Logging on to the National Commission of Certification of Physician Assistant’s website and seeing I passed the boards was one of the happiest moments of my life. All of the hours I invested learning to take great care of patients were worth that feeling.

Like an entire generation of young, new graduates looking to make a positive impact in this world, I never felt more ready to begin my career. I accepted a dream position working at an urgent care clinic in Arizona. This work environment provided the variety I needed to stay stimulated, a very supportive staff and the most helpful supervising physician a PA could ever ask for.

But then I experienced a major paradigm shift. Nothing could have prepared me for the disappointment I felt when I realized we have inherited a healthcare system that is broken beyond repair.

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The American healthcare system is designed to keep patients sick and poor. Although not intentional, years of greed, poor regulation and many other variables have contributed to the skyrocketing cost of care.

My realization began when a young skateboarder came into the urgent care unit complaining of a broken collarbone. Before I entered the exam room, I saw a pink form creeping out from his chart, indicating he would be paying cash for this visit.

I walked in to the room and was greeted by a college-age gentleman in obvious pain. After hearing his story about a routine day ending in injury, I asked him what made him so sure his collarbone was broken. “I could hear and feel the snap. I’m positive it’s broken,” he replied.

When I suggested an x-ray, he began to politely argue the point of it. He asked me what difference it would make, if I were just going to put a sling on him anyway. I explained why it was not wise to skip the imaging, but I knew without a doubt he was concerned about cost.

Reluctantly the patient agreed to have x-rays taken. The result: a displaced clavicle fracture, completely broken in three places. What followed renders all healthcare providers powerless.

I began to educate the patient about his diagnosis, and how my resources are somewhat limited in the urgent care clinic. I explained that I am not an orthopedic specialist, but his injury warrants a consult.

I warned the patient that the worst-case scenario may be surgery and I would like him to be transferred to the local ER for further care. With a mixed expression of disbelief and hopelessness, he questioned my opinion and asked me call his father.

Within minutes, I found myself speaking with a father who was looking for answers. At one point he even said, “Can’t you just pop it back into place yourself? We don’t have the money for the ER, much less surgery!”

After hearing this man’s desperate attempt to avoid an ER visit, I grew angry. What healthcare system makes people feel it’s better to stay home suffering than seek the care they need? The answer: It’s the system we’ve inherited.

New graduates today are the forefront of tomorrow’s healthcare model. But no matter how much training you have had or hours you have spent studying, there is little that can be done about a patient refusing care.  

This encounter made me wonder “is this what I’m going to have to deal with the rest of my career?” I would like to think the patient in my story eventually made it to the hospital, but I am not sure.

I don’t know the solution to this healthcare crisis and our imploding system. But I can make a predication that it will inevitably collapse. I don’t think it takes a healthcare provider to recognize this.

With an aging population, comorbidities in epidemic proportions and the number of primary care providers dwindling everyday, the healthcare crisis is going to get worse before it gets better. It is important that all new graduates experience this paradigm shift themselves, because we’re not taught nearly enough in school about life.

Healthcare is more than just a field — it is an industry. It stands to be reasoned that the healthcare industry is not immune to the same strife as the U.S. banking, auto or oil industries. There will be many changes in upcoming years. We have to be prepared to accept whatever may come and be part of the solution.

I expect all new grads never to lose sight of why they chose this career path. There are too many older, miserable doctors — we’ve all met at least one — who have not remained positive about their jobs.

Despite the stresses and challenges that come with learning a new job and building a life for yourself, always remember the moment of accomplishment when you passed your boards. Make keeping your positive outlook a priority for the future.

Zachary Leonard, PA-C, is a 2012 graduate of King’s College Physician Assistant program in Wilkes-Barre, Penn. He is currently practicing full-time in urgent care medicine in Arizona.