Discussion on the future of obamacare: effect on primary and mid providers

[TPA16]

Hey guys,

I am pre-health and before I make an ultimatum decision on my career I wanted to discuss some things regarding the future of what obamacare will implement on our healthcare system and how that will affect job satisfaction/demand/ and salary

I think its obvious that as of now, doctors are getting more administrative in their duties with studies showing that a significant amount of their time is spent doing clerical/insurance work and that they are needing to see more and more patients with less time allotted to each patient. I can only assume that this has a huge negative effect on job satisfaction.

At the same time, Is this the driving force that is responsible for the influx of demand for PAs?

Are these new factors implemented by obamacare here to stay? There is much talk with the presidential candidates on TV about how they all hate obamacare and it needs to be removed. How realistic is this? In the end, will the US healthcare system still be driven to provide more coverage i.e. "a shortage of physicians"... i.e. "a demand for PAs"?

Also,

Just because there is a projected rate of 30% growth for the PA professsion from here till ~2022 (i could be wrong with this stat a bit), does this mean that the salaries will also increase? I am wondering if the demand is overhyped and that saturation of the profession could be an issue due to so many pa programs opening up.

[tunafish]

Why those questions bother you? It sounds like healthcare management bs where people in suits try to pretend to be important by doing their excel and powerpoint on their stupid meetings. What is job satisfaction in general? Does it exist? It is a personal thing for each individual. You like medicine - go for it. People who go into medicine for other reasons usually regret their decision and what's more important, become bad practitioners. "Docs have less time now than before"... you never worked "before" so for you now is the way you learn and after 20 years there will be another rant in the news why 20 years ago the trees were higher and apples were sweeter... just 0.02

[Shazzy1228]

At this point, I have come to the conclusion that healthcare is changing for all providers. If you want to only make big money in this field, get out now. There is a strong possibility you may find yourself in an area of healthcare that is the "loser" in terms of reimbursement, etc. You better have a passion for it. Has anyone talked to pharmacists these days? Too many pharm schools popping out too many grads and not enough jobs for all of them. You get stuck in retail pharm where you are a slave to wrongaid,cvstress,richgreens,etc. I'm a CPht so I know. If you want to make money, go into investment banking or something like that. My engineer classmates never seem to struggle to find work. I'm so over all this obamacare hoopla.....=/

[ilovelost]

^ Problem with engineering is that after about 5-7 years, its cheaper to hire new grads then re-train old ones as technologies change. My parents are both in engineering and strongly advised me to choose something else. 

 

I like what PA's do and after working jobs making like $12-13 an hour, a PA salary just working 40 hours per week is gonna seem like a fortune to me. At least in the medical field, experience seems to be valued. Things will change no matter what field you go into - just be open to change and persistent with finding a job that you like. I know many people who fall into a groove and whine and complain about their job/workplace, but never actually take action to find another job or environment that they might like better because they get comfortable with a routine. I figure if I try PA and don't end up loving it, I can always branch out and try other things - a different specialty, academics, business side of medicine, public health, etc. At least it gets me some life experience that I can apply elsewhere too :-). I've already endured some stinky jobs, so PA would be a huge improvement for me. 

 

In the big picture, your career is just gonna be one part of your life anyway, and building it will be a lifelong process. People make career changes all the time nowadays. 

[electric130]

Your concerns are valid.  I have been in practice for 13 years, I absolutely loved my job for the first five years and then at times since then, but overall a lot of things have changed.  Reimbursements are down and the Physicians that have practiced in the glory days cannot seem to adjust.  For example many practices are cutting nursing hours and just overall trying to trim all overhead expenses.  I know this is in effect to try to increase revenue for the MDs in the group, this would be fine if those hours were not needed, but they are.     Thankfully I feel like the PA profession has done well, our income has steadily gone up in the last 10 years as it should.  I feel like practices are finding that we add value and we can actually be a profitable partner. 

The downside of this is that once you are productive and a good producer the pressures of medicine are close to what you would have as an MD but still at 1/3 the salary.  I am currently seeing 25-30 patients a day of all types, I am capable of doing this, but it is exhausting and is somewhat leading to some burnout. I know I am not in a vacuum and we are all being looked at by our "numbers" as opposed to just patient care.  I have really seen this shift in the last few years and it is discouraging. 

If you love medicine then go for it, but honestly I have seen some posts on here where they are just looking for a stable well paying job I would go into accounting or engineering.  My husband is an engineer and has done very well, and although he has his own stresses they are completely different and I really think he could continue happily working for another 20 years, whereas I am hoping I can make it another ten. 

[EMEDPA]

I assume you are talking about the affordable care act, which has just survived yet another challenge in the supreme court. it is here to stay.

[DogLovingPA]

"I like what PA's do and after working jobs making like $12-13 an hour, a PA salary just working 40 hours per week is gonna seem like a fortune to me"

 

ilovelost.....    a lot of us work much more than 40 hours a week.  On average I clock 44-50 hours plus 8-10 hours of commuting.  Right now I am finishing up an 80 hour work week (with 14 hours of commuting).   And don't forget to factor in the $$$$ you will shell out every month for student loans (my student loan payments are higher than my mortgage). 

 

Not that I don't like what I do.  But it's not all dollar signs and a blissful schedule. 

[Maverick87]

It seems that I've turned into an optimist, but I think that PA salaries and demand will actually increase (before leveling off) due to Obamacare and physician salaries will decrease (as they have been). Based on my research and observations, many practices appear to be hiring a few docs and many PAs/NPs in order to increase production and decrease cost. Also, the ACA will bring an increase in enrollment in healthcare and mass chaos, for the most part. It will be 5-10 years before things settle down.

 

Also, I think that the field MAY become like pharmacy (or law, for that matter) one day, but not anytime soon. Maybe in 10+ years. But, by then, the old timers here will be retired and the young guns will be seasoned veterans that have found their niche. Do you think established, experienced lawyers have trouble finding a job? Nope. It will be similar with us.

[EMEDPA]

"I like what PA's do and after working jobs making like $12-13 an hour, a PA salary just working 40 hours per week is gonna seem like a fortune to me"

 

ilovelost.....    a lot of us work much more than 40 hours a week.  On average I clock 44-50 hours plus 8-10 hours of commuting.  Right now I am finishing up an 80 hour work week (with 14 hours of commuting).   And don't forget to factor in the $$$$ you will shell out every month for student loans (my student loan payments are higher than my mortgage). 

 

Not that I don't like what I do.  But it's not all dollar signs and a blissful schedule. 

yup. 226 hrs this month. requested 160.

[rev ronin]

yup. 226 hrs this month. requested 160.

You guys need to hire more PAs down there?

[EMEDPA]

You guys need to hire more PAs down there?

we just hired 6. interviewing another this month. lots of folks(myself included) are trying to cut way back. I am actually looking to leave, but have not worked out an exit strategy yet.

 we have had a few folks quit and/or retiire as well.

[TPA16]

I assume you are talking about the affordable care act, which has just survived yet another challenge in the supreme court. it is here to stay.

I have lurked these forums and noticed you actively post so I will take what you have to say seriously

 

It seems as if due to the  PA field's confidence or from outward economic and social pressures that PA responsibility will go up. Currently there are debates to make medical school shorter from 4 to 3 years at the same time as there are debates to make PA school from 2 to 3 years. There are laws being passed now that would allow unresidenced MDs to become "assistant physicians" while pas are trying to find a better name. 

 

Basically it seems that there is sort of a "meeting in the middle for PAs and MDs" for lack of a better idea, at some point in the future.

 

I don't think it would be viable for such an increase in responsibility for PAs to not accompany some sort of steady salary increase for the next 5-10 years atleast. Would you agree with this idea?

[TPA16]

You guys need to hire more PAs down there?

if you could respond on the above post that would be nice as well. thank you

[EMEDPA]

I have lurked these forums and noticed you actively post so I will take what you have to say seriously

 

It seems as if due to the  PA field's confidence or from outward economic and social pressures that PA responsibility will go up. Currently there are debates to make medical school shorter from 4 to 3 years at the same time as there are debates to make PA school from 2 to 3 years. There are laws being passed now that would allow unresidenced MDs to become "assistant physicians" while pas are trying to find a better name. 

 

Basically it seems that there is sort of a "meeting in the middle for PAs and MDs" for lack of a better idea, at some point in the future.

 

I don't think it would be viable for such an increase in responsibility for PAs to not accompany some sort of steady salary increase for the next 5-10 years atleast. Would you agree with this idea?

YUP. agree. PA responsibilities and salary will both increase.

[EMEDPA]

if you could respond on the above post that would be nice as well. thank you

see post #11

[ilovelost]

"I like what PA's do and after working jobs making like $12-13 an hour, a PA salary just working 40 hours per week is gonna seem like a fortune to me"

 

ilovelost.....    a lot of us work much more than 40 hours a week.  On average I clock 44-50 hours plus 8-10 hours of commuting.  Right now I am finishing up an 80 hour work week (with 14 hours of commuting).   And don't forget to factor in the $$$$ you will shell out every month for student loans (my student loan payments are higher than my mortgage). 

 

Not that I don't like what I do.  But it's not all dollar signs and a blissful schedule. 

 

The majority of the people I work with do 80+ hrs per week for a fraction of what a PA makes - 40-50 hrs is a huge improvement. 

[Shazzy1228]

Maverick, don't be so evil. PA ending up like pharmacy is a nightmare. One of my buddies is a floater pharmacist and can't seem to get enough hours. Meanwhile his company keeps cutting tech hours. You try filling over 400 scripts a day with barely any help.We can't end up like pharmacy....no way dude. =(

[JimM]

we just hired 6. interviewing another this month. lots of folks(myself included) are trying to cut way back. I am actually looking to leave, but have not worked out an exit strategy yet.

 we have had a few folks quit and/or retiire as well.

 

EMEDPA.... why do you want to leave?  workload/stress/burnout? other reason?

[EMEDPA]

EMEDPA.... why do you want to leave?  workload/stress/burnout? other reason?

30+ pts/12 hrs every shift with minimnal help and almost no recognition or suppoort from hospital admin.

contrast this with both of my rural jobs at which they love me, we have adequate support staff, and they treat me and respect me very well in every way.

[Maverick87]

Maverick, don't be so evil. PA ending up like pharmacy is a nightmare. One of my buddies is a floater pharmacist and can't seem to get enough hours. Meanwhile his company keeps cutting tech hours. You try filling over 400 scripts a day with barely any help.We can't end up like pharmacy....no way dude. =(

 

With all of the PA schools opening, along with NP, DO, and MD, it's likely to happen eventually. But if you are established by then, you'll be fine.

 

And pharmacists can do fine. I have a pharmacy friend that consistently has multiple job offers. He's outgoing and is very good at networking. This is what new grad PAs will likely have to do one day as well to be successful. This is already true in some of the bigger cities.

[Nonlegit]

"I like what PA's do and after working jobs making like $12-13 an hour, a PA salary just working 40 hours per week is gonna seem like a fortune to me"

 

ilovelost.....    a lot of us work much more than 40 hours a week.  On average I clock 44-50 hours plus 8-10 hours of commuting.  Right now I am finishing up an 80 hour work week (with 14 hours of commuting).   And don't forget to factor in the $$$$ you will shell out every month for student loans (my student loan payments are higher than my mortgage). 

 

Not that I don't like what I do.  But it's not all dollar signs and a blissful schedule. 

 

I've mentioned this before, but just so its said... some of us ARE working in healthcare already purely from a "love of it" standpoint.

 

I made more money doing construction in the early 2000's than I do now. And while I rarely go over 36hrs/wk, I do also take 12+ credit hours a semester, 14 right now. I work all the same silly off hours, and while your jobs aren't cake...I never see a provider (or admin, or manager, or half of my triage RNs) wading through 40+ aggressively angry people in the lobby day in and day out revitaling and placating the masses, telling my "actors" to get off the floor you are not passed out/seizing/in cardiac arrest, cleaning the piss off the homeless cat lady in the bathroom, and on and on.

 

I wholeheartedly agree with the point being made though. I just want it to be clear; issues can be found with any job. It probably is a lost cause to tell me that your issues wouldn't be worth 100k when our housekeepers get paid more than us (not that they don't deserve it either, just saying).

[BruceBanner]

...Just because there is a projected rate of 30% growth for the PA professsion from here till ~2022 (i could be wrong with this stat a bit), does this mean that the salaries will also increase? I am wondering if the demand is overhyped and that saturation of the profession could be an issue due to so many pa programs opening up.

 

 

I'm of the opinion that urban and suburban markets (where 90% of people want or need to work) are becoming saturated with providers.

 

I think this will continue to worsen over the next 5-10 years. The profession is attractive to many people, new programs are springing up everywhere, and there are a lot of new grads out there looking for work. New grads in my area (Denver) are getting offers as low as $60-65k a year!!! Supply and demand.

 

As far as salaries, I think the upward trend is leveling off. We may see an small increase in the average salary but I truly do not see it going over $100k. With corporations are taking over healthcare delivery, the benefit of PAs is we can move patient volume for less $$$ than a physician. I think this coupled with increasingly difficult reimbursement (ICD-10, tight-a$$ insurers, groups mandating you take Medicaid, etc) will cap our earning potential pretty quick.

 

Like EMED and others said, those who have good career capital (read: EM, IM, FP experience), and rare/valuable niche skills will do fine for the foreseeable future. New grads are not going to have it any easier in the coming years, and you can take that statement to the bank. The best networkers, the lucky, and the early birds will get the good jobs; while others will be forced into rural areas or into dubious quasi-medical jobs like weight loss, low T, pain mgmt, walk-in runny nose clinics, etc.

 

So in short, it's still a viable career, but don't do it for the money alone. There are far less painful and lower-debt avenues to a good salary.

[Skeeter]

 

"...... while others will be forced into rural areas or into dubious quasi-medical jobs like weight loss, low T, pain mgmt, walk-in runny nose clinics, etc."

 

 

Rural jobs suffer from an attitude / perception issue, unfortunately. There are a lot of amazing jobs in truly rural areas, with great pay, great benefits, beautiful areas, and great community. The only things missing are traffic, housing congestion, smog, noise, polluted night skies, and shopping centers.  It's a mistake to represent them with statements like this, and even worse to equate them to "quasi-medical" jobs and bottom-of-the-barrel employment options.

[AliB]

 

"...... while others will be forced into rural areas or into dubious quasi-medical jobs like weight loss, low T, pain mgmt, walk-in runny nose clinics, etc."

 

 

Rural jobs suffer from an attitude / perception issue, unfortunately. There are a lot of amazing jobs in truly rural areas, with great pay, great benefits, beautiful areas, and great community. The only things missing are traffic, housing congestion, smog, noise, polluted night skies, and shopping centers.  It's a mistake to represent them with statements like this, and even worse to equate them to "quasi-medical" jobs and bottom-of-the-barrel employment options.

 

 

What ^^ said!  I'm doing this because it's something I will enjoy AND so that I CAN make good money and get back to my roots with my kids.  I've been making a lot more money in business and technology than I'll ever earn as a PA, but I've had to be based in a major metropolitan area and be willing to travel for work to do so.  That's not all bad - I've worked all over the US and in 5 other countries - but after more than 20 years of it, I'm 'done'.  Here's hoping the demand continues to exceed the supply for quite a while.  :) 

[BruceBanner]

 

"...... while others will be forced into rural areas or into dubious quasi-medical jobs like weight loss, low T, pain mgmt, walk-in runny nose clinics, etc."

 

 

Rural jobs suffer from an attitude / perception issue, unfortunately. There are a lot of amazing jobs in truly rural areas, with great pay, great benefits, beautiful areas, and great community. The only things missing are traffic, housing congestion, smog, noise, polluted night skies, and shopping centers.  It's a mistake to represent them with statements like this, and even worse to equate them to "quasi-medical" jobs and bottom-of-the-barrel employment options.

 

 

 

I would love to have a rural job. I think a lot of PAs would. The problem with them is feasibility. Relocating as a single person with no anchors is not a huge undertaking, it's an adventure. But relocating with a spouse and/or kids...different story. Many, many people need to work in or near cities due to their industry. With kids there's the issues of schooling, leaving friends, etc. For some being too far away from their extended family is a dealbreaker. And of course your spouse may not find the experience as enriching as you.

 

The point is, it's not most people's first choice. There are many inconveniences involved. And not all rural locales are created equal. Everyone and their mom would love a rural gig in some idyllic Colorado mountain town, but I don't see people lining up for Indian reservations in North Dakota.