Job Outlook

[PrePA94]

Hello everyone!

Im currently applying for PA school, and Im really excited in terms of learning, practicing medicine, helping people, and having a good, respectful job that I can do amazing things in. However, I have been looking around on this forum, and I keep seeing posts about how the profession is changing, the "feud" for jobs/equal pay between PA's/NP (which I obviously had no prior idea about), and just a lot of other things that I was not aware of previously. It has made me question whether this profession is what I thought it was before I began applying. Nonetheless, I am so excited to become a PA, but I am just wondering how the future PA's might be affected with all the drastic changes happening today(and those that will happen in the future). Like many other pre-PA students, I want to help people, and have the job security I imagine I would have as a provider in the US. I have begun to become discouraged as I read posts about how the profession will be "over saturated" and how PA's in many ways will be at a disadvantage when compared to NP's due to us having the "assistant" in our name, not being able to practice independently, and obviously not having the strong background that nurses do (I keep reading about their strength in numbers and their union). I think NP's are awesome, as are PA's, and that we are similar in many ways, as are different. with all due respect to the nursing profession, becoming a nurse practitioner is not nearly as competitive and hard as becoming a PA is. I think nurse practioners are needed and provide something that PA's might not, but I also think PA's do the same (in providing something NP's do not). I just worry that because of their strengths in numbers and their union, PA's will be put at a disadvantage in the field.

Additionally, although I Obviously  do not expect anyone to know the future, I am curious to know what are your best predictions about how things will play out in the future for PA's in healthcare? Do you anticipate the field growing for PA's (in a positive way)? Do you think that for PA's to find jobs, theyll have to start doing more (residencies) and sticking to a specific field, as opposed to having the luxury of switching fields freely?

I hope my question(s) makes sense, but I really care about this field, and I want to become a PA in the future and see the field grow. I think its important now for PA's to worry about this, and do what is in our power to secure our future (not to sound too pessimistic, but I truly have no idea what's in store). What does the field need now to secure our positions? 

 

 

 

[Cideous]

After 25 years in this field I can give you only one piece of advice.  Do a residency, do a residency.....do a residency.  

[PrePA94]

1 minute ago, Cideous said:

After 25 years in this field I can give you only one piece of advice.  Do a residency, do a residency.....do a residency.  

Really?! Thank you- do you mind elaborating why? Also- have you done a residency? 

 

 

[Cideous]

Residencies were not a thing 25 years ago, and when I graduated there were 13 jobs for every PA graduate AND I had never even heard of a Nurse Practitioner.  In today's world, you will need to fight, scrape and separate yourself from the pack to just find a job.  The only way to do that is with a residency.

[EMEDPA]

a residency and a doctorate...in a few years every NP will be a DNP. If you know nothing about medicine like most HR folks Doctorate> masters.

If I was a 23 year old paramedic with a BS again I would go to medschool without considering any other options quite honestly. Not doing so was probably the biggest mistake of my life. There are some people who can stomach being treated like an "assistant" despite > 30 years of specialty experience. I am not one of them.

[ProSpectre]

I agree with the residency comment, as I think that's the most surefire way to set yourself apart from other early career PAs (and NPs in general). A doctorate is also a good idea, but you can always work on that while you're employed and after completing a residency; the Lynchburg Doctorate of Medical Science program is already allowing certain residencies to fulfill some of their degree requirements too, and hopefully other doctorate programs will follow suit. As a side note, the ARC-PA has recently decided to reinstate formal accreditation of PA residencies, which should help weed out those programs that aren't up to standard or just use PAs for cheap labor, so that's a positive development as well.    

Overall though, I think the most important thing you can do is continue to educate yourself about the issues affecting the PA profession, and once you graduate, make sure you are active in the AAPA and your state organisation. Contributing time and money to those organizations is what will allow us to continue passing PA-positive legislation and hopefully close the gap between NPs and PAs nationwide. The AAPA seems to have woken up over the last few years with OTP, and issues like the name change are (finally) being examined formally as well, so hopefully over the next couple years more and more positive changes will develop. 

There are definitely issues affecting our profession, but I don't think it is all doom and gloom. The key will be ensuring that new grads and currently practicing PAs that haven't been active in advocating for the profession come out and stand together to make the positive changes that we need. For too long it's been a small minority of PAs that have carried the burden, and we need all hands on deck to make sure we stay relevant in the 21st century. 

[Cideous]

1 hour ago, EMEDPA said:

a residency and a doctorate...in a few years every NP will be a DNP. If you know nothing about medicine like most HR folks Doctorate> masters.

If I was a 23 year old paramedic with a BS again I would go to medschool without considering any other options quite honestly. Not doing so was probably the biggest mistake of my life. There are some people who can stomach being treated like an "assistant" despite > 30 years of specialty experience. I am not one of them.

Considering this is coming from probably the most respected PA on these boards, I would read and re-read this statement and think really hard on it.  Everyone has to make their own choices in life, but sometimes listening more to those who have been through a struggle can keep you from making a similar mistake.  Best of luck to you.

[weezianna]

I agree with EMEDPA. Go to medical school.  I seriously considered it years before I attended PA school, and missed the boat.  Take the path with the most long-term options.  I'd go now but would be the world's oldest resident. Nonetheless, I have enjoyed my 21 years as a PA.

 

[KindnessMatters]

On 7/6/2018 at 4:57 PM, weezianna said:

I agree with EMEDPA. Go to medical school.  I seriously considered it years before I attended PA school, and missed the boat.  Take the path with the most long-term options.  I'd go now but would be the world's oldest resident. Nonetheless, I have enjoyed my 21 years as a PA.

 

I'm curious as to why you say this? My husbands a fourth year med student and every rotation he's worked at with PAs, he says he wishes he was a PA. 

[PrePA94]

7 hours ago, KindnessMatters said:

I'm curious as to why you say this? My husbands a fourth year med student and every rotation he's worked at with PAs, he says he wishes he was a PA. 

My fiancé too is a med student, and all of his housemates say that the PA is best in terms of lifestyle, practice, etc.

[Guest HanSolo]

A lot of it is "the grass is always greener" syndrome. 

My advice: take the opinions on this board with a grain a salt. It's a very small sample size of the profession as a whole. I've been reading these boards for about 3-4 years now, and many people just come on here to complain. Sorry ya'll, but it's true. You can even search back on this forum to a decade ago and see some of the same arguments about how we should have all been screwed by now, but somehow we are still here...

You have to keep in mind that many of the older PAs entered the job market as a new PA in a different era, and you can't necessarily blame them for bemoaning the current market. It's more competitive than you think. The rules have changed, so you need to know what those rules are before getting into it. However, every person who graduates from my program has a job within 6 months of graduating, and I know this isn't unique to my program. They actively help new grads network and finds jobs because they know that's a crucial aspect of their recruitment of new students. 

I'm never going to medical school. There's more to my life than work. If I get sick of being a PA later in life I will drop down to doing part-time or per diem work and find something else to do with my time. Want options later in life? Don't drown yourself in debt and buy things you can't afford. 

[PrePA94]

38 minutes ago, HanSolo said:

A lot of it is "the grass is always greener" syndrome. 

My advice: take the opinions on this board with a grain a salt. It's a very small sample size of the profession as a whole. I've been reading these boards for about 3-4 years now, and many people just come on here to complain. Sorry ya'll, but it's true. You can even search back on this forum to a decade ago and see some of the same arguments about how we should have all been screwed by now, but somehow we are still here...

You have to keep in mind that many of the older PAs entered the job market as a new PA in a different era, and you can't necessarily blame them for bemoaning the current market. It's more competitive than you think. The rules have changed, so you need to know what those rules are before getting into it. However, every person who graduates from my program has a job within 6 months of graduating, and I know this isn't unique to my program. They actively help new grads network and finds jobs because they know that's a crucial aspect of their recruitment of new students. 

I'm never going to medical school. There's more to my life than work. If I get sick of being a PA later in life I will drop down to doing part-time or per diem work and find something else to do with my time. Want options later in life? Don't drown yourself in debt and buy things you can't afford. 

Thank you so much for your input!!!!!!

 

Im optimistic about the future, and I believe that since the PA profession is growing (more schools are coming up), there will be more PA's, and there are strengths in numbers of us (much like that strength that nurses have). When PA's are making up a larger fraction of the workforce than what they are now, changes that we seek have a chance of happening. Although the name doesn't bother me, I understand now why it will be beneficial, and I think a name change could happen in my career as a PA- as well as a bunch of other things the profession as a whole is seeking. I don't know if its just from my experience, but many medical doctors prefer PA's than NP's due to the rigor of the coursework we have as students, more clinical hours in school, and the fact that we do work "under" a doctor, and the chances of a mistake are slimmer (since we run things by the dr if we are not sure)- atleast what I think.

[EMfuturePA]

we need:

#1 name change to better reflect what we do

#2 better lobbying power - much better trained than NP's who practice glorified nursing yet they are "independent" and get better publicity

#3 new AAPA delegates that would support our cause

[PrePA94]

37 minutes ago, EMfuturePA said:

we need:

#1 name change to better reflect what we do

#2 better lobbying power - much better trained than NP's who practice glorified nursing yet they are "independent" and get better publicity

#3 new AAPA delegates that would support our cause

In all seriousness, how do we even do this? Where do we start?

[EMEDPA]

15 hours ago, KindnessMatters said:

I'm curious as to why you say this? My husbands a fourth year med student and every rotation he's worked at with PAs, he says he wishes he was a PA. 

Once he graduates he will be glad to be a physician. The disrespect you sometimes get as a PA is intolerable. I have heard " I don't talk to PAs on the phone, have a physician examine the pt and have them call me" more times than I can count. being 50 and having a 29 year old as your "supervisor" can get really old really fast if you have seen >150,000 pts in your specialty and they have seen 10% of that at most and yet get to "write the rules" for how you practice. That is why I work solo/rural now, to avoid asshat physicians. The hospitalist group I work with now is 2 physicians, both younger than me. They have both seen me run critical patients, manage difficult airways, etc without their intervention and don't question my admissions. Oh, also 1/3 the salary to do the same job(but working all the nights/weekends/holidays) gets old after a while too. Physician partners often get annual profit sharing in the 10s of thousands of dollars and PAs get a nice coffee cup and get locked out of the medical staff lounge, etc. We are, in many ways, both the workhorses and the red headed step children of medicine.

[MT2PA]

I didn't do the MD route in my late 20s because I thought I was too old and didn't have the energy to put in 7-10 years of school. While I'm glad to be done with school now and making money, if I could do it over I would go MD.  Heck, I might even pursue a bridge program once it's financially not crazy.  

I don't have the war stories to back it up like others do but looking at a lifetime of defending my career and skills (both to patients and the rest of the medical field) just sounds exhausting.  

If you want to be a warrior for the PA profession, bless you.  There's no way to predict the future, just know that we've got plenty of battles ahead of us to fight.

[kingcoffee7]

I think a lot of it comes down to the calling vs job thread that was posted recently. There are definitely a lot of people who want to go to PA school for the wrong reasons, just like anything else. If you are passionate about medicine and see it as a calling and want respect and money, then it would be a mistake and med school would be a better fit. If you just like medicine and was a nice job with a decent salary and don't mind always being second then you're more likely to find satisfaction. Some peoples desire to change when they get in and realize that they do love medicine and want to be top dog and that's fine. That doesn't mean it was a mistake, people just evolve. For everyone one of those, there's a resident who realizes that it's not for them and goes to "the dropout club" website to find something else to do.

There's no one size fits all career. 5/6 of my preceptors have been MD's and told me if they could do it over again they wouldn't do it. Maybe its grass is greener, maybe its burnout, maybe they're just crazy (my surgery preceptor definitely was!) 

There's a tendency to look at the greenest grass of both sides  but we forget, (unless reminded on this forum) about the dark parts, and as PA's we're more familiar with the dark parts of ours. On my ob/gyn rotation last march, there was a fourth-year student from the local DO school who came in one morning in tears because he didn't match into EM, and in fact didn't match at all, Despite what I'm told were decent board scores. He was given the next weak off to try and "soap" into something else but with no luck. This kid was now 400k in debt (including undergrad) paying 7% interest and now had to wait a year while he watched his friends match and move on. This obviously doesn't happen to everyone but it's a dark side that I think we can sometimes forget. 

At the end of the day do what you feel is right. But whatever you do, do not let a post on the internet sway you into changing life-altering decisions. My grandpa used to tell me, "People spend their whole lives wondering if they made the right choice, rather than put in the effort to make their choice the right one." Food for thought. 

 

Also if there was a petition for this particular discussion to not come up every couple of hours I would spend a whole day making multiple accounts and having them sign it.

[EMEDPA]

"I'm completely fine with being paid 1/3 of the less salary because I didn't have to go through 4 grueling years of school + going through match + residency + fellowship + multiple board exams until making a real salary. It's not an easy journey and so when physicians are making their salary, I think it's fair.   They come out of med school working as a resident making 40-50k. PA's come out of 24-28 months of school making 80K+. On the path to being a PA I didn't give up my 20's slaving away in school and I'm young enough to be a professional yet have the flexibility to know I can have  a family and cut back on hours if I must. "

Fellowships are optional for physicians. Most do 4 years college, 4 years med school, 3 years residency(more for surgical fields), so typical doc has 11 years invested. PA does 4 (bs) + 2(PA) minimum, but many also had prior health care training for several years(Paramedics, RNs, RTs, for example have an additional 2 years). My current academic total is 10 years of full time school (BS #1, Paramedic school, BS#2 in PA, MS, Post masters certs x 3, and a doctorate)  Many of us did slave away for most of our 20s to become PAs. Also the vast majority of the PAs I know in non-surgical fields work considerably MORE than the physicians they work with and a larger portion of nights/weekends/holidays. Remember docs hire PAs to do the work they don't want to do at the times and places they don't want to do it. The group I just left had docs working 12-14 eight hr shifts/mo(max 112 hrs/mo) while the PAs did 16-20 12s(max 240 hrs/mo).  If you do the PA route right, it isn't a cakewalk by any means. Know that going in. Sure, there are sweet jobs out there with understanding physicians, great schedules, etc, but for every one of those there are 2-3 really bad jobs. It took me 15 years and multiple jobs in multiple states to find the right one. And before you say "well, that's maybe about you....", No, these jobs treated all PAs like crap. The consultants refused to talk to PAs even before they knew who they were. At the end of the day I could really care less about the salary. I think I am appropriately compensated now (the FP docs who cover the ER when I am not there make $15/hr more than I do and I made doc pay + $10/hr to work a holiday). That is fair. I would do this job for 1/2 as much. The thing this job offers that very few do is respect for my training, abilities, and experience .

[EMEDPA]

1 hour ago, KindnessMatters said:

I can understand the frustrations with that, but it's understood when you become a PA that you're a mid-level health care worker with a supervising physician. That being said, it's definitely not okay for attendings and patients to treat you like crap, but it doesn't mean everyone you work with will treat you that way.

unfortunately, I had PA role models who were not typical and when I worked at places as an ER tech and paramedic they treated their PAs well. It took moving out into the work force to get the slap in the face that many/most physicians think PAs are dumb as dirt.

[YoungH89]

Emed keeping it real! Something must have ticked you off this week to be so forthcoming. I've been mostly lurking on this forum for 10 years and never saw you talk so down on the profession. It's true tho ! It's a grind. I've worked ER 9 years now. All the negative PA stuff aside I honestly feel like healthcare is a racket sometimes. Patients come to us most of whom we can't help. We refer them to their "pcp" and the hospital charges them ungodly sums for our shitty ER work up. Can't wait to get out! 

[PrePA94]

13 hours ago, kingcoffee7 said:

I think a lot of it comes down to the calling vs job thread that was posted recently. There are definitely a lot of people who want to go to PA school for the wrong reasons, just like anything else. If you are passionate about medicine and see it as a calling and want respect and money, then it would be a mistake and med school would be a better fit. If you just like medicine and was a nice job with a decent salary and don't mind always being second then you're more likely to find satisfaction. Some peoples desire to change when they get in and realize that they do love medicine and want to be top dog and that's fine. That doesn't mean it was a mistake, people just evolve. For everyone one of those, there's a resident who realizes that it's not for them and goes to "the dropout club" website to find something else to do.

There's no one size fits all career. 5/6 of my preceptors have been MD's and told me if they could do it over again they wouldn't do it. Maybe its grass is greener, maybe its burnout, maybe they're just crazy (my surgery preceptor definitely was!) 

There's a tendency to look at the greenest grass of both sides  but we forget, (unless reminded on this forum) about the dark parts, and as PA's we're more familiar with the dark parts of ours. On my ob/gyn rotation last march, there was a fourth-year student from the local DO school who came in one morning in tears because he didn't match into EM, and in fact didn't match at all, Despite what I'm told were decent board scores. He was given the next weak off to try and "soap" into something else but with no luck. This kid was now 400k in debt (including undergrad) paying 7% interest and now had to wait a year while he watched his friends match and move on. This obviously doesn't happen to everyone but it's a dark side that I think we can sometimes forget. 

At the end of the day do what you feel is right. But whatever you do, do not let a post on the internet sway you into changing life-altering decisions. My grandpa used to tell me, "People spend their whole lives wondering if they made the right choice, rather than put in the effort to make their choice the right one." Food for thought. 

 

Also if there was a petition for this particular discussion to not come up every couple of hours I would spend a whole day making multiple accounts and having them sign it.

Thank you so much for your response!! I definitely do not mind being second, as I really do want to just help people and make a decent living. Only issue I have is the fear that I wont have a job, or that Ill have to continuously compete with NP's. I know that sounds silly, but ofcourse I don't want to go in debt for schooling and not come out with a decent job.

[BruceBanner]

Lots of good points to digest here OP. Take all of this in gestalt. I would say that pre-PA job outlook questions are one of---if not THE---most common questions we get here.

Listen to the good, the bad, and the ugly. It's easy to see only what you want to see and write off the negative stuff as "bitter", but this ain't our first rodeo and schools will not tell you all of the pitfalls and drawbacks to being a PA.

There are some good recent threads here where you can read all about job outlook. It is getting worse, not better. That's not to say you wont find work, but it may take you a long time and it may not be good work. "All my classmates got a job" isnt useful, because it doesnt tell the whole story.

My biggest regret about this pathway is not that I didnt go to medical school, it's the debt I incurred. Debt is a prison, and when it's educational debt it becomes indentured servitude. Curiously, there seem to be a lot of people out there whose parents floated their boat (at least partially), or had zero undergrad debt going into school. Maybe you are one of them. If not, I will give you a strong admonition about acquiring $200k in debt for this career. There are better ways to help people and make a living, with less stress, and less debt.

 

[kolkol]

I had a job lined up a month before I graduated this past May. And I got a ton of interviews before school. I'll be working midnight's but my starting salary is >100k in a decent COL area. My school only cost 50-60k tuition as well. There are definitely areas in the country where the market is saturated, but not all. I am in the Midwest. I have classmates that have gotten ER gigs right out of school too without a residency.

[EMEDPA]

31 minutes ago, kolkol said:

I had a job lined up a month before I graduated this past May. And I got a ton of interviews before school. I'll be working midnight's but my starting salary is >100k in a decent COL area. My school only cost 50-60k tuition as well. There are definitely areas in the country where the market is saturated, but not all. I am in the Midwest. I have classmates that have gotten ER gigs right out of school too without a residency.

getting an ER job right out of school is not hard. Getting one that provides you with a good education and the opportunity to grow as a provider and see the full scope of the specialty is. Many of these are fast track/uc only types of jobs with no real acuity. 

[EMEDPA]

14 hours ago, YoungH89 said:

Emed keeping it real! Something must have ticked you off this week to be so forthcoming. I've been mostly lurking on this forum for 10 years and never saw you talk so down on the profession. It's true tho ! It's a grind. I've worked ER 9 years now. All the negative PA stuff aside I honestly feel like healthcare is a racket sometimes. Patients come to us most of whom we can't help. We refer them to their "pcp" and the hospital charges them ungodly sums for our shitty ER work up. Can't wait to get out! 

I am not down on the profession, I am down on my choice to pursue it. PA is a great match for some folks. Others really would just do better as physicians. I am one of those.