Never Say Never: The Journey of a Critical Care PA

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Tracy Bingaman

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I'm a PA who burned out, big time, and now I teach PAs to negotiate effectively because every PA deserves a paycheck they are proud of and to feel valued at work. I love leopard print, skiing, and my morning routine. My mission? To help PAs stop feeling overworked, underpaid and overwhelmed and start feeling valued and earning what they deserve.

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Never Say Never

Sarah is a critical care PA in a community hospital in Maryland. She lives in southern Pennsylvania with her husband (a firefighter) and two young boys. She also is an entrepreneur and has her own business as a virtual assistant. 

She never thought she would commute an hour to work, work only nights, or become an entrepreneur. But never say never! Learn about why Sarah has worked at the same hospital since graduation and how she created a work schedule to fit her changing needs in different seasons of life.

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Hospital Changes

Sarah has worked at the same hospital since she graduated PA school. When she started working there, it was a great environment as a new grad because instead of having various departments with PAs working in each department, it was structured as a department of PAs who worked on different units. She was able to learn from more senior PAs and start to hone her medical acumen as she began covering acute care/general medical/surgical floors and then moving onto progressive care units/telemetry and then into IMC and ICU. 

After about a year working at her hospital, there were some system-wide changes that included the PAs covering more hospitalist patients as well as PAs now becoming more assigned to different departments. Part of that was exciting – getting to be the attending provider for patients from admission to discharge, diagnosing patients, creating treatment plans, and determining discharge planning. But part of it was also stressful as there were many changes at once with several more senior PAs leaving. Sarah jumped into learning how to care for critically ill patients, including becoming credentialed in procedures like central lines. 

The hospital also created an official critical care department that partnered system-wide with their sister hospital, a bigger trauma center. After 1.5 years of working both in the hospitalist department and in the critical care department, Sarah transitioned full time into critical care. 

Career Flexibility 

This is an important lesson that nothing stays the same. As a new grad it’s important to remember that departments and jobs can evolve. By communicating your interests and career goals to your manager and others you work with, you can position yourself for new roles and experiences to find the exact role that’s right for you. It’s also important to identify your job criteria, whether you’re a new grad or a seasoned PA looking to change jobs. Be able to specifically list what you are and are not willing to do as well as some of your specific preferences in how you work. Being flexible is attractive to employers and helpful to you as an employee, but it’s also important to set parameters and find a job that fits inside those boundaries so that it’s a good fit for you. 

By staying at her hospital through big transitions, Sarah also showed her managers that she was a team player and dedicated to the hospital system as a whole. Throughout your career, there will be constant changes, growth, and evolving of departments and hospitals. This is important to keep in mind when trying to determine sticking it out at your current job or looking for a new job. 

Thinking About Leaving

After working full time in critical care for a few years, there was a point where Sarah did think about leaving. At that time, there was an intensivist and 2 PAs working during the day, but coverage went to only one PA at night. The night shift PA was responsible for ICU admissions, critical care consults, transferring patients to IMC and ICU, handling all medical issues that occurred with patients, running codes, intubating, and performing procedures such as central line placements, arterial line placements, and chest tubes. 

As the census and acuity continued to increase, Sarah’s stress level also increased. She began looking for other jobs because it just felt like too much to be the sole ICU provider at night that carried so much of the burden of caring for patients and supporting other providers. 

However, administrators also recognized this burden and the importance of expanding coverage, so additional positions were created so that now there are 2-12 hour PAs during the day and 2-12 hour PAs at night. This has created a world of difference with having another critical care provider in house. It has improved provider morale as well as patient safety. There is also a dedicated intensivist on call to discuss admissions, complex patients, etc. 

Creating Positive Changes

As a PA, if you are thinking about leaving your job, it can be beneficial to have a conversation with your manager or supervisor to discuss why you’re thinking about leaving. It may be helpful to discuss the problems with the current system and changes that could be made so that you would consider staying in your position. During these conversations, it’s important to come with a positive attitude and to bring suggestions to the table, not just complaints. By collaborating, you are showing your employer that you are a team player and that you are invested in the medical system you work in. 

The people who work in the trenches are usually the people who need to be present for conversations about changes in workflow and systems. Administrators and directors can be very removed from the day-to-day workflow and patient care, so their ideas for changes may not make sense when they go to be implemented. The people providing direct patient care are often the ones who can solve the problems present in a work environment because they deal with those stumbling blocks every day. 

For these reasons, it’s important to find a job where administrators are willing to listen to those working in the trenches. It’s imperative that administrators who make the final decisions listen to the employees who will be dealing with the effects of these decisions. As an employee, it makes you feel more valued when your voice is heard. 

Transitioning From Full-time to Part-time

Sarah knew from a young age that she wanted to work part-time, especially after seeing her own mom as an example of a woman continuing her career in a part-time capacity while raising children. 

Before getting pregnant, Sarah sat down with her manager to discuss going part-time after having children. She recognizes that this is not always a normal conversation to have with a manager, but Sarah’s coworkers are very close-knit. Because they work in critical care and see lots of death and dying, they are bonded by the trauma and complex diseases and patients they care for. Sarah doesn’t see her fellow PAs as coworkers, but as an extension of her family. They have supported each other through marriages, divorces, births of their children, and deaths of family members. One of Sarah’s coworkers was even in her wedding. Because of their close relationships, Sarah felt comfortable and safe discussing her career goals and how they fit with her personal goals with her manager. 

At this time, the department only had full-time positions, so Sarah wanted to discuss if it was even possible for her to go part-time after having a baby. If part-time positions were not an option, then she would start looking for a new job prior to getting pregnant. Her manager said, “I don’t want to lose you, so I’ll make a part-time position.” Sarah also discussed her overall schedule and asked if she could work opposite shifts of her husband, who is a firefighter. He works shift work with 24 hours on and then 72 hours off. Sarah’s manager said he could also make that happen.

This speaks to the importance of how you present yourself at work. Are you a team player? Are you someone other people want to work with? Does your employer think you are a valuable member of the department?

Never Say Never

Sarah never thought she would commute an hour to work and never thought she would be a night shift worker. But yet, she’s doing both. She continued to work at her hospital in Maryland even after moving to southern Pennsylvania for a few reasons. These include her incredible department, with a truly fantastic group of PAs and MDs, as well as working at a very PA-friendly hospital where PAs are well-respected and have a high level of autonomy. 

She also picked up more nights after moving to Pennsylvania to have a more consistent schedule and to allow her to see family and friends who lived in Maryland and worked a more “regular” 9-5 schedule. She had never been a night shift person and never pulled an all-nighter, but working nights allowed her to have the social schedule she desired, especially after moving. 

It’s difficult working nights, because your sleep is so disrupted. Studies have also shown that working nights and shift work disrupts your circadian rhythm and can shorten your lifespan. So while working nights isn’t great for her health, it allows her to otherwise have a lifestyle that she wants. 

After going part-time, Sarah now only works nights. While she has limited sleep when she works, she does have more time at home with her family and young children. Because her husband also works shift work, Sarah’s family often has family nap time where her husband sleeps after his shift, Sarah sleeps before her night shift, and their children take their regular naps all at the same time. 

If you asked Sarah five years ago what her unicorn job would be, she never would have described her current job. But never say never. While she never would have thought she’d be a night shift worker, this job works so well for her family right now. She wouldn’t trade the ability to be home during the day with her children and husband. 

The Importance of Flexibility

As a working parent, it’s important to be flexible and to be open to change when life changes. Currently, working part-time nights and opposite shifts of her husband works very well for Sarah and her family dynamic. But this could change when her children start school or when her husband retires. 

As a previous PA coworker once told Sarah, embrace a current job or current schedule when it’s working for you and your family for this season of life, but be open to change when a new season of life starts. Don’t be afraid to make changes in your job when you need to make changes. You are not stuck in this schedule or this job forever. You can change it as your family needs change. 

Oftentimes, we can wait too late to pivot. By waiting too long to make changes with work, we can become resentful in our current jobs. It’s important to be proactive and to continually evaluate if your current schedule or job aligns with your family’s needs and your own goals and values. Your priorities will change throughout life, so it is important to evaluate them as life continues and if any changes need to be made. 

It’s also important to remember that your work isn’t your life. You are a person first and a PA second. Your work should fit into your life, not the other way around. 

Changing Priorities

Some of the downsides of working nights include not being as involved in committees and being able to interact with administrators. When she was working mostly day shifts, Sarah was very involved in various committees and groups in her hospital. But now that she works part-time nights, she is less involved. 

This speaks to changing priorities at this point in her career. Sarah is still working, keeping up to date on current medical treatments, and maintaining her CME and credentialing, but her main priority now is her family. We can often feel like “now is the only chance I’ll have” to do something, but more often than not, that opportunity will still be available in the future. We need to lean into our current priorities while letting go of things that are less important in this season of life. 

There is no perfect work-life balance. You need to create that for yourself, and what that looks like will change with time. There are seasons where you are leaning into work and other seasons where you are leaning into your family and personal goals. Be brave enough to lean into what matters during this season of life. 

Entrepreneurial Endeavors 

Sarah never thought she would be an entrepreneur or own her own business, but never say never. After going from full time to part time, Sarah started to look into something she could do working from home to help make up some of that income gap. She thought about starting an Etsy shop or creating a proofreading business, but ended up becoming a virtual assistant. 

Sarah had been an active member of an online community ran by an ex-hedge fund investor who had started her own business teaching women and moms about investing. The owner reached out to Sarah a few months after she went part-time and asked if she was interested in joining their business team as the VA. Sarah said yes, but what exactly is a VA?

There are many types of VAs, including administrative, social media management, and tech support. Sarah focuses mostly on administrative tasks, including calendar management and scheduling, email management, support in running online community groups, customer support, and proofreading. Sarah works as Tracy’s VA and specifically helps with email management, scheduling and corresponding with podcast guests, and scheduling Tracy for speaking engagements. 

By taking over administrative tasks for small business owners, Sarah allows them to focus on content creation, coaching, and the big picture of their business. Sarah can take care of the day to day tasks that are important to keep the business running, but the business owner isn’t bogged down in the minutiae of the business. 

Sarah loves to organize and create systems to make things run more efficiently and smoothly, so she fully embraced being a VA. After working as a VA with her first client for about a year, she decided to officially create her own VA business and start to connect with other clients. Sarah currently has three VA clients, all moms who own their own businesses. Sarah loves supporting these women and their businesses from an administrative standpoint.

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I'm Tracy Bingaman

It's so nice to meet you... I’m a PA Mom life coach, self-care promoter, curly haired achiever, mom and dog mom, and a margarita drinking badass.

I burned out working as a PA... BIG TIME. I quit my job, doubled my hourly income earned, work half as much and learned to build a life around the things that I value instead of a schedule set by someone else and now I get to share all that I've learned with you. 

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Now I teach PAs to do the same.

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