Physician Assistant Career Dislikes #1: The Giving Tree

Posted By: Paul   |   PA Profession   |   18 Comments

physician assistant dislikes

Sometimes it’s no fun being the giving tree

Since Inside PA Training’s inception, we’ve tried to keep it positive, since that’s how it’s been.  Our readers are fired up about physician assistant careers, and we’ve worked to harness that enthusiasm whenever possible.

But another tenet we’ve tried to adhere to is to be real about what this work is like.  We shared a few bite-sized chunks of reality (the awesomeness and the bummerness of it) in our recent post, Being a Physician Assistant, Part I.  It got a great response – readers seemed to find it helpful to read about the low points as well as the high ones – and we’re back to give you more.  Enthusiasm is great, but it can blind you to some pretty important observations about the downsides of a career if you let it.  Hear us: overall, we are very bullish on PA careers.  But every career has a downside.  Today Paul shares more about what he could do without in his work as a PA.  If you are trying to join this field, you need to know about it.

The Giving Tree

When I was a pre-PA, I spent some time shadowing my family physician, who eventually became my first preceptor.   “The thin man,” as I ended up calling him, taught me a ton about the field of medicine, including what he disliked about his work.  It was an important bit of knowledge to glean from shadowing – If I’m going to go to all the trouble to become a PA, I need to make sure I know what I’m getting into, good and bad, I told myselfAn experienced and balanced guy, the thin man shared with me that he had his own personal life – problems and all – and most of the people he came across during his workday either 1) couldn’t know about it because it just wasn’t appropriate to share with them, or 2) didn’t care about it because they were there to get help for their own problems. I’ve been practicing for about 8 months now, and I’m starting to understand.

In Shel Silverstein’s much loved children’s story, The Giving Tree (click for a short film version), a tree gives of itself to a boy until it becomes a stump and has nothing left to give.  Sometimes in medicine, in much the same way, you give and give and give, and still you are asked to give more.  At the urgent and primary care clinic where I work patients walk in with a mind-numbing variety of problems – injuries, illnesses, life stressors, relationship problems, financial difficulties, horrible habits, and personality challenges.  No matter what my own state, my job is to help them, and if that sounds a little unfair, you’re catching on.

I feel like the giving tree when I am struggling personally.  When I have my own needs to attend to, if I am at work, there is pressure to forget about them and be present for others.  A precious few patients ask me how I’m doing, and when I’m hurting for one reason or another, I hate it, but I usually avoid the issue with a perfunctory “I’m fine.”

For example:

The other day, my dog Chloe, an eleven year old, three-legged Golden Retriever who was essentially my first child, began having terrible seizures.  This wasn’t the only stressful thing going on in my life; it was just the latest, and a particularly emotional one.  It quickly became clear that Chloe likely had an advanced cancer of some kind and needed to be put down.  My ex-wife handled it because I couldn’t be there – I was working.  Instead of dealing with it, I went from room to room pretending I was doing better than the absolute sh*t that I was feeling, and continued my usual ten-hour day of problem solving with patients.

I was in a dark, irritable mood.  My staff (bless them) joked and reassured me to cheer me up.  But all I wanted was go home to see my dog one last time, or failing that, crawl in a hole.  I had a hard time with some fairly easy medicine because I just couldn’t concentrate.  My supervising doc left me to close the clinic on my own for the last two hours but I didn’t want to call him unless absolutely necessary.  You’ll know that pressure too, but I guess that’s another article…

Amidst the struggle to bury my own problems and listen empathically to patients about theirs, my mind hovered on how I could finish each appointment quickly so I could get a momentary break.  Then maybe I would have a minute to collect myself.

But no.  I had back-to-back patients, and waited several hours for a good opportunity to use the restroom.  I got behind at one point and my lunch break vanished before it started.  To make matters worse, between patients, I was called upon by my staff for the usual running commentary of needs:

Such-and-such pharmacy is calling about so-and-so’s prescription that you wrote for blah blah – they don’t have neomycin/polymyxin/bacitracin eye drops and they want to know you want to do instead – Paul, can you sign this form – so-and-so is supposed to get their CPAP machine, but the medical equipment company needs the pressure settings before they can deliver it – Mrs. J from an hour ago is still here because you forgot to refill her blah blah –  Paul, can you sign this prescription – can you sign that too – and this – oh, and Mr. G needs a note for work – and there’s a pharmaceutical rep waiting to tell you all about the samples Newfancydrug-izole she’s leaving you…

And so on.

What kept circling through my head was nobody cares that my dog is dying, or more precisely, while I’m struggling personally to keep it together, everybody actually needs my help. 

Sometimes, friends, the job is just like this – you are the giving tree.

No matter what your specialty, population, location, or style, there are days when you need something and you won’t get it.  Not only will you not get it, you will not get it while continuously being vacuumed of what you do have as you minister to the needs of others.  I am also a marriage and family therapist, so I know all about “Self Care,” and “Sharpening the Saw,” but in this work, there are days when they go out the window.

Summary: The Giving Tree

For better and sometimes worse, medicine is a giving profession.  Before you jump into becoming a physician assistant (or a physician, for that matter), know that it will sometimes ask things from you even when you don’t have them to spare.  It will seem plenty unfair.  Sure, medical providers derive meaning and job satisfaction from helping others, but selflessness is a losing long term strategy for a provider’s mental health.  If you are sensitive, high maintenance, not-so-resilient, or dare I say needy, this may not be the field for you.

I’m guessing that there are readers out there who know exactly what being The Giving Tree is like.  Care to share?  I’m tapped out.  -P




  1. Ama March 27, 2013 at 3:09 am - Reply

    Paul I must say this is the most honest post about the day to day life of a medical professional I’ve seen by far. I do appreciate your candor and I think we as prospective PA’s need to know the reality of this field we so badly want to get into. This doesn’t change my resolve to be a PA by no means but it is a great insight into professionalism.Thanks Paul

  2. Kimberly Potter March 27, 2013 at 6:09 am - Reply

    Thanks Paul for sharing that! Very well written, I can feel exactly what you’re saying! I personally am resilient but I have my moments of weakness for sure and I am learning in my job as a CNA that this is true. I take a deep breath because there’s no turning back now! And I wouldn’t but it’s good to have a heads up! Thanks again!

  3. Rose G. March 27, 2013 at 12:03 pm - Reply

    Paul, you’re the best. Great writing, too. Hope all is well.

  4. Tiffany Welsh March 28, 2013 at 7:29 am - Reply

    Thank you Paul for your honesty! I am still on the long journey of finishing up my AA and applying to schools with a major in health science (yes I still have such a long way to go!). Stumbling upon this website was a huge help!

  5. Natasha March 29, 2013 at 8:49 am - Reply

    The giving tree idea can be applied to just about any medical profession (not just PAs). People need to realize it when they are going into medicine. We are there to help people get better. We all have things going on in our lives that can sidetrack us. In those situations I always put myself in the shoes of the patients I see because they are in the hospital during their most vulnerable times. That is why I always suggest every person that wants to go into medicine to do some volunteering/shadowing first. Many people unfortunately dont realize it is about patients and the team and not about themselves, the money, or the status.

  6. Sandy March 30, 2013 at 9:43 am - Reply

    WOW! Thank you, I never heard of “Giving Tree” until I read your post. So, I decided to go get the book myself and I have no regrets. To me the book means, Unconditional Love. This the REASON I want to become a PA. Thank you for sharing your life story with us Paul.

  7. josh pumroy March 30, 2013 at 6:58 pm - Reply


    I know exactly what you mean. I worked on an inpatient ward for a while as a Navy Corpsman, and I experienced that kind of fatigue first hand. It wasn’t the length of the shifts that wore me down, but it was a combination of seeing the same people come back time and again for the same problem and dealing with other less than cooperative patients. Some patients had mental health problems that were exhausting to deal with, and some were just plain demanding and whatever you give them never seems to be fast enough or helpful enough. Like you said though, it is part of the job and on some days you have to grit your teeth and be as pleasant as possible.

  8. Saul April 2, 2013 at 8:55 pm - Reply

    You are right about being like the giving tree. I am a PA student but before school, I was a paramedic. I remember days when I dealt with many sick people while I had problems of my own. It was difficult to do and those were restless days. I imagine more of the same when I become a PA. I believe that the most important thing is to always focus on the positive aspects of the profession. Every job in the world has good and bad days. We must all deal with our own problems but the level of satisfaction we get from working in the medical field must be what drives us to keep going. Knowing that every day, we have made a difference in someone’s life is a great feeling. Keep moving forward and thanks for the site! It has helped me tremendously.

  9. Samuel O Johnson April 3, 2013 at 8:30 am - Reply

    Paul, what a great resource this site is! I have gained a lot of useful information. Re: the Giving Tree, I admire and appreciate your honesty and your hard work. Yet, isnt it possible that being sensitive can be a strength and a positive attribute for a PA? Sometimes just being listened to by your PCP, as opposed to rushed through your eval, can help considerably with one’s ailments.

    I’m still taking pre-reqs and working toward the PA program is my goal. This site is bookmarked and referenced often. Thanks for keeping it up, despite life stuff happening. And finally, I’m so sorry about your pup. I hope your memories provide you bits of comfort throughout your day.

    • Paul April 3, 2013 at 8:56 am - Reply

      Thanks, Sam. Yes, I like to think that my psych background and my being an emotionally intelligent male improve my patient’s expereinces when they work with me. At the very least, I know that when someone comes in in tears because their spouse is leaving them or a family member died, I will sleep well that night because I have listened and gone beyond a 10 minute exam.

  10. Amy P April 5, 2013 at 1:25 pm - Reply

    I’m so sorry to hear about you losing Chloe. And, I understand about having to continue to put one foot in front of the other to help others while suffering inside. What would it have been like to say briefly to a patient or two that you trust, “I just want to share that I’m not quite myself today. I’m having a hard time because I just found out my dog has to be put to sleep.”? Our humanity connects us and makes others love us. You’ve talked about it in your e-book. Being candid in your post has truly been appreciated by everyone that has commented. Many thanks!

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