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NC by far followed in no specific order by AK, WA, ME, VT, AZ, GA, MT, NH, MI

The supervision requirement in NC is you have to meet with your SP for 30 minutes twice yearly to discuss your practice. no chart review, etc. That's called lunch or a golfing/fishing outing. PAs there can be 100% practice owners and never have a doc step into their practice.

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NC by far followed in no specific order by AK, WA, ME, VT, AZ, GA, MT, NH, MI

The supervision requirement in NC is you have to meet with your SP for 30 minutes twice yearly to discuss your practice. no chart review, etc. That's called lunch or a golfing/fishing outing. PAs there can be 100% practice owners and never have a doc step into their practice.

 

Hey EMEDPA, do you know much about being a PA in Florida? How friendly is that state? 

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Hey EMEDPA, do you know much about being a PA in Florida? How friendly is that state? 

 

Just to offer an in FL opinion.... according to the AAPA salary survey the pay is about middle of the pack (avg w/ bonus is 100K). 

 

As for laws, yeah tons of annoying details. FAPA is as active as they can be to get them changed. Changing legislation in FL is a slow and painful process, but they have been chipping away for years. Schedule II prescriptive authority is their current #1 priority. Good news is that, inpatient and surgical orders, including controlled substances, are not considered prescriptions per state regs. 

 

http://www.fapaonline.org/node/80

 

Also, I just found out that PAs (with an EMT and ACLS can challenge the paramedic exam in FL. Again, lots of oddities in the state regs.

 

Florida is the #5 state for the number of certified PAs, so I wouldn't write it off. 

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I wouldn't write off California. Great salaries in the rural areas, Schedule II authority, large PA populations in most areas, but still some barriers to practice that CAPA continues to chip away at (10% chart cosignature, etc.). NC sounds great.

Also CAPA is very active and a great organization (despite the recent drama). They recently got the bill passed for us to finally sign EDD forms in 2017. And they continue to push our agenda in Sacramento which I can only imagine is a task all its own.
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many of the desirable locations in CA have very few PA jobs (bay area, san diego, coastal SoCal) and the NP lobby in NorCal is very strong. I have been looking at EMPA jobs in coastal central and northern CA for over 20 years and there are very few and folks tend to hold on to them forever.

As Steve mentioned, there are lots of jobs in rural areas away from the coast if you are willing to live in the central valley of CA.

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I would recommend the nonmetropolitan areas of Ca. I'm two hours to Carpinteria, Santa Barbara and LA. I don't have to commute in a mess everyday because I can't find affordable housing close to the jobs. And, most importantly, salaries are much higher in the rural parts of the state with a much lower COL. The competition is so heavy in the metropolitan areas that it drives down salaries for PAs and NPs. It is an employer's market in these areas.

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NC by far followed in no specific order by AK, WA, ME, VT, AZ, GA, MT, NH, MI

The supervision requirement in NC is you have to meet with your SP for 30 minutes twice yearly to discuss your practice. no chart review, etc. That's called lunch or a golfing/fishing outing. PAs there can be 100% practice owners and never have a doc step into their practice.

Woah, Outer Banks here I come. 

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is a state like NC really what PA's are supposed to be about?

 

Yes. Having fewer barriers doesn't mean it's the wild west of medicine.  Though I am in NC, I still have a high level of physician(and experienced ACP) oversight/support/backup.  This is partly because I am doing a residency and partly because I am a new grad.  I think it's only natural for less experienced providers to desire a strong support system.  I certainly don't want to hurt or kill a patient due to inexperience and I think most new medical providers feel the same way.  By having fewer barriers it allows a more seamless transition into greater levels of autonomy.  Why would a doc want to work with a PA if they have to spend tons of time repeating everything that was already done and then cosigning most/all of the charts?  We need to remove such barriers to not only secure our profession's place in medicine, but to provide quicker and better care to patients.  

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is a state like NC really what PA's are supposed to be about? Isn't physician oversight the core of PA-dom? Seasoned  PAs are obviously most likely to be able to "run the show" but less requirements shouldn't really be looked down upon, if that's the case go back and become a physician.

yup, the initial idea for PAs was to send them to places docs wouldn't go and "extend the work of the physician" by essentially replacing them in those settings with some physician oversight. new grads need lots of oversight. experienced PAs, not so much. After 28 yrs working in em, including time teaching md residents at 2 facilities, I am comfortable with the vast majority of pts who present with emergent conditions and am confident I can manage them better than anyone but a very experienced er doc.

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NC by far followed in no specific order by AK, WA, ME, VT, AZ, GA, MT, NH, MI

The supervision requirement in NC is you have to meet with your SP for 30 minutes twice yearly to discuss your practice. no chart review, etc. That's called lunch or a golfing/fishing outing. PAs there can be 100% practice owners and never have a doc step into their practice.

 

I was surprised not to see NY and PA on this list.  Many NY and PA schools seem to graduate lots of PAs who stay in state.  Your thoughts?  Also, teach a man to fish?  What's the most efficient way to learn the basics of practice laws by state (ie without having to search through lots of legal mumbo jumbo on each state's medical board website)?  Thanks!

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I was surprised not to see NY and PA on this list.  Many NY and PA schools seem to graduate lots of PAs who stay in state.  Your thoughts?  Also, teach a man to fish?  What's the most efficient way to learn the basics of practice laws by state (ie without having to search through lots of legal mumbo jumbo on each state's medical board website)?  Thanks!

upstate ny has lots of good jobs. nyc , not so much.

PA is a terrible state for PAs because there are so many there and pays among the least nationwide.friends of mine doing the equivalent of my job there make 50k less/yr.

any state in 2014 that does not have sch 2 dea rights has a restrictive  practice environment.

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I was surprised not to see NY and PA on this list.  Many NY and PA schools seem to graduate lots of PAs who stay in state.  Your thoughts?  Also, teach a man to fish?  What's the most efficient way to learn the basics of practice laws by state (ie without having to search through lots of legal mumbo jumbo on each state's medical board website)?  Thanks!

 

If you are a member this link should help: http://www.aapa.org/threecolumnlanding.aspx?id=304#sthash.DI0SOLVs

 

"Select your state to read a synopsis of its PA practice act. Summaries include information about scope of practice, prescribing and supervision, among other topics that cover PA practice."

 

Also (From the AAPA): 

 

These six key elements should be part of every state PA practice act:

  1. "Licensure" as the regulatory term
  2. Full prescriptive authority
  3. Scope of practice determined at the practice level
  4. Adaptable supervision requirements
  5. Chart co-signature requirements determined at the practice
  6. Number of PAs a physician may supervise determined at the practice level

More in-depth: http://www.aapa.org/WorkArea/DownloadAsset.aspx?id=628

 

And: http://www.aapa.org/WorkArea/DownloadAsset.aspx?id=800

 

State Practice Profiles: http://www.aapa.org/threeColumnLanding.aspx?id=328

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I suspect it's a slow walk to progress. The laws have improved steadily in Ohio, with the latest bill just clearing the Senate with one opposing vote after having cleared the House. Hopefully will be in effect on April 1. A doc will be able to have 3 PAs, no physical distance limitation, the supervisory agreement filed at the practice, etc. We got Schedule II rights a while back.

 

Not quite drinking the pink bubble-up and eating the rainbow stew yet, but progress. I think it puts us with 5 of the 6 AAPA goals, but don't quote me and I don't know which one we will still be missing.

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  • 2 weeks later...

And what's the draw to states like VT and NH?

Some people like rural areas. I grew up in SoCal, but have absolutely no desire to return, except to visit family still there. I will probably continue living in the Intermountain West (ID, UT, WY) until I die. I love it here. That's just my opinion, though. Some of the pros for me:

 

-Great autonomy

-Greater impact on a high needs area, vs being just another number in a large hospital/practice

-No/little traffic

-Lower cost of living (A colleague living in a house in SoCal very similar to the one I owned in Meridian, ID paid 3x what I did)

-Less population density, and the problems that go with it, like crime and smog

-It's an outdoor paradise, if that is your thing

 

Of course it's not all farts and rainbows, but for me the pros outweigh the cons.

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