compensation Compensation

[eggama]

Hello fellow PAs. I am posting this discussion with frustration. I am very disappointed with a PA hourly compensation rate compared to a doctor, I know we did not do an EM residency as compared to doctors, But in certain settings such as the ER, we do the same thing as the doctors but yet we are paid in most cases 1/3 of what doctors make in an ER(the average rate is $210-240 per hour while PAs make on average only $60-80 per hour. In most cases, the doctor’s expectation is that we do everything they do and get paid a fraction, and most of the time we don't get a production bonus like they do and in some cases, see most of the patients while the docs sit on their butts.

i am very disappointed with. The AAPA for not advocating ompensation closer to doctors versus nurses. In most cases offers in hourly rate not much more than a nurse! With demand high and the supply low as reported by several resources, why are the rates not going up? It’s about time we have this discussion on the forum. I think our pay is ridiculous for what we do and expectations, and would like to get perspective from the other PAs on their pay, along with potential solutions to raising our pay. Don’t we all think our pay should be closer to a doctor and not a nurse? I say Union!

[rev ronin]

How did you get this far and not realize that was the world you were getting into?

If you want to make money, medicine is really not the place for it, and within medicine, PA is not the best-paying profession.

[TWR]

I agree that we as PAs should be compensated at rate higher then we  are if doing the same thing the doc's do but $60-$80 an hour will certainly keep the wolves from the front door.  PA may not be the best paying profession in medicine but it ain't bad!!!

Union?  I don't know.  I lean towards a yes on that but can't picture myself walking out on patients and marching with a sign.  I haven't really seen that in years.  I guess they arbitrate and do a little give and take.

[sas5814]

In some cases it really is an unexplainable gap. I work in urgent care right now. There are 4 docs and 19 PAs and NPs. We do, quite literally, the exact same job. The docs make twice what we do. *shrug*

Union? Maybe. Now that medicine is being corporatized and the decision makers are all admin types I see more and more benefit to the concept. I started a new job in January of this year and in April our new "strategic partner" basically shoved my employment agreement into a shredder, changed major aspects of the job and said "take it or leave it." No discussion. No negotiation. I could have used a union.

[Guest ral]

A six figure salary for a few years of school, isn't fair compared to that of a board certified emergency physician?  Hmmph.  

 

[eggama]

No it isn’t- especially when the expectation in some practices expect the physician assistant do exactly the same thing as the physician. Being paid 1/3 of what they get is a joke. Kids coming straight out of college can make a 6 figure income in a few years and are not saving people’s lives!

[Guest UVAPAC]

In our practice the PA's/APRN's see at least double the amount of patients that the MD's do.  They are always claiming "administrative work" and "management meetings"

[GetMeOuttaThisMess]

1 hour ago, eggama said:

No it isn’t- especially when the expectation in some practices expect the physician assistant do exactly the same thing as the physician. Being paid 1/3 of what they get is a joke. Kids coming straight out of college can make a 6 figure I come in a few years and are not saving people’s lives!

Did you not know what you were getting yourself into?  Did you not know what the salary levels where?  Did you not know beforehand what activities you would be performing?  Did you not understand the hierarchy of healthcare?

Bottom line, as told to me by another late wise man many years ago (who also played a role in providing me a twice monthly paycheck), if someone is bitching about their job they have two choices:  1)  go do something else since you're the only one in control of your life, or 2)  shut up and go do your job.

As another far wiser and perfect man said in a parable years ago; did you not agree to the wage for a day's work before you accepted it, and what business is it of yours as to how much I choose to pay someone else for their work?  That is between the boss and the laborer.

[Guest ral]

I worked barely minimum wage jobs for a few years out of high school, before wising up and going to college.  As an RN, I constantly listened to LPN/LVN's bitch about how they did so much of the work that I did, and the vast pay difference between the two.  My answer was short and simple: don't like it, go get your RN degree.  After going back to school many years later to become a PA, I had to listen to RN's bitch about how well paid I was, while doing less "work" than they were doing.  My answer was short and simple: don't like it, go get your PA degree.  My advice to you is: if you are going spend your career bitching about how much doctors make, go get your MD/DO degree.

[jmj11]

Life is unfair and, at many times, irrational. I've shortened my life I'm sure by not understanding that early on. Yes, we always stand against injustices, wherever we find it. But much we can't change and at times we must accept absurdity . . . or go insane.

[EMEDPA]

In primary care and urgent care PA/NP folks and docs typically DO see the same patients. In most emergency departments(unless you are working solo) the docs will typically cherry pick all the strokes/stemis/traumas/cool procedures and patients. In solo departments (at least rural) the compensation is more reflective of the work done. When I do solo 24 hr shifts I only make $25/hr less than the docs who are there the days I am not. I feel that is fair given the extra 2 years of medschool and 3 years of residency they have that I didn't pursue.

[eggama]

I can see $25 less and I can live with that, but to make 30% of what the doctor makes is truly ridiculous and the AAPA is not doing anything to change it. There are a lot of health systems, especially in emergency medicine that have very high expectations of the PAs and think we should be paid accordingly. Those of you who accept the extremely low compensation will be the ones who keep our pay low which has not gone up over the last 5 years I've been practicing. if nothing is done, our pay will be undesirable. With the shortage of PAs and need for more providers, now is the time to raise the pay, not just sit back and say "now let's go to med school". That's not the answer.

[narcan]

If where you work you're credentialed to intubate, reduce a hip under procedural sedation, do a pericardiocentesis on a crashing patient and tap a febrile neonate, then yes, you should be making a lot closer to what the physician does.

I'm assuming you're not qualified to do those things. We pay physicians for a lot of what they can do, not what they actually do on a daily basis. We pay pilots for a lot of scenarios we hope never arise too.

Now, you are absolutely right that in a lot of ED's, the PA's see more patients than the docs and watch the docs sit around in the "critical pod" while they're getting hammered in intermediate. That's not a compensation problem; that's a management problem. By that same token, if the group only profit shares with the physicians, that's an organizational problem. No one is making you work there. I've worked for some good organizations and some bad ones, and the difference is always in how they treat their employees.

Should we be making closer to what the physicians make? Probably so, but let's first find some good comparative data on what an average ER MD vs ER PA generates in revenue. I'd love to see some, seriously. I've been wondering this myself for a while.

[eggama]

Thanks Narcan for the excellent response. Even though we are not credentialed to do those procedures you listed above, it is definitely not worth the physicians making 2/3 more than PAs. Here’s a report that is more frustrating: https://www.medscape.com/slideshow/compensation-2017-overview-6008547

it shows physician compensation increase of over 40% the last 6 years. With this huge demand of PAs, how are the health systems getting away with the low salary offers?

i am going to research the billing/revenue of a PA vs MD/DO to see what I can find-this was a very good point. My guess is the ratio doesn’t justify a physician making 3X more than PAs!!

[newton9686]

It's a biproduct of the time invested. I'm totally fine with the MD making double my salary. I also am given 6 more years of full income potential than my MD counterpart with likely half the debt. Also only the top candidates are able to secure a high sought after residency like ER, versus my PA class had 5 out of a class of 39 hired at a nearby ER making a 6 figure salary starting out. And we will be given opportunities to eventually credential to the highest level our license up to being credentialed to do transvenus pacing. 

[Boatswain2PA]

19 hours ago, eggama said:

I can see $25 less and I can live with that, but to make 30% of what the doctor makes is truly ridiculous and the AAPA is not doing anything to change it. There are a lot of health systems, especially in emergency medicine that have very high expectations of the PAs and think we should be paid accordingly. Those of you who accept the extremely low compensation will be the ones who keep our pay low which has not gone up over the last 5 years I've been practicing. if nothing is done, our pay will be undesirable. With the shortage of PAs and need for more providers, now is the time to raise the pay, not just sit back and say "now let's go to med school". That's not the answer.

You just moved the goalposts here.

Wanna make what a BC EP makes?  Then finish the pre-reqs (including physics, OChem 2, etc), ace the MCAT, get accepted to medical school, spend 4 years in medical school, have the stress of matching into a residency, get through your residency, and then you can make what a BC EP makes.

You want to talk about PAs accepting "the extremely low compensation" then let's have that conversation.  But if you look at that scenario, I think you will see that the PAs accepting the "extremely low compensation (let's say $40-$55/hr) work in areas where there is certainly no shortage of PAs due to the explosion of PA programs.  

[EMEDPA]

6 hours ago, narcan said:

If where you work you're credentialed to intubate, reduce a hip under procedural sedation, do a pericardiocentesis on a crashing patient and tap a febrile neonate, then yes, you should be making a lot closer to what the physician does.

I'm assuming you're not qualified to do those things. We pay physicians for a lot of what they can do, not what they actually do on a daily basis. We pay pilots for a lot of scenarios we hope never arise too.

 

agree with all of this. I am credentialed for all of this. I imagine Boats is too. That's why we can ask for more money than a new grad PA or even someone with 10 years of supervised intermediate level experience. At the end of the day we are held to the same standard as a residency trained and boarded EM physician. I just spent 3 days taking a physician level difficult airway course so that I could practice techniques like fiberoptic nasal intubation for the critically ill angioedema patient so I have options other than surgical airways if they present with airway issues not compatible with oral approaches. I think in the vast majority of cases a residency trained/boarded EM physician is the gold standard, but next in line is an experienced EM PA, way ahead of typical fp docs or moonlighting physicians from other services.

[narcan]

9 hours ago, Boatswain2PA said:

You just moved the goalposts here.

Wanna make what a BC EP makes?  Then finish the pre-reqs (including physics, OChem 2, etc), ace the MCAT, get accepted to medical school, spend 4 years in medical school, have the stress of matching into a residency, get through your residency, and then you can make what a BC EP makes.

You want to talk about PAs accepting "the extremely low compensation" then let's have that conversation.  But if you look at that scenario, I think you will see that the PAs accepting the "extremely low compensation (let's say $40-$55/hr) work in areas where there is certainly no shortage of PAs due to the explosion of PA programs.  

THIS. I am very concerned about the growth of for-profit PA schools with less than stellar credentials and who knows what kind of faculty, clinical affiliations, etc. There are already a lot of NP programs that are online! They get to set up their own clinicals. We are on the cusp of a lot of poorly trained PA's/NP's coming into the marketplace, and it's going to drive compensation down (in addition to making us all look bad).

At the end of the day, compensation is market driven. If the "average" ER pay for us is $60-80 an hour, that hopefully means that in certain markets and for certain highly qualified individuals, that it's much higher than the average. And consequentially, for the newbie with no experience it should be below average. I do agree we are likely underpaid as a whole in the ER for the revenue we generate. On a purely financial basis, we are a great deal for both hospitals and democratic groups. We should do our homework and advocate for ourselves to show that we know our worth and ask for fairer compensation. And hopefully before the explosion of PA programs floods the market and screws us all.

[gbrothers98]

The AAPA is addressing compensation by supporting OTP. If much of the underpinnings to that measure can become law across the US, it likely will result in compensation increases. Physicians won't be able to rely upon the 'supervision' component when working with a PA to justify pay differences. Concurrently, a move to a doctorate as a terminal degree will also aid in moving the compensation needle north. While the case can be made that both OTP and doctorate are unnecessary for current practice, untethering from our current status will enable a discourse based solely upon competency and outcomes. When those are shown to be be comparable, the only argument left will be one that cannot stand against reason. George

[Boatswain2PA]

A move toward a doctorate would do NOTHING for our compensation.  Pharmacy Ds, Physical Therapists, and now DNPs have shown that.

Just makes colleges richer (and bankers).

[Anachronist]

I'll share two little stories that in a way define my outlook. My father is a retired MD, the Army paid for his med school and when he was an officer in the 60's, he was making (inflation adjusted) the equivalent of $60k a year. Later in private practice while working in the ER (70's) he recounts that he charged $5 to see a patient, and $10 if they needed stitches, if they couldn't pay, "oh well." He didn't start making the money commonly associated today with MDs until the 90's, and even then, on the lower end of it (as a full partner in a 7 physician practice)... but he loved every second of it. My grandfather is also a famous (at least to trial lawyers) judge, as a defense attorney he was often paid with produce, chickens, and even a horse once, or labor favors (roofing, home repair, car work, etc)... but (you guessed it) he loved every second of it. The big bucks in medicine is a relatively new phenomenon, and may not last the careers of those who are graduating now if the US moves toward socialized medicine and/or there is significant insurance and malpractice reform (that I would wager is very likely in the coming decades).

My two cents is do what you love, not what writes the biggest checks. I had a lucrative career prior to going down the PA path, that will actually be a significant pay cut for me. And as far as I'm concerned, if I'm doing what I love and can provide security for my family, that is all that matters. 

[BruceBanner]

On 11/24/2017 at 10:43 AM, GetMeOuttaThisMess said:

1)  go do something else since you're the only one in control of your life, or 2)  shut up and go do your job.

Ultimately this is what it boils down to.

Listen, if you perseverate on how little we make compared to docs (especially for those of us who do the same work, like urgent care, primary care, etc), it will get under your skin. I've been pissed off about it, everyone has. We all knew what we were getting into...that doesn't make it any less unfair.

But what are you going to do about it???

It's not fair, life isnt always fair, and the likelihood of getting this changed in our career span is dismal. It would take a massive collective effort and probably collective bargaining. Bottom line is we are LABOR. Labor. We do skilled medical work for 1/3 the cost of a doc. That is our role in the economy of healthcare. To change this on a global level would take an incredible amount of leverage and political firepower, both of which we lack.

Think about it---how are you going to convince an employer to pay you even 3/4 of what a doc makes to do the same work when there are thousands of new grads flooding the market each year and driving the cost of our services down. Not to mention most insurers will never reimburse you at the rate of a doc across the board, making it a net LOSS for employers to pay you fairly. Lastly, without residencies and fellowships we dont really have a platform to stand on when demanding more money. 

I'm not being pessimistic either. Them just straight facts.