As those of us working in healthcare know, people don’t just seek medical care between the hours of 9-5. This means that for those of us on the clinical side, hospitals and other healthcare centers need staffing at all hours of the day. It’s often tough to know which is a better fit for your professional and personal life, and often the choice is an binary as working in changing shifts (eg Emergency Department, Hospitalist, Urgent Care) or working with a fixed-schedule (Primary Care and many other outpatient practices). Given we sit on different sides on this, my co-author and business partner from The PA Blueprint, Jordan Fisher (PA-C), decided to discuss and debate shift work vs. fixed-scheduled work:

At this point in our careers, I (Shayne) am working in Family Medicine, doing the 8am-5pm, fixed-schedule thing.  Jordan is working in Urgent Care, doing the 8am-8pm, shift work thing.  There are certainly pros and cons to each type of work schedule, and we, of course, both feel that our current choice is FAR SUPERIOR to that of the other person.  Given that we love to have a little banter about this topic, typically as one of us is stuck at work and the other is doing something really fun during their time off, we figured we could bring our friendly debate to the masses, especially as we get TONS of questions about this during our PA Blueprint presentations.  Please find our agree-to-disagree, back-and-forth below, along with some recommendations about each type of work schedule, more of which can be found The PA Blueprint Ebook:


JORDAN: Imagine this: WORK STAYS AT WORK. The minute you clock out, you are done. No late night phone calls or finishing charts at home. Anything that is left open-ended becomes the work of your colleagues (which you of course pay forward when you are the one working). Outside of work you are free to do whatever you want. String multiple shifts together to get a long weekend, or even get a full week off without using a day of PTO. The flexibility of shift work is prime for the young (like me) and adventurous (like me). 

SHAYNE’S COUNTER:  First of all, Jordan’s claim to be adventurous couldn’t be further from the truth: His idea of adventure is a spending spree at REI.  Secondly, not everyone doing fixed-schedule work is doing hours and hours of work outside of our clinical time.  If you are efficient, and are able to draw hard and appropriate boundaries, the extra-clinical work is minimal, and totally worth working shorter shifts as a trade-off.  These days, fixed-schedule work allows me generous amounts of PTO, which should be used strategically, as saving up for a rainy day may actually be at the expense of your mental health!  I find plenty of time to have adventures and act young with my current schedule, in addition to having shorter days and less overall stress.


SHAYNE:  First of all, let me point out that Jordan is like 15 years old, and I’m like 80, so obviously I am the wiser one within this pairing.  Secondly, I’ve done both shift work for 4 years and fixed-schedule work for 4 years, so I have more experience to draw upon than Jordan (pulling the wisdom card yet again!).  Now that I’ve discredited my debate partner, here are three reasons why fixed-schedule work is better than shift work:

  1. Fixed-schedule work better appeases the Type A, “prefers-to-feel-in-control” side of all of us.  When you at least know the structure of your days and weeks, then you can be the master of your universe.  With “lack of control or autonomy” being listed on Medscape’s National Physician + Suicide Report 2020, having more control may also actually help to prevent burnout.
  2. A fixed-schedule is typically much better for aligning yourself to standard “9-5 life demands”.  If you have kids, then you may have to drop them off or pick them up, or take them to an appointment with their pediatric PA.  Or, perhaps you just have a spouse with a 9-5 job, so aligning your schedules allows you to maximize your time spent together (assuming you see that as a good thing).  Conforming to the societal norm of 9-5, Monday-Friday, might just be a good decision for some people.
  3. Shift work may not be good for your physical or mental health.  Whoa, this just got serious, and fast.  The bipolar nature of shift work, with really long work days and no structure on days off, may feel like too much of a roller coaster for your liking.  If you thrive with structure, then shift work may present some challenges to find time for self-care and other important aspects of having life-work balance.  Personally, I found that working 2-3 days in a row that started around 4am (self-care, breakfast, commuting, etc.) and ended around 9pm, was brutal, and really drove me to bad habits, burnout and depression.  With a fixed-schedule, you may have better consistency with your routines, leading you to feel better mentally and physically. 

JORDAN’s COUNTER: I will admit, the old man makes some good points. Shift work is not for the weak. The days you work are long, and if you are in certain settings, the hours may vary. You need to be on top of your game to maximize both days working and days off. This includes meal prep, fitting in exercise, and making sure you get an adequate amount of sleep. If you can do this, then you will get to enjoy monthly week long stints off to fill with fun. 

OK, so up to this point, who is winning this friendly debate?  Either way, here are some additional thoughts about what qualities may make you a better candidate for shift work versus a fixed-schedule:



  • You can fall asleep whenever. 
  • You like to have multiple days off in a row, including during the week. 
  • You don’t need structure. 
  • You are single or have a simple family situation. 
  • You don’t mind working weekends or holidays. 


I think that, should you agree with some of the following statements, you may be a good candidate for shift work:

  • You like variety.
  • You don’t mind working different shifts, such as an overnight or second shift.
  • You don’t mind running on a different schedule than much of the rest of the people around you.
  • You prefer to work longer shifts and less days per week.
  • You won’t feel totally burned out by working 3+ days in a row.
  • You love the idea of moving your schedule around to accommodate time off without burning up your paid time off hours.
  • Your personal life (family, self-care, chores, rest, etc.) is conducive to adjusting to a varied work schedule.
  • You DO NOT have insomnia or other chronic sleep issues.



  • You have a dog and don’t want to pay for doggy daycare. 
  • You don’t have discipline- it is very easy to skip workouts, eat out, and develop other bad habits after a long day. 
  • If everyone you hang out with lives for the weekends and you don’t want to miss out. 


Pretty much the opposite of my answer above, if you agree with some of the following statements, you may be better off considering a fixed schedule:

  • You prefer structured days.
  • You like to plan your days and weeks.
  • Your personal life has demands that only the typical 8am-5pm workday can accommodate (picking up/dropping off children, night classes, weekend plans, etc.).
  • You are not an evening or night person.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) By clicking any links from Efficient Clinician to their helpful website and purchasing any of their products, I will receive a percentage of the purchase. But, as I said previously, I will never commit to any agreement that will sacrifice my integrity.

KEYWORDS: #thePAblueprint #author #book #ebook #resource #compensation #loanrepayment #investing # retirementaccounts #CME #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance


I’ve been working as a PA for nearly 10 years, but only within the last 1.5 years did I understand my finances. I had no idea about investing upon graduation, and can still remember declining the 401k at my first job, as for some reason I thought of it as “gambling”. Whoops. Should I have starting maxing out my 401k from day 1, I would have another $375,000 to my name (estimated for simplicity)! Take a look below and you can see for yourself:

$375k is the amount I would currently have if I had been maxing out my 401k/403b since day 1 of my PA career.

So, just by not taking the step of maxing out my retirement accounts at my jobs, I’ve lost between $300-400k!

At my 2nd job, I was a bit wiser and took the 403b offered, but only was putting 3% in to get the 3% match. So, not all bad to know enough and take advantage of this “free money”, but still far from putting me on the path to financial independence.

It was during this third job though that my financial interest was piqued, so I decided to listen to Tony Robbins’ book Money: Master the Game. At the time, it was enlightening and motivating, and I rushed out to get myself a Registered Investment Advisor (RIA) to help me get on the best path forward. I found a group that seemed to align with my goals and interests, so I signed up for them to manage my investments, and they helped me organize my finances. This included me putting some savings to work by investing it, and then automating a set amount to go to those investment accounts each month.

Fast forward 3+ years, all of which was during one of the best bull (for the uninformed: A Bull market is good, Bear market is bad) markets in history, but my investment accounts didn’t seem to be reflecting those gains at all. I asked for an explanation, received what I thought was an appropriate and reassuring answer, and moved on with my life.

Then the pandemic started and my whole world seemed up in the air. Like many others in medicine, I was unsure if I would be furloughed, laid off, have a pay cut, or even get COVID and have my health suffer. I wasn’t sure if we really had 6+ months of emergency funds, nor did I understand if our finances we strong enough to give us the option to make career moves. I kept asking myself: “How financially resilient are we?

With our investment accounts not moving in a positive direction despite thinking we were set up for success, I decided that my financial ignorance needed to go. It is at that time that I discovered the F.I.R.E. (Financial Independence, Retire Early) movement. I read a few books (at the cost of <$100), and dove headfirst into some recommended blogs.

With just minimal time and money invested in my education, I could look at our numbers as an informed participant in our finances, which allowed me to ask better questions to our RIA. I also knew what to watch out for, such as expense ratios and AUM (Assets Under Management) fees, and I quickly realized that our investment accounts were far from optimized.

So, as many other Type-A people would do, I hit the spreadsheets. What I found astounded me! I compared what we were paying in fees with our financial management team, as opposed to what fees would be should we switch over to self-managing Vanguard index funds, and my mind was blown! I ran and re-ran the numbers to make sure they were correct, and here’s how much we were slated to lose to fees if we stayed on our current path:


Finding this out really pissed me off, frankly. I was upset with my financial team for feeling led astray from my “financial best interests”, but I also realized that they weren’t doing anything abnormal or illegal. I was also left mourning all of those investment gains that could have been with a better financial plan. On the positive side, I was relieved to be figuring all of this out now and saving nearly $500,000 in fees over the course of my lifetime!

When I approached my financial advisors about my findings, they gave me a bit of a run-around about how Index Funds aren’t for everyone and how their returns had not been what they expected. I informed them that I was likely moving my assets to Vanguard, and wanna know what they did: They immediately offered to lower their fees from 1% to 0.5%, just like that! Did YOU know that these fees were negotiable??? I sure didn’t, and with that offer, I could see that I was in the more leveraged position, and still said “Bye bye” to them and headed towards greener pastures.

Fast forward to now, and what a very different financial picture! Within the first half of 2021, our net worth has grown by $70,000, and all signs point to sustained and healthy growth in the future. I am also now on track to reach financial independence in 10 years, granting me the option to retire at age 50!

Here’s what we are doing to reach our goals:

  • Maxing out retirement accounts (Fidelity Index Fund for 403b via my employer).
  • Maxing out Roth IRAs.
  • Investing in Index Funds via Vanguard for IRAs/Roths.
  • Paying off student loan debt aggressively (so far, >$200k in 2 years of payments!)
  • Sustaining a savings/investment rate of close to 50%
  • Tracking everything through Personal Capital and homemade spreadsheets
  • Keeping expenses low by living our rich life

Back to the original question: What is the cost of financial ignorance? For me, it was $375,000! It’s a challenge not to think about that and ask the “What if” questions, but dwelling on the past is pointless. So, I choose to focus on the money that we are saving and earning with our new financial plan, knowing that we’re on the path to FIRE now.

If you feel financially ignorant yourself, then you are at risk of being taken advantage of, or at least not being positioned to optimize your finances. The potential losses due to your ignorance will cost you hundreds of thousands, maybe millions, such as what happened to me. The idea of this should piss you off, or at least scare you into consider learning a little bit about finances and investing. I can tell you from experience that it’s not that hard to get yourself on the optimal path forward, but the key is being willing to take ACTION!

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) By clicking any links from Efficient Clinician to their helpful website and purchasing any of their products, I will receive a percentage of the purchase. But, as I said previously, I will never commit to any agreement that will sacrifice my integrity.

KEYWORDS: #thepablueprint #burnout #medicine #physicianassistant #nursepractitioner #doctor #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #pandemic #timeoff #lifehacks #leverage #finances #studentloans #retirement #leverage #investments #FI #financialindependence


For many PA graduates, it’s interview season! Here are 5 tips to crush your interview:

  1. DRAW ON YOUR PA SCHOOL INTERVIEW EXPERIENCE. We all had to go through interviews to get accepted into PA school, so don’t you forget about these invaluable experiences. If you’re out looking for jobs, you obviously convinced 1 or more PA programs of how great you are, so reflect back on what you did to stand out from the crowd.
  2. DO YOUR HOMEWORK. You should enter each interview having researched the company that is interviewing you. Pay close attention to their mission statement and try to integrate some of the keywords from that into your answers. Ask yourself: “What can I say and do to show that my values are aligned with theirs?” Another example is if your potential employer is a FQHC, you need to understand what that means, and should demonstrate that understanding in your interview.
  3. DRESS FOR SUCCESS. First impressions are critical, so dress nicely for your interview. Do not wear anything flashy, provocative or sexy, but look like you mean business. This doesn’t mean you should break the bank getting a tailored Italian suit, as you poor post-PA students could probably do just as well at Marshalls or through online shopping.
  4. SPIN EVERYTHING POSITIVELY. Here’s an example: You’re not just a new grad, as you’re also a clean slate ready to be trained by your prospective employer. My example: I’ve had interviews where they questioned my PA-employment gaps (for extended time-off and sabbaticals), only to explain how I was prioritizing my life outside of work, leading to interesting conversations and allowing me to become unforgettable to them.
  5. BE PREPARED TO ASK QUESTIONS, NOT JUST ANSWER THEM. After doing your homework (see #2), prepare a few questions to ask of your interviewers. Not only does this demonstrate engagement and interest, but it also gets you out of the hot seat for a few minutes, and can lead to more conversations, as opposed to a standard question/answer format.

If you’re looking for even more interview tips, try this link. I highly suggest you also check out The PA Blueprint to better understand compensation, which may help with negotiating your contract, once you are offered a job.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) By clicking any links from Efficient Clinician to their helpful website and purchasing any of their products, I will receive a percentage of the purchase. But, as I said previously, I will never commit to any agreement that will sacrifice my integrity.

KEYWORDS: #interview #jobs #job #thePAblueprint #author #book #ebook #resource #compensation #loanrepayment #investing # retirementaccounts #CME #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance


Here’s a peek behind the curtain of my work days, as I’ve been asked about this recently, but before you read ahead, here’s this disclaimer: It’s not ground-breaking nor particularly exciting stuff. The keys for me to remain efficient and effective are consistency, structure, awareness, preparation and execution.

4-5AM: Wake up (before even Jocko Willink, might I add??!!), because early bird gets the worm, eh? Grab some locally-roasted coffee, fire up the computer and work on catching up from my previous work day, as well as doing pre-charting for the day ahead.

5-6AM: Self-care. I use a self-designed, balanced schedule to not have to think about what I need to do for that day:

Monday/Wednesday/Saturday = Yoga

Tuesday/Friday = Weight Training

Thursday/Sunday = Outdoor Recreation

6:30AM – 7:30AM: Shower, Breakfast, Dog Walk. I start my day with a healthy meal, usually 1 of 2 options:

Breakfast #1: 3 Eggs, Refried Beans, Cheddar Cheese, Roasted Sweet Potatoes on Salad Greens or Spinach

Breakfast #2: Vegan Smoothie w/ Coconut Milk, Pea Protein Powder, Banana, Blueberries, Peanut Butter, Cocao Powder, Maple Syrup

7:30AM – 8:15AM: Work prep. I walk to work (2 minutes down the street), get situated at my desk, finish anything up from the day before, and make sure I am maximally prepared for my day ahead. We do a provider-nurse huddle between 8-8:15, wherein we discuss the schedule, what is to be expected, and this is where my preparation begins to pay dividends. If I am precepting a student, this is the time where we review their documentation from the day before, discuss interesting cases, work on educating them about the PA career or just let the day unfold.

8:15AM – 12:30PM: Morning of patient care. I work in family medicine, so I see all ages, and like that variety. Patient visits are usually 15-60 minutes, depending on the complaint and what is available on the schedule.

12:30PM – 1PM: Lunch break. I walk back home to let my dog out and physically remove myself from the office, eat lunch, then head back for finishing touches on the morning. Lunch is almost always some Indian food from Trader Joe’s…I know, it’s frozen food, but I like it, it’s convenient, and I don’t have to make a big decision about.

1PM – 5PM: Afternoon of patient care. Nearly identical to the morning, but without the huddle. Always striving to get out on time (5PM), or close to it, so I’ve gotta stay focused and on top of seeing patients, writing notes, managing messages, paperwork and keeping good communication with the support staff.

5:30PM: Dinner. Usually my wife and I sit down and catch up, typically we are eating a meal that we prepared previously and are just heating up. Mondays are “date night”, so we invite each other to speak freely and use the opportunity to discuss anything important and/or heavy.

6-7:30PM: Wind down. Usually a show or two on Netflix, and if I’m feeling motivated, some passive stretching while we are watching.

7:30PM: Prepare for sleep. Brush teeth, read a bit, then go to sleep. Rinse and repeat the next day if working, and if not, tip the scales towards more life and less work.

Is any of that particularly excited? Probably not. What it is though is what works best for me, optimizing my work days, and allowing me to have structure, life-work balance and feel like I’m firing on all cylinders. You should figure out a routine that allows you to be at your best, one that compliments how you function, and stick to it.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) By clicking any links from Efficient Clinician to their helpful website and purchasing any of their products, I will receive a percentage of the purchase. But, as I said previously, I will never commit to any agreement that will sacrifice my integrity.

KEYWORDS: #thePAblueprint #author #book #ebook #resource #compensation #loanrepayment #investing # retirementaccounts #CME #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance


This is my beautiful wife at Lac Blanc.

Here’s the message that I want to help spread: You get to make choices about which path you take during your PA career. You either choose  a Path of Prosperity or the Status Quo path.

With approximately 50% of PAs experiencing burnout at some point during their careers, along with massive student loan burdens and a lack of financial acumen, it’s easy to start and then continue down the Status Quo path. Along this Status Quo path, you have a moderate amount of success on most fronts. However, you play more of a passive role in how your career advances, how much money you make, how quickly your 401k grows, how fast you pay off your student loans, how frequently you experience burnout, how balanced your life and work are, and how fulfilled you feel. From what I’ve seen, most gravitate to this track, and there’s inherently nothing wrong with that, but it’s not optimal.  As someone whose been on that path before, it’s not great.

On the flip side, there’s an ability to grab the wheel of your career and your life, steering yourself down the Path of Prosperity. With some vision, intention, and energy, you can cultivate your best life. As you become empowered by taking control of your destiny, you may be able to accomplish goals such as:

  • Finding your optimal life-work balance.
  • Paying off over $200,000 of student loan debt in 2 years.
  • Becoming the highest paid and/or highest ranking APP in your organization.
  • Getting on track to become financially independent within 15 years and have the option to continue working or not.
  • Take sabbaticals and extended vacations to prioritize life over work.
  • Start a passion project or side-hustle to scratch your entrepreneurial itch.

I know these things are possible because I’ve achieved all of these within my 9 years of being a PA-C. Although your idea of prosperity may not completely align with mine, I’m sure that you have a vision of what an “optimal life” looks like.

Many of us daydream about this Path of Prosperity, but sadly, many also fail to take action on their vision. Overcoming the inertia and fear is scary and not always easy, or else we’d probably all be millionaires with six-pack abs, right?  Fortunately, many of us just need someone or something to light a fire in us that burns hot enough to drive us to take that first step towards what we want.

Practically speaking, the best place to start your journey is with learning the basics, as we all did via our PA school educations. Well, my former student, Jordan Fisher and I got together last year and were discussing how there were no great resources to help kickstart your career learning. So, we created such a resource to light your career fire, educating and guiding you to your Path of Prosperity: The PA Blueprint.

In The PA Blueprint, we cover the basics on what you need to know, along with practical tools, tips and hacks to take action with your knowledge.  There are 6 chapters: Compensation, Loan Repayment, Retirement Accounts (401k, 403b), CME, Burnout and Navigating your Work Environment. As you started your PA training with Medical Terminology, we like to think of this book as “Career Terminology” with an action plan. The information contained within these chapters have the potential to save you hundreds of thousands of dollars (or more!), years of spinning your wheels feeling complacent as a slave to your student loans, and countless headaches and frustrations. In short, it is the resource that we wish we would’ve had upon graduation from PA school.

To demonstrate the power of the book’s contents, here are a few of the many positive reviews we have received:

“We may spend years becoming PAs but we spend a lot more time actually being PAs. The PA Blueprint provides nuts and bolts, practical tools to use in the important endeavor of being a successful PA, both professionally and personally. Whether you are a recent graduate navigating the new landscape of being an advanced practice provider or you are a seasoned PA, Jordan and Shayne’s straightforward, no-nonsense approach will definitely be beneficial as you work to make the most out of your profession.”

–Amy, Urgent Care

“As a 20-year veteran APP, I still found so much useful information in The Physician Assistant Blueprint. This should be required reading not just for new graduates, but for professionals every couple of years. It is an opportunity to schedule a checkup on finances, take a temperature on burnout, and do a self-assessment on personal practice style. The Ebook is a great value, including not just interesting content, but also a host of useful links.”

-Alison, Family Medicine

So, if you’re ready to get on the Path to Prosperity, here’s another nudge in that direction: An exclusive 25% discount on The PA Blueprint, only for those who are truly ready for change.

PROMO CODE:  imready25

Either before or after you take action on your journey, I’d love to hear from you, and you can email me at: For now, get going on making your actions align with your visions, and I’ll hopefully catch you on the flip side!

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) By clicking any links from Efficient Clinician to their helpful website and purchasing any of their products, I will receive a percentage of the purchase. But, as I said previously, I will never commit to any agreement that will sacrifice my integrity.

KEYWORDS: #thePAblueprint # author #book #ebook #resource #compensation #loanrepayment #investing # retirementaccounts #CME #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance


Photo by Karolina Grabowska on

Remember when I said “Call me MDCalc?” Well, as it turns out, they did, and I’ve since learned a lot more about their CME packages. For using their research-based algorithms, which most of us are already doing, you can claim CME credits and simultaneously get Gift Cards upwards of $2750! These gift cards can be used at the following places:

Visa, Amazon, Target, Apple, Home Depot, Athleta, Lowe’s, Omaha Steaks, Best Buy, CharityChoice, Barnes and Noble, Walmart, and Nordstrom

Not bad, eh? All you have to do is to take the extra few minutes to log into your FREE account, make sure that the calculators that you’re using do qualify for CME credits, and read up on the calculator. Familiarizing yourself with the background, appropriate use, limitations and other details about these calculators can only improve your integration of these tools into your Medical Decision Making (MDM)! So, this is a triple win:

  1. Learn more about the calculators used by and improve your MDM documentation!
  2. Get your required CME credits via your CME $$$ allotment from your employer.
  3. Receive a massive Gift Card to spend as you wish.

If you find yourself with some leftover CME $$$ with the end of your fiscal year rapidly approaching, I STRONGLY recommend using those funds to get yourself one of those Gift Cards from MDCalc! Do not let that free $$$ go to waste!

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) By clicking any links from Efficient Clinician to their helpful website and purchasing any of their products, I will receive a percentage of the purchase. But, as I said previously, I will never commit to any agreement that will sacrifice my integrity.

KEYWORDS: #MDCalc #burnout #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance


Unsolicited opinion warning: I see a lot of Hippocratic hypocrisy when I look around medicine.  During our training and careers, we are laser-focused on the clinical skills needed for a career of “doing no harm” to those we care for, yet we never had to pledge to give the same to ourselves, nor did the system-at-large have to do so.  Our altruism and efforts are honorable, but the current state of healthcare worker well-being tells me that we may need to take some of our own medicine.

Sadly, many of us are walking around feeling burned out, underpaid, unable to pay off our student loans, losing hundreds of thousands of dollars on retirement investing and generally feeling unfulfilled.  One of the main reasons is that our medical system doesn’t simultaneously develop our clinical and career skills, leaving us to naively figure out the latter.  During our didactic and clinical educations, we are so focused on learning our trade that we fail to learn about what it takes to have a prosperous and fulfilling career.

It seems that there is not enough time within a compact curriculum to integrate in lectures about critical aspects of our career.  For argument’s sake, let just agree that that is true, making the next opportunity to learn about these career facets once you start your clinical experiences.  My question is: Have you had the experience of a teacher, preceptor, mentor or supervisor taking the time to give you solid career training?  Mostly likely, your answer is no, and that is one of many opportunities lost.

Maybe our clinical training time is not the optimal to learn about and absorb information on compensation plans, 401k investment options, continuing medical education (CME), burnout prevention or any of these things.  Perhaps our mental bandwidth doesn’t allow for concurrent learning of clinical and career skills, and we just need to focus on getting to Day 1 of our new careers, and then will figure it out.  Our employer will be there to act as our financial and well-being fiduciary, guiding us onto the optimal career path, right?  Well, maybe not.

Tell me if this sounds familiar: 

You’re excited and anxious about starting your new job, and your new employer sets up a whirlwind of an orientation.  You are introduced to your new colleagues, meet with HR, sign a mountain of paperwork, and then get set up at your new workplace.  During these hectic first few days, you’re so focused on getting to Day 1 that you can’t even recall what health insurance plan you signed up for, which 401k plan you chose, the details of your compensation plan, or which resources you have for burnout.  All you have to show from your orientation is that folder briming with paperwork and flyers, much of which is impossible to decipher.  You were told that you can always change the elections that you’ve made, once per year during open enrollment.  So, between the ability to do that and those optional meetings with the Fidelity representative, you convince yourself that you’ll be able to figure out these complex issues, but just after you start.

Then comes day 1, and you realize that being in the medical field is quite demanding.  The tasks are complex, consequences of making a mistake dire, and support not as present as you hoped for.  Within those first formative years of your career, the learning curve is steep, and commands most of your attention.  The months and years pass, with each open enrollment coming and going, your financial advisor telling you to stay the course, and that life-work balance not quite where you want it. Nonetheless, you soldier on and vow to figure out how forge your best path forward.

Perhaps you decide that you deserve a raise, but yet don’t know the optimal way to do this?  Or, perhaps you get inspired to better understand your 401k, but get so overwhelmed by the details that you decide to stay the subpar course that you’re already on.  Or, perhaps you want to take control of the burnout that is setting in, but yet don’t know strategies to start the healing process?  If any of this sounds familiar, then you’re not alone, and need to understand that much of this is not your fault or evidence of your inability to hack it.

How can we be expected to thrive in our careers if most of us do not even receive training on critical aspects of our career foundation?  What saddens me is that our ignorance on professional training is causing us harm.  This is evidenced by the burnout epidemic, huge chunks of retirement savings being siphoned away by predatory practices, crippling loan debt and healthcare workers feeling disenfranchised. 

The good news is that there is way to forge a better career path.  There are many things that you can and should be doing on your own, which can serve to empower you to live your best life.  But the onus of responsibility is not just on us as individuals, and should be shared with our medical institutions.  What we need is more educational and healthcare institutions making career training a priority, taking actions to standardize and improve upon this.  Fortunately, some well-renowned public and private establishments are helping us move the needle towards better well-being for medical professionals. 

What I’d like to see is a more pragmatic approach to career development, with practical and meaningful actions being taken to relieve the burden of harm being done to us caregivers.   I’d like to see more institutions swearing to fulfill, to the best of their ability and judgment, with “warmth, sympathy and understanding”, a pledge to improve the lives of medical professionals in order for us to “enjoy life and art” as we so deserve.  And in doing so, may these institutions “experience the joy of healing those who seek their help.”

Want to take some steps forward in your career? Check out The PA Blueprint, where we cover the most pertinent aspects of a career in medicine: Burnout, compensation, loan repayment, retirement accounts and more.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) Remember when I said “Call me MDCalc?” Well, as it turns out, they did, and we have entered into an affiliate agreement. By clicking any links from Efficient Clinician to their helpful website and purchasing any of their products, I will receive a percentage of the purchase. But, as I said previously, I will never commit to any agreement that will sacrifice my integrity.

KEYWORDS: #thePAblueprint #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance


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Before you just right into Burnout Part 7: Prevention, I’d like to bring attention to this NYT article on Burnout, from 4/30/21. While I agree with the content, these articles are too brief for a good understanding of burnout, and leave us with only a few actionable items. Given that this was an epidemic amongst medical professionals before the pandemic, and likely is at an all-time high now, Jordan Fisher and I dedicated an entire chapter on Burnout in “The PA Blueprint” (early release sale here). In our chapter, we discuss the nuts ‘n bolts of burnout, including signs and symptoms, and then spend the majority of the chapter discussing treatment and prevention. Below is my gift to you: the entire Burnout prevention section. Enjoy, and thanks for your support with the book!


Now, if you have successfully treated your burnout, or are in the process of doing so, you should be considering ways to keep yourself protected from having a recurrence. The best way to prevent “future you” from once again experiencing burnout is by transitioning from a reactive to a proactive mindset, and also from a fixed to a growth mindset

“An ounce of prevention is worth a pound of cure.”

-Benjamin Franklin

Ben Franklin’s words are a powerful reminder when it comes to burnout. Prevention, although not a guarantee that you will be immune, acts similarly to a vaccine: It makes you less likely to develop the problem in the first place, but can also decrease the severity of a case. 

Prevention is often thought of as a passive and defensive strategy, and although there is absolutely a protective and insulating element to it, you also need to go on the offensive. Take yourself out of the “helpless victim” mindset and into a “master of your destiny” mentality. You can go from feeling like the puppet to feeling like the puppeteer. Even within the medical systems that you find yourself in, all you will need is to learn the nuances of the systems, deconstruct them, and then re-engineer them by tailoring a strategy to fit your needs.

The way to do this is to look at both the causes of burnout and your “DRAIN vs. RECHARGE” list (see this previous post). We’ve already talked about the easy part, rebalancing your scales through this metric. Now, let’s move on to the offensive and talk about flipping the script on causes. 

Have another look at the Mayo Clinic’s causes for burnout, listed earlier in this chapter. Each “cause” is not a dead end; there are many potential solutions if you look at the list through the lens of how you can flip the script.

  • Cause: Lack of control. Solutions: Take control. Be like a stoic, and focus on what is within your control. If you’re a Type A personality, which I’m willing to bet the majority of you are, then focus on some factors that you can control, such as EMR efficiency, healthy eating choices, improving the dialogue in your head, and perhaps limiting time spent with the “angry elves” in your office.   
  • Cause: Unclear job expectations. Solutions: Clear up those job expectations. Ask your office manager, medical director, or whomever is in a leadership position just what exactly is expected of you, and demand specifics.
  • Cause: Challenging dynamics in the workplace. Solutions: Improve those office dynamics. Work to improve your relationship with your boss, coworkers, etc…be the change you wish to see. Send a note of “Thanks,” commend someone for their thorough documentation, or schedule a time to have 5-10 minutes with a coworker. Break down those barriers.
  • Cause: Extreme demands on energy. Solutions: Moderate the activity extremes. Keep in mind that your attention requires energy, and that is finite. If work is slow, don’t fill that gap in with checking Instagram, but instead fill it with silence or something from your RECHARGE list. If work is crazy busy, plug the energy-leaks found in your DRAIN list and minimize the damage. Focus on your breathing, lean on your efficiency systems and be aware of the stories that you may be telling yourself. 
  • Cause: Lack of social support. Solutions: Take concrete actions to build your social support network. Randomly message a colleague with a compliment. Join a committee at work. Deepen the relationships with your coworkers. Find a support group online. Schedule time to chat with your most supportive friends and family.
  • Cause: Life-work imbalance. Solutions: Focus on finding your personal balance point. “Know thyself,” including your own signs and symptoms of burnout. Set clear boundaries and defend them mercilessly. Be intentional about how you spend your non-clinical hours.

Similarly, we can reconsider the Medscape National Physician Burnout & Suicide Report 2020 with the flip the script mindset, to focus our burnout prevention efforts on a few priorities:

  • Cause: Excessive bureaucratic tasks. Solutions: Decrease time spent on bureaucratic tasks. Delegate paperwork to others. Minimize distractions. Batch bureaucratic activities. Increase EMR efficiency and proficiency.   
  • Cause: Too many hours at work. Solutions: Work fewer hours. Say “NO” to extra shifts. Schedule stretches of consecutive days off. Minimize work time spent outside of clinical shifts.
  • Cause: Lack of respect from colleagues. Solutions: Demand and earn more respect from colleagues. Be consistent and calm. Grow your medical knowledge and let that show. Lead by being an example of what work-life balance should look like.
  • Cause: Increased use of EHR. Solutions: Decrease time spent with EMR/EHR. Use Dragon to dictate. Take a FREE EMR proficiency class through IT. Get FREE EMR training as a Super-User in your specialty and then teach others.
  • Cause: Insufficient compensation. Solutions: Get paid more. Go above and beyond what is required (and document examples). Be a leader. Improve your billing and coding skills. Reread your compensation plan, deconstruct it, and re-engineer it to allow you to earn more money. (Read the COMPENSATION chapter of this book for a deeper dive, along with resources and tips.)
  • Cause: Lack of control/autonomy. Solutions: Gain more control and autonomy. Stay focused on what is within your control. Go on the burnout prevention offensive. Keep up on your CME for clinical confidence.

Some will read these lists and think “Sounds like a PA fantasy world, but it’s not realistic.” While it is true that the medical-industrial complex is only recently recognizing the burnout epidemic, there are practical steps that you can take, in conjunction with small changes via reframing your cynical outlook, to make the system work for you. 

Finally, let’s look back at this Mayo Clinic list of burnout-associated statements and flip the script to create some thriving-associated statements:

  • Problem: You identify so strongly with work that you lack balance between your work life and your personal life. Solutions: You identify not solely as a PA, but as a multi-dimensional being who works as a PA. You value the importance of balancing your personal and professional life, for sustainability and for health. You leave work at work, as much as possible.
  • Problem: You have a high workload, including overtime work. Solutions: You set clear work boundaries. You advocate for yourself, take small steps to decrease your work burden, and are thankful for the ability to change jobs if necessary.
  • Problem: You try to be everything to everyone. Solutions: You understand and accept your limits. You remember “everything to everyone” is an impossible goal and remind yourself that doing your best is enough. You know your capabilities and are mindful not to overextend yourself. 
  • Problem: You work in a helping profession, such as health care. Solutions: Physician, heal thyself. You value helping others, but appreciate that you cannot give what you don’t have yourself. Remember, you need to put your own oxygen mask on first before you can be of help to others.
  • Problem: You feel you have little or no control over your work. Solutions: Put your energy where it counts. You appreciate that, although you cannot control everything, you are empowered to focus on the aspects where you do have control, and put energy towards those.
  • Problem: Your job is monotonous. Solutions: Appreciate the little things. You find or intentionally cultivate tiny wins and novel experiences each and every day, and then celebrate them. You see every day as a scavenger hunt for the extraordinary and beautiful. 

Some causes of burnout are likely to be beyond our control (such as “reimbursement rates for services rendered”), so there is little sense in focusing on those. Instead, it’s best for you to focus on the things you can change, keep your expectations reasonable as you build your prevention strategies, and then take small, manageable steps to strengthen your resolve and resilience as they apply to burnout.   

One way of looking at the process of positive change, which we highly recommended, comes from the best-selling book “Atomic Habits” by James Clear. The overarching message is to aim for making yourself 1% better than the day before. These “atomic” changes, via new habits and systems, will amount to exponential benefits when implemented consistently over time. By simply adding in one new EMR template, taking 5 minutes of quiet time during your workday, or reconnecting with your curious PA-S self, you have moved the needle by 1% in the right direction, and need to acknowledge and celebrate that fact. No good deed should go unappreciated, and your future self will be saying “Thanks.” 

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

KEYWORDS: #thePAblueprint #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance


Fellow PAs and other medical professionals: We are just about at the finish line and ready to publish “The PA Blueprint”, and below you see a brief preview of the PDF version.


We are looking for medical professionals who are interested in a HUGE discount on “The PA Blueprint”, in exchange for a review. If you are interested, email us: We will send you a discount code and ask that you send us a review within 5-7 days.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

KEYWORDS: #thePAblueprint # author #book #ebook #resource #compensation #loanrepayment #investing # retirementaccounts #CME #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance


As the saying doesn’t go: “When life hands you a pandemic and leaves you with a lot of time on your hands without the ability to do much, connect with a former student and write a book to improve your profession.”

Well, I took that great advice that nobody has ever said, and ran with it, connecting with another PA-author, Jordan Fisher, whose previous work, “Physician Assistant Next Steps”, is an excellent resource for PA students about to graduate.

“The PA Blueprint: your guide to career advancement, getting rich, beating burnout and finding your dream job” is a resource for PAs and other medical professionals that can and should be used to get what you want and deserve out of your career. In the 100+ pages, packed with hundreds of hyperlinks, tips, hacks, anecdotes and action items, we cover the following:

  1. Compensation.
  2. Loan Repayment.
  3. Retirement Accounts (401k, 403b, etc.).
  4. CME.
  5. Burnout.
  6. Navigating Your Work Environment.

Jordan and I thought that these were the post pertinent topics to cover, and are dimensions that, when you get them right, lead to exceeding your goals and designing of the career path of your choice. I like to think of these career-facets as the foundation of your career, and also as having the potential to make you “pandemic-proof” in the future.

“The PA Blueprint” will be out next week, which I’m excited to announce. It will be available via ebook and PDF, given that the resources contained with it, such as the hyperlinks, do not lend themselves to a hard copy. Our website is, but is under construction still, with some last minute changes being made.

We are also booking presentations for PA programs across the country, establishing ourselves as a critical piece of the professional education necessary for new clinicians. If you’re interested in this for your PA program, let us know, as we are offering this for FREE still:

If you’ve liked reading this blog so far, this has just been the beginning, where I’ve cut my teeth and also gained the momentum to tackle larger projects with even bigger impact. Cheers to my readers for their contributions so far, and I encourage you to come along with me for whatever comes next.

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

KEYWORDS: #thePAblueprint # author #book #ebook #resource #compensation #loanrepayment #investing # retirementaccounts #CME #burnout #depression #medicine #physicianassistant #nursepractitioner #doctor #physician #barriers #wellness #efficiency #proficiency #control #worklifebalance #happinessatwork #carpediem #clinician #stress #covid #covid19 #pandemic #lifehacks #leverage #tools #charting #physician #MDM #worklife #worklifebalance