The Hard Parts of Practicing as a PA

As much as I love what I do, I have days, and sometimes whole weeks, that are just really tough. When I first started working, there were more rough stretches because I didn't feel like I had a great grasp on dermatology yet and felt like I should already know everything. It's gotten easier, but some days are still hard.

In school we mostly talk about the good parts of medicine. Occasionally we'll cover difficult or non-compliant patients, but that barely scrapes the surface of the real world. You can role-play situations all you want, but you won't truly know how to react until you're face to face with a patient. I work in dermatology, so I know plenty of providers in other specialties handle even harder situations than I do.

Some of the hardest moments from my first year: telling a patient a treatment for their eczema or acne didn't work, even though I gave them what I genuinely thought was best. Declining to inject an area like the glabella, between the eyebrows, where a steroid injection could risk blindness, because there isn't always a quick fix. And making the phone call to tell someone they have melanoma. I hate melanoma calls. Many people don't think of skin cancers as real cancers, but a 50-year-old with a melanoma and a 15% five-year survival rate counts as real cancer. [VERIFY]

Then there are the scheduling realities: three no-shows in a row, patients arriving 30 minutes late or with no appointment, which throws off the whole day. I once had to tell a patient she might have MRSA and shouldn't hold her new grandbaby until cultures came back, and she called saying I didn't help at all. A phone call usually makes those situations better. When I called her back and explained she had normal staph, not resistant staph, it eased things a lot. Patients almost always appreciate your time.

Part of what makes this work hard is the sense that patients sometimes think I didn't make them better on purpose, or that I don't care about running behind. Those things genuinely bother me, and I know they bother most providers. I wish patients could see behind the scenes sometimes instead of assuming we're just moseying around.

But I've been on the patient side too. At my own GYN appointment last year I waited three hours and got about five minutes, because my physician had an emergency patient. If I'd been the emergency, she'd have done the same for me. People are quick to judge and slow to be patient. As someone who's sometimes responsible for the wait, I think we all need a little more grace, patients and providers alike. At the end of the day, we're all just people, and we all make mistakes.

The hard parts of practicing are real, but they're also part of what makes the work meaningful. If you can lead with honesty and extend grace, to your patients and yourself, the tough days get more manageable. If you're working toward this career and want an honest picture of what's ahead, we're always glad to talk it through.