Perspective of a Rural PA

[StevenStallings]

I wrote this a couple of years ago and it still holds true. After reading the compensation thread, I felt compelled to revisit the reason I am where I am...

 

Perspectives of a Rural American PA

An email from a prospective PA candidate led me to send him this. I wrote this in response to a medical student asking about a rural career.

 

I have practiced medicine in rural Texas (look up Bremond on the map) for the last nine years. I left a rural practice in Kentucky (Hardinsburg) to come here. I left Kentucky because I was literally working myself to death with 80-90 hour weeks as the norm. I just could not do it any longer.

 

I am what I would call semi-retired. I work monday-friday in a Christian ministry health clinic. The clinic is located in a town of about 3,000 and is twenty-five miles from my home. I no longer see nursing home patients, take call, or admit to the hospital. I do have an extremely busy daily practice which is heavily pediatric. Most of my patients are indigent or have medicaid. I personally provided around $100k of uncompensated services here last year. I am not doing this for the money. My life revolves around my church, my family, music, and my practice. It is full as well as blessed.

 

I spent twenty three years in the Army moving sixteen times in that period, living in Europe, New York, Texas, Washington, Mo, NC, Maryland, Oregon, California, New Mexico, Ky, and MA. I lived in big cities, small cities, rural areas..etc.

 

Rural life is slower paced and more focused on non-monetary values. I know virtually every single person in Bremond. I think you would be hard pressed to find someone in our county who does not know me or of me. Yes, the artistic/socialite aspect of life is close to non-existent here. If that is important to you, you are in the wrong spot and won't be happy. Of course, Houston is but two hours away, and most anything can be found there.

 

The biggest difference between here and the large cities I have lived in is this: Life here is not about things...it is about people and family. Bremond, Texas is the best place I know of to raise children. Great school (one school for all grades), low cost of living, non-existent crime, and Gods very own good folks have convinced me of that.

 

That is not to say that I don't have things... of course I do, but the focus of life is more family/spiritually centered.

 

Rural medicine poses unique challenges for the family doctor. You often are the only provider they can see. You don't have immediate access to big city tests like MRI/CT etc. You face discrimination from the doctors in the city who tend to look down on rural docs. You face a bewildering array of goverment entities and insurers who simply do not understand the rural side of medicine. Rural medicine might get a lot of press.. but that's all it gets. Rural clinics and Hospitals are waging a desperate fight for survival. The simple fact is that legislators pay attention to their constituency. Since rural medical America is in the distinct minority, it gets little but lip service.

 

Wow... sounds bad huh? Ok, here is the deal. It takes people who care, to make a difference. It takes young, dedicated practitioners (MD/PA/DO...no difference) who will make the commitment to become a part of the community. Your life is going to be different than city physicians. In my heart, I am the one getting rich.

God Bless, Steve Stallings

 

 

After reading some of the writings on this forum, I am moved to furthur embellish upon this....you thought you'd get off easy?

 

 

I see much angst with the issue "should I be a PA or a Physician" and I would like to offer my two cents.

 

I was born the son of poor sharecroppers and walked to school in the snow five miles uphill...both ways Well not exactly, but I do come from a rather impoverished background. I was a juvenile deliquent, high school drop out who volunteered for the army and Viet-Nam. I came home, worked in a sawmill in NW Washington, logged, and realized that if I ever wanted anything... I had to take advantage of opportunities. No one in my family had ever graduated from high school. I returned to the army and became a lab technician, eventually going to the armys advanced lab program and getting an associates from Baylor. It was during this period that I met my first PA. These guys walked on water as far as we were concerned. They were the "creme de creme", the ultimate evolution of the army medic. Much to my dismay, the army refused applications from lab techs at this point, citing "lack of clinical exposure". I went on to become the clinical laboratory director of the US Army Biochemical Research Lab, Aberdeen Proving Ground, Md. About two years into this position, the army started accepting applications from lab techs. The army application and selection process is a bit of a test in itself

 

To make a short story even longer, I remember receiving my aknowledgment of application and realizing I was applicant number 2,027 for a class of 60... Much to my surprise, I was selected. This was the single most happy day of my life. One year later, my father pinned my bars on. Two years later I graduated and began the real process of learning.

 

I have been many things... but I have never once been ashamed of being a PA. I did consider going to DO school about ten years ago after a fellow army PA (Tony Hedges) followed that path. I chose not to do this for a number of reasons:

...I am proud of being a PA

...I have never felt restricted or constrained in this role

...I could care less about social strata, but honestly, I've never felt

any social "black hole" as perceived by at least one PA posting

here.

...I make a good living. With my military retirement, I make as

much as many FP MDs.

...After twenty plus years, I don't see much difference in my

practice as opposed to the physicians I work with. Of course

I choose not to do nursing homes or hospital rounds...but I

could if I so desired.

...I feel like I am a valued member of my community.

 

 

Finances... this seems to be a big concern. Let's take a look at a hypothetical PA vs his Supervising MD.

 

PA BASE $85k

Fringe Benefits including 401/403 match, CME, Paid Malpractice, Social Security, Medical, Dental, etc....$25k

This equals about $110k

 

Physician Salary $140k

Subtract malpractice, and other fringes worth about $25K and you wind up with a real income of about $115-120K.

 

This is a real world difference of about $10k/year. Of course, there are folks who make more...or less. I have PA friends making well over $140k, and I know folks making $60k. Of course there are MDs knocking down $200k plus...

 

I guess it really depends on your priorities. If chasing the dollar is important to you, quite frankly, I would not recommend becoming a PA. You are not going to get rich. If your ego requires you to be in charge...become a physician. Though I must point out that I know several PAs who own their own practice. I personally don't want that stress. PAs are a valid force in todays medical world. Those folks who have problems with this, by-definition , subservient role need to look elsewhere. The vast majority of PAs I know are very happy in their chosen profession. The absolute worst PA I've ever met in my life is now a DO. I somehow suspect that he is not much better at being a physician

 

I'm in my fifties now and plan to practice into my sixties. I don't envy my MD friends the call, stress, and vastly more hours they put in than me. I'm happy with my career, though I sometimes wish I would have stayed in the army a little longer. The satisfaction I obtain from long term following of a family is a joy difficult to express.

 

The only one who can answer the posed question is yourself. We need people who care about people. We need the next generation to step up to the plate.

[rcdavis]

Well said.

Very well said.

[TOP]

Awesome...

[EMEDPA]

welcome back steven-missed you around here-e

[doboy]

Steve, that was beautiful....

[Monica]

There is just something about reading the truth that puts everything back into perspective.

 

Your post was humbling and inspiring.

 

God Bless you,

Monica

fellow Texan:)

[ToppDog]

That's how I've always wanted to do it! Now, if I can just get in...

[Cliff1974]

Steve,

Thanks for positng that.

I am a very soon to be new grad who is moving out to the country to practice.

 

Thanks,

Cliff

[Febrifuge]

I think even for those of us who intend to practice in the city, a similar approach and a similar set of priorities should work very well. I salute anyone who feels the stress and disruption is worth the higher salary, but I'm here to do good work, not win some kind of competition.

 

Well, okay, I'm about to do my CASPA app, so I guess it's a competition for now, but you know what I mean. :D

[Guest paintballfene17]

now that was truly uplifting! Great thoughts , and well arranged ! Buitieful!

[Mr. Brown]

...its always inspiring to see someone who upholds Christian values in their practice. Thank you for being an example!

[troygem]

Maybe we should have an "inspirational" board. It could be all the success stories and great things about being a PA. I LOVE this forum, but so many times it seems the boards are dominated by PA vs. "the world" topics. It is stories like this that I print out and post close to my desk. I look at things like this when Im stuck studying some silly liberal arts class(pre-req) when I can here my son in the next room playing. (Before I had kids I never thought I would what to play horsey so much) It is stories like this that help me picture what Im working for. Thank you.

 

Troy

[Febrifuge]

Hey, there! Careful -- some of us spent four years (or more) on those "silly liberal arts classes," and wouldn't be who we are without 'em. Nothing helps make a connection with patients like being able to step outside that "science nerd" box... :D

[Mr. Brown]

Funny...I was a liberal Arts major with a Science addiction.

[Guest harshlanguage]

One of the best things about PA, IHMO, is the fact that you can "switch" specialties without years of retraining. If you get tired of the big city and the rat race, rural FP is always an option.

 

You can also work anywhere in the states you want to live. It is an excellent option, nursing is the only other health profession that I can think of with the amount of flexibility that a PA has.

[OrthoSurgeryPA]

Wow, I had the opportunity to work out in rural Texas towns. The Hem/Onc Doc I worked for actually took the clinic to the pts. in these small rural towns from the city lights of San Antonio. We literally put charts and medical supplies in crates, packaged epogen, neupogen, etc. in transport refrigeration containers and used a single room in the small community hospital/clinic to administer chemo and do f/u visits. The most humbling experience and this post just nails that feeling. :D

[SRCumpston]

I love this post. I live in upper East TN along the Appalachian Mts. where we are very close to some of the highest poverty levels and rural areas in the country. In undergrad, I did research studies for the Dept. of Psychology (I was a psych major) at ETSU where we studied the needs and brought psychologists to rural areas nearby. This often involved collaborating with pediatric primary care offices. It was such a humbling and awesome experience. There are so many underserved areas where people suffer from somewhat common injuries and illnesses just because they cannot get to a doctor (or PA!) or cannot afford the care. I would LOVE to come back to this area when I finish school and give the care to these people that they so much deserve. I think it is wonderful to hear what you are doing in TX, I hope I can do something similar here in TN.

[jillthom]

In case anyone is interested, this group works a lot in the Appalachian area, bringing basic medical and dental care to rural areas. http://www.ramusa.org/index.html

[Shawn_Not_Sean]

Wow! That was am awesome post!! Thank you so much!! I hope that a year and a half more into it you still have the same thoughts and feelings.

 

To be honest, sometimes I get wrapped up in the money issue, but it stories, testemonies like this that really bring me back down to earth!

[CAdamsPAC]

I wrote this a couple of years ago and it still holds true. After reading the compensation thread, I felt compelled to revisit the reason I am where I am...

 

Perspectives of a Rural American PA

An email from a prospective PA candidate led me to send him this. I wrote this in response to a medical student asking about a rural career.

 

 

 

 

After reading some of the writings on this forum, I am moved to furthur embellish upon this....you thought you'd get off easy?

 

 

I see much angst with the issue "should I be a PA or a Physician" and I would like to offer my two cents.

 

I was born the son of poor sharecroppers and walked to school in the snow five miles uphill...both ways Well not exactly, but I do come from a rather impoverished background. I was a juvenile deliquent, high school drop out who volunteered for the army and Viet-Nam. I came home, worked in a sawmill in NW Washington, logged, and realized that if I ever wanted anything... I had to take advantage of opportunities. No one in my family had ever graduated from high school. I returned to the army and became a lab technician, eventually going to the armys advanced lab program and getting an associates from Baylor. It was during this period that I met my first PA. These guys walked on water as far as we were concerned. They were the "creme de creme", the ultimate evolution of the army medic. Much to my dismay, the army refused applications from lab techs at this point, citing "lack of clinical exposure". I went on to become the clinical laboratory director of the US Army Biochemical Research Lab, Aberdeen Proving Ground, Md. About two years into this position, the army started accepting applications from lab techs. The army application and selection process is a bit of a test in itself

 

To make a short story even longer, I remember receiving my aknowledgment of application and realizing I was applicant number 2,027 for a class of 60... Much to my surprise, I was selected. This was the single most happy day of my life. One year later, my father pinned my bars on. Two years later I graduated and began the real process of learning.

 

I have been many things... but I have never once been ashamed of being a PA. I did consider going to DO school about ten years ago after a fellow army PA (Tony Hedges) followed that path. I chose not to do this for a number of reasons:

...I am proud of being a PA

...I have never felt restricted or constrained in this role

...I could care less about social strata, but honestly, I've never felt

any social "black hole" as perceived by at least one PA posting

here.

...I make a good living. With my military retirement, I make as

much as many FP MDs.

...After twenty plus years, I don't see much difference in my

practice as opposed to the physicians I work with. Of course

I choose not to do nursing homes or hospital rounds...but I

could if I so desired.

...I feel like I am a valued member of my community.

 

 

Finances... this seems to be a big concern. Let's take a look at a hypothetical PA vs his Supervising MD.

 

PA BASE $85k

Fringe Benefits including 401/403 match, CME, Paid Malpractice, Social Security, Medical, Dental, etc....$25k

This equals about $110k

 

Physician Salary $140k

Subtract malpractice, and other fringes worth about $25K and you wind up with a real income of about $115-120K.

 

This is a real world difference of about $10k/year. Of course, there are folks who make more...or less. I have PA friends making well over $140k, and I know folks making $60k. Of course there are MDs knocking down $200k plus...

 

I guess it really depends on your priorities. If chasing the dollar is important to you, quite frankly, I would not recommend becoming a PA. You are not going to get rich. If your ego requires you to be in charge...become a physician. Though I must point out that I know several PAs who own their own practice. I personally don't want that stress. PAs are a valid force in todays medical world. Those folks who have problems with this, by-definition , subservient role need to look elsewhere. The vast majority of PAs I know are very happy in their chosen profession. The absolute worst PA I've ever met in my life is now a DO. I somehow suspect that he is not much better at being a physician

 

I'm in my fifties now and plan to practice into my sixties. I don't envy my MD friends the call, stress, and vastly more hours they put in than me. I'm happy with my career, though I sometimes wish I would have stayed in the army a little longer. The satisfaction I obtain from long term following of a family is a joy difficult to express.

 

The only one who can answer the posed question is yourself. We need people who care about people. We need the next generation to step up to the plate.

 

 

Steve,

You are what this profession was when I started my long march to become a PA 30+ years ago. I am humbled by your thoughts and proud to say that I am one of your peers.

[KJH]

Thanks for that.

I just visited a Rural site in Northern California. I have a close friend inside a major medical equipment development company for insulin devices in Research.

My comment on the visit ties into the stigma of rural care in that Medicaid will pay for the insulin pump for Type I diabetics that this friend has spent years involved in assisting development of. Yet, the field rep from this same company has not responded to a single request for prescription of a pump. I was shocked but not amazed. I would not say that this is a policy of the company, more like lack of integrity on the part of the field rep as a portion of the cost of the pump does come out of pocket in the general population and is written off for low-income. Poor form. Working on addressing this with that corporation's head office at the moment.

I grew up with rural healthcare and am heading back there now.

Blessings to all holding the line against the dark today in Rural Healthcare.

[Guest etcope]

Wow... Steven, I will print your post and keep it with me. Your stories and thoughts are an inspiration to aspiring PAs like myself. I'm sure you make your patients feel safe and taken care of and that ultimately is why we do medicine. Thank you for posting.

[jflassing]

Let's bring this thread back to life as it really struck a cord with me. Working as a new grad PA in rural Virginia, http://www.monroehealthcenter.com/, at the Craig County Health Center, I am inspired by the words of those who have traveled this road before me. The values held in this rural community may not exactly match on some levels but the mutual understanding and respect makes for a wonderful working environment.

 

I am most grateful for my career choice and echo the sentiments shared in the above thread. I am yet to see more than 25 patients in a day (most days much less) and yet to have to spend less than 30 minutes to talk with a patient who really needs it. To me, this is how medicine should be practiced. Have a nice weekend...I know I'll love spending mine with my family.

[StevenStallings]

Thank you all for the kind comments. I would like to update this post....

 

My wife recently retired after many years as a probation officer. Our children and grandchildren had all moved away with most of them living in the Tomball, Texas area. My wife and I decided after much thought and prayer to move closer to the kids. We moved in December of 2008 to the Cyfair/Tomball area and are very happy.

 

I have been driving back and forth 190 miles four days weekly to the RHC. It's a lot of miles and three hours in the car each day, but it's not too bad. I began working 2-3 shifts a week in an ED near our new home and have been rewarded with a new set of challenges.... that is, brushing up on old skills and learning new ones. I have not decided as of yet, but I am serously considering leaving the RHC and doing ED full time. I would miss my patients but would gain three hours a day of commuting time. I actually am really enjoying the mental stimulation of the ED.

 

Again... thank you for the kind comments.

[Grinder993]

OK...here comes the water on the fire. Sure the rural communities have there upside: safety, community, values...etc. But I think the rural FP's and clinics are the place for PA's that are.....hmmmmm... shall we say ready for pasture? I mean this in the nicest way, I one day plan to go to that pasture! But, you have to earn your battle scars, you have to pay your dues in the big cities, the crushing ER's with insane varieties of pathology and trauma or the inner city clinics. This is where you cut your teeth, this is where you pay your dues. Only after many, many years of this are you ready to take that level of knowledge and experience to the countryside and really bring those rural communities something they don't have access to....an intensely trained and battle hardened PA!

 

I know that most of you on here fit that category and are ready for pasture...LOL. But, it worries me to see some posts on this thread from prospective PA students or fresh graduates who want to move to the rural communities. In my opinion, you are not ready. You don't possess the skills, the knowledge and the experience to fill that post. Not yet guys....you have to earn it and it's a loooooooong road.