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What is the future of this profession looking like?

 

bright?

 

increase in scope of practice (NP like or better)?

 

increase in salaries?

 

more responsibilities?

 

anything to fight out the "glass ceiling"?

 

your predictions?

 

discuss!

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I think it is a mixed bag.  Yes, it is bright and I still would recommend the profession to a young person looking for a career.

 

Salaries: 

 

 I really don't see a lot of room for increasing salaries.  As a practice owner, I know how hard it is getting paid for the work that we do by insurance companies. I suspect that this will only get worse as the insurance industry has a lot of power in Washington and no one is going to reign them in.  If I hired a PA, and that PA worked very hard, we would be able to pay him/her an average salary but not much more because the income above that is really overhead and that overhead is increasing as time goes on through things like HIPAA, ACA, complexity of submitting claims and fighting for payment.

 

The biggest cost is doing business with insurance companies.  More than 50% of all our resources are completely wasted with insurance companies. There may be a future in cash-only practices or some hybrid.  Until this point interventionists (including surgery) have been spared from the cash crunch but I bet the insurance companies have them to in their crosshairs. In the future it will become more and more difficult to get approval and payment for procedures too.  So providers will be left with the option of running a patient mill (seeing one every 5-7 minutes) to earn a good living, or being the provider you wanted to be, where you really do care about the patient, and settling for an average salary.

 

I do see, looking at the path that we are on now, more daylight forming between PAs Vs MDs & NPs.  The powerful NP group will do whatever they can to increase that daylight. Eventually Practitioner will mean either a MD, DO or NP and then PAs would be seen by society as subordinate helpers to them.  I wish this was not true but this is the path the PAs have chosen for themselves and unless the next generation of PAs see things differently, it will continue and worsen. There are a lot of PAs out there who still believe in the matra, "if you really wanted autonomy you should have gone to medical school.  Don't be arrogant, remember we are just PAs.”  Maybe the next gneration will be different. At least I hope.

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bright future, but many changes coming down the line:

1. longer programs. likely 3 years. the profession has decided to accept folks without experience so programs must get longer to compensate for this.  

2.  required 1 yr postgrad internship/residency/fellowship/whatever name you want in specialty of choice. implied: loss of lateral mobility between specialties without doing 2nd postgrad program.

3. more required testing: pance, then a caq-like exam in specialty of choice done after completion of residency

4. Doctorate either as entry level or after postgrad training. this needs to happen to put us on an even playing field with the DNPs in the eyes of folks who Know nothing other than highest degree earned.

5. collaboration in all 50 states with some ties maintained with medical boards, but a mechanism for a pa to practice in a rural or underserved area without direct oversight by a named physician. maybe the board itself would oversee practice so a pa can work without a doc in those areas where docs won't go or pa can continue to practice if only doc in town dies, etc.

6. more responsibility, especially in rural and underserved populations/better scope of practice/respect, etc

7. gradual increases in pay to perhaps 60-75% what physicians make in outpt settings

8. expansion of bridge programs from PA to physician. original bridge program at LECOM has demonstrated that PAs make better medical students than typical applicants due to their prior experience. Most programs will emphasize a transition to areas of need: primary care( to include fp, im, ob, and peds) and potentially general surgery as many rural areas lack adequate surgical coverage.

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EMEDPA, 

 

This sounds good but how do you know that it will happen?  What is the evidence now that the profession will move in that direction? Or, like my, are you just hoping?

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gradual and incremental steps in that direction point that way. last year aapa got on board with collaboaration. they are gradually working on decreasing chart review, etc.

I think we will get to the place I mentioned above, but also think that is 20+ years in the future for all those changes to come to pass.

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gradual and incremental steps in that direction point that way. last year aapa got on board with collaboaration. they are gradually working on decreasing chart review, etc.

I think we will get to the place I mentioned above, but also think that is 20+ years in the future for all those changes to come to pass.

how is that beneficial? just wondering.

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how is that beneficial? just wondering.

docs are more willing to hire PAs vs NPs when they are not mandated to review their charts by the state. Several states already have this (WA and NC plus several others).

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One 

 

docs are more willing to hire PAs vs NPs when they are not mandated to review their charts by the state. Several states already have this (WA and NC plus several others).

One bottle neck are the lawyers at malpractice and health insurance companies.  Most lawyers see PAs as idiots (from my personal experience). So most malpractice contracts mandate physician chart review even though the state laws don't. You may ignore that fine print but if you were sued, and your own malpractice insurance company found out that the SP had not been reviewing your chart notes, they may opt out of covering or defending you.  I wish there were a law that mandated that malpractice insurers and health insurance companies (some of their contracts also require chart review by the SP) to follow the laws of the land rather than making up their own, more restrictive rules.

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I think some states say things like "physician must have "an ongoing understanding of PA practice patterns" or something similar, which implies they work some shifts with them every now and then or review some charts every now and then.

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It is very scary indeed how NPs will have it much better than PAs.  I feel that it will even get to the point that  where NPs will make more money than PAs due to their autonomy and being able to bill directly.

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It is very scary indeed how NPs will have it much better than PAs. I feel that it will even get to the point that where NPs will make more money than PAs due to their autonomy and being able to bill directly.

AFAIK they bill at the same rate as us. We typically make more also. Though at my place we make the same rate. It's based on years in practice not title.

 

They do have an advantage in convincing everyone else they're "better" than us.

 

Sent from my S5 Active...Like you care...

 

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I think it is a mixed bag.  Yes, it is bright and I still would recommend the profession to a young person looking for a career.

 

Salaries: 

 

 I really don't see a lot of room for increasing salaries.  As a practice owner, I know how hard it is getting paid for the work that we do by insurance companies. I suspect that this will only get worse as the insurance industry has a lot of power in Washington and no one is going to reign them in.  If I hired a PA, and that PA worked very hard, we would be able to pay him/her an average salary but not much more because the income above that is really overhead and that overhead is increasing as time goes on through things like HIPAA, ACA, complexity of submitting claims and fighting for payment.

 

The biggest cost is doing business with insurance companies.  More than 50% of all our resources are completely wasted with insurance companies. There may be a future in cash-only practices or some hybrid.  Until this point interventionists (including surgery) have been spared from the cash crunch but I bet the insurance companies have them to in their crosshairs. In the future it will become more and more difficult to get approval and payment for procedures too.  So providers will be left with the option of running a patient mill (seeing one every 5-7 minutes) to earn a good living, or being the provider you wanted to be, where you really do care about the patient, and settling for an average salary.

 

I do see, looking at the path that we are on now, more daylight forming between PAs Vs MDs & NPs.  The powerful NP group will do whatever they can to increase that daylight. Eventually Practitioner will mean either a MD, DO or NP and then PAs would be seen by society as subordinate helpers to them.  I wish this was not true but this is the path the PAs have chosen for themselves and unless the next generation of PAs see things differently, it will continue and worsen. There are a lot of PAs out there who still believe in the matra, "if you really wanted autonomy you should have gone to medical school.  Don't be arrogant, remember we are just PAs.”  Maybe the next gneration will be different. At least I hope.

 

I have to disagree with the salary statement - I think there is increase, but it only comes when they reset the bias against the intellectual medicine and stop reimbrsing so much for procedures.  My wife had knee surgery, 10 min! - paid $3800 to the surgeon (and he screwed it up)  This is more then I make in an entire week serving home bound seniors - illogical

 

Once we drive the specialist and hospitalization reimbursement down, then the PCP can be paid more... and PA and NP

One 

 

One bottle neck are the lawyers at malpractice and health insurance companies.  Most lawyers see PAs as idiots (from my personal experience). So most malpractice contracts mandate physician chart review even though the state laws don't. You may ignore that fine print but if you were sued, and your own malpractice insurance company found out that the SP had not been reviewing your chart notes, they may opt out of covering or defending you.  I wish there were a law that mandated that malpractice insurers and health insurance companies (some of their contracts also require chart review by the SP) to follow the laws of the land rather than making up their own, more restrictive rules.

 

As my Doc is closing his own practice and knowing how hard it is to find a great doc, I have elected to pay 50% of his insurance, which is no small expense for a small practice.  Malpractice insurance companies just don't get it, and if we were independent (why I need to doc is merely a legal issue) it would save me X% and make it more viable for PA to own practices

 

It is very scary indeed how NPs will have it much better than PAs.  I feel that it will even get to the point that  where NPs will make more money than PAs due to their autonomy and being able to bill directly.

 

I have never understood why we should be paid differently then Doc's in the primary care world. Sure it makes us "more affordable" but it seems illogical as we are held to the same standards, and require the same overhead to run a practice, but we are worth less????

 

Need pay parity to the doc's for the PCP world....

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So what exactly can we do to get the ball rolling so we can see some change?

 

Join PAFT. I'm only an advocate of joining professional groups if you can have some impact. Paying $100-400 a year for some lame magazines and a resume fluff is a waste.

 

As far as the outlook of the next 10 years for PAs, I see a few things. And this is from a "blue collar" PA perspective; I'm not on any sort of board nor do I hold any office.

 

1. PAFT is strengthening their influence and now has several members who are AAPA delegates and the PAFT past president is an AAPA director-at-large now. PAFT is very progressive and pro-PA, and I expect meaningful changes will be spearheaded by them.

 

 

Our numbers are increasing, which means a few things:

 

2. I do not see our salaries increasing by any significant measure in the next 10 years. This is fantasy and there is absolutely no reason for an employer to give a dependent provider higher salary potential. Our value to them is we cost less than a doc. I think the average PA salary will level off at or near 100k for non-procedural specialties.

 

3. Market saturation, similar to what happened in nursing. What I am seeing in my state is a tighter and tighter job market, and I have new grad friends who are corroborating this elsewhere in the country. The "write your own ticket" selling point of PA programs is bull. Yes, there is work out there, but it's an employer's market. Residency-trained and experienced PAs will get the best jobs.

 

4. We still do not have near the numbers or political power of NPs. I don't think we should view them as our nemesis; but the nursing empire does not have PA's best interests at heart and will gradually edge us out of healthcare if we just do nothing. The major issue of concern is legal changes giving employers a reason to preferentially hire NPs---i.e. independent practice rights.

 

 

Overall I'd still recommend it to a younger person thinking about the profession. The hours, pay, and scope can still be very good depending on your experience and where you are willing to live. There are certain things that do need to happen if we are to remain viable into the next 10,20,30 years: An official title change, appropriate autonomous practice rights, and a strong professional lobby.

 

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What is the future of this profession looking like?

 

Overall, I think the outlook is good.  I say this based on looking how far we have come from the past.  Yes eventually I think the salary will be capped but likely in the 6 figure range.  I can argue that some PAs deserve much more than this (and in actuality some are paid much more than this, but that is uncommon), but at the same time I do feel a bit greedy if I cannot be satisfied with a 6 figure salary.  The opposition to this, however, are all the new PA mills (schools) popping up that, according to supply and demand, may cap our salary a lot sooner than we wanted, and the same goes for NPs.  Because so many new NPs and PAs are being churned out, and especially because an NP degree is pretty (relatively, IMHO) easy to get, eventually we MAY saturate the market somewhat and see our salaries decline.  Time will tell.

 

increase in scope of practice (NP like or better)?

 

Yes, eventually, yes.  I think as PAs are more and more utilized, we are going to shine through many of our NP counterparts, and I have seen many jobs - usually in patient - giving preferance to PA > NP, although many other places prefer NPs for licensing reasons, even though they know our training completely lapses theirs (at least from a quality program, IMHO).  As a whole, PAs have gone from not having Rx privleges, to now running their own practices with pseudo-physician-oversight, running EDs solo, ordering the same tests and consults MD/DOs do, etc.  I think we may always lag behind NP because they have so much more money and resources than we do, but overall, I believe autonomy/scope will continue to uptrend.

 

increase in salaries?

 

See above.  Yes but with eventual cap and possibility of downtrending if NPs and PAs oversaturate the market.

 

more responsibilities?

 

This is obvious - yes.

 

anything to fight out the "glass ceiling"?

 

Better residencies in sub-specialties, a shorter DO bridge, more administrative and teaching opportunities - yes I think these things will all come in time.

 

your predictions?

 

Eventually all PA programs will possibly be 3 years.  Residencies will likely be mandatory but in 6 and 12 month varieties.  Overall predicition is good but only time will tell.  The responses here probably have more to do with attitude than someone having a more or less accurate forecast.

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This is a great discussion. I hope more PA's will chime in as I’m considering becoming a PA but I’m truly somewhat concerned about the future of health care.  When I see surveys, discussions, and news posts (e.g. from The New York Times, etc) about how many doctors and nurses want to leave (and are leaving) medicine because of the ever increasing stress, long hours, paperwork, regulations, malpractice costs/legal liability, decreases in reimbursements, etc.  Various surveys say anywhere from 5 out of 10 to 9 out of 10 doctors/other health providers would not recommend medicine to their children as a career and more than 50% of those surveyed want to leave medicine because of the reasons above and many of those say they are overloaded and/or burnt out.  This makes me concerned, even if it’s only 50% which is pretty significant.  I know things are vastly changing in medicine, especially with the Affordable Care Act, but these numbers seem pretty high. Are you worried at all about the future or medicine and being a PA?

 

On a similar note, do you think medicine will see a “trickle down effect?”  That is, it seems logical and to be expected that if many doctors are doing ever more work and are not particularly happy, then how could those working with and under them not be affected via trickle down?  If the doctors are overloaded then I would think that any work that can be handed down to others would be done so, thus increasing the workload, stress, etc for PA’s, NP’s, nurses, etc. and potentially affecting the “great work/life balance” that is such a hallmark of being a PA/NP.  Am I being reasonable with these concerns? Or am I blowing them up out of proportion? 

 

Any thoughts would be greatly appreciated!

thank you!

Jim

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 Just read EMEDPA use the term collaborative.  Is that term starting to spread?  We need to at take it over now from NPs (since they've given it up and are going for all out independent practice).  We need to emphasize the idea of collaborative practice and specify that responsibilities are delegated to us to perform independently.  That is at least language we can use that can maintain our close relationship with physicians while giving us both practice freedom to compete with NPs and legal freedom to avoid getting bound up in technicalities ("dependent practitioner" vs "licensed independent practitioner" a'int Medicare grand).  We need to modernize before we are left behind.

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 Just read EMEDPA use the term collaborative.  Is that term starting to spread?  We need to at take it over now from NPs (since they've given it up and are going for all out independent practice).  We need to emphasize the idea of collaborative practice and specify that responsibilities are delegated to us to perform independently.  That is at least language we can use that can maintain our close relationship with physicians while giving us both practice freedom to compete with NPs and legal freedom to avoid getting bound up in technicalities ("dependent practitioner" vs "licensed independent practitioner" a'int Medicare grand).  We need to modernize before we are left behind.

 

that is the new standard term for the last year per the aapa president's address in Boston

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What is the future of this profession looking like?

 

bright?

 

increase in scope of practice (NP like or better)?

 

increase in salaries?

 

more responsibilities?

 

anything to fight out the "glass ceiling"?

 

your predictions?

 

discuss!

I think we should remember that by 2025 there is expected to be a shortage of 90,000 doctors, 40-50,000 of which will be primary care. The future is for PA and NP's to fill that void and many programs are "ramping up" for that prediction, particularly our NP colleagues. I am in the winter of my career (year 34 for me) but those of you who are in the early stages and mid careers should be preparing yourselves for this. 

 

Bob

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"Collaborative...."  WOW...I was a member of the Professional Practice Council a couple of years ago (as they closed all those neat councils) and the last thing we did was sit in the PA headquarters on a Saturday and go through the AAPA documents for regulation and change "supervisory/ supervisor" to "collaborative/collaboration" and never heard anything about it again.....

 

I am so pleased to hear this. 

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I hope collaborative is just a first step. We need parity with NPs I think to survive in some markets.

 

Sent from my S5 Active...Like you care...

 

 

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This would put us at parity as far as practice physician/"midlevel" relationships are concerned. 

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