Sunday, May 30, 2010

When does one retire?

I am at work this spectacular Memorial day weekend taking care of patients, pups, and the home. It is so funny working here at this small comunity hospital where the politics are generally ingrained in our everyday working lives; not so in a large University hospital as I worked at in MN.

For those of you who do not know what the "heck I do" let me elaborate. I am a PA, a Physician Assistant, at a hospital. My title is a "Hospitalist PA". This refers to the new trend of family practice and internal medicine Physicians hiring out to a specialist group to take care of their patients solely in the hospital. The benefits to the MDs are that Hospital medicine is mostly a money losing venue, so if they are able to fund their hospitalized patients with a grant to pay for that service, the family medicine and internist MDs dont lose money. The benefit to the hospital to pay the grant is that the Hospitalists obviously specialize, which translates into a larger volume, greater turnaround, and less money wasted on inappropriate admissions or testing. The benefit to the patient is that the length of stay goes down and the outcomes are better, be it through morbidity or mortality. Therefore, here I am. SO I work for an MD; typically there are two PAs on for every doc, and we work 8am-8pm. I admit patients from the ED up to the floors, I round on the patients that have already been admitted, and I also discharge patients to home, rehab, or nursing homes. I do not work in the ICU. Typically the MD does the highest acuity patients and then manages the PAs load by being a constant presence for advice and direction. He or she also cosigns all my notes and plans, and pops in to see all my patients. Therefore the benefit for a Hospitalist service to hire PAs is strictly monetary as well. I cost less than an MD and can do a large portion of the work.

Most of my patients are older, average age being 70s, range being 17 to 108 years old. My favorites are the old guys; as evidenced by my two favorite rotations in school being at the VA medical center. We get a lot of pneumonia, breathing problems from prior history of smoking, urinary tract infections that can spread to the blood, surgical problems like appendicitis and diverticulitis, broken hips and other broken bones from falls, fainting, heart attacks, other heart problems, strokes.....thats most of my day.

Do I ever think I will specialize? Yes, most likely. I love my job. I love the hospital; I doubt I will be outpatient at least in the near future. I love cancer but am more interested in talking to patients about it and seeing when they are sick and making them well than just pushing medications here and there, so who knows about oncology. I have thought about ER many many times; that may be a possibility too. Frankly, I am not bored with my job yet (surprise!) so am not too worried about moving on yet.

We are going through some contract renewals this year which means I may not get hired back and would have to change jobs at the end of the year. I am keeping my fingers crossed that that is not the case. Should we get resigned I will have job security for another three years. Should I need to start looking I know of a few options here and there, including a Hospitalist program in Concord, about 30 minutes north, which I could apply for. I know the MD that runs the program and have a few references so may be able to get in. All in good time.

So when is it that the average person retires? And do I qualify as "above average"?

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