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Job outlook and ability to find one?


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Hello All,

 

I decided to post this here instead of the Pre-PA forum because you all have experience and more knowledge about the question I am asking. When you graduated PA school how hard was it to find a job? Also, how hard do you think it will be now a days?

 

The biggest thing I am seeing is that LP's are pushing out PA's, which worries me for obvious reasons. I am still somewhat young (23) and would like to practice medicine as a PA for various reasons. I'm worried that by the time I graduate from PA school that NP's will have consumed many of the jobs and my chances of practicing medicine will be low. Is this a realistic fear?

 

 

I know this is kind of a newbie question and I will delete it, if it has already been answered before.

 

 

Thanks for your time!

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I graduated PA school in 2010, and was a paramedic prior to that for 20 years, most of it in the military and the U.S. Government in wonderful places like Iraq, Afghanistan, Bosnia, Somalia and El Salvador. I also worked as a private contractor doing bodyguard work along with being a medic in Sierra Leone, Israel, Libya and Mexico. I just got my first full-time job in Austin three months ago, and when privileges are done, will start in early September.

 

Here in Austin, it's very difficult to get jobs as a PA. I had one doctor actually tell me to my face, I need to come to the realization that I am going to get offers 30% less than anywhere else in Texas because I want the privileges in Texas. He told me that if I wasn't willing to take this cut for the privilege of working for him, I might not be the right person for his team. Since that was only the second question he asked me, I thanked him for his time and for wasting mine, took several drinks out of the refrigerator in the lounge, a handful of cookies and as many sandwiches off the tray that I could cram into my backpack and left. He may have wasted my time, but I got several days of Jimmy John's and soft drinks!!

 

It really depends on where you are wanting to live before you get an accurate answer. PA's in Houston in ER make 30K more starting right out of school than PA's in Austin ER's make; just the way it is. There is no demand for PA's in Austin because there so many doctors that work here, why hire a PA? Doctors leave Houston in droves, so PA's can negotiate good salaries over there without being made to feel like you are stealing food out of the mouths of your SP's children.

 

The next thing to kill pay salaries is doctors that desire to keep medicare patients on the rolls, but pawn them onto the mid-level staff. Many providers say they will see medicare patients in Texas for 5 years so they can get their licenses early. Sadly, all these low yield losers fall to mid levels as their providers. Not only am I being told I have to take them, I'm told I have to give them education. The same education they've been give twice a year for the past three years. They didn't pay attention then, they won't pay attention now. You are seeing patients with the lowest possible reimbursement, who complain and gripe constantly "yes honey, that is your morning pill, didn't you know that? Then why do I take it in the evenings before I pee? I've been doing this for years, this isn't a doctor, why are we wasting out time with him? Yes, the low yield loser, love him or hate him, but he is the vampire bat of medical resources. He bleeds it dry then moves on to another hospital to destroy; he used to be easy to identify, the medicare patient or the illegal alien. One presented with poor insurance and in poor health, the other presented with no insurance, a fake name and a lawyer to call when he couldn't get fixed and come out treated like the president.

 

Ah, the lovely medicare group. The obamacare group will be the medicare group on pcp if they are under 30 and on Haldol if they are over 30. Hopefully the rest burned away into obliviion... These are the patients that can't be seen anywhere else. Basically, Emergency Rooms will get this low yield loser dumped on their doorsteps when obamacare is fully implimented. It's because their own doctors were smart enought to get rid of this low yield loser early, and the ER is now the treatment room for those people sad enough to have obamacare or medicare, medicaid, chip or any other federally funded plan.

 

It's sad, and I get calls from Doctors daily that want PA's all over central Texas. They want part time, under 30 hours a week. They want you to only see medicare patients, CHiP patients and obamacare patients. Basically the low yield losers that all the doctors decided to dump. What am I supposed to do with this bunch? They won't be compliant on meds (they never are), they won't take care of the basics forst, weight loss, diet change, regular exercise, more weight loss tricks, and move that large set of gluts you are carrying around why don't you?

 

I told my last SP that if he wanted to bring this Obamacare goup in, and ramp the cumputer system as well, I needed to implement it. I didn't want the system to be designed to be thourough by medical standards, I wanted it to take into consideration that these were an exception. They were non-compliant, uneducated and unable to learn or one of the many other providers that see them monthly would have made them grasp a few concepts. It's clear with this group, you look into the eyes and nobody's home... Why are you wasting time here you ask yourself. These patients don't need a provider, they need a babysitter and an LVN. They don't do what we say, month after month, they come back in and ask the same questions they asked the month before...

 

What is the solution? I see myself trying to work concierge; with select patients, you won't get the medicare curse.... that small group of 10% of your patients who take up 90% of your time.

 

John K, PA-C

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.........What is the solution? I see myself trying to work concierge; with select patients, you won't get the medicare curse.... that small group of 10% of your patients who take up 90% of your time.

 

John K, PA-C

 

Speaking of concierge practices, are PAs playing a role there? These practices are usually advertised as providing excellent access to "the doctor". Is there ever any pushback from patients, who have paid that extra concierge fee, when they see a PA instead?

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"Sadly, all these low yield losers fall to mid levels as their providers." "Yes, the low yield loser, love him or hate him, but he is the vampire bat of medical resources." "Basically, Emergency Rooms will get this low yield loser dumped on their doorsteps when obamacare is fully implimented. It's because their own doctors were smart enought to get rid of this low yield loser early, and the ER is now the treatment room for those people sad enough to have obamacare or medicare, medicaid, chip or any other federally funded plan." "Basically the low yield losers that all the doctors decided to dump."

 

 

John K, PA-C

 

 

wow.......

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I started my job hunt in Chicago, as that was where I lived and went to PA school. I had no problem getting interviews but the offers were pretty bad. I did not get the impression that NPs were pushing out PAs in that market, although obviously you'll always be able to find an example if you look hard enough. I ended up moving a significant distance for a great offer in a field I love, and started working three weeks ago (2 months after I graduated). My classmates who've stayed in Chicago have all found work if they were actively searching.

 

I can't imagine that in a few years the landscape will have changed so much, but it's always possible.

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Wow... I have never seen someone slam the elderly on Medicare quite as harsh as I have in this thread.

"The next thing to kill pay salaries is doctors that desire to keep
medicare
patients on the rolls, but pawn them onto the mid-level staff. Many providers say they will see medicare patients in Texas for 5 years so they can get their licenses early. Sadly, all these
low yield losers
fall to mid levels as their providers. Not only am I being told I have to take them, I'm told I have to give them education. The same education they've been give twice a year for the past three years. They didn't pay attention then, they won't pay attention now. You are seeing patients with the lowest possible reimbursement, who complain and gripe constantly "yes honey, that is your morning pill, didn't you know that? Then why do I take it in the evenings before I pee? I've been doing this for years, this isn't a doctor, why are we wasting out time with him? Yes, the low yield loser, love him or hate him, but he is the vampire bat of medical resources. He bleeds it dry then moves on to another hospital to destroy; he used to be easy to identify, the medicare patient or the illegal alien.
"

 

...

"
What am I supposed to do with this bunch? They won't be compliant on meds (they never are), they won't take care of the basics forst, weight loss, diet change, regular exercise, more weight loss tricks, and move that large set of gluts you are carrying around why don't you?"

If it makes you any happier... they are old and will probably die soon??? Stupid low yield losers!

 

Edit:

I get the common frustration with Medicaid patients. I guess I just don't understand the vitriol for the Medicare ones. Maybe I will someday come to a point where I see a 70 year-old come in and think to myself, "Not another low yield loser!"

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Wow... I have never seen someone slam the elderly on Medicare quite as harsh as I have in this thread.

"The next thing to kill pay salaries is doctors that desire to keep
medicare
patients on the rolls, but pawn them onto the mid-level staff. Many providers say they will see medicare patients in Texas for 5 years so they can get their licenses early. Sadly, all these
low yield losers
fall to mid levels as their providers. Not only am I being told I have to take them, I'm told I have to give them education. The same education they've been give twice a year for the past three years. They didn't pay attention then, they won't pay attention now. You are seeing patients with the lowest possible reimbursement, who complain and gripe constantly "yes honey, that is your morning pill, didn't you know that? Then why do I take it in the evenings before I pee? I've been doing this for years, this isn't a doctor, why are we wasting out time with him? Yes, the low yield loser, love him or hate him, but he is the vampire bat of medical resources. He bleeds it dry then moves on to another hospital to destroy; he used to be easy to identify, the medicare patient or the illegal alien.
"

 

...

"
What am I supposed to do with this bunch? They won't be compliant on meds (they never are), they won't take care of the basics forst, weight loss, diet change, regular exercise, more weight loss tricks, and move that large set of gluts you are carrying around why don't you?"

If it makes you any happier... they are old and will probably die soon??? Stupid low yield losers!

 

I'm glad to see there is outrage out there. I've been fuming. Wanted to respond much, much more vehemently than I allowed myself to do.

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I'm glad to see there is outrage out there. I've been fuming. Wanted to respond much, much more vehemently than I allowed myself to do.

 

I held back too. As a Pre-PA we sometimes get slammed for speaking without actual PA experience. But I cant help but think a bit of humility might be beneficial.

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Speaking of concierge practices, are PAs playing a role there? These practices are usually advertised as providing excellent access to "the doctor". Is there ever any pushback from patients, who have paid that extra concierge fee, when they see a PA instead?

 

There are a few concierge practices popping up in our larger cities - they have all let their PA's or NP's go. Our docs tried to go concierge a few years ago and our community balked and there was a lot of anger amongst our patients (remember this is small town KY). Several of the docs that have started a concierge practice, all tell me they see about 8-10 patients a day so there is no need for a PA or NP.

 

Regarding the medicare/medicaid population - since I am in FP - I am sure we do not see those folks that are the dredges of society that come, to perhaps the ER, for their pain meds, etc. Everyone in the area knows that our practice does urine drug screens, contracts, pill counts and KASPER reports for anyone that comes in seeking narcotics.

 

I do my best to remember that those medicaid patients sitting opposite of me have not always gotten to where they are, by being a deadbeat loser. Sometimes bad things happen to good people. There by the grace of God, go I.

 

And those medicare people are my parents, grandparents, aunts, uncles, etc. I give the same care to the medicare/medicaid patients that I give to everyone else because, again, those patients are someone else's parents, grandparents, aunts, uncles, etc.

 

Sure, there are those patients that frustrate the $%& out of me - and i do not let them be disrespectful or demanding to me or my nurses or my staff. I dont care what type of insurance they have.

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wow, really don't understand where those thoughts come from......

 

Every person deserves our attention, this type of thoughts really do not belong in medicine.... if you are feeling this way maybe it is time to take a break???

 

Do you really think people choose to be on medicaid and poor? do you think they like just scraping by?

 

There is enough times in life that society beats them down, do we need to do it in the exam room too?

 

I have worked with all different populations and when ever their is unacceptable behaviors be a professional and professionally tell them what the lacking behavior is. I have commonly advised someone that a sniffle for 24 hours is NOT worth and ER visit..... sometimes just being a professional and stating expectations is the better route, followed by patient education.

 

I certainly understand the burn out and cynicism but we must avoid such generalizations

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In terms of the original question about jobs ~ I've not yet had a problem finding work. But I think both job availability and salary depend a great deal on one's location and practice type preferences. I have worked in inner city and rural underserved areas. I prefer seeing the old, not so well off and sick over the young, affluent and healthy.

 

Medicare patients = "low yield losers??!!" Er, I see and have seen an enormous number of Medicare patients, including many with multiple medical problems ~ people who have survived massive technological and cultural changes over their lifetimes, often people facing financial hardship in old age after a lifetime of hard work. And the phenomenon of not knowing what pills one takes is not at all age-related, although the inability to remember well and the inability to read that tiny print on the prescription bottle may be.

 

Low yield losers??? Whose yield, and how are we defining loser?

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I graduated PA school in 2010, and was a paramedic prior to that for 20 years, most of it in the military and the U.S. Government in wonderful places like Iraq, Afghanistan, Bosnia, Somalia and El Salvador. I also worked as a private contractor doing bodyguard work along with being a medic in Sierra Leone, Israel, Libya and Mexico.C

 

Oh God, you're one of those people....

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Considering a profession without considering future employment opportunities is asinine.

Its one thing to consider employment, But hypothesizing about jobs being gone/pushed out based on a myopic interpretation of supposed trends is a fallacious way of considering future employment. The jobs are/ will be there for the right employee(s).

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Its one thing to consider employment, But hypothesizing about jobs being gone/pushed out based on a myopic interpretation of supposed trends is a fallacious way of considering future employment. The jobs are/ will be there for the right employee(s).

 

So you are conveying that the opinions of many PAs that provide these "myopic interpretations of supposed trends" are erroneous and would vehemently deny a pre-pa performing due diligence without you having acquired a position as a PA. Intriguing indeed.

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I'm glad to see there is outrage out there. I've been fuming. Wanted to respond much, much more vehemently than I allowed myself to do.

 

I think you are "fuming" because you focused in on the medicare/Medicaid aspect instead of looking at the entire rant. He is not talking about CMS patients specifically. He is talking about the non-compliant folks who consistently shoot themselves in the foot with their behaviors (smoke, eat like crap, refill their 44 oz mug four times a day at quicktrip, non compliant on the HTN meds, drink a pint or two of vodka every day, suck on the crack pipe, etc ad nauseum), but then come into the ER with exacerbations of their behavior (CHF, CAD, CP, GERD, etc ad nauseum again).

 

Here's an example from my last shift. Early 20's female who had been on synthroid for a couple of years. She apparently watched an episode of Dr. Oz where he talked about a "natural supplement" that will fix hypothyroidism. She bought a bottle and started taking it instead of her synthroid 10 days before. Now she comes into ER feeling "off", fatigued, tired, no energy, etc. Not too difficult to figure out what's wrong with this one medically, but her bigger problem was that she listened to Dr. Oz over her own physician! She got a little brutal honesty that might stick (ie: NEVER LISTEN TO DR. OZ).

 

Or how about the dental pain patient(s) that have been seen 4 and 5 times in the ED over the past year. They know exactly what they are going to get for their abscess (which is caused by teeth rotten off from sucking on the meth pipe) - amox & 3 lortabs. They have also been told 4-5 times that they need to go to a dentist to have that tooth (or, more likely, those teeth) pulled. They always say "but I can't afford to go to the dentist", yet they can afford a $5-$6/day nicotine habit. These folks get a little brutal honesty from me. If you stop smoking cigarettes, and perhaps even put down the meth pipe, then you would probably have enough money to go to the dentist and get your damn teeth pulled.

 

Or the hypertensive urgency patient who had been off her blood pressure medicines for about a year. Yeah, she can afford that smoking habit, but she can't afford her generic HCTZ and metoprolol. I restart her on her meds and tell her she may likely feel more tired for the next week or so as her blood pressure comes own. Sure enough, she comes back in by EMS the next night because....you guessed it....now she feels tired.

 

So, while some of you may get your feelings hurt and fume a bit, remember nobody has at all insinuated that we don't give these folks the best care we can. I am brutally honest with them precisely BECAUSE I believe this is the best care I can give them.

 

OH, and lastly, those of you who made the assumption that he is bagging on CMS patients try to remember the difference between association and causation. These "losers" (as he indelicately put it) are almost always CMS recipients, but most CMS recipients are not these "losers".

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In terms of the original question about jobs ~ I've not yet had a problem finding work. But I think both job availability and salary depend a great deal on one's location and practice type preferences. I have worked in inner city and rural underserved areas. I prefer seeing the old, not so well off and sick over the young, affluent and healthy.

 

Medicare patients = "low yield losers??!!" Er, I see and have seen an enormous number of Medicare patients, including many with multiple medical problems ~ people who have survived massive technological and cultural changes over their lifetimes, often people facing financial hardship in old age after a lifetime of hard work. And the phenomenon of not knowing what pills one takes is not at all age-related, although the inability to remember well and the inability to read that tiny print on the prescription bottle may be.

 

Low yield losers??? Whose yield, and how are we defining loser?

 

I think he was pretty clear on the "low yield losers". Low yield = no matter how much time you invest in educating them on how to get better (which is WHY they came to us in the first place), they won't do a damn thing you tell them.

 

Loser - If you suck on a crack pipe, you're a loser. I'll still treat your multiple morbidities to the best of my abilities so that you can have that chance to turn your life around.

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I think you are "fuming" because you focused in on the medicare/Medicaid aspect instead of looking at the entire rant. He is not talking about CMS patients specifically. He is talking about the non-compliant folks who consistently shoot themselves in the foot with their behaviors (smoke, eat like crap, refill their 44 oz mug four times a day at quicktrip, non compliant on the HTN meds, drink a pint or two of vodka every day, suck on the crack pipe, etc ad nauseum), but then come into the ER with exacerbations of their behavior (CHF, CAD, CP, GERD, etc ad nauseum again).

 

Here's an example from my last shift. Early 20's female who had been on synthroid for a couple of years. She apparently watched an episode of Dr. Oz where he talked about a "natural supplement" that will fix hypothyroidism. She bought a bottle and started taking it instead of her synthroid 10 days before. Now she comes into ER feeling "off", fatigued, tired, no energy, etc. Not too difficult to figure out what's wrong with this one medically, but her bigger problem was that she listened to Dr. Oz over her own physician! She got a little brutal honesty that might stick (ie: NEVER LISTEN TO DR. OZ).

 

Or how about the dental pain patient(s) that have been seen 4 and 5 times in the ED over the past year. They know exactly what they are going to get for their abscess (which is caused by teeth rotten off from sucking on the meth pipe) - amox & 3 lortabs. They have also been told 4-5 times that they need to go to a dentist to have that tooth (or, more likely, those teeth) pulled. They always say "but I can't afford to go to the dentist", yet they can afford a $5-$6/day nicotine habit. These folks get a little brutal honesty from me. If you stop smoking cigarettes, and perhaps even put down the meth pipe, then you would probably have enough money to go to the dentist and get your damn teeth pulled.

 

Or the hypertensive urgency patient who had been off her blood pressure medicines for about a year. Yeah, she can afford that smoking habit, but she can't afford her generic HCTZ and metoprolol. I restart her on her meds and tell her she may likely feel more tired for the next week or so as her blood pressure comes own. Sure enough, she comes back in by EMS the next night because....you guessed it....now she feels tired.

 

So, while some of you may get your feelings hurt and fume a bit, remember nobody has at all insinuated that we don't give these folks the best care we can. I am brutally honest with them precisely BECAUSE I believe this is the best care I can give them.

 

OH, and lastly, those of you who made the assumption that he is bagging on CMS patients try to remember the difference between association and causation. These "losers" (as he indelicately put it) are almost always CMS recipients, but most CMS recipients are not these "losers".

 

No, I was fuming because of the unabashed and untempered display of vitriol. Not to mention the palpable hubris. I just found it thoroughly off-putting and couldn't help but think that I would hate to be under the care of a medical practitioner with that mindset.

 

Also, you insinuated that it's ok to associate "CMS patients" and "losers." Seems like an awfully poor practice, associating certain patient populations with such a negative descriptor. That sort of mindset inevitably affects the way a practitioner approaches a patient population, and how they treat and speak of that group (which is what led to this discussion in the first place).

 

Also, it probably would have been easier for me to communicate my feelings on the subject via the use of a descriptor that I feel aptly characterizes the kind of person that would post something like that online, but I wouldn't want to offend anyone on the forum via the use of mild vulgarities. :;;D:

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