Five Hospitals in Five Years?

Sometimes I like looking back at where I have been to get to where I am today. I’ve worked at five hospitals within five years and doing this has allowed to me to understand that I like where I am now. Of course, I did not purposefully pursue having so many workplaces under my belt — it was a combination of opportunity, timing, graciousness, difficulty, and patience.

Teaching Hospital #1

After I graduated from my physician assistant program back in 2016, I was blessed with working at one of the greatest medical institutions in the world. It was a cardiology and CCU position — the perfect first job: the learning curve was not too steep, I was able to learn cardiology and medicine at a good pace and slowly be trained in CCU medicine. I learned from my senior PAs, residents, fellows, and attendings. I would have stayed longer but after 1.5 years, I was given the chance to challenge myself more and be a part of something new.

Teaching Hospital #2

I joined some of my colleagues and went to a nearby academic medical institution about a mile away in the city to be apart of a newly built ICU pavilion and CVICU team. This team would solely be advanced practice providers in a combined CCU/CTICU. I spent another 1.5 years here and learned the in-and-outs of cardiac surgery, transplant medicine, and honed in on my CCU medicine. I learned to be more independent but also learned how to work better with dedicated intensivists and cardiac surgeons. However, this position was also cut short when my colleagues and I were transitioned out of the ICU and into acute cardiac surgery (not our decision). This taught me to get “everything in writing” and that hospital politics can be gruesome and merciless.

Non-teaching Hospital #3

After having lost the patience to practice in a non-ICU setting, I set out to my hometown and worked in critical care in a local community hospital with a very reputable cardiac surgery program. It was a five minute commute, not much traffic, and a money-saver since I lived at home (although a bit of a pay-cut). It was in this non-teaching hospital where learned to be even more independent and put my critical thinking skills to the test. I rotated throughout the ICUs (CTICU, SICU, MICU, Stepdown) and the code blue/rapid response team. I was becoming more proficient in running codes and RRTs. I learned different management techniques for post-cardiac surgery patients and how there is “more than one way of doing something” and able to compare and contrast between institutional management. Placing PICC lines and midlines were also part of our responsibilities (this allowed me to familiarize myself with upper extremity anatomy). I learned a lot in this institution and enjoyed the autonomy but after 6 months, realized I wanted to focus on cardiac critical care and that I flourished more in teaching hospitals. Somehow by God’s grace, I received a call from an old colleague and now the manager from old Teaching Hospital #2 and was requested to fill an open position in the new CCU there (now not a CVICU).

Back to Teaching Hospital #2

So now, I’m back at the second hospital. I’m away from most of the politics and working with close friends, colleagues, and attendings with the patient populations I enjoy (cardiac ICU). I am able to independently perform bedside procedures and really make the unit our own. However, little did I know that my first day would be with COVID ICU patients (my start date was March 30, 2020) and that I would be with this population for another 5–6 months. This is where I really did a deep dive into advanced ventilators, steroids, hyper-inflammatory syndrome, sedation infusions, and VV ECMO management (another story for another time). But now, back in the CCU with a mix of MICU at times to offload our TICU. It’s really enjoyable. Here, I think I could really encourage my own growth with people who are willing to support me. At this time, I could really refine and perfect my individual approach to my subspecialty of cardiac critical care.

Supplemental Hospitals #4 and #5

I also work in two other hospitals as a temporary/per diem PA in the COVID ICU and CTICU. I did it so I would be able to further my knowledge in how other institutions practice and also to network with brilliant providers. As a PA, it’s also manageable to work a second job for more income (so why not). So far so good.

Culmination

Now, you can imagine what it was like at my interviews for each hospital. Yes, I jumped around to a lot of hospitals and that could be risky for an employer. I did not seek this out like I had previously mentioned. But all these experiences at all these institutions have made me the provider I am today. The knowledge I have acquired at each place (at the right times) I hope has made me a well rounded PA. It’s the combination of each procedure I have done, each complication I had encountered, each bypass graft and chest tube placed, each code I ran, each mentor I had learned from, each technique I watched, and so much more. The bottomline is this: sometimes it’s okay to make mistakes and see what you like and don’t like. Trial and error is apart of science and a part of life. And after all, it’s for your own growth. I learned I like critical care with a dose of cardiology, large academic teaching hospitals, and the resources. I thrive in those settings and it’s okay if I need to drive or pay a bit more to live nearby for that luxury. Some people like smaller community hospitals that are more intimate or maybe closer to the suburbs. It’s okay to find out what you like and dislike — it’s all part of the process.

Thank you to all my mentors, colleagues, PAs, MDs, RNs, NPs, RTs, pharmacists, and supervisors for teaching me.

Dk

Darren is a physician assistant specializing in Cardiac Critical Care in New York City. Passionate about resus, shock, PE, cooking & coffee.

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