A warning and example from Pennsylvania

[PAC94]

I live in FL and agree that it is a terrible place to practice as a Physican Assistant.

Pay is low and most primary care practices want to use and abuse you! Usually working you 10-12 hour days 5 days a week and  sometimes weekends hours in addition to taking call.

I have also worked in other states where you are treated as a colleague not as a scut monkey and work life balance is actually encouraged! 

Florida is also one of the last states to get on board with improvement in PA scope of practice updates. :(

[hayhay163]

Central PA (York/Harrisburg/Hershey) pays significantly better than Pittsburgh area and doesn’t have too bad of starting pay at least in the hospitals. Given it’s not a prime location but isn’t too far from other major cities. As a new grad two offers were: 102,000 plus sign on bonus, a conference your 1st year that’s in addition to your CME; another one of 95,000, 8000 relocation assistance, 10,000 loan repayment in the 1st year. 

[CorpsmanUP]

I can confirm first hand both KY and OH are horrible on the pay side. A top children's hospital in OH attempted to recruit me to start a Neo residency for them and to split clinical/admin time 60/40; they offered me almost half of what I was making locums. Their response was "that is what PAs make and are worth." Needless to say I politely declined. The irony is that they are short staffed, looking to expand, and are now paying locums contracts for what I asked for. 

In regards to KY, they pay ALL of their medical personnel poorly. At the U of KY, one of the two level IV NICUs in the state, Neo attendings are paid 1/2 of what they are paid in other states. I actually make as much or more doing locums as a neo PA than the attendings make there. That is a sad state of affairs.

[Fernwood]

Hey guys, just a little heads up. PA salaries are taking a hit across the country. Physicians and hospital organizations have figured out that PAs are smart and can do pretty much all the clinic work previously done by physicians but you can pay them peanuts. In the last orthopedic group I worked for I generated well over $80K+ cash money for my supervising physician, each quarter. My last year with him he did $1.4M, I left and his next year he made less than half that. In the time I worked for him he offered no pay increase in the last 4 years and took away 75% of my bonus. Medicine is a business and PAs are in a position that allows no leverage. 

Things are about to go from bad to worse.  Currently there are a number of organizations that are accumulating data to then formulate algorithms that will drive fully automated telemedicine platforms. Pretty soon we will be replaced by a Suri-like device that will diagnose and treat many illnesses. If you think I'm being preposterous check out apps like "LemonAide", or look at what they are doing with urgent care via telemedicine via offerings like "GoodHealth" . It is simply absurd. I was recently told by the senior management that telemedicine is the "wave of the future" and that "brick and mortar physician offices are going away". He can talk like that because he now sits in a corner office reading memos and isn't hanging his ass out for a lawsuit by practicing pseudo medicine.

[Guest HanSolo]

The sky is falling! The sky is falling!

 

[PACJD]

20 minutes ago, HanSolo said:

The sky is falling! The sky is falling!

 

LOL! A little dramatic up above huh?

[PACJD]

2 hours ago, Fernwood said:

PA salaries are taking a hit across the country

I strongly beg to differ. Be careful making generalizations like that, as you really cannot speak for the whole country. Maybe that is the way it is in your region, but I can tell you that is not the way it is by me. NYC is thriving right now, and in the past 10 years I can tell you that the salaries have increased 30-40k per year on average. I am a preceptor for several students, many of whom received multiple job offers in various specialities at >105k/yr. Some are even starting at 115-120k /yr. When I started practicing 10 yrs ago, I started at 83k and that was considered very good. 

I'm sorry that you are in the situation you are in and that your bonus was taken away. Maybe its time to look for a different job or relocate. As far as I am concerned, I believe salaries will continue to increase over the next 5 years as long as OTP and name change are being worked on.

[Cideous]

3 hours ago, PACJD said:

As far as I am concerned, I believe salaries will continue to increase over the next 5 years as long as OTP and name change are being worked on.

 

Wrong.  Salary will decrease along with benefits.  Way to many people all applying for the same jobs = lower pay and lower benefits.  This is simply fact, not conjecture.  

[Fernwood]

I will stand by my assertion. My standard reply with any question regarding healthcare is, “the answer is money, now what was your question”.

I will check in on you guys in a couple years.

[ravenspac]

On 9/1/2018 at 1:18 AM, hayhay163 said:

Central PA (York/Harrisburg/Hershey) pays significantly better than Pittsburgh area and doesn’t have too bad of starting pay at least in the hospitals. Given it’s not a prime location but isn’t too far from other major cities. As a new grad two offers were: 102,000 plus sign on bonus, a conference your 1st year that’s in addition to your CME; another one of 95,000, 8000 relocation assistance, 10,000 loan repayment in the 1st year. 

Please let me know what specialties or hospitals these were. Im currently in one of the major hospitals in this area

[ravenspac]

17 hours ago, Fernwood said:

Hey guys, just a little heads up. PA salaries are taking a hit across the country. Physicians and hospital organizations have figured out that PAs are smart and can do pretty much all the clinic work previously done by physicians but you can pay them peanuts. In the last orthopedic group I worked for I generated well over $80K+ cash money for my supervising physician, each quarter. My last year with him he did $1.4M, I left and his next year he made less than half that. In the time I worked for him he offered no pay increase in the last 4 years and took away 75% of my bonus. Medicine is a business and PAs are in a position that allows no leverage. 

Things are about to go from bad to worse.  Currently there are a number of organizations that are accumulating data to then formulate algorithms that will drive fully automated telemedicine platforms. Pretty soon we will be replaced by a Suri-like device that will diagnose and treat many illnesses. If you think I'm being preposterous check out apps like "LemonAide", or look at what they are doing with urgent care via telemedicine via offerings like "GoodHealth" . It is simply absurd. I was recently told by the senior management that telemedicine is the "wave of the future" and that "brick and mortar physician offices are going away". He can talk like that because he now sits in a corner office reading memos and isn't hanging his ass out for a lawsuit by practicing pseudo medicine.

Theres alot to unpack here.

 

1) I think there will be continued growth in non diserable locations (basically the fly over states).

 

2) Telemedicine is a direct threat to Retail clinics and Urgent care offices, but most are being used as a stop gap because its so hard to get Family practice appointments.

Our hospital has a 3 month wait for new patients in Family medicine, even if your an employee....yet the medical group complains about decreased patient census...wtf?

 

 

[Guest HanSolo]

12 hours ago, Cideous said:

 

Wrong.  Salary will decrease along with benefits.  Way to many people all applying for the same jobs = lower pay and lower benefits.  This is simply fact, not conjecture.  

Facts are what are published in the annual AAPA salary reports. These indicate salaries are increasing across the board. I'll change my mind when I see data suggesting otherwise. 

[LT_Oneal_PAC]

2 hours ago, HanSolo said:

Facts are what are published in the annual AAPA salary reports. These indicate salaries are increasing across the board. I'll change my mind when I see data suggesting otherwise. 

Fair enough. Here is some evidence and plug for why OTP is vital.

 

Following are bullet points copied directly from the Merritt-Hawkins Recruiting Service  report (Merritt-Hawkins, 2018).  

 

--PA salaries have decreased 5% from $120,000 in 2017 to $109,000 in 2018.

--NP salaries have increased from $123,000 in 2017 to $129,000 in 2018, an increase of 5%....the highest increase ever reported in the Review.

--PAs do not command as much recruiting attention as NPs in today's market given the broader level of clinical autonomy NPs possess and their ability to provide stand-alone services in rural areas.

--The number of searches conducted for NPs has increased dramatically.... reaching a record high in 2017/2018.  It is anticipated that demand for NPs will continue given their role in team-based health and....physician shortage.

--From Table 5:  In 2017/2018, NPs were 3^rdout of 20 in list of most requested specialties.    PAs were 20^th out of 20.

--Nationwide average pay for NPs:  $85,000 – 205,000.  Nationwide average pay for PAs:  $89,000 – 141,000.

--Missouri law passed use of assistant physicians in healthcare [medical doctors who haven't matched with a residency]. Since then Arkansas, Kansas and Utah have approved similar bills.  

 

Reference:

(Merritt Hawkins 2018):  2018 review of physician and advanced practitioner recruiting incentives. MERRITT HAWKINS.  Retrieved from https://www.merritthawkins.com/uploadedFiles/Merritt_Hawkins_2018_incentive_review.pdf

 

 

[Cideous]

^^^  Exactly.

 

It has always amazed me about this profession how much PA's keep their heads stuck in the sand.  "The whole house isn't on fire, just the bedroom, so everything is fine".   Like all fires, it is spreading fast and if the younger PA's want a career/job in the next 10 years that actually has good pay and a few benefits left, I hope they can do what we could not and pass a name change and OTP.  I really do hope this for you guys.

[PACJD]

^^ Looks like someone woke up on the wrong side of the bed. All I am saying is that over the 10 years I have been practicing, my salary has increased significantly from 80k to 150k, benefits stayed the same, I have seen the same with my colleagues. Also 10 years ago jobs were scarce, but now new grads are getting 10+ offers all worth 100k+ in NYC (supposedly one of the more saturated areas in the nation). 

There is no doubt things that need to be changed, otherwise the profession will start to take a hit. OTP and name change being a few of those things. I think we are on par with NPs at the moment, and without this movement we will be left in the dust. Don't get me wrong its not all bells and whistles, but I think some of you are overreacting just cause your hospital system is cutting salaries at the moment. 

[lkth487]

20 hours ago, LT_Oneal_PAC said:

Fair enough. Here is some evidence and plug for why OTP is vital.

 

Following are bullet points copied directly from the Merritt-Hawkins Recruiting Service  report (Merritt-Hawkins, 2018).  

 

--PA salaries have decreased 5% from $120,000 in 2017 to $109,000 in 2018.

--NP salaries have increased from $123,000 in 2017 to $129,000 in 2018, an increase of 5%....the highest increase ever reported in the Review.

--PAs do not command as much recruiting attention as NPs in today's market given the broader level of clinical autonomy NPs possess and their ability to provide stand-alone services in rural areas.

--The number of searches conducted for NPs has increased dramatically.... reaching a record high in 2017/2018.  It is anticipated that demand for NPs will continue given their role in team-based health and....physician shortage.

--From Table 5:  In 2017/2018, NPs were 3^rdout of 20 in list of most requested specialties.    PAs were 20^th out of 20.

--Nationwide average pay for NPs:  $85,000 – 205,000.  Nationwide average pay for PAs:  $89,000 – 141,000.

--Missouri law passed use of assistant physicians in healthcare [medical doctors who haven't matched with a residency]. Since then Arkansas, Kansas and Utah have approved similar bills.  

 

Reference:

(Merritt Hawkins 2018):  2018 review of physician and advanced practitioner recruiting incentives. MERRITT HAWKINS.  Retrieved from https://www.merritthawkins.com/uploadedFiles/Merritt_Hawkins_2018_incentive_review.pdf

 

 

Look, I fully support OTP (and a simple pathway to obtaining a MD - and thus being eligible for physician residencies - by taking the STEP exams, if PAs wish).

However:

1) Hard to make judgements with a single year snapshot, there's a lot of factors involved in this. 

2) There are 250,000 NPs in the USA, and 26,000 (!!!) new NPs completed academic programs in the US (https://www.aanp.org/all-about-nps/np-fact-sheet) last year.  That's larger than graduating MDs.  I couldn't find the number of PAs, but I think it's around 7,000 per year.  So obviously there is going to be a lot more recruitment directed towards NPs.  And they are going to have a lot more political power.

3) One thing that is often forgotten is that the job market for new NPs is NOT good (except some specialties, like NNPs).  You can see this on the forum.  It's a double edged sword - do PAs want to just pump out 20-30,000 new PAs per year - so they can get the same political clout?  That would give more political power but you might be sacrificing new PAs if a lot of them can't find jobs (think job market in PA but everywhere).

4) PAs are generalists, like MDs, when they graduate.  NPs are specialists from the day they graduate.  If residencies are the way of the future (as many on this board want), there is no chance of having that many residency spots for graduating PAs in the next 10-15 years (especially if you want to have some level of minimum standards).

I think OTP will help, and the name change is long overdue (I personally like MP, medical practitioner, or even a DMP - doctor of medical practice, if people want degree parity - but that's my opinion from the outside).  But I have a suspicion that if (and when - I think it's inevitable) those changes occur, I am not sure that it will really do much to solve some of these problems that people are raising.

 

 

[PACJD]

25 minutes ago, lkth487 said:

One thing that is often forgotten is that the job market for new NPs is NOT good (except some specialties, like NNPs).  You can see this on the forum.  It's a double edged sword - do PAs want to just pump out 20-30,000 new PAs per year - so they can get the same political clout?  That would give more political power but you might be sacrificing new PAs if a lot of them can't find jobs (think job market in PA but everywhere)

Well said. What people don't understand is that the NP profession are making strides because they have a good political body, they have a good political body because they have the numbers. Additionally, they have a lot of experienced RNs with high stature in their hospital system, who are doing online programs to get their NP, thus when they graduate they may have some room for negotiation when it comes to salary. 

My mother was an NP, and my aunt and cousin are NPs. They love what they do, but there are definitely downfalls of the profession just like there are downfalls in the PA profession, just like there are downfalls in every profession. I too am all for OTP and name change and I do think changes need to be made within the next 5 years otherwise we are in trouble, but there is no need for the panic at the current moment. 

[sillycibin]

As someone above posted there are 26,000 new NPs being created every year.  PA programs have been increasing in number and class size without regard to need as well.  There were around 130-140 PA programs in 2007.  In 2015 there were 183 and projections for another 77 programs by 2020.  The average number of students per program in 2007 was around 80.  It is now almost 120 per program.  There are around 19,000 MD graduates every year.  So we are creating almost 2 PA/NPs per new MD.  And there isn't any sign that growth is going to stop.  And the experience requirements by employers has continually crept up to where 3-5 years experience is becoming a commonly seen requirement.  In my area the salary offers are definitely coming down.

[LT_Oneal_PAC]

3 hours ago, lkth487 said:

Look, I fully support OTP (and a simple pathway to obtaining a MD - and thus being eligible for physician residencies - by taking the STEP exams, if PAs wish).

However:

1) Hard to make judgements with a single year snapshot, there's a lot of factors involved in this. 

2) There are 250,000 NPs in the USA, and 26,000 (!!!) new NPs completed academic programs in the US (https://www.aanp.org/all-about-nps/np-fact-sheet) last year.  That's larger than graduating MDs.  I couldn't find the number of PAs, but I think it's around 7,000 per year.  So obviously there is going to be a lot more recruitment directed towards NPs.  And they are going to have a lot more political power.

3) One thing that is often forgotten is that the job market for new NPs is NOT good (except some specialties, like NNPs).  You can see this on the forum.  It's a double edged sword - do PAs want to just pump out 20-30,000 new PAs per year - so they can get the same political clout?  That would give more political power but you might be sacrificing new PAs if a lot of them can't find jobs (think job market in PA but everywhere).

4) PAs are generalists, like MDs, when they graduate.  NPs are specialists from the day they graduate.  If residencies are the way of the future (as many on this board want), there is no chance of having that many residency spots for graduating PAs in the next 10-15 years (especially if you want to have some level of minimum standards).

I think OTP will help, and the name change is long overdue (I personally like MP, medical practitioner, or even a DMP - doctor of medical practice, if people want degree parity - but that's my opinion from the outside).  But I have a suspicion that if (and when - I think it's inevitable) those changes occur, I am not sure that it will really do much to solve some of these problems that people are raising.

 

 

I am not advocating greater numbers of students. What I want is the ones who are already PAs to contribute to their PAC. Analysis of contributions show that we don’t even give the same per capita as nurses do. If we did, we would have a lot more political power. 

I also am not personally panicking, but the point is to get people involved BEFORE the panic. As noted in politics, you have really talk up these problems is needed to galvanize the base. Not spreading any false statements about data, but emphasizing the importance prior to fallout.

[PACJD]

2 hours ago, LT_Oneal_PAC said:

I am not advocating greater numbers of students. What I want is the ones who are already PAs to contribute to their PAC. Analysis of contributions show that we don’t even give the same per capita as nurses do. If we did, we would have a lot more political power. 

I also am not personally panicking, but the point is to get people involved BEFORE the panic. As noted in politics, you have really talk up these problems is needed to galvanize the base. Not spreading any false statements about data, but emphasizing the importance prior to fallout.

Definitely agree with what you have to say. Right now we as PAs are in a good place, in 5 years or so we may not be, so we need to make changes for what is to come. 

Just for clarification my comments about panicking wasn't directed toward you but others on this thread.