PA's & changes...what if?

[JimM]

I'm thinking...what if?

 

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 other healthcare professionals want to leave (and are leaving) medicine because of the ever increasing stress, long hours, paperwork, regulations, decreases in reimbursements, etc.  Various surveys say anywhere from 50 to 80% of 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 and EMR/EHR's, but these numbers seem pretty high. Are PA's worried about how this will affect them in the future?

 

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 soooo great to hear since I must decide very soon on my future path.... thank you!

Jim

[BruceBanner]

Those are valid concerns but don't read too much into op/ed pieces in magazines.

 

The reality is healthcare is changing and will continue to change for the foreseeable future. But look at it like this: People will always get sick and injured. Society will always need trained and credentialed providers. We will always be employable, the question is in what capacity? The old guard of physicians are retiring en masse but that doesn't necessarily mean they aren't being replaced. There is no quantitative physician or PA "shortage"; only disproportionate distribution. If anything the "midlevel" demographic is becoming saturated with all the new PA programs and NP programs coming out of the woodwork. It's an attractive career for people because they get to practice medicine and have a good lifestyle with less debt, or at least the illusion thereof.

 

If I were you I would be more concerned about being employable in a growing sea of PAs/NPs rather than if you will be able to deal with modern stresses of healthcare. EMRs can suck, ICD-9 and ICD-10 will suck, managed care organizations and health insurance juggernauts will continue to---for the most part---suck. It's just the reality of a complex multi-payer healthcare system. You do still get to do the job, you just spend about 50% of your time charting and billing.

[JimM]

BruceBanner,

Thanks for the response!  And yes, I know PA's will always be employable, but you hit the nail on the head: in what capacity and in what type of environment - those are the big questions I have!

[CAAdmission]

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?

 

Some of the most miserable people I know are physicians. Most of them are miserable because they deserve to be. They went into medicine with the expectation of tremendous wealth and prestige and they find themselves working as a employee for some big corporation where some kid with a business degree tells them what to do.

 

The docs I know who are in medicine because they care about people instead of their ego still love what they do. They have headaches to deal with, but they see human value in their work. The ego guys generally see it as a way to pay bills and are longing for a way out.

 

Finally, I take complete ownership for my happiness. Never let other people make you miserable. I actually like being surrounded by miserable people. It is kinda funny to watch them wallow in self-pity.

 

[JimM]

@CJAdmission... Thanks for the reply.  I completely agree: happiness is a choice - my choice, and I take complete ownership of that responsibility..... However, reality does intervene.  Allow me to give a personal example.  I became a licensed public school teacher and then entered the trenches only to find out that while I absolutely loved helping people, especially children, that the whole of the education system (regulations, BS testing, limited freedoms in how & what to teach, etc, etc) simply made teaching much, much less enjoyable.  I certainly didn't switch from a higher paying career in IT into teaching for the money, that's for sure.  My motive was to help others and do meaningful work.  So, while I choose to have a positive, motivated attitude it does not mean that I would enjoy working in a poor (dare I say toxic?) environment?  

[joanna.nola]

JimJ, I hear what you are saying re: teaching. I was also a teacher in a toxic environment (a failing urban school system) in one of my several career paths before becoming a PA. As a PA, I feel like I have a lot more choices. For me a non-toxic supportive environment where I'm not working 60+ hours a week is my goal. I realize I may have to move jobs a few times and that perfect job may pay less than some others (most PAs making well over 100k have jobs that sound very stressful to me...then again there are plenty of low-paying jobs that are also stressful & toxic) but doing something meaningful combined with a nice life outside of work is what I want.

[jmj11]

Those are valid concerns but don't read too much into op/ed pieces in magazines.

 

The reality is healthcare is changing and will continue to change for the foreseeable future. But look at it like this: People will always get sick and injured. Society will always need trained and credentialed providers. We will always be employable, the question is in what capacity? The old guard of physicians are retiring en masse but that doesn't necessarily mean they aren't being replaced. There is no quantitative physician or PA "shortage"; only disproportionate distribution. If anything the "midlevel" demographic is becoming saturated with all the new PA programs and NP programs coming out of the woodwork. It's an attractive career for people because they get to practice medicine and have a good lifestyle with less debt, or at least the illusion thereof.

 

If I were you I would be more concerned about being employable in a growing sea of PAs/NPs rather than if you will be able to deal with modern stresses of healthcare. EMRs can suck, ICD-9 and ICD-10 will suck, managed care organizations and health insurance juggernauts will continue to---for the most part---suck. It's just the reality of a complex multi-payer healthcare system. You do still get to do the job, you just spend about 50% of your time charting and billing.

I, personally, am ready for socialized medicine like the Europeans. We are in a real mess right now. In turn for being part of ACA, the insurance companies have become a huge problem. I have a stack of prior auths on my desk every morning, most of which I put into the shredder as I have the option of seeing patients and giving them care or spend my entire day filling out paper work for the insurance companies for free. There must be a huge class-action law suit against them to change their behavior. Their lobby is too powerful for congress to do anything about it. I was on the phone this week to my congressman in DC and gave him an ear full.  He says there is nothing he can do about it.  I'm now getting denials for amitriptyline, generic sumatriptan and of course denials for many of the patient's claims despite our charting being excellent and my biller doing it correctly. Now, 90% of the denials are due to our insurance companies making mistakes, but it still gets them off the hook. Can you imagine that if you had a job that paid you for each "mistake" you made (the insurance companies makes money on each of their mistakes)?  

[Guest Paula]

^^^^^^^  I'm starting to agree with JMJ on the socialized or national health care type of system.  I've always been a free market capitalist but it sure seems the insurance companies and pharmaceutical industry have taken it all to the next level where their power has overtaken the health of Americans.  And yes, I blame pharma too.  They got their sweet deal with the ACA and all of those lobbyists and the groups they represented ( pharma, insurance co's and the AMA) had their pockets lined when the ACA went into effect. 

 

IMHO. 

[LKPAC]

remember to old line, "If you think health care is expensive now, wait until it's free!"

 

Americans will never be happy with European or Canadian health care restrictions and waiting times for MRIs, PT, and elective procedures.  They want health care now.  Some of the most demanding patients are the ones who get their health care for "free" via the government.  Until we  solve the problem of patients who get "free" health care from abusing the system, i.e going to ER for a week-old rash instead of going to their PCP, we will never be able to control costs. For that matter people who have private insurance shouldn't abuse, either.  

 

There are solutions out there that we need to discuss, but socialized medicine (or whatever you call it such as single payer) will not work in this country. IMHO.  I'd like to see a national debate on real solutions and alternatives, before we see another government power grab of health care.

 

For the record, I'm not a hater. I believe everyone deserves access to health care, but does not deserve to abuse the system. I've read that up to 70% of ER visits are not urgent or emergent.  In Oregon, for instance, 50% of ED expenses in Oregon could be attributed to 3% of the Medicaid population.  http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-01-16-14.pdf

[Guest Paula]

A national debate is needed for sure but it should not be lead by any politician, presidential candidates, AMA, government entities, HHS or university college professors.

 

It should be lead by PAs.  We would get it done. As long as AAPA wasn't part of it.  LOL!

[SHU-CH]

We clearly need to do something better in this country. The main thing that scares me about socialized medicine is that it will grow into socialized everything. Our government does not empower people to manage their own affairs very well.

[JimM]

Thanks for all the viewpoints everyone....but I feel we are straying away from my original questions.  Are there any more comments/opinions more directly related to my original post?  Thanks.

[SocialMedicine]

If you survey ANY profession what % will want to leave ? Think about the prevalence of depression and anxiety. Unfortunately, I think a lot of people are dissatisfied.  I have no idea the answer but I think people often fall victim to the "grass is greener on the other side". There are also issues with how you structure a survey. 

 

Also, IMO, clinicians are notorious for complaining as a way to show how challenging and prestigious their work is.  "Ohhhh you'd never want to do this" "I tell my kid to never go into medicine" Meanwhile they have 3 homes and a porsche in the driveway heading out to the summer home in the Hamptons.  :p

[BruceBanner]

Health insurers are, IMO, way too powerful for anyone's good.  That said I think there are too many people in the US for a socialized, single payer system to work; and too many people who are fat and sick from their own making. The implementation alone would cost tens of billions, and beyond that we are an impetuous and wasteful society. We want the best care, right now, without having to wait and without having to change our lifestyles.