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Officially giving up on Ohio


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I interviewed for a PA job in March in Cleveland.  Despite the fact that they appeared to be very enthusiastic about me, it took 2 months to get an offer, and then it was very low and insulting. It was actually lower than what new grads are getting, and I have 27 years' experience! PAs are not valued in Cleveland, pure and simple. The only games in town are University and Cleveland Clinic, and I don't want to work for either.

 

Now, the job I interviewed for  is a federally qualified health center, but I still think they can pay better.  I have come too far to work twice as hard for much less pay. I mainly wanted to be in Cleveland to be near my mom, but I think I can talk her into moving somewhere else, more friendly to PAs. I will keep doing locums until I find the right permanent job.

 

My advice to any prospective PAs:  do not go to PA school unless you are willing to leave the state.  Ohio and Indiana are probably the worst states in the country for PAs.

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Curious what's the opposition to The Clinic?

Just not my cup of tea.  Too big, they make you pay for parking and not that great benefits.  They kind of have the attitude that you should be grateful to work there. Of course, being that they are like the only game in town, that is pretty much true.

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I live on the border of Ohio/Indiana, and am curious as to what stinks about Indiana? I am hoping to get into PA school at some point, and although we don't want to stay here long term... who knows what might happen! I know it's one of the better states for physicians...

I may not be up-to-date on Indiana, but I do know that they are the last state in the country to allow PAs prescribing privileges. That cannot be good.  I am sure they are better for docs.  It is a very conservative state and I would expect that physicians are very protected and strong tort reform has been enacted.

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I agree, KMD.  That is why I am going to donate to PAFT, Physician Assistants for Tomorrow.  They support collaboration versus supervision.  We should definitely stand on our own license, like RNs do.

 

Read some of the online forums like MedPage.  Primary care docs are running scared, especially from NPs.

 

The way I see it, physicians had their chance to fix primary care access.  And maintained the status quo.

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Would either of you two mind elaborating on what makes Ohio such a bad state to practice as a PA?  I am ready to apply and moving out of state after PA school is really not an option for me due to my wife's career.  All of the PAs I have met seem to be happy with their job and a couple have even made comments about Ohio getting better for PAs.  

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It may depend upon what part of the state you are in.  But most of the PAs that I knew in the Cleveland area that were relatively happy in their jobs fall into two categories: they work in the surgical arena and are hospital-based, or they have never experienced the joys of working in a more PA-friendly state. Many of the others simply cannot leave, as you, for family considerations.

 

I find in general we are not valued there.  NPs have always held the upper hand, and I think it will always be so. There are also a number of medical schools in Ohio, and the residents tend to gravitate to Cleveland. So the provider shortage is not as severe there.  Salaries tend to be on the low side, as I referenced above. I became used to a great deal of autonomy in states like NC and MI, and the jobs I have interviewed for in Cleveland did not seem to have that.

 

I do agree that things are slowly improving in Ohio, with the new prescriptive laws (allowing Sched. II).  But jobs continue to be scarce. It is all the Clinic and UH.  They have bought up virtually everything there. I hope that with the ACA and Medicaid expansion, demand will increase, and health care systems will realize that we are a damn good bargain.

 

I don't want to discourage you and predict doom and gloom.  If you become a PA, you have far more years to work than I have left. (I am assuming you are relatively young).  I would strongly recommend you get politically involved in the OAPA. I got discouraged with them because when I first came on the scene, the leadership was mostly surgical PAs who did not take a long or broad view. They kept electing the same 3 or 4 guys every few years as president.  Not much changed. Plus, the nurses fought us tooth and nail, and had a stranglehold on the medical board.

 

One need only look north to Michigan for a good role model. I think they have a full-time lobbyist, and they continue to improve their practice laws.

I also think that if states move to a collaborating rather than supervisory model, that will create more latitude. That's a big advantage NPs have on us.

 

In the long run, I do believe that PAs will have more opportunities everywhere.  They are even using them in Canada and the UK now. The AMA has had plenty of time to address the primary care shortage.  Their response was to continue to severely limit med school enrollment to keep salaries high. Hence, they have been sidelined with a weak voice in the ongoing discussions and strategy to address the issue. The nurses simply outnumber them, and financial, governmental, and societal pressures necessitate looking for solutions among non-physician providers. Most studies have shown care to be equivalent, at least in primary care.

 

I also believe the time is ripe to push for more efficient PA-MD bridge programs. I have been talking with some of the physicians I work with in the VA and they are very enthusiastic. I have even been contemplating putting forth such a proposal for a pilot program in the VA.  OF course, when something makes too much sense, it automatically gets shot down.

 

Anyway, sorry I got off topic.  I wish you the best of luck in your application and PA career.  I am sure you will be fine.  I am just looking at it from my perspective, as someone with 27 years experience.

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Just not my cup of tea.  Too big, they make you pay for parking and not that great benefits.  They kind of have the attitude that you should be grateful to work there. Of course, being that they are like the only game in town, that is pretty much true.

You should look into the Cleveland Clinic community hospitals like Lutheran or Fairview hospital. You don't pay for parking and you get to know everyone in the hospital since it's a lot smaller. I've been working at the Clinic (as a PCNA) or about a year now and absolutely love it. I float so I work on all the inpatient floors including the ED and everyone works together and appreciates each other's work. Personally, i'd stay away from main campus.

 

Also, all the PAs at the hospital I work at can write prescriptions. I just shadowed a new PA in the ED that graduated less than 2 years ago and does exactly what the physician does, including writing prescriptions.

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Also, all the PAs at the hospital I work at can write prescriptions. I just shadowed a new PA in the ED that graduated less than 2 years ago and does exactly what the physician does, including writing prescriptions.

You won't understand the issue until you're a fully fledge practicing PA.

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glennfia, thank you for the detailed response.  I joined OAPA as an affiliate member a while back and even emailed asking if there is any way to get more involved as a pre-PA.  Unfortunately, I did not get a response.  I plan on being as involved as possible both during school and once I begin to practice.

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Guest Paula

Michigan is indeed a great PA state.  We have a lobbyist.  We proposed a collaborative practice bill including deleting supervision, delegation and including independent prescription rights.  The bill is stagnant now but had support from the medical societies.  Michigan is on the right track.  I am hopeful we can restart the bill or get something positive passed in the future. With AAPA officially recognizing PAs as collaborative providers who practice medicine we may be able continue the effort started last year.

 

I have nearly complete autonomy working in a FQHC and work with one physician.  

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I hope that happens, Paula.  I think it is high time we stand on our own license like nurses do. How many of us have had at least one asshole supervising doc in our careers?  If they decide they don't like you for any silly old reason, that is all she wrote. It could be they don't like the way you look, the way you talk, or dress. Or, they may not like you because you have a strong sense of self.  I want to see that sort of thing come to an end.

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