Making a career change for better work-life balance [PODCAST]

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“Is it possible to have it all?  Can you have a job that you love, helping people and using your brain and hands all at the same time; plus, a family, with a spouse and children, that you are always there for?  Is it possible to have a balance between your work and your family live while working as a medical practitioner?”

James A. Quinn is a physician assistant.

He shares his story and discusses his KevinMD article, “Our patients matter, but at what cost to our families?”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have James Quinn. He’s a physician assistant, and he wrote the KevinMD article “Our patients matter, but at what cost to our families?” James, welcome to the show.

James A. Quinn: Thank you, Kevin. I appreciate you having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

James A. Quinn: Well, I have maybe a unique background. I was a former engineer, and I worked for the Navy for several years. When I got started with that career, I also started exploring my interest in medicine, which came from my youth as a Boy Scout, going through first aid merit badges and learning CPR. I felt it was very interesting but quite challenging at 11, 12 years old.

And so I started to explore my interests when I moved to Virginia and started working for the military. I joined a fire department rescue squad, became an EMT, and moved my way up to paramedic. It was at that point, when I started bringing patients to the local emergency room, that I started meeting physician assistants, and I was like, “What is a PA?” I had no clue. So I learned more about them. A friend of mine went to PA school at James Madison University, and I just started to get interested in it. Before I knew it, I was starting to take classes and learn more about medicine. I took anatomy and physiology and some other classes that I didn’t get in college, and before I knew it, I had moved to Florida and started PA school, and it’s been a wild ride ever since.

Kevin Pho: All right. Tell me a little bit about your practice and how it’s being affected by the pandemic.

James A. Quinn: So I’ve worked in many different areas in medicine. I started off in hospital medicine and some emergency room medicine, and then I moved my way to critical care, and I’ve been doing that for the last six years. I certainly love critical care, but it was nights and weekends, and it was hard on my family. Over the last few years, my family has grown and grown, and this year I made the decision to start to get out of that world, have some more family life balance, and start in family medicine, which I told myself I would never do. I never wanted to work in a clinic; I just didn’t think it was for me.

But to tell you the truth, I’m really loving it. It’s a whole new challenge, a different set of types of patients, and you have to deal with insurance companies. It’s a whole different type of medicine than the hospital world, but I’m definitely enjoying it. I get to see patients on a regular basis, and I get to see them improve over days to weeks to months, versus critical care patients that maybe I only spent a couple days with, who sometimes got better and of course sometimes didn’t. So it’s been an interesting experience.

As far as coronavirus, I started pretty much when all things started to get bad, and so I quickly moved to virtual medicine. It was a couple of slow months, and then it’s been picking up ever since. So I’m just really starting to get the hang of family medicine and what normalcy is like in that world, with coronavirus kind of starting to calm down in Texas now. I’m really enjoying it.

Kevin Pho: Now, how do you see the role of physician assistants going forward as our health care evolves? How do you see the future within the next three to five years?

James A. Quinn: It’s certainly come a long way from the ’60s. The PA profession was designed to kind of fill the primary care needs that they saw were going to be a major problem going forward, and certainly PAs and nurse practitioners have kind of filled some of that role. But at least half of them have moved into specialty medicine, just like doctors. PA education costs a considerable amount of money, and maybe that’s part of a driving force which directs PAs, just like physicians, into the higher-paying specialties. So about half the PAs work in specialty types of medicine, like emergency, critical care, and dermatology.

But I still see them as a big component to filling in those needs that are out there. We tend to work similar shifts as physicians sometimes, depending on the type of medicine, but we also fill in the gaps, which tend to be nights and weekends, and often those gaps are in rural settings as well. So I have friends that work in all different areas of medicine, and our profession is growing exponentially.

Kevin Pho: And how big is that physician assistant pay gap between specialty care and primary care?

James A. Quinn: I mean, it depends. My wife is a PA as well. She’s in dermatology and makes a considerable amount more money than me, which I personally have no problem with. But critical care was never a well-paying profession; it’s not for physicians either. And I actually got a pay increase by taking this job in primary care. So it all kind of depends on where you’re going to. But if you work in emergency medicine and orthopedic surgery, you’re going to make a considerable amount more money than a primary care doc, PA or a doctor.

Kevin Pho: Sure. Now let’s talk about your KevinMD article, “Our patients matter, but at what cost to our families?” You alluded to this a little bit earlier, but for those who haven’t read your article, can you share a little bit about it and the reasons why you decided to write it?

James A. Quinn: Over the last several years, my family has grown. I got married about eight years ago, and we’ve had three children since, and we have number four on the way. Those challenges have to be the nights and the weekends, when my wife’s working a normal Monday through Friday type of schedule and I’m working the night shift, the weekends, the overnights. It puts a strain on her; it puts a strain on my family. I was going for weeks, well, not weeks, but days at a time where I wasn’t seeing my family, because our schedules consistently overlapped each other, and I was starting to miss out on my children growing up. I did work maybe 10 days a month, or 10 nights a month, which gave me lots of freedom and flexibility, but the times that I was working were hard on my wife and hard on me, and it was starting to take a toll on our family. I just knew that things had to change.

So it was a tough choice and a tough move for me, because it wasn’t exactly what I thought I wanted to do. I do love being a PA, and I love working in that critical care hospital type of world, but it just wasn’t worth it anymore. I love my wife, and I love my children, and I just don’t want to miss out on their lives anymore. So it was a tough move personally, but looking back, it’s only been six months, and it’s been a great experience. I get to come home and pick up my kids every day and cook them dinner and be home with my wife, and I’m home every weekend. It’s a little different with coronavirus, but we’ll eventually do a little bit more activities. It’s been a great experience, and I just feel like I had to get that out there into the world. I feel like I had to let my voice be heard.

When I was kind of considering being a PA back in my paramedic days, I was working with this emergency room physician who told me that she felt she could not be a mother and a good physician. She had to choose, and she chose to be a doctor. I thought that being a PA, I would probably have some more say, some more flexibility, a more balanced lifestyle, and I’m not so sure that’s necessarily the truth. I think it depends on what area of medicine you work in, who your employer is, and your work-life balance. So it all had to be related to finding that balance for me. For right now, or hopefully for the rest of my life, my family is my priority, and I’m OK with that, with my career taking a little bit of a back seat. I’m certainly enjoying my new role, and I have no concerns with what I’m doing at this time. It was certainly the right move for me.

Kevin Pho: Now, before you made that transition and completely changed fields, did you exhaust all the options in critical care? Was there any way that you could see yourself staying in critical care and having some semblance of family life?

James A. Quinn: So every city is different, and in Dallas, the majority of the PA and NP critical care jobs are at night and on the weekends. UT Southwestern has a unique program that I’ve been looking at for years, and they do have a majority of day shifts, but they do have some nights and weekends as well, and I was trying to get away from that entirely. That might be an option for me down the road, when my kids might be older, in 20 years or so, but it was not something I was willing to give up at this point. I just needed to get away from the night and the weekend shift and find some more balance back to my family life.

Kevin Pho: And in your current position, do you have to take call?

James A. Quinn: I do. It’s very minimal. I was on call last week, and I think I got three or four calls all week long. Pretty rare. In family medicine, or at least with my current job, it’s not a big deal. I’ve taken call for other jobs before, and it was much more intrusive on my life.

Kevin Pho: So it almost sounds like a binary option: You could either be a full-time clinician or a full-time parent, or you have to choose one or the other. Do you see any other solution where you could be both, going all into medicine and all into family? Is there any way that you could do that, or do you always have to cut back on one or the other?

James A. Quinn: Well, I think that’s the big question. Again, it depends on who you’re working for and what your role is. I am a full-time PA, as is my wife, and we have a balanced lifestyle at this point. But to work in certain areas of medicine, whether you’re a physician or a PA, if you’re on call all the time, you have to go in the middle of the night; if you have to often choose work over family, I mean, those are decisions you personally have to make. There are a lot of doctors who want to be doctors, and they also want to have a good family life, and maybe that’s what drives them towards primary care or ophthalmology or something more of a normal work life, a Monday through Friday, eight to five kind of balance.

So I think it just depends on you. It also depends on what your spouse is doing. I mean, some physicians I work with are married to a physician; some physicians, their wife is a stay-at-home mom. We don’t have those options, and sometimes that provides a little more flexibility. I think it just depends on your family life. But for us, it was important that I’m there every night and there every weekend, and it was certainly a good choice.

Kevin Pho: We’re talking to James Quinn. He’s a physician assistant, and he wrote the KevinMD article “Our patients matter, but at what cost to our families?” James, a lot of clinicians are in similar positions, in that they have to really manage their work-life balance. What kind of advice can you give them, after making the decision you made?

James A. Quinn: Just again, it depends on your role. Some of us work for physician groups; some of us work directly for hospitals. Whoever your employer is, is going to set what your requirements are. Do you have to be on call? Do you have to be in the hospital at night? Can you hire PAs to supplement and balance your life a little more, so you can work a little less, maybe make a little less money, but have a little bit better family work-life balance? If you’re working for a big hospital, you may not have those flexibilities. If you’re contracted with a hospital and you work for a doctor’s group, like many of the physicians in Texas do, then maybe you have more say and more ability to adapt.

The reason that the group that I worked for in critical care had some flexibilities was because I was an employee of the doctor’s group and not of the hospital. They brought PAs in because they were getting significant volume. It’s now a trauma two hospital, and they were needing to be home at night and have some balance to their family work life. So they brought the PAs or nurse practitioners in at night to kind of balance that out. Meanwhile, I’m sure they took some bit of a pay cut in order to do that, at least from a practice and group level, but it certainly helped to balance their life out. So they had to decide: How much do they want to give? How much money are they willing to give up so that they could be home at night and be with their families? I think it just all depends on who you work for.

Kevin Pho: And my final question: Do you have a take-home message that you want to share with the KevinMD audience?

James A. Quinn: You have to look at who you’re working for and what flexibility you have as far as your position. I think that PAs are excellent practitioners. We’re trained well coming out of school, and certainly we don’t know it all, but we’re very trainable. I certainly wasn’t a great critical care PA when I first started, but I think that over the last six years, I had become one, and I was good at what I did. But it was just too much. So maybe there’s a better option, so that PAs can have a better life balance, just like doctors, and we each take a little and give a little, so that we have a little more balance to life and can enjoy life a little more. Because ultimately, that’s what it is all about. It’s not about making money; it’s about helping patients, and it’s about having a good family life.

Kevin Pho: James, thank you so much for sharing your story and your insight, and thanks again for being on the show.

James A. Quinn: Thank you, Kevin. I appreciate it.

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