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February Q-Wave: I Was Fired From My Job As An Emergency Room Physician Assistant Only After Working There For A Year.

John Bielinski, MS PA-C By February 2, 2023No Comments

I was fired from my job as an emergency room PA only after working there for a year. It was my first job after I graduated from PA school. I was called into the office by the emergency department director and nurse manager and told to find a new job. It was explained that if I leave quietly, they would give me a good reference. However, if I make it difficult, they would fire me and not give a good reference. I was devastated. 

My problem wasn’t medically. It was socially. I had brought a military attitude into a civilian emergency room. I upset key people in the hospital, doctors, consultants, and nurses. That spilled over into patients. I always thought if I worked hard, stayed late, came in early and studied, my work ethic would make up for my lack of social skills. Well, it got me fired. I blamed a lot of people for this, the doctor that I upset because I called him out for being lazy, or the charge nurse that was “out to get me,” or even the lead PA that was duplicitous and enjoyed criticism. It took a few years to get over, until I realized it wasn’t anybody else’s fault but was my own. I created these problems. 

When I made that understanding, I became a student of human interaction. I began studying leadership, influence, and emotional intelligence. I read books and went to classes. I took seminars. I became a lifelong student of human effectiveness. 

What solidified for me that this needed to be put into a lecture was from the executive MBA program at the University of Buffalo. There was one mandatory course that spanned all four semesters. It wasn’t accounting, organization business, or economics. It was emotional intelligence. This MBA program found how critical it was to teach executives how to interact with people at a very high level. There is good science behind this; enhanced human interaction skills are needed to succeed in today’s business culture. I have taken the principles learned through my years of study, and the material learned in the MBA program that I had attended and put that information into a format designed for medical professionals. 

You need two key components to be an expert in your field of medicine and to provide excellent care. 

  1. Medical Knowledge
  2. Likeability and effectiveness

They are equally important, and they balance out. We will start with medical knowledge, but first I need to ask you a question. What makes an expert? When I say that, I mean, what makes one person an extraordinary provider when the people around them are only average? What factors decide who is an excellent clinician? 

Is it: 

  1. Education (where they went to school)
  2. Experience (where they worked or how long they worked) 
  3. Domain specific training (classes that they attended or courses taken) 

Which one of these three is most important: education, experience, or domain specific training? The answer is: all of those contribute but that isn’t the deciding factor. The deciding factor is the provider that practices “meta-cognition” or a learning philosophy known as “deliberate practice.” 

Meta-cognition was studied by evaluating four different groups of people; chess players, musicians, professional athletes, and physicians. It looked at who obtained knowledge the quickest and most effectively. It wasn’t education, experience, or domain specific training. It was the person that learned through “meta-cognition;” the provider that evaluates their own thinking. They ponder about weakness in their own practice and how to fix it. They constantly reflect on their practice. They have a goal set and are courageous in taking on new challenges. But, most importantly, they identify the areas in their practice and make corrections. 

Where are they weak? What patients do you avoid because you are uncomfortable with them? Those are the people you need to focus on. Why are you uncomfortable with them? What clinical skill set do you need to feel more comfortable with them? Those are the areas of your knowledge you need to focus on. When I started working for a regional stroke center, I had a difficult time making clinical sense out of the neurological exam. It really motivated me to learn neurology. Meta-cognition is the key to your professional growth. I challenge you to research this concept independently. 

Now we will move on to the other side of the balance, equally as important as medical knowledge; human interaction and effectiveness. You can be a very bright provider, but if you have a lost bedside manor, you won’t do well, especially if you are a mid-level provider. You can be a brilliant clinician, but if you upset your patients they won’t listen to you or respect you. If you upset the consultants, they won’t want to help you. Who ultimately suffers? It is your patients that suffer. You will have a very difficult time if you upset a consultant, and then have to interact with them again. I am speaking from experience. I call this the “intelligence to ego” ratio, or “I:E” ratio. 

If you are very smart and you have a very big ego; you will do fine in medicine. If you are an orthopedic surgeon or a radiologist, and you are very good at what you do, but you are cocky about it; that’s ok too. You’ll be fine. If you have a low I:E ratio, meaning you are not very smart medically (or not very experienced) but if your ego is low, you will also be fine. You will frequently not know the answer, but you are humble enough to ask for help. If the opposite happens, and your ego is high and your intelligence (or experience) is low, that is when you make very bad decisions and people can die. 

How is your I:E ratio?



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