Why Are We So Unstable?

[GetMeOuttaThisMess]

Maybe it's just me, but it seems that we're the most unstable medical career going with regard to job stability and satisfaction.  Me?  Numerous positions over the past 34 years and it seems that all have the ability to get away from what I was told my job responsibilities were (none ever to the better I might add).  We're always talking about how we have to work around physician situations, worrying about other competitive providers, lack of respect from insurers, etc..  I've even had a couple where the position itself was never felt to be stable.  Heck, I gave up a chance for broadcast journalism because it was "too unstable" to go into a "stable" field like medicine.  Yes, it was a bad week.

[EMEDPA]

had those weeks too.

my solution- work at a place where you are the only provider on site, seeing low volume and high acuity and there is no higher authority present than you.

[Reality Check 2]

I agree with the instability feeling. I thought it was just me for a long time but realized it had to do with being the "employee" and the "expendable" provider and not really being in control of our destiny.

 

Friday, I had 26 patients in 8 hours - more than my doc. It was exhausting and defeating and I really have NO CONTROL. The front desk only listens to him and since his dad and the other doc regularly saw 30 a day - that is "normal" and profitable in his eyes.

 

It is not what I want to do for 20 more years and it really isn't sane or safe. 

 

PAs are smart and flexible and we get trashed at every turn as someone has an "idea" of how to change their practice and we are the Gumby, the Yo-Yo and the Guinea Pig for these changes since our roles seem ill-defined and open to interpretation regardless of how insane the interpretation. 

 

Another vote for independent practice rights or unleashing us from physicians so we can define our duties and obligations more in line with the practice of medicine. 

 

I still have issues with the legalities of this practice and the stuff the doc just will NOT look at or realize. Still balancing how badly it could damage my license while supporting my family and looking for another job. 

 

Still trying to figure out how I see more people, charge more and get more money than the doc I replaced but he can't justify paying me more but they paid the retired doc nearly twice what I make....... yet the doc says he lost income last year.  Office manager immune from his scrutiny and won't call in a forensic accountant or business consultant. 

 

I am exhausted and defeated. He just will not talk to me about business matters regardless of my experience and resources. That business degree I got years ago counts for nothing. Nor does 25 years in various practice settings witnessing and participating in different management styles - I kind of KNOW what works. He has never been anywhere else. But he is a doc and he owns the place - so I am nothing. 

 

Deep Sigh

 

My teenage thoughts of using my foreign language skills in international business don't sound so dumb anymore.

[BruceBanner]

I can relate. I have not observed the job satisfaction of most PAs (and some docs to be honest) to be especially high. Maybe it's confirmation bias on my part.

 

The happiest seem to be the docs who totally run their own show, or PAs in a similar autonomous niche.

 

Primary care sucks!! Let's just say it. It chews up providers and spits them out. You have virtually no control over the sh!t that gets dropped on your plate. Seeing 10-12 easy, acute patients per day? Yeah, that's not so bad. But like the old saying goes, it's good until it isnt. Just when you think "hey, I could do this for a while", you get a DUMP of unmanaged, chronic, cranky, sick patients with a side of whacko labs, inappropriate bookings, service complaints because you didnt make them better immediately, and pressure from above to see more people and make them happier.

 

It's just a soul-draining job much of the time. I for one want OUT of patient care entirely, or at least want to find a more relaxed gig with narrower responsibility.

[GetMeOuttaThisMess]

I might add that the most stable area by far was EM. Only problem with the first position was the hospital sold us out to another contractor after 14 years. Next ED job (hired same day by another group after we lost the first contract) I just grew tired of hours and always getting called to cover someone else's shift. I had a young daughter at home at the time and felt that I was missing too much. One would think gov't jobs would be set in stone but not so much I'm realizing as the years pass.

[overthehorizen]

I agree that practicing as a PA is not a very stable field. The big problem is that we do not have independent practice. Physicians create many problems for PAs because they know we do the exact same work for half the pay and far less training. It should serve as a warning to the future physicians that they are investing too many years and too much money in a field that has a lot a new competitors eating away at their share of the pie. They are left with no real power so they resort to make the lives of the PA miserable as best they can. The more experience I get, the less physicians have to contribute to the discussion but they try desperately to say something meaningful though it rarely is relevant.

[BruceBanner]

Think about it though, if you were a doc would you care about PA welfare?

 

As a PA I can tell you I dont really give a hoot about nurses' professional welfare. It's not my problem. I have my own.

 

I dont think the majority of docs are out to get us. I just think that, when presented with a relevant decision, they will choose what benefits them the most. Which usually results in PAs getting the shaft in some way or another.

[Reality Check 2]

My very first post to this forum was about burnout and wondering if this is as good as it gets.

 

Well, almost 2 years later - yep, it hasn't gotten any better.

 

I am frustrated with being an "employee" of a doc who thinks he has "his PAs" and we are to "his bidding" (yep, a direct quote). I am older than him with a lot more experience. My ethics aren't negotiable. My knowledge base is good and I strive to increase it daily. Do I know everything? Obviously not and would never claim to.

 

I don't think the profession is dying as others on this forum claim. My personal situation has reached a point where I am a threat of some sort due to age, experience, and personality - not a wallflower by any means. 

 

It is a bummer of a day as I still receive no reply from multiple applications on indeed.com and have no contact info for the folks on these ads - it must be nice for the employer to have a barrier and amount of anonymity to protect them from inquiries. Professionalism is all but dead.

 

So, I do not feel stable 25 years in and, in fact, feel more unstable than ever before.

 

I don't have a Master's and have no real motivation or financing to achieve one, much less a doctorate. I won't get paid any more for a 99213 or 99214 if I have a masters or doctorate. A doc isn't going to pay me any more for those letters behind my name either.  The teaching positions are state and the posted salaries for a master's teaching level PA are laughable - even less than the VA pays and easily $25K less than I make now which is under median. So, WHY would I go put myself in debt to get another degree? It isn't going to help me at this stage in my career. 

 

I have easily 15-20 years of having to work and don't like what I see. 

 

So, yep, still feeling unstable. I don't see independent practice fixing everything for me at this stage and I don't see it in my state anytime soon. 

 

Does it get any better than this for us old folks???

[Katera]

My very first post to this forum was about burnout and wondering if this is as good as it gets.

 

Well, almost 2 years later - yep, it hasn't gotten any better.

 

I am frustrated with being an "employee" of a doc who thinks he has "his PAs" and we are to "his bidding" (yep, a direct quote). I am older than him with a lot more experience. My ethics aren't negotiable. My knowledge base is good and I strive to increase it daily. Do I know everything? Obviously not and would never claim to.

 

I don't think the profession is dying as others on this forum claim. My personal situation has reached a point where I am a threat of some sort due to age, experience, and personality - not a wallflower by any means. 

 

It is a bummer of a day as I still receive no reply from multiple applications on indeed.com and have no contact info for the folks on these ads - it must be nice for the employer to have a barrier and amount of anonymity to protect them from inquiries. Professionalism is all but dead.

 

So, I do not feel stable 25 years in and, in fact, feel more unstable than ever before.

 

I don't have a Master's and have no real motivation or financing to achieve one, much less a doctorate. I won't get paid any more for a 99213 or 99214 if I have a masters or doctorate. A doc isn't going to pay me any more for those letters behind my name either.  The teaching positions are state and the posted salaries for a master's teaching level PA are laughable - even less than the VA pays and easily $25K less than I make now which is under median. So, WHY would I go put myself in debt to get another degree? It isn't going to help me at this stage in my career. 

 

I have easily 15-20 years of having to work and don't like what I see. 

 

So, yep, still feeling unstable. I don't see independent practice fixing everything for me at this stage and I don't see it in my state anytime soon. 

 

Does it get any better than this for us old folks???

 

 

 

All three UC's I work at require PA's to have a Masters before they will hire them.  Why?  NP degree match.  I graduated from one of the best PA schools in the country in the early 90's, but when I went it was a BS.  Very few were masters back then.  Around 2006 I saw the handwriting on the wall, and did the University of Nebraska PA bridge to an MPAS.  Soooo glad I did it. The year I finished it, UofN almost tripled the cost for the program.  I think I paid around $5k.  Btw, MinuteClinic won't even hire PA's with no MPAS...just saying.

[GetMeOuttaThisMess]

Only when we retire. Caribbean Life on HGTV tonight and daily watches of real estate on Maui/Kauai. I wonder what ever happened to the resort PA position on Maui a couple of years back that didn't pay enough for all living expenses BUT if you had your residence paid in full or with a small mortgage that would work? I can't get my SP's to commit to overseeing a bridge program even if I wanted to go that route. I should know in the next two weeks if our slots at work are contracted for another year.

[Reality Check 2]

All three UC's I work at require PA's to have a Masters before they will hire them.  Why?  NP degree match.  I graduated from one of the best PA schools in the country in the early 90's, but when I went it was a BS.  Very few were masters back then.  Around 2006 I saw the handwriting on the wall, and did the University of Nebraska PA bridge to an MPAS.  Soooo glad I did it. The year I finished it, UofN almost tripled the cost for the program.  I think I paid around $5k.  Btw, MinuteClinic won't even hire PA's with no MPAS...just saying.

 

 I have not run into ANY employers in the State of Washington who require a masters. At all - in 20 years.

I graduated in 1992 and was told the only thing that mattered was my NCCPA. 

 

So, I have not run into problems with not having a masters personally. Moreover, I think they know I am older than a lot of the docs and that makes them uncomfortable. 

 

My 25 yrs outdoes a masters anyday anywhere. A masters does not make someone with less experience more clinically capable than me - I don't care when they graduated. You walk this walk long enough - you earn the knowledge.

[GetMeOuttaThisMess]

They want the MS in Tejas, at least in the north (DFW).

[Avalon]

Wow, can I relate.  I left the probably the most stable of jobs (tenured professor) for my new life as a PA.  Brief employment summary to follow:

 

Job 1: Family medicine with an incompetent doc whose 21 year old, psychiatrically impaired daughter was the practice "manager."  Doc upcoded most of my billing, reluctantly agreed to 30 minutes "supervision" once weekly after four to five months of my asking for this, and couldn't answer most questions I posed about cases of concern.

 

Job 2: Started at 10 hours weekly while I cared for a terminally ill family member.  An anti-"mid-level" family medicine DO to whom I had to prove myself.  Ultimately, I won him over.  Then, his partner left unexpectedly for an academic position and I was asked to essentially become full time, managing very complex geriatric cases.  This was a bit overwhelming with my other responsibilities.  He hen brings on a resident to train and ultimately offers her partnership.  I am reduced to part-time, so I then take on a second, part time position in women's health.  That job demanded full time employment within six months of my start, and I made the decision to accept.

 

Job 3: Full time women's health.  At the time the ultimatum was made to me to come full time or leave and be replaced, the doc was already in negotiations to sell the practice.  He was paid "a ridiculous sum of money" and then stayed on as an employee.  The new owner, also a doc, had 43 legal cases pending against him in the state (as well as many in other states) and it became increasingly clear he was engaging in insurance fraud and drug diversion.  I resigned -  without another job.

 

Job 4: Turned down two other offers to take another full time position in women's health.  Came on board with a solo practitioner MD and two part-time NP colleagues, both of whom left within the year (one retired unexpectedly; one took another job with a competitor to our practice).  CP spends perhaps 6-8 hours a week on-site and is out of state four to five days per week.  She is unsupportive, incapable of self-awareness, and hostile.

 

Unstable?  Feels like it to me.  Alas - I grow weary...

[Katera]

 I have not run into ANY employers in the State of Washington who require a masters. At all - in 20 years.

I graduated in 1992 and was told the only thing that mattered was my NCCPA. 

 

So, I have not run into problems with not having a masters personally. Moreover, I think they know I am older than a lot of the docs and that makes them uncomfortable. 

 

My 25 yrs outdoes a masters anyday anywhere. A masters does not make someone with less experience more clinically capable than me - I don't care when they graduated. You walk this walk long enough - you earn the knowledge.

 

 

 

Of course I agree with you 100%, but that is simply not the case in Texas.  There are a LOT of corporate owned facilities down here and they, as a whole will not even talk to you without a Masters.  Just pointing that out.  I would assume it might be more of a regional trend.

[Guest JMPA]

I agree with the instability feeling. I thought it was just me for a long time but realized it had to do with being the "employee" and the "expendable" provider and not really being in control of our destiny.

 

Friday, I had 26 patients in 8 hours - more than my doc. It was exhausting and defeating and I really have NO CONTROL. The front desk only listens to him and since his dad and the other doc regularly saw 30 a day - that is "normal" and profitable in his eyes.

 

It is not what I want to do for 20 more years and it really isn't sane or safe. 

 

PAs are smart and flexible and we get trashed at every turn as someone has an "idea" of how to change their practice and we are the Gumby, the Yo-Yo and the Guinea Pig for these changes since our roles seem ill-defined and open to interpretation regardless of how insane the interpretation. 

 

Another vote for independent practice rights or unleashing us from physicians so we can define our duties and obligations more in line with the practice of medicine. 

 

I still have issues with the legalities of this practice and the stuff the doc just will NOT look at or realize. Still balancing how badly it could damage my license while supporting my family and looking for another job. 

 

Still trying to figure out how I see more people, charge more and get more money than the doc I replaced but he can't justify paying me more but they paid the retired doc nearly twice what I make....... yet the doc says he lost income last year.  Office manager immune from his scrutiny and won't call in a forensic accountant or business consultant. 

 

I am exhausted and defeated. He just will not talk to me about business matters regardless of my experience and resources. That business degree I got years ago counts for nothing. Nor does 25 years in various practice settings witnessing and participating in different management styles - I kind of KNOW what works. He has never been anywhere else. But he is a doc and he owns the place - so I am nothing. 

 

Deep Sigh

 

My teenage thoughts of using my foreign language skills in international business don't sound so dumb anymore.

though it is true that PAs as a whole are considered income generators for physicians and hospitals, one should never forget that most doctors will not discuss business matters because he does not want you to realize how much of an asset you are. The problem at large is that most (yes i mean most PAs do not realize how much we bring to the table. The amount of money that is generated and not reciprocated as salary is tremendous. If you let a profession learn how much they generate for others, than they will demand a much fairer wage. A well seasoned PA can economically equal a MD with weekly/monthly/yearly earnings. Know your value.