How difficult is it to switch specialties as a PA?

[EMEDPA]

regarding those pa's who change jobs it seems to me that there is a group of pa's who change jobs frequently on an almost yearly basis because they view being a pa regardless of specialty as "just a job" so a 5% raise is a valid reason to go from peds to ortho to nephrology to hospitalist and then there are those who stay in the same or related specialties for their entire career. I think if you broke down the #s of pa's changing specialties you would see that 8% is the same folks every yr while the 92% is those folks who have settled on a specialty.

in my group of 15 pa's 1 has worked in a field other than fp or er and those who worked in fp did it for a yr or 2 to get experience, switched into er and have been there ever since. similar stats at my other 3 jobs. folks have done primary care/urgent care to get some experience to qualify them for entry level er jobs and then they stay here.

the pa's I know who have worked in > 5 unrelated specialties really aren't that good at any of them. the pa's I know who have worked in multiple related specialties( say ct surgery, trauma surg, ortho surg) tend to have a strong understanding of the specialty knowledge base.

[coloradopa]

Well we already do specialize, we just don't formalize it with postgrad. The equation is still 2+1 for PAs vs 4+ 3 (or 4 or 5.....plus fellowship) for docs. You're adding 12-18 mos extra for PA residency at about 50% the pay of an equivalent regular job.

 

This extra requirement might weed out those PAs who are less committed to the specialty.

 

I understand it's still a barrier but we should weighh the effect of those barriers against the drain on productivity and efficiency of practices who are trainig new grad PAs.....as well as the added reputation specialty PAs get by having a formal credential (which means a lot in this world).

This is a fairly classic argument for a guild system. Introduce barriers to entry so that it protects those who are already in the guild. It also in the end inhibits mobility. An attempt to "weed out" PAs quickly becomes a requirement. It should be an alternative route (especially for new grads) but the profession should be ready to tolerate the "drain on productivity and efficiency".

[coloradopa]

regarding those pa's who change jobs it seems to me that there is a group of pa's who change jobs frequently on an almost yearly basis because they view being a pa regardless of specialty as "just a job" so a 5% raise is a valid reason to go from peds to ortho to nephrology to hospitalist and then there are those who stay in the same or related specialties for their entire career. I think if you broke down the #s of pa's changing specialties you would see that 8% is the same folks every yr while the 92% is those folks who have settled on a specialty.

in my group of 15 pa's 1 has worked in a field other than fp or er and those who worked in fp did it for a yr or 2 to get experience, switched into er and have been there ever since. similar stats at my other 3 jobs. folks have done primary care/urgent care to get some experience to qualify them for entry level er jobs and then they stay here.

the pa's I know who have worked in > 5 unrelated specialties really aren't that good at any of them. the pa's I know who have worked in multiple related specialties( say ct surgery, trauma surg, ortho surg) tend to have a strong understanding of the specialty knowledge base.

I would again disagree. While the AAPA data doesn't show if a particular group of PAs changes job every year as opposed to a larger group changing jobs every five years, the distribution is fairly consistent as the years of experience gets longer suggesting the second scenario. My experience in a large health care system is the opposite. We have a group that stays in the same area for many years, and some that change at various intervals. The ones that change frequently change into unrelated areas (for example among our IR PAs none have a related background). I do agree that there are PAs that bounce from area to area and aren't a good fit for any, but they seem to be relatively rare.

[andersenpa]

This is a fairly classic argument for a guild system. Introduce barriers to entry so that it protects those who are already in the guild. It also in the end inhibits mobility. An attempt to "weed out" PAs quickly becomes a requirement. It should be an alternative route (especially for new grads) but the profession should be ready to tolerate the "drain on productivity and efficiency".

 

I've hired for a few CTS positions in my current practice. One we hired an experienced CTS PA who hit the ground running. One was a PA with only heme-onc expeirence who had never seen inside the chest. The heme onc PA had significant MICU experience. This PA still has required extensive precepting- which we understood is part of the game when hiring a PA w/o CTS experience. Was her inexperience a barrier? No. If she had formal training would it have increased our productivity and work flow? Undoubtedly. Would a residency of other postgrad CTS training for her in any way protect the "guild" of current experienced CTS PAs? Not in this case. We may be an exception to the norm, I don't know how to measure that sort of thing.

 

Keep in mind (and you would know this having specialty surgery background) that all PAs coming into the specialty are essentially new grads. Ironically I have had PA students who have picked things up faster than "experienced" PAs who are new to CTS. Go figure.

[coloradopa]

I've hired for a few CTS positions in my current practice. One we hired an experienced CTS PA who hit the ground running. One was a PA with only heme-onc expeirence who had never seen inside the chest. The heme onc PA had significant MICU experience. This PA still has required extensive precepting- which we understood is part of the game when hiring a PA w/o CTS experience. Was her inexperience a barrier? No. If she had formal training would it have increased our productivity and work flow? Undoubtedly. Would a residency of other postgrad CTS training for her in any way protect the "guild" of current experienced CTS PAs? Not in this case. We may be an exception to the norm, I don't know how to measure that sort of thing.

 

Keep in mind (and you would know this having specialty surgery background) that all PAs coming into the specialty are essentially new grads. Ironically I have had PA students who have picked things up faster than "experienced" PAs who are new to CTS. Go figure.

For a lot of specialties there are quite a few jobs chasing a relatively small number of "qualified candidates". At some point the organization has to decide either to pay enough money to entice a "quality candidate" or accept the inefficiency of training someone that is less qualified. In my current specialty even if someone is fully qualified they get four months of orientation, mainly due to the complexity of the job and organization. Its a graduated system with six to eight months for experienced providers and eight to 12 months for new grads. We hired 35 PAs and NPs last year so we have it down to something that resembles a science.

 

The problem with a requirement for residency for a position is that we have a competitor that traditionally doesn't do a residency. Lets say that you require a CTS training program before you hire a PA. After six months without applicants the surgeons come to you and say, "well we haven't found any qualified PAs but we have a bunch of ACNPs that will work for half of what a PA will. Train them up will you."

 

The US health system has never been able to accurately predict provider supply needs. The PA profession acts as an important safety valve. As the only profession that is widely trained in all areas of medicine we have the unique ability to move to areas which suddenly develop under supply and move out of areas that develop oversupply. Residencies are fine for the 3-4% of PAs that think they need them. On the other hand requirements for residencies inhibit what should be a natural flow based on need and supply.

[v_chicky]

I've hired for a few CTS positions in my current practice. One we hired an experienced CTS PA who hit the ground running. One was a PA with only heme-onc expeirence who had never seen inside the chest. The heme onc PA had significant MICU experience. This PA still has required extensive precepting- which we understood is part of the game when hiring a PA w/o CTS experience. Was her inexperience a barrier? No. If she had formal training would it have increased our productivity and work flow? Undoubtedly. Would a residency of other postgrad CTS training for her in any way protect the "guild" of current experienced CTS PAs? Not in this case. We may be an exception to the norm, I don't know how to measure that sort of thing.

 

Keep in mind (and you would know this having specialty surgery background) that all PAs coming into the specialty are essentially new grads. Ironically I have had PA students who have picked things up faster than "experienced" PAs who are new to CTS. Go figure.

 

i've always assumed that a new-hire PA with no relevant experience would garner a lower salary for thise exact reason; they are not useful for several months to a year so their pay reflects that. i suppose residencies just schlep the cost of this training year from hiring physicians/groups to universities.

 

The problem with a requirement for residency for a position is that we have a competitor that traditionally doesn't do a residency. Lets say that you require a CTS training program before you hire a PA. After six months without applicants the surgeons come to you and say, "well we haven't found any qualified PAs but we have a bunch of ACNPs that will work for half of what a PA will. Train them up will you."

 

and when there are only a handful of residency slots available each year, the applicant pool of PAs is severely limited, exacerbating this issue further.

[HemeOncPA]

Doable but not without a challenge (just like most things). Switched from Heme/Onc to Internal Medicine 4 months ago due to relocation for Husband's job. I like the fact that I am brushing up on dx like HTN, DM, Dyslipidemia to get ready for boards in a couple of years. Switching specialities in our profession is a beautiful thing.

[andersenpa]

For a lot of specialties there are quite a few jobs chasing a relatively small number of "qualified candidates". At some point the organization has to decide either to pay enough money to entice a "quality candidate" or accept the inefficiency of training someone that is less qualified. In my current specialty even if someone is fully qualified they get four months of orientation, mainly due to the complexity of the job and organization. Its a graduated system with six to eight months for experienced providers and eight to 12 months for new grads. We hired 35 PAs and NPs last year so we have it down to something that resembles a science.

 

The problem with a requirement for residency for a position is that we have a competitor that traditionally doesn't do a residency. Lets say that you require a CTS training program before you hire a PA. After six months without applicants the surgeons come to you and say, "well we haven't found any qualified PAs but we have a bunch of ACNPs that will work for half of what a PA will. Train them up will you."

 

The US health system has never been able to accurately predict provider supply needs. The PA profession acts as an important safety valve. As the only profession that is widely trained in all areas of medicine we have the unique ability to move to areas which suddenly develop under supply and move out of areas that develop oversupply. Residencies are fine for the 3-4% of PAs that think they need them. On the other hand requirements for residencies inhibit what should be a natural flow based on need and supply.

 

It's obvious that any idea for a residency "requirement" couldn't be implemented with the current number of limited postgrad training seats. Only if the capacity to train met the attrition rate of specialty PAs could such a thing be entertained. Until then it would be optional/recommended/or whatever jargon the CAQ people are using now.

 

I don't recall which specialty you are in but most jobs have some mandatory orientation. I would be comfortable saying that those orientations would be more concise and focused if applicants coming through the doors had a credentialed training period which met certain objective standards. Facility-specific trainig is one thing; how to interpet swan numbers or do a thoracentesis is another.

 

I agree that the current avaialbility of residency spots could not meet the workforce needs for spec PAs but with such a system in place I don't see how that safety valve (for specialty, not PC) would be any different that for docs. They trend the needs and adjust their training seats accordingly.

[andersenpa]

i've always assumed that a new-hire PA with no relevant experience would garner a lower salary for thise exact reason; they are not useful for several months to a year so their pay reflects that. i suppose residencies just schlep the cost of this training year from hiring physicians/groups to universities..

 

You will make more as an inexperienced new grad in specialty than going into a residency spot, for sure. Residency training is way more cost effective in terms of labor units per dollar spent than a practice training a new grad.

[bradtPA]

It's obvious that any idea for a residency "requirement" couldn't be implemented with the current number of limited postgrad training seats. Only if the capacity to train met the attrition rate of specialty PAs could such a thing be entertained. Until then it would be optional/recommended/or whatever jargon the CAQ people are using now.

 

Once again Andersen is on the money. It would be unrealistic to require 60% of the 80,000 PAs in the US to compete for 100 residency slots (average of two slots per program listed on the residency web site) without a complete overhaul of the system.

[andersenpa]

Once again Andersen is on the money. It would be unrealistic to require 60% of the 80,000 PAs in the US to compete for 100 residency slots (average of two slots per program listed on the residency web site) without a complete overhaul of the system.

 

 

The little I know about residency economics is that the facilties that house them are funded federally (subsidy/medicare reimbursement?)

To inc PA residency seats would require some serious legislating I'd guess.

[coloradopa]

It's obvious that any idea for a residency "requirement" couldn't be implemented with the current number of limited postgrad training seats. Only if the capacity to train met the attrition rate of specialty PAs could such a thing be entertained. Until then it would be optional/recommended/or whatever jargon the CAQ people are using now.

 

I don't recall which specialty you are in but most jobs have some mandatory orientation. I would be comfortable saying that those orientations would be more concise and focused if applicants coming through the doors had a credentialed training period which met certain objective standards. Facility-specific trainig is one thing; how to interpet swan numbers or do a thoracentesis is another.

 

I agree that the current avaialbility of residency spots could not meet the workforce needs for spec PAs but with such a system in place I don't see how that safety valve (for specialty, not PC) would be any different that for docs. They trend the needs and adjust their training seats accordingly.

 

I work in critical care now. A post graduate program has been discussed in our institution. Its currently stillborn from lack of internal interest. The problem is that we need lots of people now. We hired more than 30 last year. We have a structured program that depends on the PA or NPs experience. New grads are hired without a specific job. They spend a month in each of the different ICUs and are then matched to a specific position. They then train in that unit for the specific position. New grads generally get 9-12 months. Exceptional new grads may get around six months depending on their comfort level.

 

Experienced PAs or NPs get 3 months of orientation in all the ICUs and then 1-3 months in a specific ICU where they will be working.

 

The issue of post grad program comes up in opportunity cost. First from a program view we would be taking a year plus unit specific orientation prior to the job. No matter which way we cut it, it will take longer to put someone in a position through the post grad program. From a personal view why work longer hours at less pay if the program is willing to pay you full pay and a forty hour work week for up to 12 months with a guarantee of a job. Even if we pay the post grad graduates more it takes a long time to make up for the loss of money in that first year.

 

I think that post grad programs make sense in a specialty such as CVS where you have multiple new skills to learn. But again our new grads are marginally effective in around six months. If you need to get people into positions again it doesnt make much sense.

[coloradopa]

The little I know about residency economics is that the facilties that house them are funded federally (subsidy/medicare reimbursement?)

To inc PA residency seats would require some serious legislating I'd guess.

Residency is paid by Medicare. Essentially there are funds to pay for the resident and funds to pay for the education of the resident. Residency slots were fixed in 1996 and any additional resident slots must be funded by the hospitals. Basically its a zero sum game. Any money for PA "residencies" would have to come out of other residency money. There is some redistribution going on with unused residency slots going to surgery or primary care.

 

Right now PAs in post grad programs are fully licensed and can bill. Depending on the specialty they probably cost relatively little. Its the opportunity cost and the cost vs pay of a PA is going to be highly dependent on the specialty. CVS pretty easy to make it pay. Same for ortho in the right payor mix. Trauma in an inner city hospital is going to be nothing but cost.