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Why are PA's paid half as much as doctors if they bill patients same amount.


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So I am a prospective PA student. An naturally I'm factoring in prospective salary. I am happy with it, but I am also confused. From what I have gathered online, PA's charge roughly 85% of what a doctor charges for a clinic visit. So why are they paid on 50% of what a doctor makes? 

 

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Physician Assistant -  4 year undergraduate degree, 2.5 year masters degree

 

Physician -  4 year undergraduate degree, 4 years medical school, 3-4 years of residency (working 40-80 hours a week for $40,000 a year), fellowship if you want any credibility 2-3 years (I would guess at $125,000 a year).  

 

 

A quick google search (unsure of credibility) shows medical school private = $278,455, public = $207,866

Average physician assistant degree cost somewhere between $65,000 - $80,000

 

 

Im summation:  Extra 2 years of school.  Extra $120,000+ in student loans.  4 years of residency working crazy hours for $40,000 a year, and fellowship on top of that.

 

 

I was actually discussing with a physician I work with which is a better career path.  He wrote down his estimates, and believes it would take a physician 6-7 years out of medical school to break even with a physician assistant after factoring in loans, and salary difference versus a physician assistant and a resident.  

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Residency can be as long as 5 years and around 50K/year. Fellowship as far as I know is 1 year and like 60K/year, unsure if there are longer fellowships. You can, of course, do more than one fellowship if you really wanted to. My guess for the pay discrepancy is that we need a SP to practice. Maybe more PAs should open their own practice? Who knows.

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most docs , however, DON'T do a fellowship. unless you do surgery or some IM fellowship, FP and EM are 3 years. you can moonlight yr 2 and 3 and make > 100k on top of your residency salary those years.

the real difference between docs and PAs is the MS1 year in school and the residency. in the residency the first year is a bear in all specialties, but after that fairly cush in many. the fp residents at my last job were in the hospital less than me after their internship yr was over.

yes, docs deserve money and respect, but we don't have to make their path seem more difficult than it really is.

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As PAs become untethered from docs, this may change. But I'm not optimistic, since we are income-generators for any practice. Docs are too, to an extent, but not at the level of cost/collections we are. Unless it's surgical.

 

I think physicians deserve the compensation they get due to their higher level of training, but I also think we deserve a bigger piece of the pie.

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Good points above, I agree with Bruce and ventana.  We are definately a profit center, at least an experienced PA that is practicing to their full ability is.  

I am probably an outlier, I actually make about half of what my collections are.  However, I see mostly medicaid and medicare (pretty much so the doc does not have to), and we have a terrible collection rate.  Both of those things are out of my control, so really for how hard I work my compensation is  probably more like a third of what my collections should be.  I do wish that in general we were treated more like providers instead of employees. 

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most docs , however, DON'T do a fellowship. unless you do surgery or some IM fellowship, FP and EM are 3 years. you can moonlight yr 2 and 3 and make > 100k on top of your residency salary those years.

the real difference between docs and PAs is the MS1 year in school and the residency. in the residency the first year is a bear in all specialties, but after that fairly cush in many. the fp residents at my last job were in the hospital less than me after their internship yr was over.

yes, docs deserve money and respect, but we don't have to make their path seem more difficult than it really is.

Completely disagree. I helped my husband get through med school, a 5-year surgery residency, and a fellowship. His debt is astronomically higher than mine. His malpractice insurance is way higher than a PAs. He was paid about 50,000 in the last years of residency and fellowship. Fellowship isn't necessarily more. You're paid based on the institution, and it can be a pay cut. He averaged 120 hours a week during residency. Now, as an attending, he averages 80. He deserves to make more than me.

 

I could have gone to med school. I chose not to after truly seeing what goes into that side. I have literally hundreds of friends who are physicians. I have never seen an easy, cushy residency. The lightest residencies I have seen had 60 hour work weeks, but that's without all the stuff on top of that work. Residents have conference requirements, research requirements, and much more.

 

They are not equivalent in investment of time or money.

 

Further, I co-owned and ran a surgery practice. There are a lot of reasons that doctors make more for doing the "same work." Reimbursement is falling. Insurance contracts are getting worse. PAs are valuable. I love the PA profession. There are many, many reasons I chose to be a PA. As it is right now, though, we have to have an SP. They don't. A PA is more easily replaceable, as crappy as that is.

 

It's easy for PAs, I think, to see ourselves doing the same work and get pissed off that we're not making as much. I've seen both sides. It's really just no comparison for time and monetary commitment.

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so the fact I've done the same years of school (all in clinical nursing/medicine), that I'm doing a residency, and I practice the EXACT same in hours, patient complexity, and procedurally as my physician counterparts mean I should be paid the same? I suspect your answer is going to be no and will perform some mental gymnastics as to why that should be.

 

Equal pay for equal work, or at least equal percentage of the profit I generate.

 

I wouldnt pay a Phd electric engineer more to wire my house than a electrician who can do it equally well. I certainly wouldn't as a contractor.

 

Now if I worked in a practice where a physician brought some value that I didn't, sure, pay him more. I think the Catholic physicians who won't discuss birth control or place IUDs/subcutaneous implants should be paid less than me too.

 

What about the fact I have just as much, if not more, debt than a physician? The answer is likely "your fault," and I would agree. So why do physician's get to claim this when they could have gone to a state school and saved tons of money? They didn't have to go to that private college or Yale, etc.

 

ETA: I don't necessarily think I should make a physician salary. I think they should make closer to my salary. Would I love to be paid more? Yeah, but I think healthcare costs are to high and part of fixing that is everyone making some sacrifice. Further, I don't think specialists showed make so much more than generalists.

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Completely disagree. I helped my husband get through med school, a 5-year surgery residency, and a fellowship. His debt is astronomically higher than mine. His malpractice insurance is way higher than a PAs. He was paid about 50,000 in the last years of residency and fellowship. Fellowship isn't necessarily more. You're paid based on the institution, and it can be a pay cut. He averaged 120 hours a week during residency. Now, as an attending, he averages 80. He deserves to make more than me.

 

I could have gone to med school. I chose not to after truly seeing what goes into that side. I have literally hundreds of friends who are physicians. I have never seen an easy, cushy residency. The lightest residencies I have seen had 60 hour work weeks, but that's without all the stuff on top of that work. Residents have conference requirements, research requirements, and much more.

 

They are not equivalent in investment of time or money.

 

Further, I co-owned and ran a surgery practice. There are a lot of reasons that doctors make more for doing the "same work." Reimbursement is falling. Insurance contracts are getting worse. PAs are valuable. I love the PA profession. There are many, many reasons I chose to be a PA. As it is right now, though, we have to have an SP. They don't. A PA is more easily replaceable, as crappy as that is.

 

It's easy for PAs, I think, to see ourselves doing the same work and get pissed off that we're not making as much. I've seen both sides. It's really just no comparison for time and monetary commitment.

 

 

I suspect your experiencewith a surgical setting is VERY different from the PAs that are doing any of the PCP fields....  This is a topic I hear come up from specialists PA that say they are fine with where they are at and what they do.

 

The problem is that the primary care fields are FAR different!!

 

I had my own practice for 3 years doing a great thing for the community with a great CP - who only took about 10% of revenue (which was a pretty good deal)   So I get 85% of his pay (for the same work - EXACTLY) then I loose another 10% to paying him (no value in that - I called him about 4 times over three years and the answer was the same (and I knew it going into it)   send them to the specialist.....            there is no different standard of care, there is no difference in how I do the job or how he would have done the job.  I fact I was the first PA owned PCP practice in the whole state (that I am aware of) and had a great deal of difficulty establishing it.    Prior to my own practice I worked in various different practices around town and got a pretty good feel for the PCP world as well so I was not drawing on just a single knowledge base / experience. 

 

 

All to work 60+ hours per week, for 85k/year...... that 25% of GROSS that I was loosing (meaning my gross would have been 25% higher) would have added 50% to my income - this would have likely allowed me to stay doing the thing I loved - geri house calls.    There is NO WAY a doc wants to enter this field for a $125+k salary for living as a practice owner and being on call 24x7x365 - But I loved it.

 

 

 

So my point is - the surgery world and medicine world, and even more specifically the out patient primary care world (separating out hospitalists) there truly is NO difference in the production or medicine delivered by an experienced PA or MD/DO.  Yes the MD might know more (maybe - as I have had to explain UE DVT to a IM doc who had a female high school volley ball player with a swollen arm.. seriously he thought DVT only happened in leg - and I ended up taking over the care of this patient as he was clueless...) and might have FAR more debt initially, but we are not asking for EQUAL pay, just representative pay of our value.....

PA in the surgical specialties will not be doing THR or TKR solo - this is not the point.  What is the point is the PCP fields where we are truly doing the same as the Doc's should have a more fair compensation set up..

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I suspect your experiencewith a surgical setting is VERY different from the PAs that are doing any of the PCP fields....  This is a topic I hear come up from specialists PA that say they are fine with where they are at and what they do.

 

The problem is that the primary care fields are FAR different!!

 

I had my own practice for 3 years doing a great thing for the community with a great CP - who only took about 10% of revenue (which was a pretty good deal)   So I get 85% of his pay (for the same work - EXACTLY) then I loose another 10% to paying him (no value in that - I called him about 4 times over three years and the answer was the same (and I knew it going into it)   send them to the specialist.....            there is no different standard of care, there is no difference in how I do the job or how he would have done the job.  I fact I was the first PA owned PCP practice in the whole state (that I am aware of) and had a great deal of difficulty establishing it.    Prior to my own practice I worked in various different practices around town and got a pretty good feel for the PCP world as well so I was not drawing on just a single knowledge base / experience. 

 

 

All to work 60+ hours per week, for 85k/year...... that 25% of GROSS that I was loosing (meaning my gross would have been 25% higher) would have added 50% to my income - this would have likely allowed me to stay doing the thing I loved - geri house calls.    There is NO WAY a doc wants to enter this field for a $125+k salary for living as a practice owner and being on call 24x7x365 - But I loved it.

 

 

 

So my point is - the surgery world and medicine world, and even the out patient primary care world (separating out hospitalists) there truly is NO difference in the production or medicine delivered by an experienced PA or MD/DO.  Yes the MD might know more (maybe - as I have had to explain UE DVT to a IM doc who had a female high school volley ball player with a swollen arm.. seriously he thought DVT only happened in leg - and I ended up taking over the care of this patient as he was clueless...) and might have FAR more debt initially, but we are not asking for EQUAL pay, just representative pay of our value.....

PA in the surgical specialties will not be doing THR or TKR solo - this is not the point.  What is the point is the PCP fields where we are truly doing the same as the Doc's should have a more fair compensation set up..

ahhh. could you imagine a surgeon doing all of his perioperative care? comical at best. specialty PAs are worth their weight in platinum

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Completely disagree. I helped my husband get through med school, a 5-year surgery residency, and a fellowship. His debt is astronomically higher than mine. His malpractice insurance is way higher than a PAs. He was paid about 50,000 in the last years of residency and fellowship. Fellowship isn't necessarily more. You're paid based on the institution, and it can be a pay cut. He averaged 120 hours a week during residency. Now, as an attending, he averages 80. He deserves to make more than me.

 

I could have gone to med school. I chose not to after truly seeing what goes into that side. I have literally hundreds of friends who are physicians. I have never seen an easy, cushy residency. The lightest residencies I have seen had 60 hour work weeks, but that's without all the stuff on top of that work. Residents have conference requirements, research requirements, and much more.

 

They are not equivalent in investment of time or money.

 

Further, I co-owned and ran a surgery practice. There are a lot of reasons that doctors make more for doing the "same work." Reimbursement is falling. Insurance contracts are getting worse. PAs are valuable. I love the PA profession. There are many, many reasons I chose to be a PA. As it is right now, though, we have to have an SP. They don't. A PA is more easily replaceable, as crappy as that is.

 

It's easy for PAs, I think, to see ourselves doing the same work and get pissed off that we're not making as much. I've seen both sides. It's really just no comparison for time and monetary commitment.

 

I agree. I too have known and trained alongside many physicians and I've always felt they deserve their pay. While I dont have HUNDREDS (???) of doctor friends, I chose not to go that route for the reasons you described. I'm still glad I didn't.

 

I think like Ventana said we are talking about apples and oranges here--PC vs surgery.

 

PC PAs really do, in most settings, do the exact same work as docs. I see the same number of ppd as my doc counterparts. In fact, my billing may even be higher because I do office procedures and they dont. I get the way the system is set up---we are employees who generate revenue, and we are pretty replaceable. That is what it is for now. But I still think we deserve a bigger cut for the money we bring in. I'm not even asking for equivocal doc pay, I'm asking for like 60-75%. So if the IM doc next door to me makes $250k with her bonuses, then I want $150-185k.

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If any of you guys are PA's. Exactly how much are you guys making? I'm looking at Boston and average PA salary according to indeed is 117k a year which looks really good even after considering the cost of living there.

 

It is not the current pay but instead a comparison of revenue generated for doing the exact same PCP job that we are discussing....

 

Simply looking that gross doesn't help much

 

117k in Boston is barely a living wage

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All this talk about whether PAs "deserve" the same as MDs is moot.

 

I'm a subsurgical PA and I do EXACTLY the same things that my surgeon attendings do, yet get paid about 1/3 of what they get.

 

PAs will NEVER have a pay raise to get paid the same level as MDs across teh board.   What COULD happen is that insurance companies decide to cut reimbursement to MDs and lower them to the PA level.

 

So PAs could very well make the same money as MDs but we wont get a raise; instead the MDs will take a paycut

 

Insurance companies aren't going to raise us up to MD level, but they will cut MD pay down to our level.

 

That's the way this is going to shake out -- so stop being delusional about magically getting a 50-100% pay raise from the insurance companies because that just aint going to happen

 

 

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All this talk about whether PAs "deserve" the same as MDs is moot.

 

I'm a subsurgical PA and I do EXACTLY the same things that my surgeon attendings do, yet get paid about 1/3 of what they get.

 

PAs will NEVER have a pay raise to get paid the same level as MDs across teh board. What COULD happen is that insurance companies decide to cut reimbursement to MDs and lower them to the PA level.

 

So PAs could very well make the same money as MDs but we wont get a raise; instead the MDs will take a paycut

 

Insurance companies aren't going to raise us up to MD level, but they will cut MD pay down to our level.

 

That's the way this is going to shake out -- so stop being delusional about magically getting a 50-100% pay raise from the insurance companies because that just aint going to happen

The 1/3 pay you get has nothing to do with the insurance company. The group you work for is keeping a higher portions of your billings than they do the physicians. That's the problem, not being fairly compensated as a percentage of revenue.
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All this talk about whether PAs "deserve" the same as MDs is moot.

 

I'm a subsurgical PA and I do EXACTLY the same things that my surgeon attendings do, yet get paid about 1/3 of what they get.

 

I don't know your exact situation, but this sounds overstated and illegal

 

I am not aware of anywhere in the country that a PA can perform surgery alone... maybe you are in a non-surgical subspeciality of surgery? Most hospitals require a Doc to be involved somewhere in the admission to their facility, and most insurance companies are not going to pay for a PA to be primary on a surgical case. And this is where the PCP PA is vastly different from the surgical PA's.

 

My point it that income should be tied, alteast somewhat, to revenue generated. We should not be generating 4x's our salary, while geting 1/3 the pay of the doc's.

 

The days fo the doc owning the practice are history, we are all likely just employees and a cog in the large health care system. Somewhere the amount we generate has got to come into play....

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