Jump to content

Best $tate$ for PAs


Recommended Posts

I live in OH, have no family, no children, no attachments. I'm frugal and would like to pay my student loans in at least 2 years. So my plan is to move to a PA friendly State where taxes are low and where I can make good $$, but I' not sure where. Any suggestions? 

I'm paying more than $2K in taxes every month. It sucks! 

Edited by PsychiatricPA
  • Upvote 1
Link to comment
Share on other sites

Texas may have no state income tax, but their property taxes are crazy high. Paying 2K a month in tax doesn't really mean much, how much are you making and what's your state income tax? Everything else will be the same no matter where you live. Just checked the Ohio tax table and you're probably paying like 4% in state income tax. That's really not much and I would base where you move to on what the PA pay is, where you personally want to live, and cost of living, rather than the difference in state tax rates.

  • Upvote 1
Link to comment
Share on other sites

Michigan has some of the best practice laws (one of three blue states in the US on the AAPA map), low state income taxes and low property and sales tax.  Outside of the SE Michigan area housing and insurance are pretty cheap *auto insurance very high in Detroit^

 

Deecent pay even in more rural areas but all specialties available in northern lower michigan.   All hospital systems hire PAs.  Minimal bias vis a vis for NPs.

  • Upvote 1
Link to comment
Share on other sites

Texas is fine if...

You don't care about weather, floods, hurricanes, tornadoes, hail and torrential downpours.  DFW gets 40 inches of rain a year where I live and Houston?  Yea...... 2015 I believe we topped 80 inches in DFW.

You don't buy a nice house.  Property ins here is sky high compared to say Nevada.  See natural disasters above.

No income tax is great, until you buy said house.  My $350k house property taxes just went up to over $9000/year.  Think about that for a minute.  $350k is not a great house and I have to make almost $12k before taxes just to make enough to pay the property taxes.  Asinine.

Jobs...DFW at least has become VERY tight in the job market now that NP's are taking over here.  VERY VERY tight...

 

  • Upvote 1
Link to comment
Share on other sites

Texas is vast. If you think Texas and want to most bang for the buck go rural. I joined a practice 60 miles from Dallas, bought a 3/3 3400 SF house in a beautiful neighborhood for 134k. My insurance and taxes every year were $2300.

Don't base your decision on Dallas or Houston. They are crowded markets and expensive places to live.

  • Upvote 2
Link to comment
Share on other sites

2 hours ago, sas5814 said:

Texas is vast. If you think Texas and want to most bang for the buck go rural. I joined a practice 60 miles from Dallas, bought a 3/3 3400 SF house in a beautiful neighborhood for 134k. My insurance and taxes every year were $2300.

Don't base your decision on Dallas or Houston. They are crowded markets and expensive places to live.

True, unless you want to do much anything other then rural family practice and not live near the amenities a larger city provides.  There's a reason why small towns are small.  People get tired of nothing to do or having work opportunities and move to the city.

 

Link to comment
Share on other sites

Indeed. It is all give and take. I like a quieter country life and once or twice a month my wife and I would spend the weekend in Dallas or Ft Worth or San Antonio or Austin or Shreveport etc etc using the money I wasn't spending on other things. Folks who like the city life and all the amenities and options it offers would hate it.

I don't like crowds, traffic, and sometimes, people very much. I like my privacy...a lot. We each have to balance the scales and figure out what is our personally most important issues. No place I have ever been rang all the bells of a perfect place to live...and yet I have enjoyed them all.

  • Upvote 6
Link to comment
Share on other sites

On 5/28/2018 at 8:27 AM, rpackelly said:

Michigan has some of the best practice laws (one of three blue states in the US on the AAPA map), low state income taxes and low property and sales tax.  Outside of the SE Michigan area housing and insurance are pretty cheap *auto insurance very high in Detroit^

 

Deecent pay even in more rural areas but all specialties available in northern lower michigan.   All hospital systems hire PAs.  Minimal bias vis a vis for NPs.

And you forgot to mention it is one the coldest places in the USA. You could not pay me to live up there.

  • Upvote 1
Link to comment
Share on other sites

On 5/28/2018 at 9:27 AM, rpackelly said:

Michigan has some of the best practice laws (one of three blue states in the US on the AAPA map), low state income taxes and low property and sales tax.  Outside of the SE Michigan area housing and insurance are pretty cheap *auto insurance very high in Detroit^

 

Deecent pay even in more rural areas but all specialties available in northern lower michigan.   All hospital systems hire PAs.  Minimal bias vis a vis for NPs.

I can attest to this, living in rural Northern MI.  Plus my productivity income is about to increase significantly with the increased patient load from the Controlled Substance law going into effect Friday!

Link to comment
Share on other sites

17 hours ago, Boatswain2PA said:

$350K is a flipping MANSION in many places.  My dream house is gonna cost less than that (minus land).

Our neighbors house was built last year by an Amish crew and their house is 4/3 3,200 sqft, hardwood floors, granite, etc on 3 acres and cost less than $175K (with land). Our dream home in the near future (10 years) ? will cost around $350K and that will be with 10+ acres, all the bells and whistles, and 4,000+ sqft.

Link to comment
Share on other sites

1 hour ago, camoman1234 said:

Tell us more about this law please?

It was signed into law on 12/27/2017 and goes into effect on Friday, 6/1/2018.  It was meant to combat the abuse of narcotics, but the brilliance of MI state government was to make the wording vague and not specific so it actually applies to all controlled substances.  So, to boil it down, basically every patient on a controlled substance must be seen before every single refill, therefore a lot of them now have to be seen every month (as a clinic we required CS patients to be seen at minimum every 3 months). So this is a massive influx of patient visits we must accommodate.  As a result, every Wednesday I am now seeing 40-45 patients (only CS patients)  for 10 minute appointments to fulfill state requirements.  It started today and actually isn't as awful as I expected.  I usually see 15-20 per day, but these CS appointments are ONLY for CS and are very specific/efficient.

Since a significant portion of my income is RVU based, my bonus is going to increase dramatically.  Essentially, if I see 40 patients I will make approximately $900 per Wednesday - so $3600 per month.

Link to comment
Share on other sites

22 hours ago, camoman1234 said:

And you forgot to mention it is one the coldest places in the USA. You could not pay me to live up there.

There is that, but no hurricanes, no earthquakes, temperate climate lower half.   Floods and tornadoes and wild fires rare.  Outside of SE Michigan and flint crime is pretty low, good health care standards; neither housing or taxes are at insane levels.  

Link to comment
Share on other sites

42 minutes ago, mgriffiths said:

It was signed into law on 12/27/2017 and goes into effect on Friday, 6/1/2018.  It was meant to combat the abuse of narcotics, but the brilliance of MI state government was to make the wording vague and not specific so it actually applies to all controlled substances.  So, to boil it down, basically every patient on a controlled substance must be seen before every single refill, therefore a lot of them now have to be seen every month (as a clinic we required CS patients to be seen at minimum every 3 months). So this is a massive influx of patient visits we must accommodate.  As a result, every Wednesday I am now seeing 40-45 patients (only CS patients)  for 10 minute appointments to fulfill state requirements.  It started today and actually isn't as awful as I expected.  I usually see 15-20 per day, but these CS appointments are ONLY for CS and are very specific/efficient.

Since a significant portion of my income is RVU based, my bonus is going to increase dramatically.  Essentially, if I see 40 patients I will make approximately $900 per Wednesday - so $3600 per month.

Do you know the Public act#?  I have kept up with all of the changes and must have missed where all patients receiving controlled substances need monthly visits. 

Link to comment
Share on other sites

1 hour ago, mgriffiths said:

It was signed into law on 12/27/2017 and goes into effect on Friday, 6/1/2018.  It was meant to combat the abuse of narcotics, but the brilliance of MI state government was to make the wording vague and not specific so it actually applies to all controlled substances.  So, to boil it down, basically every patient on a controlled substance must be seen before every single refill, therefore a lot of them now have to be seen every month (as a clinic we required CS patients to be seen at minimum every 3 months). So this is a massive influx of patient visits we must accommodate.  As a result, every Wednesday I am now seeing 40-45 patients (only CS patients)  for 10 minute appointments to fulfill state requirements.  It started today and actually isn't as awful as I expected.  I usually see 15-20 per day, but these CS appointments are ONLY for CS and are very specific/efficient.

Since a significant portion of my income is RVU based, my bonus is going to increase dramatically.  Essentially, if I see 40 patients I will make approximately $900 per Wednesday - so $3600 per month.

Gotcha. My private clinic that I work at is based out of MI, so did not hear about this. What you are explaining is what we have been doing here at my clinic for years. It was very bad before I took over and got rid of ~200 CS patients for various reasons. Now I have ~60 left and we split those refill days up on 2 different days. It is not as bad as we thought as well. Thanks for the info!

Link to comment
Share on other sites

49 minutes ago, rpackelly said:

There is that, but no hurricanes, no earthquakes, temperate climate lower half.   Floods and tornadoes and wild fires rare.  Outside of SE Michigan and flint crime is pretty low, good health care standards; neither housing or taxes are at insane levels.  

I will deal with tornadoes and earthquakes any day instead of 8 months of freezing weather! haha! ? No wild fires or hurricanes where I live. Crime is low in the rural areas which is where I live. Every house has 5+ guns so people do not break in around my neck of the woods (I truly have not heard of a home break in on the news or word of mouth in years). 

Link to comment
Share on other sites

48 minutes ago, wilso2ar said:

Do you know the Public act#?  I have kept up with all of the changes and must have missed where all patients receiving controlled substances need monthly visits. 

Senate Bill 167, item #3:

"(3) Before prescribing or dispensing a controlled substance to a patient, a licensed prescriber shall ask the patient about other controlled substances the patient may be using. The prescriber shall record the patient’s response in the patient’s medical or clinical record."

I called and spoke with DHHS and MSMS about this statement, and they both agreed that basically I have two options, either call and ask the patient over the phone (and because it state's the "prescriber" I can't have my MA or front desk ask) or see the patient in office and ask.  I don't get paid to make phone calls, and that would be a TON of phone calls, so they come in for a visit.  But, if you are able to write a 90 day prescription, then they only have to be seen every 90 days.

I also asked about seeing them one day and printing three prescriptions on that day with "do not fill" dates on them, and the DHHS stated that with the way the law is written they would expect me to call and chart the above question before those two refills - so doesn't really skirt the issue.

Edited by mgriffiths
Link to comment
Share on other sites

19 minutes ago, camoman1234 said:

I will deal with tornadoes and earthquakes any day instead of 8 months of freezing weather! haha! ? No wild fires or hurricanes where I live. Crime is low in the rural areas which is where I live. Every house has 5+ guns so people do not break in around my neck of the woods (I truly have not heard of a home break in on the news or word of mouth in years). 

I don't know about 8 months of freezing weather - at least not where I live.  We had a longer "winter" than normal this year lasting well into April, and will have really nice weather through at least September/October.  So, at least 4 months of gorgeous weather on the lake, 2-3 months of cool weather that are perfect for sitting around a fire, and 2-3 months of FRIGID.  Yeah, winters suck, but awesome place for hunting/fishing/hiking/camping etc.

Link to comment
Share on other sites

19 minutes ago, mgriffiths said:

I don't know about 8 months of freezing weather - at least not where I live.  We had a longer "winter" than normal this year lasting well into April, and will have really nice weather through at least September/October.  So, at least 4 months of gorgeous weather on the lake, 2-3 months of cool weather that are perfect for sitting around a fire, and 2-3 months of FRIGID.  Yeah, winters suck, but awesome place for hunting/fishing/hiking/camping etc.

I do love me some sitting by the fire nights! Those are truly the best. 

Link to comment
Share on other sites

1 hour ago, wilso2ar said:

Interesting. We already see CIIs every month anyway so doesn't effect us. I wonder how that would be interpreted for controls that can have refills like Lyrica?  I mean it is just one prescription. 

DHHS stated the question mentioned above should be asked before the patient refills the medication, but if you can just send a single script for 90 days (which Lyica you can) then it is fine, but I'm curious if parts of the law changed how pharmacies are allowed to fill.  I didn't read that far.

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More