Lateral movement getting harder?

[dndandrea]

One of my biggest reasons for deciding to go to PA school over MD school was the versatility that PAs have over MDs. I admired the luxury of being able to switch roles as a PA if I wasn't satisfied with what I was doing or if I felt that I could make myself more useful in another field of medicine. However, I keep reading all these posts on this forum about how it's becoming a myth just like how people think PAs have more free time than physicians...

 

With that being said, I present to you this question: If you were a doctor or clinic interest in hiring a PA for your family practice, would you rather hire some hospitalist or emergency medicine PA who's been working for 5-10 years, or would you rather hire some fresh PA graduate with only nursing assistant experience? Sure, you can factor in the money and say that the experienced PA might demand more money... but even then, I still think the hospitalist/EM PA would have an edge over a new grad for the job position.

 

So my ultimate question is: why are people on this forum making it seem like it's hard to change jobs as a PA? I'm sure i'm missing something. What is it that I do not know?

[Guest Paula]

I am going from Family Practice to an Internal Medicine position the end of this month.  They are similar and I have 11 year experience.  My new employer wanted someone who was experienced and one they would not have to train.

 

I have worked in three/four basic areas in my career: Family Practice, Urgent Care, EM and now Internal Medicine.

 

If I ever get to a point where I want to super-specilaize I would pick diabetes and I think I could get hired in a minute in a diabetes focused clinic.

 

Surgery:  Now that's another story.  I would be looked at as a new grad as my surgical skills are nearly nil. 

[EMEDPA]

each specialty has its own skill set. some are close like urgent care to EM while others like peds to nephrology have very little in common.

every hospital based job now requires one to prove that they have a procedures list and certain skills to work in certain positions. it is easier for an employer to hire someone who already has those skills or has done a residency in that specialty than to train someone from scratch.

If I wanted to do transplant surgery, for example, I could probably find a doc in a very undesirable location (say detroit) who could not find a surgical pa willing to work there who might hire me and train me. Any place folks want to live (say san diego or san francisco or NYC) will be able to attract folks with the needed skills.

We don't even look at folks without EM experience now at any of my 3 current jobs. We will hire selected new grads, but only if they trained with us and know our system.

[dndandrea]

each specialty has its own skill set. some are close like urgent care to EM while others like peds to nephrology have very little in common.

every hospital based job now requires one to prove that they have a procedures list and certain skills to work in certain positions. it is easier for an employer to hire someone who already has those skills or has done a residency in that specialty than to train someone from scratch.

If I wanted to do transplant surgery, for example, I could probably find a doc in a very undesirable location (say detroit) who could not find a surgical pa willing to work there who might hire me and train me. Any place folks want to live (say san diego or san francisco or NYC) will be able to attract folks with the needed skills.

We don't even look at folks without EM experience now at any of my 3 current jobs. We will hire selected new grads, but only if they trained with us and know our system.

Understandable, to an extent... but finding someone with experience in a specific field of medicine might not always be an easy task. You're left with choosing between a new grad or an experienced PA (in similar or completely different field). The PA has years of experience acting as a clinician for patients and/or diagnosing patients. Sure, I understand that each speciality has their own specific set of skills that might only be used in their realm of medicine, but a new grad has zero set of skills (ignoring what you learned in school/clinicals).

 

Worst case scenario, both the new grad and experienced PA have zero set of skills that might be used in the specific practice an employer is looking to hire in. Assuming the experienced PA and new grad are going to be paid the same, I don't see how the new grad has any advantage over the experienced PA... So this goes back to my ultimate question: why is it HARD to for lateral movement? That's like saying it's HARD to get a job as a new grad.

 

I understand that it might be harder for an experienced PA to break old habits or following his/her previous system whereas a new grad would be trained into your system and wouldn't have trouble with mixing it or confusing it with another one that might be completely different. I still don't think that's enough to make it harder for an experienced PA than it would be for a new grad to get a job. Either way, you'll have to spend time training both the new grad and the experienced PA, but I feel like the experienced PA will settle in a lot quicker than a new grad.

[Maverick87]

I can't say for certain since I've never been in the job market as a PA, but people that I graduated with seemed to jump from job to job and field to field for a while before finding their niche. One guy in my class easily worked family medicine and hospitalist at the same time. Another girl went from OBGYN to derm without much issue.

 

This was in metro New York and these two people certainly weren't at the top of my class and did not have any connections. (I know of other people in similar situations...these are just two examples).

 

Anecdotal, sure, but it's what I've observed first-hand.

[EMEDPA]

not too many folks with 10 yrs experience are willing to take an entry level salary in a new specialty....you hear a lot on this site about folks saying " I couldn't work for less than X salary". for most folks 10+ years out that X is > 100k. 

[EMEDPA]

I can't say for certain since I've never been in the job market as a PA, but people that I graduated with seemed to jump from job to job and field to field for a while before finding their niche. One guy in my class easily worked family medicine and hospitalist at the same time. Another girl went from OBGYN to derm without much issue.

 

This was in metro New York and these two people certainly weren't at the top of my class and did not have any connections. (I know of other people in similar situations...these are just two examples).

 

Anecdotal, sure, but it's what I've observed first-hand.

it's NYC...they were probably also jumping between entry level jobs paying less than 70k...

[BruceBanner]

So this goes back to my ultimate question: why is it HARD to for lateral movement? That's like saying it's HARD to get a job as a new grad.

 

 

Lateral movement is becoming a thing of the past, quickly. This will continue to change with the influx of new grads and more urban market saturation. It's mostly a factor of economics---it takes time and investment to get a new provider who has no peripheral experience up to speed. And there's the risk they may not work out and the employer would be back to square one. With more PAs than jobs in many markets, why not just hire the experienced ones.

 

Peripheral transfers, i.e. family to IM, IM to endocrine, IM to hospitalist, hospitalist to ICU, etc, are still doable and certainly happen. But lateral "leaps" without a relevant background are a fairy tale, unless you are talking about a very immediate-need area (aka somewhere no one wants to live).

 

And as far as new grads...it IS hard to get a job as a new grad!! ESPECIALLY in desirable metro and suburban areas. I've been out of school for almost 3 years and it just took me 5 months to get into FP, coming from occ med. I live in a very large city but it is a desirable area. Many people are moving here each year, and the folks who already live here aren't leaving. I took this job as a contractor for $40/hr with NO benefits to start....which will make some PAs here cringe but I had to do what I had to do to get my foot in the door. It was either take a compensation hit and build up my CV, or sink to the bottom-of-the barrel gigs like low-T clinics and grocery store retail clinics.

 

So in a nutshell: within the IM/FP/EM spectrum you can move around, but you'll need career capital. Major specialty changes like IM to surgery without prior experience are almost impossible.

[EMEDPA]

agree with most of above. Desirable locations infrequently post jobs. I would love to work in the town I went to college and medic school in. There are 2 ERs within commuting distance. One only uses PAs in fast track(because plenty of docs want to live there too). The other posts new jobs about every 10 years and pays a lot less than I make now(like 1/2) because they know they can get someone with lots of experience more desperate than I am to work there. .

[Soulfari]

What are the day-to-day chief complaints when working EM fast-track?

[EMEDPA]

What are the day-to-day chief complaints when working EM fast-track?

minor ortho, lacs, abscesses, cough/cold, well children with runny noses or ear pain, std's, etc.

most are minor complaints in folks under 65.

the thing about fast track is that the criteria is highly dependent on who is in triage and how well they can recognize badness. take a look at the thread in the EM forum on " it's probably nothing: fast track disasters.".

[Guest JMPA]

lateral movement getting more difficult is a myth. total BS. especially in large cities. employers want you to learn their model, not drag some outside model. most people that have difficulty with lateral moves are stubrin fools who don't know how to shut up and learn a different field. there is so much overlap in medicine that everything builds to everything else. pure myth, do not buy into it. Now locking people in with CAQ exams is a political way to close this lateral door. that is why the PA profession must unite against CAQ exams. It takes away the strongest quality of the PA profession which is lateral mobility. Not NP nor MD can move so freely between fields and that is all do to our training.

[Maverick87]

it's NYC...they were probably also jumping between entry level jobs paying less than 70k...

Maybe.

 

I also know someone working in the California area that was able to transition from family medicine to urgent care to emergency medicine pretty easily (all within less than a year time period). However, she had been working as a family medicine PA for 6 years before making this transition.

 

We are close and I know for a fact that she makes good money....but, again, she was certainly not a new grad making this kind of transition.

[Joelseff]

I applied for an ER locums job as a side gig and got a lot of push back. I don't have any ED experience outside of my rotations in school. They approved me for UC because I included that I take walk in in certain days at my practice but didn't take it since I found a better full time FM gig.

[Maverick87]

So in a nutshell: within the IM/FP/EM spectrum you can move around, but you'll need career capital. Major specialty changes like IM to surgery without prior experience are almost impossible.

This seems more applicable to what I've seen in the real world. I've seen people transition between medical specialties (IM, FP, EM, derm, OBGYN, cards, etc.) fairly easily.

 

I do not know one person that transitioned between medicine and surgery.

[meaux]

For what its worth, I have been Emed my entire PA career (5 years) in Seattle, I began in ernest applying for non ER gigs about a year and 1/2 ago.  I applied for hospitalist medicine gigs, and actually was offered a couple in decent areas.  I also applied for Ortho surg gigs and have recently been offered a position in a smaller town, but was interviewed in larger more desireable to live areas several times, all to no avail.

 The take away, is that lateral movement is definitely a possibilty, but as EMED and others have said, the more desireable the area, the more likely the competition is going to be equally as staunch.

[whoRyou]

I see pros and cons moving laterally. It's ingrained in our way of thinking from the beginning -- and from popular culture -- that climbing up the ladder is the direction of choice as well as a sign of success, but in today's business environment, that simply is no longer the case.

Pros

• Promotion Potential. 
• Improving Job Security.
• Increased Marketability.
• Professional Development.
• Fresh Faces.
• New Boss.
• No Additional Responsibilities.

Cons

• Internal Perceptions.
• Same Salary.
• Further From Your Passion.

[ventana]

I think the safety of the patients has to enter the "lateral mobilty" conversation

 

 

In the past we were hired by a doc, and would be their resposibility,keeping patients safe

 

As we are growing and becoming more of a major player in the field, the hospital systems have realized we are a great deal, and are hiring us as commodities, not as their own PA. This creates the situation where there is no one directly overseeing work, and as a PA with less then 3 years (or so) experience is being thrown into the deep end. Think about it - doc's take a bare min of three years to get through residency - at the 3 year mark in the same speciality I think a PA hits their own stride, but until then they could be less then desireable.

 

 

I think hospitals and employers are realizing this (not every PA or NP is the same and new grads are NOT the same as experienced) and hiring people with experience or residency training saves them $$ in the long run. This is due to turn over, productivity, and patient safety/need for mentoring.

 

 

I, along with EMedPA,, have commented that even up to a few years ago we would have considered returning to do a residency, even as long time established PA. This is a good over simplified example of the fact that a good residency program is highly valuable to a PA wanting to practice at the top of their license, which lets face it - in non surgical specialties is really functioning like a doc for 99% of it. You do not get this type of professional responsiblity and patient care responsiblity quickly, easily or with out putting effort into it. NOR SHOULD YOU! More important then the advancement of the PA brand is to protect and do what is best for our patients.

 

 

So lateral mobilty is likely decreasing in the ease of which you can do it, BUT this is a result of the gains in the marketplace that the PA profession has made, and the normal exceptionally high level of care we are being expected to deliver.

 

I for one am all for 1 year residency, along with CAQs (when is the IM CAQ coming out?) as it protects patients and elevates our stature. If I were a patient, I would not want to 10 yr peds PA who just switched to surgery working on me the first time! They can and should return for additional training IMHO.

[gbrothers98]

A lot of great insight into this issue.

I think what is consistent with lateral mobility is similar to the new grad job search.

3 areas: salary, region, specialty. You likely wont be able to score high in all 3 but definitely in one, prolly in 2, you choose.

E points that out regularly and this has basically been discussed in several different ways above.

So lateral mobility exists, the question is to what ends and with what compromise will the job seeker go to and accept?

Example, had an EM colleague who was tired of EM. Wanted to move to a very specific area also. Lined up an office gig, FP. 

Problem was he wanted his EM salary. Admin at the new place got him close but he would not take even the slightest hit.

No offer in the end.

For the OP, there really is 2 PA job markets. The new grad and the PA with experience. The important thing is to get that first job and be successful for at least a year. The jobs after that are going to be dependent upon your flexibility within those 3 areas.

 

As for the post stating the CAQ process is limiting mobility, there is probably some truth there except for 2 things. Obtaining the CAQ can only be done AFTER getting the requisite time in specialty. It is a chicken vs egg thing. Any employer requiring a CAQ doesnt understand the CAQ process and limits themselves to seeking from a limited pool of applicants much like an employer seeking a board certified physician only. For the CAQ holder this is a good thing, helps increase demand and therefore salary. But it is more likely that a CAQ holder has a stable position that they like and are not actively seeking a new position. I would also like to point out the example of a handful of dual CAQ holders. I dont know any of them but I imagine that any of us are up to that task given enough effort and opportunity. 

 

Last thing to point out, our profession is an infant that is starting to crawl to pulling itself up in healthcare employment. For those of us that have a decade or 2 in, the field is changing and needs adapting to. For the new grad or interested applicant, work now on making moves to build a solid career. Be flexible and seriously consider opportunities that are professional building blocks for you including seeking a residency or fellowship within 5 years after graduation.

 

Good luck.

G Brothers PA-C

[ohsnapPA]

@ventana what primary care residencies would you recommend that is high quality? is there loan forgiveness/deferment if we choose to do a residency straight out of PA school?

[ventana]

@ventana what primary care residencies would you recommend that is high quality? is there loan forgiveness/deferment if we choose to do a residency straight out of PA school?

 

I don't know specifics, but have seen and heard the program at Baystate in Springfield MASS looks pretty good, also, anyone that is actually credentialed is good.  I think the VA programs are probably pretty darn good as well.

 

Basically I would go with a know residency spot that does currently have  MD/DO residents so that you know you are not just going to be slave labor for a year.  

 

Unknown about loan deferment