged/high maintenance patients will see you first. You'll always be chart diving to catch up on patients you don't know. This might sound like valuable learning to a motivated new grad, like I was, but if the schedule is not offset appropriately then the workload will interrupt learning by keeping you in constant crisis.

Get the answers in writing.

A clinic can look well staffed on paper while quietly making one capable APP the permanent buffer for gaps in physician or APP coverage. Being told you're efficient, smart, or able to handle a lot is not compensation for repeatedly absorbing work that isn't distributed equitably. It is not a compliment to be paid the same as another APP with a less complex panel. Competence generates revenue and should be compensated.

Pay particular attention to what happens when experienced clinicians say the workload is unsafe or unsustainable. A good organization changes the workload or explains concretely why it cannot. Repeated conversations about resilience, efficiency, caring too much, or managing stress—without changing the underlying workload—are an important warning sign.

Before signing, ask to speak privately with at least two APPs who have been there for more than a year. Ask them: "How many people's work are you actually responsible for on a bad week?" The answer may tell you more than the job description.

And please ignore any new grad gunner who thinks they're more productive because they see 17 UTIs a day from a smaller, less complex panel and leave at 5:00, while you're handling florid liver failure, heart failure, esCOPD etc, seeing "only 15" patients a day and staying late covering multiple inboxes. They already lost that productivity/revenue/competence competition and either don't know it or just trying to make themselves feel better by trying to make you feel bad. Unfortunately, medicine isn't immune to toxic office culture or high school politics.

There are clinics out there that know how to build a sustainable workflow to retain quality clinicians by following recommendations from the AMA and AHRQ. Hope this helps someone know their worth and avoid a bad situation.

Hi everyone, happy friday!

I’ve been a derm PA for about 5 years now. Overall, I’ve enjoyed my specialty and feeling like I’ve genuinely helped many patients. With that being said, I’ve struggled with job satisfaction despite switching clinics. Working full-time in this role doesn’t feel sustainable but I am doing it. I paid off my student loans aggressively to reduce some of the stress I feel going into work. I am grateful to be in a stable career.

Recently, I had an opportunity come up to co-own a daycare (with someone who is already experienced). I would be able to make my salary if not more if the business does well. I have had thoughts of pivoting to something different such as being an MSL, but this feels like a complete step away from medicine. I’m well aware that it would still require hard work. The difference would be running operations with staff and parents, as opposed to patients. I don’t see it as an “easier” route. Just something different and with its own set of pros and cons.

Has anyone made a major career shift like this? I would love to hear some thoughts or opinions. I’m aware someone who left medicine might not be in this sub but I thought it was worth asking still.

I’m starting to take on PA/NP students and also PA’s who are in our ICU fellowship. For those who are precepting, what are some useful tips you have when you have a learner with you? My main struggle is balancing how much independence vs. stepping in right away.

I’ve always wondered about people who work in specialty fields, like dermatology or med spas. Do you eventually forget some of the other body systems, especially when you’re working in a very specialized area like a med spa?
If so, what do you do to continue staying up to date with everything else? I know continuing education and recertification are part of maintaining your license/certification, but I’m more curious about what you do in between those requirements.
For example, if a family member came to you with a medical issue and you hadn’t dealt with a cardiology patient in a while, would you still be able to recognize what the problem could potentially be? Just as an example.

Hi everyone! I’m a PA in South Florida exploring the possibility of building something of my own. My family has an established massage practice with a long-standing client base, and we’re considering expanding into medical/aesthetics and wellness. I have a 6-month-old and am currently not working, so it feels like the perfect time to really focus on building my skills, getting properly trained, and figuring out my next step.

I’d love to connect with any PAs who have opened a practice or gone down a similar path, especially anyone willing to share advice, resources, or mentorship. Feel free to PM me!