Exit Plans...Any Ideas?

[Incognito]

I'm strongly considering my exit plan from full time PA profession and maybe the profession all together.  I am 61.  Several things have been starting to break the camel's back.

1. Spouse with progressive dementia at an early age (60) and the need to be more available to manage his needs.  I have help coming in 2x a week and he attends a dementia day program 2 days a week, and I have one day a week off, plus weekends.  I travel 27 miles one way to my job, easy commute.

2. My employer was recently taken over by a very large non-profit religious organization that has caused severe demoralization with all practitioners, staff and managers. Previously we were a very small non-profit religious organization that held to its founding values.  The large one not so much.  While I am a person of faith, I decry the double speak of "show justice, mercy, and compassion"  to your patients by the  daily emails we receive  when the staff is treated like slaves. 

3. Recent news that our state DHS regulations will now require co-sig for all orders from PA/NP for medicaid patients.  This was a surprise to all parties involved and currently we are getting clarification on the regulation.  If it is in fact true the rural practice I am in will not have enough physicians who are willing to co-sign every single order.  Every order.  One of our well respected IM physicians told me with our new EHR and management he does not have time or desire to collaborate with either profession.  He is supportive of changing our state laws to collaboration and for all professions to be responsible for their own actions and medical care of patients. 

4. My previous SP retired from full time family practice in February and transferred to a part time nursing home practice.  Therefore, the new physician who is our department VP is my SP. Very nice person....but does not read EKG's which I just found out yesterday......   Traditionally I have read my own EKG's and am privileged to do so...BUT....my state law says I cannot practice outside of the SOP of the SP......it now begs the question.....can I still read my own EKG's and what else does she NOT do?  I need to have the discussion with her.  Our state is in the process of attempting to change the PA SOP laws to being determined at the practice level based on experience and credentialing.    Only time will tell if we are successful.

5. Speaking of EHR's.  We were forced to change to a new EHR.  The hospital, clinic and ER now have 3 different EHR's which do not communicate with each other.  I am exhausted trying to find the records of what was done at each section of our hospital (my clinic is located in a wing of  the hospital campus) when my patients come in for follow up or for transitional care management.  The greatest pitfall is medication reconciliation and none of the 3 EHRs can help me verify meds and patients do not know what to stop and  what to start and they THINK I know what happened at their hospitalization.  Nope, I didn't have a clue and I have no idea what medications they are on in actuality.  The pharmacies are no help either.  

6. I will turn 62 in August 2018 and am considering triggering social security and maybe working enough to have some income so I will be able to pay for health insurance for myself.  My husband will be able to get on Medicare fully if I no longer carry the health insurance.

7.  One decision I made this week is I will be taking a one year sabbatical from being a preceptor starting Oct 1st after my current PA student finishes the rotation with me that ends Sept 28th.

8. The good news:  We have no debt and can live frugally and may consider selling our home and downsizing to a small 2 bedroom condo closer to one of our children who lives in a   larger city .  This would be so I can get more services for my husband and the medical services include many more options for specialist, etc.   I love rural but as we age the needs for us are increasing and finding it in small communities is quite a challenge. 

9.  Mostly, my post is to just help me vent and to see my thoughts on the screen.  It may help me clarify the next steps.  

 

[PACJD]

It seems as though you had a good career and have made a good living, so you should be proud of what you have done as a PA. The circumstances at this point suggests that you have other obligations that you need to fulfill, but definitely be happy with what you have accomplished in this field. I always believe that family comes first, and with all the changes going on in your workplace it can be overwhelming/aggravating. Enjoy your time, and thank you for your service in this field!

[EMEDPA]

financially would you be able to cut down to 20 hrs/week or so to keep benefits and not take Soc Sec early? if you take it at 62 vs 67 there is a sizeable penalty in $/mo. If you have a big nest egg and soc sec is not a big part of that than by all means retire now. wish you all the best with your personal and professional situation.

[Incognito]

My employer will offer PHYSICIANs 20 hours a week and keep full benefits.  Advanced Practice Clinicians must work no less than .9 to keep full benefits. I am working on getting clarification of what my costs would be for health insurance, if I still qualify for 401K, disability and other fringe benefits at 20-24 hours per week.  We had our CME cut in half at the beginning of the year and if working part time less than 20 hours there is no CME.  So much has changed that finding the information from my employer is nearly impossible as most managers were fired and it is all centralized to Kansas or someplace in outer space.  I do not even know anymore who to ask and those who I do ask don't get back to me. 

I've been researching the difference in the SS at age 62 vs. 66yrs and 4 months.  Not sure I can hang in there  with my current employer till my full benefits kick in.  I  could with another employer (depending on who it is!!!!  Jobs here are limited and so far NPs are starting to get preferentially hired).

I've been a PA for 13 years and it's been great. It is a good profession and I hope it continues to survive and advance. 

 

[Guest HanSolo]

Another option is to leave the full-time gig and do locums here and there. Not sure if that appeals to you, but it could allow for a "semi-retirement," opportunity for travel, and a new, albeit temporary, work environment. 

 

 

[UGoLong]

I would suspect your spouse's condition would interfere with travel. I now do one day per week for the practice (generally seeing patients in hospitals) and then teach for a local PA program two days per week. It is a lot less pressure and much more free time, though I do a lot of course development at home.

Our prayers go out to the OP.

[sas5814]

I'm sorry to hear this as it reflects some things I just posted a rant about. I'm not sure what I would do in your situation. Shoot I'm not sure what I'll do in my situation. I do, however, feel your pain.

I hope you come up with a plan that works. I'm sorry to hear about your spouse. 

Locums is always a possibility depending on where you live. I did a lot of locums for a few years and never left the area. I was home every night. However, I set up my own company, got my own insurance, and worked for me after reaching out to a lot of local clinics and urgent cares. It takes a bit of work but YOU get to decide where you work and when and you don't having a company trying to see how much of your money they can keep.

[Boatswain2PA]

I don't have any advice or suggestions for you beyond what others have said.

But EVERY younger PA should read your post and take notice.  They don't need the brand new car or the fancy house right out of PA school.  Keep living like a student until you are out of debt, then throw major money at retirement while you save for your dream house. 

[DelusionalEnthusiasm]

On 8/28/2017 at 1:07 PM, Boatswain2PA said:

I don't have any advice or suggestions for you beyond what others have said.

But EVERY younger PA should read your post and take notice.  They don't need the brand new car or the fancy house right out of PA school.  Keep living like a student until you are out of debt, then throw major money at retirement while you save for your dream house. 

For more on this google Mr. Money Mustache