Reality check needed

[bobuddy]

I am currently a Family Practice PA - I have been at the same clinic for 12 years. We recently joined forces with a local medical center in a nearby city and from what we are experiencing in KY - hospitals are buying every one of the independent clinics/providers. There are only a few holdouts left but few and far between.

 

I knew my pay was lower than other FP PA's but since the clinic was 5 minutes from my house, four days a week (4-10's), no weekends or holidays, etc - and I like the staff and (generally) the docs - I have tried to look at the pro's instead of only focusing on the pay scale. Since we have joined this medical center, I have become aware that my salary is about $5 less per hour than the other FP PA's. On top of that, the other PA's have productivity bonus. I work the same hours as the docs - we all have 4 day work schedules and I see just as many patients (more than one of the docs).

 

After much posturing and gnashing of teeth with each other - the docs have agreed to the same productivity bonus schedule but will not budge on the salary. There were/are lots of hurt feelings on my part since I have a very loyal patient following at the clinic - yet I am not valued enough as a colleague to increase my yearly salary to the other PA's - which comes out to $700 extra a month. I have gotten the monthly billings of what I am producing and I am bringing into the clinic between 40-50K per month. I am producing well over what I should be to justify the salary increase.

 

Since the salary drama, I have been looking at other places of employment and have come to a reality of PA's being passed over for NP's due to less regulations and restrictions (Kentucky). For every 1 PA job, there are 10 NP jobs. And they are specific that they ONLY want NP's - NO PA's should apply. Even our local university hospital ( WITH the PA school) is not hiring PA's in favor of NP's. PA's in KY are in serious trouble with NP's pushing us out. To top it off, since all of the independent practitioners being bought up by the hospitals, the docs have NO SAY on who is hired now. If the hospital wants NP's - then that is what they get.

 

I am mid 40's with a BSN from PA school, a prior BS in Biology/Chemistry and a PhD in molecular biology. Now, I am seriously considering going back to school for the ARPN. Medical school seems to be out for me due to the amount of debt I would accumulate without income and by the time I get out, I would be in my early 50's.

 

I know there are those that would say to move to the location of the jobs. It is easier said than done right now. I am helping care for two elderly parents, and grandmother. My husband has been at the same place of employment for 30 years and he would not likely find as good of a job being over 50.

 

I am thinking of a few pathways - either online excelsior ADN and then try and find an online MSN program - or taking a year off and doing an accelerated BSN. Then I could return to being a PA while doing the MSN online. The Vanderbilt program looks interesting - but expensive. I am going to contact the nursing program directors at both University of KY and Eastern KY and arrange a face to face meeting to discuss my options. I will bring all of my transcripts showing that I have not only completed the classes/clinicals for PA school but also the first year of medical school classes (PhD class requirements). Unfortunately, these classes were also 15 years ago....

 

Suggestions? Thoughts? Go ahead, flame away and tell me I am nuts. I am just so sad over the current situation.

 

Laurie

[jwells78]

So you are talking about spending a bunch of money and time going back to school to get the ARNP, which will help you get a job in your area and perhaps make you the SAME money or just slightly more than you do now? Logistics: time spent/money spent combined with income lost during your time in school should be, in my mind, far outweighed by the benefits of the end result. If you were talking about a 25-30% increase in income at the end, then I would say do it. Otherwise, this just sounds ludicrous. YES- I would say move to the jobs, but it sounds like that's not an option. What about a different specialty/subspecialty? What about teaching? What about Locums Tenens? What about commuting somewhere outta state? There has to be a solution besides you wasting time and money for no clear gain besides location... ? Note to self- "do not move to Kentucky for a PA job" I am sorry for your situation, but I don't see YEARS of needless schooling as the answer here...

[Guest JMPA]

So you are talking about spending a bunch of money and time going back to school to get the ARNP, which will help you get a job in your area and perhaps make you the SAME money or just slightly more than you do now? Logistics: time spent/money spent combined with income lost during your time in school should be, in my mind, far outweighed by the benefits of the end result. If you were talking about a 25-30% increase in income at the end, then I would say do it. Otherwise, this just sounds ludicrous. YES- I would say move to the jobs, but it sounds like that's not an option. What about a different specialty/subspecialty? What about teaching? What about Locums Tenens? What about commuting somewhere outta state? There has to be a solution besides you wasting time and money for no clear gain besides location... ? Note to self- "do not move to Kentucky for a PA job" I am sorry for your situation, but I don't see YEARS of needless schooling as the answer here...

 

it is very arrogant how you assume that there is no gain. if you read through her post you would see many possible areas of gain. to original poster: i feel your pain. the pa profession is not mere dependence but also control, i wish you the best of luck in any decision you make. i would aim for happiness

[gleannfia]

Hi Laurie, I truly feel your pain. I live in Cleveland, Ohio, and the situation is just about the same here. NPs have it all locked up here. It is 10:1 here as well. The only decent jobs are at the VA, and they have an NP bias as well, and openings are rare. I am presently doing locum tenens. The only reason I am even trying to find employment in Cleveland is my aging mother. I am 52, but if I were even a little but younger, I would try to get my MD. As it is, I will likely leave Ohio for a state with better PA practice environment. or hope for a good PA/MD bridge program. Even our Rx privileges are watered down due to the manipulation of the Ohio Nurses' Association. Honestly, I do not think I would go the nursing route. I would exhaust all other avenues first. Good luck!

[bobuddy]

I appreciate the replies.

 

Jwells - Yes, it makes me sick to think of spending more money to get the APRN and do exactly what I am doing now - and for the same money. On the other hand, with PA's being let go and replaced by NP's - I am also looking at it as keeping my job.

 

Two friends that are both more seasoned PA's than myself were recently let go - replaced by NP's. One had experience in 15 years in cardiology, CT surgery/ orthopedics. The other had 18 years in FP, urgent care, etc. Both could not find jobs. Both recently accepted positions as pharmaceutical reps with better pay and excellent benefits.

 

I have a good friend that works for a credentialing company here in KY. She credentials everyone nationwide- PA's, NP's, MD/DO's. She tells me that with the Affordable Care Act, NP's are now getting 100% reimbursement from the insurance companies- equal to MD's. PA's are not. This will only increase their salary to be on par with the MD's soon.

 

Here are the pro's to going back to school (that I see)

1) employment opportunities

2) reimbursement on par with MD's ( I think this alone will set the NP's salary apart from PA's soon)

3) independent practice in many states (at this time I am not interested in this-but there are a few people on this forum that agree if they were NP's, they could open their own practice without the same difficulty and hassle as a PA.)

4) No NCCPA recert.

5) The ability to do mission trips for health care (in or out of the US) or volunteer locally - something I cannot do now without supervision issues coming up.

 

Cons:

1) cost

2)time

 

I will check into locum tenens and other opportunities. Like I mentioned, I am considering either doing the ADN online and to continue working full time. Or take a year off and do the accelerated BSN. Then return to work as PA and continue the online work for the MSN/NP. I cant believe that the NP's can do their degree online yet have more/full privileges than PA's......

 

One question I do have:

 

If I were to keep my PA cert up to date and be a dual PA/NP - does the NP trump the PA with state rules/regulations?

 

I welcome any opinions or insight. Believe me, I would love to be set straight, my eyes opened and talked out of this.

[jwells78]

it is very arrogant how you assume that there is no gain

Hey, I'm not trying to hurt anyone's feelings here- this is how I SEE IT, and she asked for opinions. THATS MINE. From the information she's given, she wants to stay in the same area and wants to practice as a midlevel provider AND be compensated as such. I see that. Is her situation unfortunate? Yes. All I'm proposing is exhausting all other options before she takes the trip down ARNP street. If YOU were in that position, would YOU go back to school to be an NP? I would not. That's me. No offense to the OP.

[bobuddy]

jwells78

 

No worries - no offense taken. I am pretty torn up about this and so my emotions are playing a big factor. Like I said, I have a loyal patient following at the clinic. There is nothing like working in family practice in small town Kentucky. That is my family too.

 

There are a few other docs in the town - both have two PA's already and the maximum that one doc can supervise is 2 in KY. You can, however, have as many NP's as you want. Or, if I was an NP, I could move down the street and hang a shingle and a significant part of my current clinic patients would follow(they have told me personally).

[ventana]

get a DNP!

 

then get a DNP program to get and keep you jobs happiness

 

then talk your DNP program into getting a PA-->> DNP bridge program.....

 

 

what you are going through is pure BS

 

You generate a fair amount (I question your # in that 40-50k/month is 500,000 - 600,000 per year and IM doc's and PA's and NP's just don't directly collect that much) but they are likely billed amounts, and should be compensated for it.

 

Talk to the competition and go work for them......

[Gordon, PA-C]

There are a few other docs in the town - both have two PA's already and the maximum that one doc can supervise is 2 in KY. You can, however, have as many NP's as you want. Or, if I was an NP, I could move down the street and hang a shingle and a significant part of my current clinic patients would follow(they have told me personally).

 

 

Doesnt your current group have a non compete clause in your contract?

[bobuddy]

Ventana,

 

Yes, I should clarify - those are billed amounts. Not collections. Thanks for clearing that up for those reading.

[bobuddy]

Gordon,

 

Nope. No non compete thank goodness.

[Gordon, PA-C]

I

I have a good friend that works for a credentialing company here in KY. She credentials everyone nationwide- PA's, NP's, MD/DO's. She tells me that with the Affordable Care Act, NP's are now getting 100% reimbursement from the insurance companies- equal to MD's. PA's are not. This will only increase their salary to be on par with the MD's soon. .

 

 

This will be the ultimate downfall of the NPs. If the NPs cost as much as MDs then the only place the NPs will be able to find jobs is rural areas where docs refuse to go.

 

If I'm running a clinic in Manhattan why in god's name would I pay 200k for an NP when I can hire an MD instead? Doesnt make any sense.

[edwinjvazquez]

Someone needs to lobby AANP for PAs with RN license to challenge the FNP certification exam. My thinking is that this will benefit both PA and NP. PAs would gain more leverage politically. And NPs would have their standards increased with as a result of better trained clinicians within their ranks.

[bobuddy]

Edwin -

 

I agree completely. In my state there would be a mass exodus of PA's converting to NP's. I wonder if the AAPA would notice?

 

Another poster has brought this up already and I agree with it - to abolish the PA/NP all together and join forces. Everyone already that is a PA/NP can be grandfathered in. We can combine the positive benefits from both programs - the medical based learning - led by and governed by the BON. Get rid of the old names and replace them with "advanced practice provider" ( which we are already labeled as this in the KY job listings). All it takes is some reaching across the aisle and presenting a united front. I think it could/would be an amazing end result.

 

Interesting post on FB that I read the other day that sums up my feelings for the past few weeks:

 

[Joelseff]

Edwin -

 

I agree completely. In my state there would be a mass exodus of PA's converting to NP's. I wonder if the AAPA would notice?

 

Another poster has brought this up already and I agree with it - to abolish the PA/NP all together and join forces. Everyone already that is a PA/NP can be grandfathered in. We can combine the positive benefits from both programs - the medical based learning - led by and governed by the BON. Get rid of the old names and replace them with "advanced practice provider" ( which we are already labeled as this in the KY job listings). All it takes is some reaching across the aisle and presenting a united front. I think it could/would be an amazing end result.

 

Interesting post on FB that I read the other day that sums up my feelings for the past few weeks:

 

 

 

The problem with that scenario is we LOSE PAs to the NP world...Which in turn weakens our profession in more ways than one.

 

Laurie, I dunno the answer but lend moral support. You have to think of your family first and foremost. Do what is best for them and you. NP/DNP is going to be THE non-physician practitoner of choice especially for our field of FP/PC.

 

As far as the shadow of a topic in this thread, What can we PAs do against the professions we work side by side, amicably, with on a daily basis who will not hesitate to feed us to the others (Docs to NPs and Vise versa)? Some of our brethren feel it's to sit around the campfire hand in hand with the NPs and sing Kumbaya...Some would have us do the same with the Docs...in the end WE are the redheaded stepchildren in the "family." We sit idly by while "Mom and Dad" kill each other and in the end, no matter how it unfolds, we remain redheaded stepchildren orphans...

 

Sorry for the rant but there are some dark realities in practicing as a PA that now, even after only a few years of practice, I (kinda) regret not just sucking it up and going for MD/DO...

[rev ronin]

Your problem is situational. Leave. Leave the practice, and leave the state. Go to somewhere where PAs are respected and well paid.

[GatorRRT]

http://www.aanp.org/legislation-regulation/state-practice-environment

 

...may I suggest moving to a "red" state per the map on the above link?

[lmccary31]

Jwells - Yes, it makes me sick to think of spending more money to get the APRN and do exactly what

I have a good friend that works for a credentialing company here in KY. She credentials everyone nationwide- PA's, NP's, MD/DO's. She tells me that with the Affordable Care Act, NP's are now getting 100% reimbursement from the insurance companies- equal to MD's. PA's are not. This will only increase their salary to be on par with the MD's soon.

 

 

I dont think this is true... can anyone provide evidence of this? I dont think ACA explicity says anywhere that NPs will now be reimbursed 100%.

[medman2007]

I dont think this is true... can anyone provide evidence of this? I dont think ACA explicity says anywhere that NPs will now be reimbursed 100%.

 

Yes, this is not true. This is a myth that has been perpetuated by many uninformed individuals

[gleannfia]

Although I share the concerns of everyone who posted, I think that there is also another dynamic occurring. Has anyone checked out some of the physician forums, like MedPage and KevinMD? The FP docs, in particular AAFP, are starting to get real pissy about all this. There is some nasty bickering going on between the docs and NPs. Many of the docs have expressed a preference for PAs. Almost every day, there seems to be an article in the Wall Street Journal and letters to the editor from NPs and MDs debating independent practice for PAs. Maybe it would service us better to try to work more with the doctors to lobby for better reimbursement for our services. After all, at the end of the day, it is all about the $$$ for most of them. I find it sad that, with potentially 30 million more patients gaining access to the health care system, that people are bickering over their piece of the pie. There are plenty of sick people out there!

[Guest Paula]

It still might be worth it to go to medical school. Goodness, you have a PhD already. Would you get any credit for the year of medical school you did for the PhD. Go to your local Kentucky medical school and have a conversation with them. Maybe they can pull strings and you can get in with credit. Or look at the LECOM program.

 

I would also send a letter to AAPA of exactly what you posted. Ask them if they think it would be advisable for you to go the NP route? Also, post your issue on the AAPA web page. It would be interesting if you get feedback. Have you contacted the KY state PA association and talked to them. Gather all the statistics you can about how the NPs seem to be taking over KY and then join me and others who are advocating for Collaborative Practices, doing away with the dependent and supervised nature of PAs, and lets get radical!

 

We need to do something and the state chapter is the place to begin. Just my 2 cents worth. Paula

[Guest Paula]

I always forget to add ? when I type questions!!!!

[gleannfia]

Along with "death panels" and lots of other misinformation.

[bobuddy]

My friend that does the credentialing is the one that tells me about the reimbursement rates. Her job is to set up the new providers and negotiate with the insurance companies to set the contract rates/reimbursements. She told me in last 6 months, she has been getting NP's equal contract rates from the insurance companies. She would have no reason to tell me otherwise. This tibit of information came up with my recent conversation with her regarding me going back to school.

 

The problem with me leaving the state is my elderly parents/grandmother - and the fact that my husband is 51 and has been at his job for 30 years. If he lost his job tomorrow I could see leaving - but to ask him to leave a good paying job in this economy where there are many 50+ year old people that were "downsized" out of their jobs now working at the local walmart - well, I just cant do it.

 

Paula - If I were even 10 years younger I would go to medical school. I have been going through the MCAT prep information (keeping options open) and re-learning everything that I knew 20 years ago in undergrad ( geez - the thought of organic chemistry makes me sweat even 20 years later) seems overwhelming. And, yes, I took the first year of med school for the PhD - but I would not want credit for it now - since I would need to re-learn it again anyways for the USMLE step 1 exams. It is the small details that you dont use everyday that have long left my brain. :)

 

As far as the bickering between the MD's and the NP's - they can bicker all they want -but the reality in KY (and obviously other states as well) the NP's are winning the fight. But the bigger issue I am seeing locally is the independent docs that say they would hire us instead of NP's - well they have already sold out to the hospitals and mega medical centers. They now are just an employee like the rest of us - with no say so in what happens or who they hire. The independent practices are falling like dominoes - with a few left in Louisville, and a few left in Lexington. I don't know about the Cinci area but I would assume it would be similar? What does everyone else see? Is this happening in your state too?

 

I am active in the KAPA organization - along with the two PA friends that lost their jobs this year (that are now pharmaceutical reps). They were both HEAVILY involved in KAPA - and worked very hard this past year to get a bill passed that took away our 18 month onsite supervision (after 10 years of fighting this). I hope they will continue to help KAPA even though they are not currently working as PA's. Guess who was our biggest opponent to our bill to remove the supervision? Yep - our lovely KMA and KBML. Instead of standing with us and supporting us - they took every opportunity, and then some, to keep us in our place. I got a first hand backstage view of the kind of kindergarten playground politics that are being played out in Frankfort and it was sickening. If the KMA had put as much energy into the concept of a MD/PA team as they did to fight us - we might be in a different spot. Meanwhile, while they were fighting us - the NP bill danced right behind them.

[rev ronin]

No offense, but if you're tied to the state by family obligations, you have a "me too" job, much like many military spouses do. You have no leverage, because you are not able to freely move to take a new job. Odds are your employers know this, and THAT is why you will never be paid as well as you probably deserve. And by "deserve", I mean that you would get paid in a completely free market, fair economy, which ours is not--employers have no incentive to pay you more than they have to, and since you can't leave the state, they don't have to pay you.

 

I remember a nurse telling me once "Oh, please go into nursing, the more men who go into a field, the better it pays". I wonder if yours isn't a case of the opposite happening:

* An increasing proportion of PAs are female

* Female adults are more likely to self-impose career restrictions (hours, location, etc.) on the basis of family obligations than male adults are.

* Career restrictions lead to below-market salaries.

 

I wonder if we're seeing NP salaries start to equalize with PAs not because of oversight issues or lobbying, but because PAs have lost the historical advantage to be more willing to switch jobs for career advancement than NPs.