LESH Posted March 30, 2015 Share Posted March 30, 2015 As my good friend LESH would say, "nothin but love".... :) And we mean that in a supportive and nurturing way... Link to comment Share on other sites More sharing options...
henryd Posted March 31, 2015 Share Posted March 31, 2015 silly rules about pa scope of practice and folks who didn't respect PAs; docs and nurses mostly... do you think things have changed or will change in favor of PAs in the near future? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 31, 2015 Moderator Share Posted March 31, 2015 do you think things have changed or will change in favor of PAs in the near future? getting a bit better every year, much due to the work of PAFT and the aapa Link to comment Share on other sites More sharing options...
didymus Posted March 31, 2015 Share Posted March 31, 2015 On 3/29/2015 at 10:31 PM, FBIDoc said: Yeah dude... we are perma-residents...unless I find a way out, I will do the same thing today, that I will when I am 70 (the probable retirement age when I get there) and get my 6 weeks vaca and maybe a bottle of wine at Christmas if I am lucky...and don't get me wrong, I am in the top 1% of PAs when it comes to awesomeness of jobs...which astounds me that the majority of my brethren suffer the way they do...meanwhile the docs I work with make 6-8x what I do, get a week off per month, ownership/partnership/profitsharing, etc...and when the ACA/ACO turd impacts the oscillator where do you think they will be compared to me? The captain will not going down on the Titanic twice... do us a favor, go to medschool and hire a bunch of us bitter, majorly experienced PAs so we can retire in peace...and you can work 2 days a week, supervising us from the golf course Not sure where you work, but this is not how it is in any setting I've ever seen or heard about from people working directly in healthcare. The vast majority of the docs I know of work insane hours, while many of the PA's are capping out at 40. NO docs are working 2 days per week and making 6-8x what PA's are making. This is simply untrue, and just a massive exaggeration in every way. The only physicians I know who are banking big money are working like 80-hour weeks and have been in practice 20+ years (meaning they haven't ever slowed down from residency, and some are working even more hours). Often the caution to students on the fence about medical school is that they need to be prepared to be working crazy hours for the rest of their careers--especially surgeons--and to be prepared not to see their families very much. Of all the docs I know (and I know a lot of doctors) none of them fit your description of hours worked and pay earned. I'm not saying you don't work with some rich physicians, but the statistics show that it is highly uncommon for doctors to make more than $400,000 (and that most are making less than $250,000) and the number that do is shrinking all the time. The docs I know are pulling between $80-$100 per hour (and $100 per hour is near the top). The PA's I know are making between $40-$60 per hour (with $60 being at the very top). That means the physicians, with a minimum of 5 years more training are making around 25% more than PA's. You must work in a niche specialty, but I can't imagine what specialty it is for the docs to only be working 2 days a week and making that kind of money. The only doctors I know working that little are those who are mothers and want more time with their children. And they sure as hell aren't making big bucks working 0.4-0.5FTE. I know of one physician who works 0.5FTE and she makes $100,000 with no benefits. On those two days she works, she sees 30-35 patients probably, and does a lot of procedures. Those are two very long, very busy days for her. To think that if she worked the other 2 days of the week to be at 1.0FTE, and make around $200K with benefits isn't all that crazy. The 1.0FTE PA's at the practice are making $95,000-100,000+. So the physician makes, maybe, double what the PA's make. Sounds fair to me. Just to make it clear, your perspective is the exception rather than the rule. The suicide rate among physicians isn't so astronomically high that studies are done over it because doctors are overstressed from 2 days a week of work and $800,000 in income, managing their overworked PA's from a tropical vacation somewhere. The suicide rate is so high because most of them are working like dogs (30+ patients per day in outpatient settings), 5 days a week, going home to chart until 10pm, not seeing their families, taking regular call, huge responsibility and liability since theirs is often the final decision re: patient care, and, thus, the backlash is theirs when things go wrong, constantly facing reimbursement decreases (while PA's and NP's are seeing steady increases in pay), increasingly negative public perception, and so on. I am married to an attending physician who works on faculty with a residency program. I know much about the stresses of physicians, residents, and medical students. I have also spent a lot of time working with PA's. The reality is, the two jobs just aren't the same, and they really aren't even close. Maybe out in the sticks the level of responsibility mirrors that of physicians, but even there it just isn't the same--and only on forums like this have I ever seen PA's complain so much about physicians, while simultaneously pleading with others to go to med school because you regret not going. It's madness. I've been hopeful about the PA profession because my experience has been that PA's and physicians have, by and large, excellent working relationships and rapport. MD's and PA's are those guarding the gates of the medical profession against the invading NP's, who are threatening the very fabric of healthcare education and delivery. Man, some of the bitter PA's on this thread really throw a wrench into that perception. There is a huge amount of bitterness with some here, and it has definitely skewed their perception of reality. - Link to comment Share on other sites More sharing options...
didymus Posted March 31, 2015 Share Posted March 31, 2015 Not everyone thinks being a PA sucks. There are veteran PAs that enjoy what they do and are happy with their career choice. I know a lot of them. They are just not forum members so you might not get to hear their perspective. This. I have actually ever only seen PA's bitch on here (some on SDN). I know a good number of PA's at a level of candid friendship, and they would share with me if they hated the work, and wished they had become MD/DO. Nope. Not one of them ever has said that. They love what they do, feel very well compensated for having a masters-level education, and really value that they get to do the kind of work they do at the level of training they have. It's PA's like these that make me feel like I won't regret becoming a PA instead of going to medical school (as I am weighing both at this time). Link to comment Share on other sites More sharing options...
didymus Posted March 31, 2015 Share Posted March 31, 2015 The PAs that I have shadowed, particularly in primary care, seem to do the exact same job as the MDs but get paid half the amount. They don't. Possibly in BFE they will, but generally, physician extenders (PA/NP) are seeing bread and butter cases to take the load off of the physicians who are better trained to see more complex medical conditions. With more groups and health systems dropping the hammer on providers to see more and more patients, doctors can't really afford to see the standard cough/cold/runny nose stuff. My experience as one who ran a primary care clinic for a few years before deciding to quit and become a clinician (PA or MD, still deciding), this is how things worked. As someone who is married to a physician, I'm aware that this is how things work at a large academic hospital as well. And even beyond primary care, PA's are not doing the exact same job as physicians in procedural specialties, either. Check out the website OR Live. Watch some surgeries where PA's are involved. There is not a PA out there doing a total hip replacement. There are PA's assisting docs with those, and, as you will see in those videos, they are mostly holding retractors and closing up after the surgery is completed (but mostly holding retractors). This is a bit of an understatement, but it's meant to make the point that PA's are not doing the same job. Rural ER? Yes, the work will mimic very closely what docs do. Metro area ER? Nope. Many (not all) PA's will be working fast track and, again, seeing bread and butter. The training of a PA doesn't really enable them to handle the complex cases without years of experience first. There are exceptions to this rule, but it is the rule. Anyway, what other masters program out there allows for such cool work and a near guarantee of $90,000 or more salary a year right out of school? Not many! Not only that, but some of the old school PA's on here may not even have a masters, but got minted back when the bachelors was the terminal degree for PA's. So these are folks with a bachelor's degree who are likely making $120,000+ There are PhD's with tenured professorships who would kill for that of pay. There are practicing lawyers sitting on $200,000 in debt making only $50,000 a year, and they have doctorates. I digress. In my opinion, this is what makes being a PA so awesome. Less school and less responsibility, with damn-respectable pay, are reasons to become a PA. Not everyone wants all that burden that doctors have. Obviously, some PA's do, and wish they would have done medical school from the get-go. I think this is probably a minority of PA's, though. Link to comment Share on other sites More sharing options...
delco714 Posted March 31, 2015 Share Posted March 31, 2015 So after A LITTLE thinking. I'm going to go out and call this whole charade b.s.. Gross Link to comment Share on other sites More sharing options...
Guest Paula Posted March 31, 2015 Share Posted March 31, 2015 Lol I really feel like you guys are too optimistic when it comes to docs. I dont know many docs only working 2 days a wk FBIDoc's sarcasm was lost on Pravy. Link to comment Share on other sites More sharing options...
Guest Paula Posted March 31, 2015 Share Posted March 31, 2015 So if PA school is more intense and not that much shorter than med school then why did you guys choose to become PAs over MD/DOs? The PAs that I have shadowed, particularly in primary care, seem to do the exact same job as the MDs but get paid half the ammount. Why didn't any of you just go to med school, enjoy a less intense curriculum, and end up with a similar job but with more autonomy&money? EMEDPA has said its cuz he wanted to avoid orgo. What about the rest of yall? I would say it was naive thinking at least on my part and the other part was my advanced age when starting PA school. I wasn't as old as the Old Man on Campus, but I did notice some gray hair coming in by the end of PA school. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted March 31, 2015 Moderator Share Posted March 31, 2015 They don't. Possibly in BFE they will, but generally, physician extenders (PA/NP) are seeing bread and butter cases to take the load off of the physicians who are better trained to see more complex medical conditions. With more groups and health systems dropping the hammer on providers to see more and more patients, doctors can't really afford to see the standard cough/cold/runny nose stuff. My experience as one who ran a primary care clinic for a few years before deciding to quit and become a clinician (PA or MD, still deciding), this is how things worked. As someone who is married to a physician, I'm aware that this is how things work at a large academic hospital as well. And even beyond primary care, PA's are not doing the exact same job as physicians in procedural specialties, either. Check out the website OR Live. Watch some surgeries where PA's are involved. There is not a PA out there doing a total hip replacement. There are PA's assisting docs with those, and, as you will see in those videos, they are mostly holding retractors and closing up after the surgery is completed (but mostly holding retractors). This is a bit of an understatement, but it's meant to make the point that PA's are not doing the same job. Rural ER? Yes, the work will mimic very closely what docs do. Metro area ER? Nope. Many (not all) PA's will be working fast track and, again, seeing bread and butter. The training of a PA doesn't really enable them to handle the complex cases without years of experience first. There are exceptions to this rule, but it is the rule. Anyway, what other masters program out there allows for such cool work and a near guarantee of $90,000 or more salary a year right out of school? Not many! Not only that, but some of the old school PA's on here may not even have a masters, but got minted back when the bachelors was the terminal degree for PA's. So these are folks with a bachelor's degree who are likely making $120,000+ There are PhD's with tenured professorships who would kill for that of pay. There are practicing lawyers sitting on $200,000 in debt making only $50,000 a year, and they have doctorates. I digress. In my opinion, this is what makes being a PA so awesome. Less school and less responsibility, with damn-respectable pay, are reasons to become a PA. Not everyone wants all that burden that doctors have. Obviously, some PA's do, and wish they would have done medical school from the get-go. I think this is probably a minority of PA's, though. With future PAs like you, glad I'm deciding to pursue med school. Link to comment Share on other sites More sharing options...
didymus Posted March 31, 2015 Share Posted March 31, 2015 With future PAs like you, glad I'm deciding to pursue med school. You'll have to be more specific. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted March 31, 2015 Moderator Share Posted March 31, 2015 You'll have to be more specific. No, I don't. Link to comment Share on other sites More sharing options...
ohsnapPA Posted March 31, 2015 Share Posted March 31, 2015 This whole thread is like a pregame for April Fools tmr lol. Have to say, it's been quite entertaining >.< Link to comment Share on other sites More sharing options...
didymus Posted March 31, 2015 Share Posted March 31, 2015 With future PAs like you, glad I'm deciding to pursue med school. You'll have to be more specific. No, I don't. Link to comment Share on other sites More sharing options...
cinntsp Posted March 31, 2015 Share Posted March 31, 2015 In my opinion, this is what makes being a PA so awesome. Less school and less responsibility, with damn-respectable pay, are reasons to become a PA. Not everyone wants all that burden that doctors have. The whole less responsibility thing is a terrible misconception. I cringe whenever I hear someone say something like that. They don't. Possibly in BFE they will, but generally, physician extenders (PA/NP) are seeing bread and butter cases to take the load off of the physicians who are better trained to see more complex medical conditions. I feel this is an inaccurate generalization. Link to comment Share on other sites More sharing options...
hrubenstein Posted March 31, 2015 Share Posted March 31, 2015 Breh let me start off by saying people on this forum are gonna bark at you. We're PAs or future PAs; who wants to hear this kind of stuff. Maybe theres a bit of truth to it but you have to keep your audience in mind. I'm not here to bark, I could really care less. I will give you my honest opinion. You sound like you need a little self confidence. I say that in the most non-condescending way I possibly can over the internet. You are completely qualified to go to Med school, pass basic sciences and knee drop step 1. You study 7 days a week, why is that a negative thing? You feel you don't have room to study more? I think you're better equipped for med school than your friends who took weekends off in college. You'll adapt, its something all humans do. You'll be surprised what you're capable of when placed in certain situations. I don't know you but you sound a little self-doubting. Try to have a little faith. Others have done it and others will do it. They're not so special. They're not doctors at birth. Relax. Stop looking at med school drop out horror stories. Facts are they're rare and if you go on a case by case basis its my belief that they're all explainable. I say this because you do kinda sound like the "pa is a great shortcut and easier and idk what it is but it sounds kinda cool" poster. Being a PA is fine if thats what you decide. But just know that you will probably regret it. Not because its a bad career but because your older self will realize you didn't go to med school because you were scared essentially. Thats gonna hurt. Sounds bitter even thinking about it. Best of luck! Link to comment Share on other sites More sharing options...
FBIDoc Posted March 31, 2015 Share Posted March 31, 2015 Not sure where you work, but this is not how it is in any setting I've ever seen or heard about from people working directly in healthcare. I'm going to stop you right here, because being married to healthcare doesn't equate with knowing about healthcare in the least...my wife was in the stock market, but I never assumed for a minute what the hell she did every day but make us money...now I am assuming you aren't actually practicing based on your naive perception of what WE do...maybe I'm wrong, so forgive me if so... I have been the sole provider in a 24 bed CVICU at a major tertiary cardiac referral center where they didn't use MD's at all...and we had better outcomes...I have worked in Level 1 trauma centers and worn the coveted "Dome" on my lab coat...I have taken care of refugees in Somalia and earthquake victims in Haiti, done surgery in Guatemala - yes DONE surgeries, while the surgeon watched...I perform my duties to this day autonomously as I have for the past 15 years, and teach, that's right TEACH physicians how to take care of patients, not pass tests...there's this thing called "sarcasm" and that directly relates to my 2-day per week comment, but it obviously was lost on you...as far as incomes are concerned, your "statistics" on income equality are highly skewed toward primary care...I can name dozens of docs I work or have worked with that make to this day in the $400K-1.5 million range - all across the country... my perception IS the rule rather than the exception - when you decide to put on your big-boy/big-girl scrubs and realize where our profession is heading then maybe you can join us at the adult table for dinner... Link to comment Share on other sites More sharing options...
whoRyou Posted March 31, 2015 Share Posted March 31, 2015 Link to comment Share on other sites More sharing options...
didymus Posted March 31, 2015 Share Posted March 31, 2015 The whole less responsibility thing is a terrible misconception. I cringe whenever I hear someone say something like that. I guess you need to define responsibility then if you believe it is a misconception. PA's do not practice independently. Unlike NP's, PA's have someone who is responsible for them; this person is the supervising physician. I hope you would admit--and I would be surprised if you didn't--that the SP is the one who has the ultimate responsibility. Shoot, it is even made clear by AAPA: https://www.aapa.org/Workarea/DownloadAsset.aspx?id=795 (see section on Supervision) "Supervising physician should be defined as an allopathic or osteopathic physician (MD or DO) licensed to practice in the state, who accepts responsibility for the supervision of services provided by physician assistants." Just by definition alone, a physician is more responsible than the PA, as the physician is responsible for the PA. The PA is the legal responsibility of the physician, and the physician is the one who will be held legally responsible for the "act and omissions of the PA". Legally, physicians are held to a greater degree of responsibility and accountability than PA's. This is not to say PA's are not responsible, just that they have less responsibility. It's a fact. It is spelled out by AAPA, and each individual state outlines the responsibility physicians have over their PA's. In Cox v. M.A. Primary and Urgent Care Clinic, the court ruled that a supervising physician had an agency relationship with a PA and thus could be found vicariously liable for the PA’s negligence, if the negligence were proven. The court held that “as a general matter a [PA] stands in an agency relationship with his or her supervising physician when the [PA] is providing authorized medical services.” Accordingly, where a “medical doctor delegates certain responsibilities to her [PA], she remains responsible for the assistant carrying out those responsibilities in an appropriate manner,” and under such circumstances, “the [PA] occupies the role of agent and the supervising doctor occupies the role of principal.” Accordingly, in Cox, the PA was an agent of the supervising physician, and the supervising physician was subject to vicarious liability. - The Physician Assistant Licensing Act (PALA) limits the scope of PA practice and mandates a supervisory relationship with a physician licensed by the State Board of Medical Examiners. - A PA holds only a limited license and can practice only in a supervisory relationship with a plenary license holder. - The general rule is that a PA may “practice in all medical care settings, including a physician’s office, a health care facility, an institution, a veterans’ home or a private home.” Such practice is subject to the following requirement: The PA is under the direct supervision of a physician. This is all basic stuff. PA's have limited licensure, whereas physicians do not. PA's can be held legally responsible for malpractice, but when they are, the SP also can--and is--held legally responsible for the PA. When a physician is sued for malpractice, that's where it ends, because the doctor is the one ultimately responsible for the care provided. Legally speaking, one of these providers has more responsibility. I'm not sure why something that is established policy and known fact makes you cringe. I can't believe me saying something that is almost universally accepted would be controversial to you. I feel this is an inaccurate generalization. It isn't. Even this forum is loaded with PA's explaining to the pre-PA and PA-S the limited scope of practice for PA's. Actual PA's on this very thread spoke about it, and use it as an example of why someone on the fence should go and be a doctor. There is even a veteran member of this forum who has essentially said this is the reason she went to medical school after being a PA for so many years. Again, I'm not really sure why my observations of well-established, generally uncontroversial information is causing you grief. Link to comment Share on other sites More sharing options...
didymus Posted March 31, 2015 Share Posted March 31, 2015 I'm going to stop you right here, because being married to healthcare doesn't equate with knowing about healthcare in the least...my wife was in the stock market, but I never assumed for a minute what the hell she did every day but make us money...now I am assuming you aren't actually practicing based on your naive perception of what WE do...maybe I'm wrong, so forgive me if so... I have been the sole provider in a 24 bed CVICU at a major tertiary cardiac referral center where they didn't use MD's at all...and we had better outcomes...I have worked in Level 1 trauma centers and worn the coveted "Dome" on my lab coat...I have taken care of refugees in Somalia and earthquake victims in Haiti, done surgery in Guatemala - yes DONE surgeries, while the surgeon watched...I perform my duties to this day autonomously as I have for the past 15 years, and teach, that's right TEACH physicians how to take care of patients, not pass tests...there's this thing called "sarcasm" and that directly relates to my 2-day per week comment, but it obviously was lost on you...as far as incomes are concerned, your "statistics" on income equality are highly skewed toward primary care...I can name dozens of docs I work or have worked with that make to this day in the $400K-1.5 million range - all across the country... my perception IS the rule rather than the exception - when you decide to put on your big-boy/big-girl scrubs and realize where our profession is heading then maybe you can join us at the adult table for dinner... Yikes. Seriously, yikes. You provided an awesome example right here of not knowing enough about who you are talking to. Also, your delivery should serve as a cautionary tale of how poorly being unprofessional can make you look. It wouldn't even matter if everything you said were true (and, man, there is just so much wrong with most everything you have said in this thread), the way you write undermines any credibility you may have. And honestly, guy, listing off all of your "gold star achievements" for the world to see isn't making anyone swoon. You must not have very in-depth conversations with your spouse if she was successful (I'm assuming here, since all you said was, "She was in the stock market--whatever that means), in her field and you didn't learn anything, or at least enough to converse intelligently on what she does, what the stock market is, who is involved, how they are involved, and what, in general, it all looks like. But, then again, my knowledge of the healthcare industry doesn't just come from "being married to it," so I am able to converse at length and in great detail about it. I've worked extensively in the field, but I won't go on listing my background, as you've shown us how distasteful that can come across. All of the ax grinding going on in this thread is a sight to behold. Link to comment Share on other sites More sharing options...
FBIDoc Posted March 31, 2015 Share Posted March 31, 2015 Yikes. Seriously, yikes. You provided an awesome example right here of not knowing enough about who you are talking to. Also, your delivery should serve as a cautionary tale of how poorly being unprofessional can make you look. It wouldn't even matter if everything you said were true (and, man, there is just so much wrong with most everything you have said in this thread), the way you write undermines any credibility you may have. And honestly, guy, listing off all of your "gold star achievements" for the world to see isn't making anyone swoon. You must not have very in-depth conversations with your spouse if she was successful (I'm assuming here, since all you said was, "She was in the stock market--whatever that means), in her field and you didn't learn anything, or at least enough to converse intelligently on what she does, what the stock market is, who is involved, how they are involved, and what, in general, it all looks like. But, then again, my knowledge of the healthcare industry doesn't just come from "being married to it," so I am able to converse at length and in great detail about it. I've worked extensively in the field, but I won't go on listing my background, as you've shown us how distasteful that can come across. All of the ax grinding going on in this thread is a sight to behold. ... and said nothing...be gone troll... Link to comment Share on other sites More sharing options...
hrubenstein Posted March 31, 2015 Share Posted March 31, 2015 im lol'ing. you guys are arguing over an internet forum. can't we all just get along Link to comment Share on other sites More sharing options...
didymus Posted March 31, 2015 Share Posted March 31, 2015 ... and said nothing...be gone troll... Link to comment Share on other sites More sharing options...
didymus Posted March 31, 2015 Share Posted March 31, 2015 im lol'ing. you guys are arguing over an internet forum. can't we all just get along It is laughable for sure! I only piped up because the thread was becoming heavily one-sided, and I wanted to add a bit of balance to the points being made to the OP. When I thought I was merely conveying, in detail, information that was widely accepted (outside of this forum, of course) I got under the skin of some posters. It happens. Moving on... Link to comment Share on other sites More sharing options...
FBIDoc Posted March 31, 2015 Share Posted March 31, 2015 The problem Didymus is that you don't add balance...just subjective opinion based on speculation and loose association with the practice of medicine...the reason I listed a few of my "gold star achievements" was to lend some credibility to you, who does not know me. I wouldn't have to be so forthcoming to the likes of andersenpa, E, Primadonna, etc...because they know me and my background...you, however list nothing other than the betrothal to medicine to wit makes not an expert in the field...as far as I can tell you want to be a PA but certainly aren't one, and your use of memes in a thoughtful discussion is outright juvenile...save it for your Snapchat friends...and by the way you're not under the skin of us, you're an ill-informed wannabe that has an opinion...your "information" isn't widely accepted primarily because medicolegal standards vary from state to state...perhaps your online MPH didn't cover that material? Link to comment Share on other sites More sharing options...
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