In PA school, everyone dreams of finding that perfect fit. We go in liking the idea of being flexible and having the ability to move among the specialties. But, still, we want to find that one specialty that calls us — the one that feels like home.
I found the one during the spring of my clinical year. It was day two of my elective rotation in oncology at M.D. Anderson Cancer Center in Texas. My preceptor, Kelli, was going through a new patient's records. She pulled up the images of his CT scan performed at an outside hospital. Something was off. She said the diagnosis did not match the CT images.
She went to meet the patient and learn more about his history. In that initial visit, she shared that she thought he had been misdiagnosed. Kelli, practicing as a PA for about five years at the time, made this determination on her own.
She didn't check with her collaborating physician or show him the CT scan before she saw the patient. She didn't hesitate or hedge her bets. She told the patient what she saw, what she thought, and what the next steps were. Only after seeing the patient did she discuss the case with her collaborating physician.
I was blown away. I wanted a role where I could be that confident in my skills. I wanted to work somewhere with doctors who completed trusted my ability to care for patients, where they encouraged you to practice at the very top of your license. I wanted to have enough knowledge that I could look at a scan and be able to tell the difference between two different cancers.
I've always been what I consider a "switch flipper." Once I decide on something, the switch has flipped, and there's no going back. It happened when I decided to become a PA. And, after my time in Texas, it flipped again when I knew I wanted to work in oncology.
For my first job out of PA school, I found a position in oncology and was able to stay in Pittsburgh. Though I enjoyed it, I spent a fair amount of time saying, "Well, this is how M.D. Anderson did it." Which, I'm sure, was a delight for everyone around me.
About eight months in, I was looking for part-time work in an ER to help pay off my student loans. But, during my search, I came across a posting for a position at M.D. Anderson. Kelli was listed as the supervisor. Why wasn't I just living in Texas? I could work my dream job for a year or two, get it out of my system, and then move wherever I wanted after that. My switch flipped. Four months later, I was a Texan.
The Slippery Slope
What no one tells you about moving to Texas is that it's a trap. I have met so many people in the past ten years that had the same plan as me. Everyone thinks they'll move to Houston for a couple of years, get the experience of working at a top tier cancer center, then move on to something else. But rarely is anyone able to pull that off.
Having access to cutting edge options for your patients. Being surrounded by some of the brightest people in the field. Feeling valued by those you work with and those you serve.
Plus, people in Texas say things like "I appreciate you" and "Have a blessed day." And, they have grits. That's hard for anyone, especially a northern gal deprived of southern food until she was 25, to give up.
So, rather than being a story about why I quit, it's more about why I could never bring myself to do it before now.
Why I Stayed
My hospital employs some of the highest numbers of advanced practice providers (PAs and NPs) of any hospital in the country. Rarely did I ever have to explain my role to patients. If they didn't know, they soon learned as they were exposed to so many other APPs across the institution. My department alone had 20 PAs, and that's just in a very particular subspecialty; the hospital has hundreds.
Beyond the number of PAs, I also had a lot of colleagues that were in the same boat as me. They moved from out of state; they didn't have family here and came alone. We developed a network of coworkers who became close friends, spent time together outside of work, and celebrated holidays as a group.
Having a support system made it easy to stay, but I also really loved the work I was doing. Being a major research facility, the physicians have many other obligations outside of patient care.
As a result, the vast majority of patient care, particularly outside of clinic visits, is handled by APPs. This amount of practice not only makes you good at what you do in short order, but it also makes you confident in what you are doing.
Given the number of questions I fielded on a daily basis, it helped me stay up to date on research and become proficient in managing complications of both treatments and diseases. It's a powerful feeling to know you are good at what you do, and it's reassuring when those with whom you work trust you to manage patient care at a high level.
My Turning Point
A few years ago, a good friend (and PA colleague) somehow managed to quit and move out of town, on to a new adventure. She had come around the same time as me, also alone from another state. Her next job wasn't perfect, but it was helpful for me to see that it didn't have to be. It was the first time I started to consider how I could eventually bring myself to leave.
Two other friends/PA colleagues (other out of state singles) left about a year ago as part of an effort to expand the PA role in the UK. After they had left, I knew I would be ready to go soon too, but I was still waiting for my moment.
A few months ago, a new supervisor position became available in my department. In nearly ten years of being there, this had never happened. It was a chance at a promotion, and I immediately knew I didn't want it.
It wasn't a matter of not wanting anything to change. Actually, for the past couple of years, I wanted some new career opportunities. I loved what I was doing, but I had to admit I wasn't really growing. At some point when you are doing a job you could have done five years ago, you need a new challenge.
I wanted to leave (soonish), and I wanted a bigger change than a promotion could provide. I also knew that the likelihood of me accepting another position while I was still in a job I enjoyed so much was nearly zero. This realization was the trigger I needed. Eight years later than expected, my switch finally flipped.
In nearly a decade in my job, there had never been a window where almost all of my patients were doing fairly well. There'd always been a patient or two that I wanted to make sure I stayed until the end for, and then that would overlap with the next patient.
I'm not a martyr by any means; I wasn't sacrificing my happiness to care for my patients. But, having specific reasons for staying was important to me. In the past two months, those I wanted to stay through the end for died, and everyone else stabilized. In all my years of working in cancer, it has been the only time frame this has happened. It's helped me to know that I picked the right time to go.
So, I worked my last day at my dream job a few weeks ago. It may be the best professional experience I ever have. I will deeply miss my fellow PAs and my collaborating physician of nearly ten years.
While I am sad to leave, I know it's time for me to move on.
I'll take a couple of months before I look for a new position. My dog, Lulu, has an advanced dog version of ALS, and I plan on staying out of work and with her until the end. My days will be occupied by listening to her soft snoring while she sleeps and feeding her peanut butter milk bones while she's awake.
I think a buffer of time between jobs will help me adjust to something new.
I am fortunate to have found a role as a PA that was so hard to give up, and I have no regrets about "overstaying" my original plan. As a PA, I hope you have as much luck as I've had in finding where you belong.