Joint Effort PAs
We're two orthopedic surgery physician assistants discussing PA school, life as a PA, cases and topics related to orthopedics, and much more!
Joint Effort PAs
Losing the Fire & the Fix : Navigating Stagnation in your Practice as a PA
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"Why doesn’t this feel as exciting as it used to?”
In this episode of Joint Effort PAs, we’re getting real about something not talked about enough—losing the fire in your career. The feeling of stagnation, going through the motions, and wondering if this is just what practice becomes after a few years.
We dive into what this actually looks like day-to-day—less excitement, feeling stuck in routine clinic flow, questioning growth, and the pressure of balancing productivity with passion.
But more importantly, we talk about the fix. How to recognize when you’re in a rut, ways to reignite your interest (without blowing up your career), and how to create growth through new skills, procedures, side ventures, and mindset shifts.
Because the goal isn’t to never lose the fire…
It’s knowing how to find it again 🔥
Tempo: 120.0
SPEAKER_01Welcome to Joint Effort PAs, where two orthopedic surgery PAs get real about life in medicine. From tips and tricks to professional growth, work-life balance, and everything in between. We're here to share what we've learned and what we're still figuring out. Let's get into it.
SPEAKER_00All right, back at it. We're back. We're back after our very emotionally invested episode last week. I listened to actually listened to it today on my drive back. Yeah. And I felt, I still felt the energy from it.
SPEAKER_01From the crushes, yeah. It was a good one.
SPEAKER_00I did get a little shade though from uh one of our reps that we use daily that we did not talk about any of his products.
SPEAKER_01Did you really? Yeah.
SPEAKER_00In fact, here's no, but here's the thing. I know he doesn't routinely listen. So I knew he wasn't gonna be upset about it until he heard it. So by Friday, like six days after release, I finally said something to him and then he listened to it, and then he got upset about it. And I'm like, bro, this is literally like you weren't gonna listen. You weren't gonna listen anyway. Yeah. Anyway.
SPEAKER_01We did give them a little shout out.
SPEAKER_00I know we did, yeah.
SPEAKER_01I think uh but I I have also uh I've also teased them coming on and being involved. So balls in your court.
SPEAKER_00Balls in your court, buddy. Yeah, yeah. All right. Well, anyway, so we are um we're at the end of the first quarter, like we're in April, right? And we started off, at least on our end this year's podcast, um, telling everybody that we're gonna level the F up. So um you and I, again, I feel like we are still riding high, um soaring. But um, you know, this podcast, I had a couple conversations recently with some coworkers that are feeling the opposite. So I think it's really important as we are, you know, proclaiming that we're going to do more and see more and experience more. Uh, feeling stagnant in orthopedics is something that is also a thing.
SPEAKER_01Yeah, yeah. And it can happen to everybody. It happens, it happens to me from time to time. Like I'll have weeks that feel like just meh, yeah. Yeah. Melancholy weeks.
SPEAKER_00Yeah, yeah. And there is a time frame though where you get out of school and everything is new, right? And you'll get to a point in your career where it's not new anymore. Yeah. And everything is, you know, somewhat easier, but then it becomes routine. And then when it becomes routine, we lose interest. Um, you know, it's like the seven-year itch in relationships.
SPEAKER_01It's like, do I stay or do I go? Right. Yeah. Yeah. Because you're used to everything. Like initially it's so overwhelming. Yeah. And you almost feel like the the burnout from overwhelming things. Yeah. Um, but this is more what we're talking about is like, you know, you're happy and satisfied and everything, but kind of like the what's next feeling.
SPEAKER_00Yeah.
SPEAKER_01Um, and I feel like it can be a dangerous place to think too. Like, I almost feel guilty when I get in these mindsets because I'm like, I actually really love what I like. Why am I feeling anything negative about it? And also, like, I mean, at least for me, I've still haven't been doing this long enough that I should feel like so comfortable with it. So I hate when I recognize it in myself, like feeling too comfortable with something. I'm like, I need to, I need to back myself down and to come out of this.
SPEAKER_00Yeah. Um, so this coworker had, you know, come up to me a couple of weeks ago and had asked me, like, hey, you know, I need to talk to you. And usually that's like, I'm putting in my notice, I'm pregnant, like, I don't know, something, right? So I was like, all right, kind of got my head like set for this is gonna be a sit-down conversation, right? Um, so it wasn't that. It was just more like, you know, hey, I've been, you know, been here for a couple of years. I'm in a subspecialty, I'm seeing the same stuff again and again and again. Like I just feel like it's repetitive and I'm, you know, kind of going through the motions. And how do you and he's looking for advice? Like, how do you show up every day and get excited about what you do and feel accomplished? So yeah, heavy question.
SPEAKER_01Yeah.
SPEAKER_00Yeah.
SPEAKER_01It's hard. That's a hard thing to answer.
SPEAKER_00Yeah.
SPEAKER_01What did you say? Um initial response to that.
SPEAKER_00How do you show up and well, so one, um, you know, we both Hannah and I work in a private practice. The beauty of a private practice is you have patients and you have your own, you have your own clinics, right? Yeah. So I will get to know these patients really well. So I look forward to seeing them. Some I some I don't, right? But some I do. So like I like the repetitiveness of it, not in a negative way, but in a I get to check in with my peeps. Like I get to see what they're doing. Yeah. I get to see the same people. And then the more the longer you are somewhere, you get to see their husband and their daughter and their grandma, and they bring their family to you. So it just feels like a network, right? So I like that I don't have to run to my computer every time to like who is this? When's the last time I saw him? Because it's like a living memory, right? Like it's it's like an active thing. Um, my advice to him, and we'll we'll kind of break it up and we'll we'll talk through a lot of this stuff, is first internally look at yourself. Like, why are you saying this? Right. Let's like what's the real reason, right? Like you pick a fight with someone, not because they let you didn't take the garbage out. Like, what's the real reason? Right. So um, are you feeling challenged? Um, do you like the people you work with? Is it the subspecialty you're in? Is it the hours? Like, what is the thing? And again, it led into a ridiculous conversation about essentially all the things. Yeah. And when you work in a private practice in a specialty, let alone a subspecialty, some things you can change and some things you can't. Yeah. Yeah. So um we'll, you know, we'll kind of dive into all that stuff. But he, I don't think he necessarily said he felt stagnant. He just didn't feel excited.
SPEAKER_01Yeah.
SPEAKER_00I mean, same thing, right?
SPEAKER_01Yeah. And I think like, I mean, there's there's days that I well, I don't know. I I love my job. I I feel fortunate, I feel excited every day to go to work. Do I leave sometimes and feel like uh like you know, next week's next week will be better? Yeah, yes, that happens. You hear about it frequently. Um, but I I do think that this happens to everybody at one point or another. Because like if you are growing and getting better at what you're doing, you're gonna hit plateaus. Um, it's gonna be like a bell curve of learning, learning and doing a lot more and being super busy. And then all of a sudden you hit that like plateau at the top, and hopefully you're not like having these drastic downward climbs as well. But it's you're gonna hopefully maintain an overall upward trajectory with some valleys in between.
SPEAKER_00But like you know, stagnation, you can define that as when you get out of school, everything's new. All the diagnoses are null, new, uh, different ways to treat things are new. And let's try it this way, but let's try it this way. So you're also so you're you're dealing with not having a big knowledge base. So that's you know, challenge number one. Challenge number two is getting confident. Challenge number three is communicating with patients. Let's say you don't have a good population. Let's say you are great with geriatrics, but you're terrible with like middle-aged women. So it's figuring out, you know, how to vibe with your patients. Um, then it's um trying to be efficient, like trying to see more numbers. So you've got a lot of variables and a lot of challenges when you start. Now, let's say you're a couple years in, now the diagnoses become more familiar. Now the list of differentials is less because you kind of have a better handle on it. You get the workflows now. Everything is less of a cognitive strain. So, like, I mean, I I think that right there is not when I say that out loud, that doesn't sound terrifying. No, that sounds great. Yeah. Like at to a certain extent, but like if you want more, yeah, the learning tends to decrease. I'm sorry, the way to learn new things is more self-driven.
SPEAKER_01Yeah, it has to be self-driven.
SPEAKER_00That's not handed to you, right? Right.
SPEAKER_01Um I think that's a big thing that people don't realize because I have people ask me that question, like, oh, like, you know, where do you get all that new stuff? Or like how how do you do XYZ? Like you're seeking it out on your own. Um, and so I think that's a big thing because, like, yeah, in school it's all fed to you, or you have this expectation that like whoever is overseeing you is going to be constantly like um teaching you and and bringing you up, and that's just not you have to take ownership of that at some point.
SPEAKER_00So, I mean, stagnation when this person came to me and we were talking about it, like, you know, red flags go off in my head, right? So I'm thinking like, you don't care. If you don't care, you're gonna get crappy reviews. Yeah. If you don't care, you're going to bring a low energy. Yeah. And that's contagious, right? Um, your curiosity is gonna be less, yeah, uh, less engagement, trying to leave early, right? Yeah. Um, maybe you're doing your visits routinely and you're not seeing the things you should see. So, like, again, very important to recognize when this is happening because there's risks of operating feeling stagnant and not addressing those things, but also like potential positives, right? If you're feeling a certain way and you're wanting to talk about it, you're looking for help.
SPEAKER_01Yeah, like you're recognizing the first step is recognizing.
SPEAKER_00The first step is recognizing, yeah. And again, I don't think that this, you know, feeling stagnant, which again, I feel like is is normal for most providers, and I don't even think it's particular to PAs, but um, it doesn't mean you're less invested. I think it just means that what was once fire is now more dim.
SPEAKER_01Yeah. The fire is it needs some uh it needs some wood. It needs some wood, some stoking.
SPEAKER_00It needs some stoking. Um but anyway, so let's talk about ways that we can get unstuck. Yes.
SPEAKER_01This is the this is the meat of it. We recognize when you are, but this is how you address it.
SPEAKER_00Yeah. So when you're stagnant, you're not failing. Um, I think it's normal to hit that. I think what defines good providers and how you get out of that is um recognizing it and then coming up with a plan of how what how to change something and figuring out if why you're feeling the way you feel is changeable, right? Yeah. Um okay.
SPEAKER_01So let's identify the flavor, the type of stagnation.
SPEAKER_00The type of stagnation. And tell me if you feel feel these varieties and have felt these varieties anyway. Okay. So this is for those listening to self-identify. Okay. First one, the comfort coaster. You don't like anything that's challenging and you love routine, right? So you will never push your side outside yourself outside the box because routine feels good. Yeah. So what I mean, what do you think are the uh potential downsides to that?
SPEAKER_01So there are downsides. Now, I I personally do love routine. I get a little bit thrown off sometimes when my routine is not the same, but that's not to say that I avoid challenges. I just don't like changes in the routine of like the order of steps for things, right?
SPEAKER_00Like Yeah, but I don't think, yeah, I don't think though that you loving routine necessarily means that you avoid challenge. Yeah, I think you know, having routine but also seeking out challenge, again, that's something.
SPEAKER_01When I think of somebody who loves routine, I think of like somebody who loves the um algorithmic medicine and can just like I'm thinking of like internal medicines sitting in the basement and being like, oh, this and this and this. Yeah there's that. Yeah. Um, then we have burnout blend. And again, like burnout.
SPEAKER_00No, to be clear, stagnation's not burnout, but if it is there, it is a subtle sign of burnout sometimes. Oh, absolutely. So I think this is more, and this is what I fear because before someone gives me their notice, I already see it. Yeah, you can see they're checked out. Um, their energy is just not the same.
SPEAKER_01Yeah.
SPEAKER_00You know, they don't reply to emails like as quickly as they once did. Like I can see it. Yeah. So the burnout blend, I think they're more like the burnout cusp, I think, is those that are mentally checked out.
SPEAKER_01The overload operator, I can definitely see this, like too, too busy to grow.
SPEAKER_00Yeah.
SPEAKER_01Um I think the one of the downsides, I guess, from a private practice standpoint too is just the constant grind to do more and more and more. Yeah. And that sometimes can limit your ability to uh invest in other things, yeah. Like invest in optimizing what you're already doing and making it better just to like hit your numbers and get where you need to go.
SPEAKER_00But also like seasons of life. I mean, you know, for those of us who are fully thrown into our careers and you spend your time and energy and focus on that, great. But what if you're planning a wedding? And what if you're pregnant in your first trimester? What if you have to drive your kids to like eight different soccer practices? What if you have what if what if you're back at work and you just left here Friday? Like I don't you know what I mean. So I think uh allowing time and energy to grow, there's seasons of life that are going to be to allow more for that than not. So you know you can feel stagnant because you just don't have your glasses too full, right? Yeah. Um, and then again, the last one's confidence plateau. And I've seen this, I've seen providers that are so good skillful-wise that they just become complacent, like they've already reached high-level functioning, and then that's it for them. Yeah. I can name a couple that I've that I know.
SPEAKER_01Yeah, and that can be hard sometimes, like as a PA to overcome because I've, you know, you do, depending on the specialty you work in and who you work with, you kind of do have like a a cap to what you can do. And so that that's kind of like a a a weird line to try to play with sometimes.
SPEAKER_00So very specific though, to your practice and your like APP physician relationship. Like if you are maxed out in your role because that's as far as your physician will let you go, yeah, then that's maybe that's not changeable. Right, right. Um, that's that's hard. That's hard to it's like a relationship mismatch, basically. Or well, yeah, unfortunately. Yeah. It's like tiny calves.
SPEAKER_01Some things you can't change. Tiny calves.
SPEAKER_00Oh, things that give me the ick. Yeah. Tiny calves. Tiny calves. All right. Um, all right. So first thing is naming it. Like what is the issue and why, right? Second thing um is try to change something, like try to overhaul something. So let's say um, you Hannah, you work in hand, okay? And is there any one thing in hand, whether it's like x-ray read or certain type of injection or use of ultrasound a certain way, like one thing you just shy away from? Or is there one thing you just don't love?
SPEAKER_01Oh gosh, we get such a variety, which is like one of my favorite parts of it. Um one thing that I don't love not really. I mean, I I will say for me, like the biggest thing that I think leads to me feeling stagnant is just repetition in c in clinic, honestly. Yeah, like seeing a bunch of post op patients um for the same things like for hours and hours. That's why I love that I have like my split of OR and clinic in the way that we do, because it's Monday clinic, Tuesday OR, Wednesday clinic, Thursday OR, Friday clinic. And so there's enough of like an up and down with it that it doesn't feel that exhausting. I have had weeks where like my physician's out of vacation and I am in clinic four or five straight days a week. And like at the end of that, that I yeah. And it's not that I don't like clinic because, like you said, getting to interact with patients that I've, you know, known for a long time and all of the positive outcomes, like those are great feelings. But for every one of those, you also have like three that are one of the mills. Yeah, just one of the mills, or like even worse, I don't know, particularly in hand surgery, I feel like there's a lot of like we see a lot of workers comp and things that sometimes are just mentally exhausting, conversation for a different day for multiple different reasons. Um, but yeah, I think that that can get me to feeling stagnant by the end of a long week of that. Yeah. Um, what about you?
SPEAKER_00Um yeah, I mean, in clinic, like the new things that I and it's clinic, it's never the hour, if I'm being honest. Because every at least every case that we do, there's some variable from one case to another that it's never the same. It's never the same thing.
SPEAKER_01And I feel like there is always something that I learn every time that I'm like, this is something I could be more efficient at, or some way that I am excited to grow in and try to do more. Yep. Um, and not to say that that never happens in clinic, but I don't know, we've talked about this before. We love the OR more, so obviously, yeah. Yeah.
SPEAKER_00So in clinic, I mean new things that I've done, I've done, I don't, I don't like like uh I I did a barbitage, I've done PRP. So PRP, right? I had a couple PRPs this week and we've got a resurgence of that. Now, if I can go in the room and I can look at the patient, I can see a vein, I'm in. Like I am your phlebotomist.
SPEAKER_01Yes.
SPEAKER_00Now that we are scheduling the PRPs the way that we are and our surgery center is busy, I don't have a nurse that I can grab.
SPEAKER_01In case it's in case.
SPEAKER_00Now, not gonna lie, if I walk in the room and I can see nothing, I won't even try.
SPEAKER_01Really?
SPEAKER_00Yeah now, yeah, challenge. I'm in. I like it. So the last two that I did this week, they both said, oh, they always have trouble getting a vein. God damn it, right? But don't you love when you get I did I got them all. I got them all the same. One, one I went completely untouched, like couldn't see, couldn't see Jack. Like I just went completely untouched. So that type of stuff. And again, like area of distinction, the other PA on our team doesn't draw blood. Like I'm the only one to do it. So like I don't want to say I'm the only one to do it when the situation's perfect, which I which I was saying. Yeah. But anyway, so I'll do that. I've done like radial nerve blocks, I don't love ulnar nerve blocks, I don't love, but I did a couple of those, um, uh spinoglenoid cyst aspiration injections. Those ones are a little like on my couple of those. So, like I think challenging myself in clinic to do those things or seeking those out.
SPEAKER_01Yeah, those are always the thing. I mean, the things that you're not as comfortable with are gonna be the things that you naturally shy away from. Yeah, definitely. But when you force yourself into it, or not force yourself into it, but when you don't shy away from it. When you just suck it up and do it, do it, yeah. You know, you you start to to feel more confident with it. As with all things, I mean, like I felt the same way about PRP when I started doing it, especially with the blood draw thing and then um, you know, all of my ultrasound guided stuff. And yeah, same thing. I um, oh, that's one thing. So I was trying to get better at diagnosing distal bicep tears on ultrasound. Not not super easy. I think I was actually looking at the brachioradialis for the longest time and I was like, oh look, there's the bicep. And it's not. Um, and so I like for a week watched all these videos on how to do it.
SPEAKER_00Still not something I would yeah, but but again, that's picking one thing, right? So focus, hyper focus on one thing that you can change or you can fix because I feel like it it's a resurgence. It takes all your energy. You can pour yourself into that um and still do the repetitious things that maybe would bore you. But at the end of the day, look forward to let me watch one more thing, let me try this again.
SPEAKER_01Or like we were talking about earlier, and I think this is something that excites me and and you as well, is like in the OR setting, finding more that you can do. Yes. That's always something I'm looking for. Like, what else can I add to this that isn't just like retracting and closing? Yeah. You know, what what more am I gonna be? In what way am I gonna be more beneficial and helpful?
SPEAKER_00Uh speaking of OR stuff, so instead of making massive changes, something small, like what can you learn? What can you reinvest yourself in? Maybe it's a skill, right? In orthopedics, it's there's a ton of stuff we do. Yeah, right. And again, I've hired a ton of urgent care PAs. And oh, we don't, I don't, I don't do carpal tunnel injections, I don't do AC joint injections, I don't feel uncomfortable in doing a trigger finger injection. Like, but like get comfortable. Maybe we start with the easiest one, right? Yeah. Um, watching a video a week, uh reading something a week. And I will provide our new providers with I wish I had a number on how many things. It's like an endless, these are the orthopedic entities that we see, and I give it to them on day one. Said when you're bored, look look through one of these. Maybe today is hand and wrist day when you don't have a lot of patience and focus on, you know, for example, trigger trigger finger and you know, what are the causes of it? Like study it so that you can, when someone comes in, you can provide them with the most amazing educational experience ever. Right. Yeah. Um, but again, focus on one thing, and that's something you can, you know, do all your brush your teeth or when you get ready in the morning or when you drive to work.
SPEAKER_01Um listen to a podcast. Listen to this podcast. Listen to this podcast. I don't know. There's a lot of other good podcasts out there that are like educational base for just, you know, um diagnosis and treatment. Yeah. But yeah, I mean that kind of it goes into the school reinvestment thing. Um, you know, trying to bring back curiosity and find things that uh that excite you again and make you want to learn.
SPEAKER_00Um Do you do you have any um I'm only asking this because I do. Do you have any like side note projects that you've started and stopped and started and I do too. I've got like a whole folder of things that I've wanted to do.
SPEAKER_01Yeah.
SPEAKER_00And when I go through these periods of like what else can I do? I'll start it. And then it's like a working document and I'll move on to the next one. I have a working document.
SPEAKER_01I have um a bunch of like clinical education paperworks, pamphlets, things for like supplement protocols that I have currently still in the works. And then I have one bigger project, like a post op videos. Yes. Yeah, I've been gradually working on. That one is like every day, I'm like, this is gonna be a good day for me to take content, like take pictures that I want to put in the video. And then I go through the day and I'm like, huh, I'm too busy. And then do those things. Um, but yeah, that's something that I'm still working on.
SPEAKER_00Yeah, I've got a ton of tabs open on my computer of just things.
SPEAKER_01Always so many tabs.
SPEAKER_00So many tabs. But I mean, they and a lot of them will turn into fruitful things. So we had um even just like with ACL patients, I saw a lot of ACL patients who were like our return to football, return to soccer, return to basketball, they kind of all follow the same thing as far as return to sport because they all require start-stop. They all require, you know, cutting and twisting and jumping in some capacity. But I had um a cheerleader this week and she wants to get back to tumbling, and there's nothing really in return to play besides, you know, yeah, the plyometrics and the jumping on the cones. And I was like, well, why not, you know, why not get yourself in a handstand and bound out of the handstand and land on two feet? Why not box jump? Like, why are we not doing those things for our cheerleader that needs to jump high impact, you know, high impact, land with uh high impact and control? And she would, you would just see her excitement. She goes, Oh my God, can you develop something for me? And I was like, I'm already on it. I'm literally already on it. Yeah. So I I put something together for like, you know, little chat GPT. What is a good return to play post-six months for a cheerleader that wants to tumble? Because guess what? You can't go from plyometric environment to like, you know, let me see you do three back walkovers, two handsprings, blah, blah, blah, blah.
SPEAKER_01Like that's just not it doesn't translate.
SPEAKER_00Yeah, yeah. Um, but anyway, like putting my curiosity like, you're like, why don't we have that? Yeah, let me create one. And then that goes into my um that's a big thing.
SPEAKER_01Like just making making new things, making maybe protocols that make your clinic more efficient, making um templates to make things more efficient. Yeah. Um, teaching for some people, like, I know you love teaching. Yeah. Um and I think that can be like a big thing to kind of be a week in Kell City.
SPEAKER_00I was, I had a student. I have a student where week two out of week six, not gonna lie, all of March, because this pre this uh person started March 28th or whatever that Monday was, all month of March. I was getting emails like, I'm really excited. And I was like, oh God, like there's just like internally, there's a lot of stuff going on. And it like it's not the best time, it never is the best time to do it, but I was like, oh, I was like kind of dreading it. Got to the point where I had him in clinic and I was like, you know what? I love teaching. Yeah. Like I love teaching. I ended up doing my, you know, this person's with me a couple days during the week, and um, it was good. Yeah, it like revived me a little bit.
SPEAKER_01Yeah.
SPEAKER_00Not every day, but yeah, you know, the days that I do have them, I was like, wow, this actually feels pretty good.
SPEAKER_01Yeah. Yeah. And I think for some people, like that's their thing. They love training and teaching and things like that. And that that helps give them uh a reason to kind of be more engaged in things.
SPEAKER_00Um so I I did with this this provider that asked me, you know, about like, hey, how do you not feel so stagnant and what are things I can do? Another really good thing is go on a walkabout. Go on a walkabout. So walkabout is a term I use when um I'm kind of looking to see what other people are doing. Yeah. Like I, you know, I feel like the team that I work on is super streamlined, very efficient. I really don't have anything to complain about. But sometimes I just want to see what other people do. Like I have operated with other surgeons just to see, quote, is it that hard? Like, is it that bad? Yeah. I have. Like I've done it just to prove to myself.
SPEAKER_01And you're like, let me, let me try this. I did that. I did that.
SPEAKER_00Yeah. So people complain about, oh, this surgeon's so hard to work with. And I was like, I will scrub a case with them. I need to experience.
SPEAKER_01Do you think that they're on their best behavior for you though? They're like, oh my God, Beth's scrubbing with me today. I don't know. I don't know. What nervous? I know.
SPEAKER_00I don't know. But I did have I think yes, I think I would answer that correctly. No, I did have this provider who uh was asking me about you know stagnation. I said, you know, come operate with us. And he he actually suggested that he actually was like, Can I come operate with you? And I was like, Well, yeah, that's great. It didn't, there was really no translation from what I was teaching him to what he would do, but I think it was just offering a different perspective. Yeah.
SPEAKER_01And just seeing how you didn't see the teamwork aspect of it, like seeing how you interact, right?
SPEAKER_00I mean, there's certain unwritten things, right? Like when I go to the OR, if I looked at my job description, it's gonna say, do this, do this, do this. It's not gonna say, you know, go small talk with the scrub tech before the case, go get to know the CRNA. Yeah. Like it's not gonna go, it's not gonna do that. But if that sets the tone for the day, then I'm going to do that because we have a really long day on Tuesday, right? So um doing that type of thing, helping with positioning, like maybe helping the nurse hold a certain body part when they're trying to prep because that patient is 50 pounds overweight. Like those those types of things. And I'm hoping that that's just translating it. Yeah, seeing it through, oh, I I can be more helpful, or like, oh, I I guess I could do this in a different way. Yeah. Um, but I applaud. I mean, he was he's like, let me, let me operate with you. Great. Um, okay.
SPEAKER_01Yeah, working with a different surgeon slash provider if possible.
SPEAKER_00Yeah, and I think it will help give you new ways of seeing things and doing things. Yeah, you know.
SPEAKER_01Yeah. I scrubbed two. Yeah, you did the same thing. Right. I did a knee and a hip all in the same week, and I was like, oh my God, these are much larger body parts than well again, it gives you if nothing else, if nothing else. Appreciation for your home. Appreciation for my home. And so sometimes you need that. Sometimes maybe you you know the grass isn't greener necessarily. You just you love your home base and yeah.
SPEAKER_00Um, and then we alluded to this ear earlier. Another um uh technique or another, you know, thing you can do is try to do something that's uncomfortable. Like volunteer. Hannah, you just did this. Volunteer for harder cases. Am I gonna say they're harder? Excuse me. I'm gonna say they're harder, but they're different. Volunteer for different cases. No, no, no. Uh different cases, different cases. Or talk to a patient you normally would avoid. I did this this week. I saw a patient who hurt herself on 624-24. She fell while walking and she works like a factory or whatever. Knee contusion, literally nothing else. MRI showed bone marrow edema, it resolved. New MRI showed residual. Guess what? It resolved. Yeah. Still not back to work. And I was like, I saw her on the schedule. I'm like, why is this person here? Like, what am I gonna do? And I I did, I hit it head on. I was like, listen, this is this is this is probably as good as you're gonna get. Yeah. You know, and we can do this and we can do therapy and we can do that, but I need you to wrap your head around the fact that you can't do a physical job. And she looked at me like, just so happy you said that. Yeah. Like I feel like I'm chasing something. And I was like, girl, I mean, it's been two years.
SPEAKER_01So let me ask you this unrelated to our topic. What do you do in those instances from a work standpoint?
SPEAKER_00Because like So here's the thing I ordered an FCE three months ago.
SPEAKER_01Okay.
SPEAKER_00And the order is just sitting. It didn't get denied. It didn't get denied. In fact, her worker scomp continues to approve therapy. Her therapy continues to say she needs it. Um, but it didn't get it denied, it didn't get approved. So I was like, listen, I can subjectively tell you exactly what I think you should do. I would like to objectively tell you what you can do. AK, you can't stand for more than 20 minutes without a rush, you can't lift, you can't push, you can't pull, but I can define it if I can get a FCE. Yeah, yeah. So she had said, like, do you think I should do injections? I'm like, let me tell you, the injection I did eight months ago, did do anything for you? No. I want to do another one. I want to do another one. Yeah. So yeah.
SPEAKER_01That that's let the FCE be.
SPEAKER_00I'm gonna let yeah, I'm gonna let the FCE, and then I'm gonna write, here are your permanent restrictions. I will rate her and we will be done.
SPEAKER_01Yeah, yeah.
SPEAKER_00But maybe those are challenging. Maybe we won't. I don't know. But anyway, doing things that are uncomfortable, whatever that means, like seeking out a new skill. I have a couple urgent care providers, just talking with one of them this past week, and she said, I'm getting all messed up with knees again. Like I don't know what's going on. I just feel like I'm ordering the wrong things on the wrong people. I was like, good, recognize it. Come follow me for a day. Yeah, let's run through, let's run through some knee patients. Um, but I think it's really uh really important to identify the things that you're not maybe the best at and just make them better. Yeah. Even if it's even if it feels, you know, it's not very comfortable to say, hey, I don't think I'm good at this.
SPEAKER_01Yeah. So it isn't, but those make you better overall. So well, I think this is helpful information. Um we uh we didn't really get into the Delzo if you had any exciting cases this week. Oh, we can end with that. Yeah, we're gonna end with that. I'm intending now that we're gonna end with that.
SPEAKER_00Yeah, no, so I guess wrap up from stagnation. I think realize what the issue is, figure out a way to fix it, uh start with little things, but at the end of the day, if those things don't work, you may need a different role, you may need a new practice setting, and that's okay. Like this is all self-realization, totally fine. Yeah, nobody wants to live stagnant and be happy about it. I mean, I don't think it doesn't. Some people do.
SPEAKER_01Maybe. I mean again, depending on what your goals in life are, because we've talked about this before. There's some people who maybe just want to have their job and the hours work for them and the lifestyle works for them, that is what matters to them. Yeah, that is not what matters to me.
SPEAKER_00No, stag stagnation can feel safe until it doesn't. If it doesn't feel safe, it's not, and you need to change it. Yeah, if nothing is changing um and you're choosing it, you whether you realize it or not, then you're stagnant.
SPEAKER_01I mean, yeah, right.
SPEAKER_00So Hannah and I, again, flipping the switch a little bit, fired the hell up. This week was great.
SPEAKER_01Yeah.
SPEAKER_00We did, we did um, we did another Misha in 37 minutes.
SPEAKER_0137 minutes.
SPEAKER_00So again, one of one of the things now the goal is 36. But here's the thing, though. Like one of the things, if you're feeling stagnant, which I'm not, this is just my internal like mechanism, is yes, we did it faster than we did it last time, which is really cool. Also, now can I close the wound faster? I literally I was like internally timing myself. Yeah. I was doing and externally timing by looking at and externally timing. Didn't have a second hand. Well, I didn't look at the second hand, but anyway. Um, no, we did a Misha this week. Um, I had a student with me this week. Um, I had a very tough conversation that I didn't want to have for a couple months um this week. So overall, I think it was great. Yeah. What about you?
SPEAKER_01Um, a lot of cool cases this week. Had a difficult um scheduling implant situation happen this week. Which by the way, is weekly. It yes, that it does happen frequently, but like, yeah, that that's something I take upon myself to try to limit. Um, but yeah, still overall good week, lots of good cases. We did three total shoulders this week. I think it's a lot. It's a lot, yeah. I know my one of my leveling up goals for uh for our team is to just do a fuck ton of shoulder shoulders. Yeah, like there's no other way to state it. Uh I here's another thing that you can do to try to like track efficiencies and and helps with stagnation is I track like all of our volume every what I see, numbers, what what our team sees, our case numbers, and I track the number of shoulders we do, and it is um exponentially increasing year to year. So good. I am hoping that we do like close to 70 this year. And for shoulders, we do a lot. What did you do last year? Last year, it's funny you ask. I have it right here. I have that somewhere up here. Yeah, it I want to say it was like in the 30s last year, and so my projection was gonna be into the uh the 60s for this year. 2024 total was 14, 2025 total was 35. And so far for this year, I mean, we're on track to to at least double that.
SPEAKER_00So that's exciting. That's really exciting.
SPEAKER_01And three in one week, like that's big.
SPEAKER_00We had um we had a scheduling uh I don't say nightmare. It was like a tough scheduling week last week with a different facility and overbooking cases. And this week we were also overscheduled, but it went much smoother. So that was a win. Like everyone's everyone's moods and attitudes responded differently this week than they did last week.
SPEAKER_01That can be a good one.
SPEAKER_00It's important. No, I can't, it could have gone either way. Like that was a coin toss from the jump, from the start of the week.
SPEAKER_01So yeah, yeah. I think it's always good to uh to also like you know, revisit what's working and what's not as far as those scheduling type of weeks, you know. Try to base your future uh how how far you're gonna push the envelope based on that.
SPEAKER_00That is true.
SPEAKER_01So but yeah, great week. How's your soccer game this week?
SPEAKER_00Um, it was good. We tied. Um, we tied, we tied a team we should have beat, but um, it's okay. Their emotions were high. We are uh on my adult soccer team, which again, this this should make its way into the podcast every single week. Um we have a like a side um group me, like it's a whole running like a text thread. Like a whole text thread. There's a game recap that's done. Um this week I woke up on because games are late Thursday, I woke up on Friday to a uh something called 4 a.m. Musings, and it was the captain of our team talking about at 4 a.m. how he was like super pissed off at a certain thing. And it just riled up and it's been going all weekend. It's very entertaining. Um, but no, it was good. Um yeah, it was good. And this week we have an even later game. Oh, so that's that's wild to me.
SPEAKER_01I mean, not I guess it shouldn't be, considering I stay up like no, I know this nights, but but no, soccer did that late.
SPEAKER_00Yeah, no, soccer was good. Um anyway, yeah, yeah. I love it.
SPEAKER_01Cool. All right, well, we got a big week this we have a big week. We got a big week this week.
SPEAKER_00So we will for us. Yeah, I think our next weekend stuff will just be a recap.
SPEAKER_01It it's gonna have to just be a recap on reflecting on yet another way we are leveling the fuck up.
SPEAKER_00Yes, no, that is very true. I can't wait to get into it next week.
SPEAKER_01Yes, all right, until then. Bye.
SPEAKER_00Thanks for tuning in to Joint Effort PAs. If you enjoyed this episode, be sure to subscribe, leave a review, and share it with a fellow PA or med minded friend. You can also follow us on Instagram at Joint EffortPAs for updates and extra content. See you next time.